Abstract
Purpose
The traditional use of pneumatic tourniquets and reinfusion drains in total knee replacement (TKR) has recently been challenged and the aim of our study was to compare the outcomes of three different blood management techniques in primary TKR.
Methods
We prospectively conducted a study of 87 patients with mean age of 71 (44-91) years old. They were randomised into three groups: Group A: 29 patients without the use of tourniquet and reinfusion drain, Group B: 27 patients without the use of tourniquet and reinfusion drain but application of intraoperative cell salvage system and Group C: 31 patients with the use of tourniquet and reinfusion drain. All groups were well matched and all patients were reassessed at the 2nd postoperative day.
Results
There was no difference between the postoperative haemoglobin drop (Group A: 3.6 g/dl; Group B: 3.3 g/dl; Group C: 3.2 g/dl) and allogenic blood transfusion rate (Group A: 6.8%; Group B: 7.4%; Group C: 6.4%). In Group B an average of 525 ml of blood was collected and an average of 148 ml of concentrated blood was reinfused. In Group C an average of 432 ml of blood was collected by the drain and an average of 324 ml of blood was reinfused. The 2nd postoperative day range of knee movements showed no significant difference. Only 2 Group C patients (6.4%) had postoperative thrombembolic events (one DVT, one TIA). Readmission rate due to knee stiffness and superficial wound problems did not revealed any significant difference. The average operative time (83 minutes) and hospital stay (5.3 days) were the same in all groups and there was no wound haematoma or deep infection in any groups.
Conclusion
There was no statistical difference between the groups for any outcome measure.
