Chemoprophylaxis without intra-articular wound drainage can replace autotransfusion in primary TKA

Abstract

We compared outcomes in 2 groups undergoing total knee arthroplasty (TKA) with different blood-saving strategies (ie, chemoprophylaxis vs reinfusion). We hypothesized that chemoprophylaxis would lead to reduced blood loss and fewer transfusions, with no increase in associated complications. Group A was a prospective series of 91 consecutive cemented TKAs undertaken with chemoprophylaxis to reduce bleeding and blood allogeneic exposure. Group B consisted of 44 historical TKAs undertaken with postoperative reinfusion. With the exception of mean patient age (group A, 74.3 years; group B, 70.9 years; P=.006), there were no statistically significant differences between the 2 study groups.Mean total blood loss throughout the 7-day perioperative period was 1490 mL in group A and 1828 mL in group B. The rate of blood transfusion in group A was almost zero. In group B, 41 of 44 patients were administered blood intravenously. Despite the absence of autotransfusion, postoperative hemoglobin levels were significantly higher in group A than in group B. No major bleeding complications emerged in the immediate postoperative period in either group.Chemoprophylaxis proved superior to reinfusion at decreasing blood transfusion requirements in the routine daily setting of unilateral cemented primary TKA.