Research advances on perioperative blood management for total knee arthroplasty / 中华骨科杂志

ABSTRACT

Acute blood loss anemia is the most common surgical complication of total knee arthroplasty. Currently, alloge?neic transfusion has been the major method of managing postoperative anemia. Although allogeneic transfusion can correct anae?mic condition temporarily, it can lead to severe complications, such as postoperative infection, prolongation of physical recovery, increased length of hospital stay, and increased mortality. Perioperative blood management can effectively reduce blood loss and transfusion rate. These strategies mainly focus on three partstherapy for anemia and autologous blood donation before operation;application of a tourniquet, antifibrinolytic drugs, topical hemostatic agents and acute normovolemic hemodilution during opera?tion; selection of reinfusion systems, restrictive transfusion thresholds, drainage and knee position after operation. Perioperative blood management should run throughout the perioperative period, which mainly aims at reducing blood loss and blood transfu?sion, improving prognosis, promoting the postoperative recovery and lowering the medical cost. Depending on the actual situations of patients, surgeons should combine different major characteristics of each strategy and weigh the pros and cons to make effective and reasonable individualized treatment plan.