Dr. Sagebien and Dr. Harwood Present “A Novel Protocol To Improve Hemostasis In Total Knee Arthroplasty”
Carlos A. Sagebien, MD
David A. Harwood, MD
Dorene O’Hara, MD, MSE
Patricia Seuffert, MD, APN
Bleeding during TKA may result in anemia and post operative blood transfusion. Here we present an effective protocol combing multiple hemostatic modalities and TKA.
Methods: Thirty nine patients undergoing TKA using a novel surgical technique were included in this retrospective, IRB-approved, cohort study. Study patient were compared to a control group of 37 patients who underwent standard TKA. All study patient underwent TKA with harmonic scalpel, extramedullary computer assisted surgery, a hemostatic matrix to all cut surfaces after cementation, and injection of local anesthetic with epinephrine. The control group underwent standard TKA with intramedullary femoral guides and no adjuvant hemostatic techniques. Drains were not used in either cohort. Tourniquets and post operative warfarin were used in all patients. Hospital records were reviewed for patient demographics, pre-and postoperative hemoglobin (Hgb), operative time and visual analog scale (VAS) for pain at discharge. Means were compared with Student’s t test,
Results: Patient demographics including age, body mass index (BMI), operative time and VAS scores were not different between groups. Preoperative Hgb was statistically the same between cohorts. However, the study had significantly smaller decrease in Hgb from preoperative values to discharge values as compared to the control group (-3.27 ± 1.1 vs. -3.88 ± 1.3), and a significantly higher Hgb each postoperative day. In addition, 5 of 37 controls had a Hgb drop of more than 5.0 g/dl, while none of the study patients had a Hgb drop of that magnitude.
Discussion and Conclusion: This novel technique significantly improves hemostasis after TKA. Study patients had decreased blood loss and higher Hgb at discharge as compared to controls. We recommend this protocol for all patients undergoing TKA.