ABSTRACT
BACKGROUND: The intraoperative blood loss of unicompartmental knee arthroplasty is lower than that of total knee arthroplasty, but the difference of postoperative occult blood loss between them has not been widely studied. OBJECTIVE: To compare the difference of occult blood loss between unicompartmental knee arthroplasty and total knee arthroplasty, and to analyze whether patients with preoperative anemia can also undergo unicompartmental knee arthroplasty without the risk of blood transfusion. METHODS: 148 patients with knee osteoarthritis treated in 904 Hospital of the Joint Service Support Force of Chinese PLA from January 2014 to December 2016 were selected. Among them, 58 cases underwent unicompartmental knee arthroplasty and 90 cases underwent total knee arthroplasty. Hemoglobin levels and hematocrit were measured before and 1, 4, 21 and 42 days after operation, and the occult blood loss and blood transfusion rate were calculated. The trial was approved by the Ethics Committee of 904 Hospital of the Joint Service Support Force of Chinese PLA (approval No. 2019-01-03). RESULTS AND CONCLUSION: (1) The hemoglobin level of unicompartmental knee arthroplasty group was higher than that of total knee arthroplasty group at 1 and 4 days after operation (P 0.05). (2) Hematocrit in the unicompartmental knee arthroplasty group was higher than that in the total knee arthroplasty group at 1 and 4 days after operation (P 0.05).(3) From day one to day four after surgery, there was no occult blood loss in the female of unicompartmental knee arthroplasty group, and the average occult blood loss in the male was 4 g/L. The average occult blood loss was 10 g/L in female and 7 g/L in male in total knee arthroplasty group. The occult blood loss in male and female in unicompartmental knee arthroplasty group was lower than that in total knee arthroplasty group (P < 0.05 or P < 0.01). (4) The blood transfusion rate was 0% in unicompartmental knee arthroplasty group and 4.4% in total knee arthroplasty group. In patients with preoperative moderate anemia (hemoglobin 60-89 g/L), there was no need for blood transfusion in unicompartmental knee arthroplasty group (n=3), but blood transfusion was needed in 2 of 6 patients in total knee arthroplasty group (33%). (5) The results showed that unicompartmental knee arthroplasty had obvious advantages over total knee arthroplasty in postoperative occult blood loss.
ABSTRACT
BACKGROUND:Hidden blood loss is an important risk for the intertrochanteric fracture patients, especial y the elderly patients, which can cause anemia in patients after internal fixation and can affect wound healing and patient recovery. OBJECTIVE:To compare the perioperative hidden blood loss and the risk factors of proximal femoral anti-rotation intramedul ary nail internal fixation and dynamic hip screw fixation for the treatment of femoral intertrochanteric fracture. METHODS:We selected 70 cases of femoral intertrochanteric fracture patients who treated with proximal femoral anti-rotation intramedul ary nail and dynamic hip screw fixation, including 21 patients with the age ≥ 80 years and 49 patients with the age30 kg/m2 and 42 patients with the body mass index ≤ 30 kg/m2;30 patients received anti-rotation intramedul ary nail internal fixation and 40 patients received dynamic hip screw fixation. The perioperative blood loss was calculated with Gross formula according to the changes of height, body mass index and the hematocrit before and after fixation. RESULTS AND CONCLUSION:The mean total blood loss was 936 mL, the mean dominant blood loss was 237 mL and the mean hidden blood loss was 699 mL. The hidden blood loss was accounted for 74.7%in total blood loss. The dominant blood loss in the dynamic hip screw fixation group was higher than that in the anti-rotation intramedul ary nail internal fixation group, and the hidden blood loss was lower than the anti-rotation intramedul ary nail internal fixation group. The total blood loss and the hidden blood loss of the elderly patients were higher than those of the non-elderly patients;there was no significant difference between male and female patients, obesity and normal patients. The results indicate that hidden blood loss is the major reason for total blood loss of femoral intertrochanteric fracture after internal fixation. The hidden blood loss of anti-rotation intramedul ary nail internal fixation is larger than that of dynamic hip screw fixation, and elder is the risk factor for hidden blood loss.