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Randomized Controlled Trial
. 2007 Jun;31(3):303-8.
doi: 10.1007/s00264-006-0173-0. Epub 2006 Jun 30.

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study

A Zacharopoulos  1 , A Apostolopoulos, A Kyriakidis
Affiliations
Randomized Controlled Trial

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study

A Zacharopoulos et al. Int Orthop. 2007 Jun.

Abstract
in English, French

The purpose of our study was to determine the effectiveness of a postoperative autologous blood reinfusion system as an alternative to homologous, banked blood transfusions in total knee arthroplasty. We carried out a prospective randomised controlled study on 60 patients having unilateral total knee replacements. In all these patients, the same surgical team applied the same surgical technique, and all patients followed the same rehabilitation program. In 30 of these patients (group A), a reinfusion system of unwashed salvaged blood was applied, and they were supplemented postoperatively with banked blood transfusions when required. A control group of 30 patients (group B), in whom standard suction drains were used, received one unit of homologous banked blood transfusion intraoperatively and additional blood transfusions postoperatively when required. The administration of banked blood transfusion was determined by the haemoglobin value (<9 mg/dl) and/or clinical signs (blood pressure, pulse, etc.). The values of haemoglobin, haematocrit and platelets were recorded preoperatively and the first, fifth and 15th postoperative days, respectively. Five patients of group A required nine units of homologous blood (0.3 units/patient) postoperatively. Ten patients of group B required an additional 15 banked blood units postoperatively (in total 45 banked blood units for group B; 1.5 units/patient). In the study group, the total homologous blood requirements were reduced by 80%, while the postoperative blood requirements were reduced by 50%. There was no significant difference in the postoperative haematocrit and haemoglobin values between the two groups. The cost of the blood management in the study group was reduced by 36%. The use of an autologous blood reinfusion system reduces highly effectively the demands of homologous banked blood transfusion in total knee arthroplasty.

Le but de cette étude était de déterminer l’efficacité d’un système de réinjection post-opératoire de sang autologue comme alternative à la transfusion homologue dans l’arthroplastie totale de genou. Nous avons fait une étude prospective randomisée sur 60 patients opérés d’une prothèse totale du genou unilatérale. Chez 30 patients (groupe A) un système de réinjection sans lavage du sang préservé était utilisé avec supplémentation post-opératoire par du sang de banque si nécessaire. Un groupe de contrôle de 30 patients (groupe B), chez qui un drainage aspiratif classique était utilisé, recevait une unité de sang homologue pendant l’intervention et des transfusions post-opératoires si nécessaire. L’indication de transfusion homologue était posé sur un taux d’hémoglobine < 9mg/dL et/ou des signes cliniques. Les valeurs de l’hémoglobine, de l’hématocrite et des plaquettes étaient relevées avant l’intervention et les premier, cinquième et quinzième jours post-opératoires. 5 patients du groupe A eurent besoin après l’opération de 9 unités de sang homologue (0,3 unité par patient). 10 patients du groupe B eurent besoin de 15 unités supplémentaires de sang homologue après l’opération (au total 45 unités de sang homologue pour le groupe B ; 1,5 unités par patient). Dans le groupe étudié la nécessité globale de sang homologue était réduite de 80% et la nécessité de transfusion post-opératoire de 50%. Le coût de la gestion du sang était réduite de 36% dans le groupe étudié. l’utilisation d’un système de réinjection du sang autologue réduit significativement la nécessité de transfusion homologue dans l’arthroplastie totale du genou.

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Figures

Fig. 1
Fig. 1
The values of haemoglobin preoperatively, the 1st, 5th and 15th post-operative days in patients of groups A and B
Fig. 2
Fig. 2
The values of haematocrit preoperatively, the 1st, 5th and 15th post-operative days in patients of groups A and B
See this image and copyright information in PMC

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