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Review
. 2018 Jul;14(2):202-210.
doi: 10.1007/s11420-017-9590-4. Epub 2017 Dec 7.

Optimizing Intraoperative Blood Management for One-Stage Bilateral Total Knee Arthroplasty

Vasileios Soranoglou  1   2 , Lazaros A Poultsides  2 , Georgios K Triantafyllopoulos  2 , Ivan De Martino  2   3 , Stavros G Memtsoudis  4 , Thomas P Sculco  2   3
Affiliations
Review

Optimizing Intraoperative Blood Management for One-Stage Bilateral Total Knee Arthroplasty

Vasileios Soranoglou et al. HSS J. 2018 Jul.

Abstract

Background: Effective blood management strategies are a major determinant of successful outcomes after one-stage bilateral total knee arthroplasty (BTKA). Proper patient selection with preoperative optimization and intra- and postoperative interventions can reduce transfusion risk and associated morbidity in these patients.

Questions/purposes: The purpose of this study was to evaluate intraoperative blood management modalities based on three keystone questions: (1) What is the role of the anesthesiologist?, (2) Which are the surgeon-dependent strategies?, and (3) Is there any place for pharmacologic interventions?

Methods: We searched the established electronic literature database MEDLINE. After critical appraisal, 94 studies were deemed eligible from which to draw documented evidence.

Results: A number of blood-conserving methods are currently implemented in patients undergoing one-stage BTKA. Among them, regional anesthesia, tourniquet use, and tourniquet deflation after wound closure, femoral canal sparing or femoral canal plugging, avoidance of drains, and tranexamic acid use were the intraoperative strategies with documented efficacy in blood conservation.

Conclusion: Combined proper intraoperative anesthesiologic, surgical, and pharmacologic interventions reduce blood loss and need for transfusion in BTKA patients. However, contemporary relevant literature is lacking evidence-based guidelines.

Keywords: bilateral total knee arthroplasty; intraoperative blood conserving.

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Conflict of interest statement

Compliance with Ethical StandardsVasileios Soranoglou, MD, PHD; Lazaros A. Poultsides, MD, PHD; Georgios K. Triantafyllopoulos, MD; Ivan De Martino, MD; and Stavros G. Memtsoudis, MD, PHD, declare that they have no conflict of interest. Thomas P. Sculco, MD, receives royalties from Exactech and serves as a board member of the Knee Society and an editorial board member of the American Journal of Orthopedics and HSS Journal.All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.N/ADisclosure forms provided by the authors are available with the online version of this article.

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