Blood loss following medial unicondylar knee replacements without a tourniquet: is there a need to group and save?

Authors

  • Sayyied J. Kirmani Department of Trauma and Orthopaedics, South West London Elective Centre, Epsom, Surrey, UK
  • Mark Middleton Department of Trauma and Orthopaedics, South West London Elective Centre, Epsom, Surrey, UK
  • Andreas Fontalis Department of Trauma and Orthopaedics, South West London Elective Centre, Epsom, Surrey, UK
  • Raka Srivastava Department of Anaesthetic, South West London Elective Centre, Epsom, Surrey, UK
  • Feroz Dinah Department of Trauma and Orthopaedics, South West London Elective Centre, Epsom, Surrey, UK

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20185074

Keywords:

Unicondylar knee replacement, Tourniquet, Blood loss, Blood transfusion

Abstract

Background: There are current trends towards not using a tourniquet in total knee replacement (TKR), but there is nothing published on what the effects of not using a tourniquet on unicondylar knee replacements (UKR) may be in terms of blood loss.

Methods: A retrospective case series of 36 consecutive UKR from our institution were analysed. All procedures were carried out without a tourniquet and also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, administration of periarticular local anaesthetic and adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion.

Results: Most patients (61.1%) experienced an estimated intra-operative blood loss of less than100 mls. There was a mean haemoglobin drop of 16.1 g/l (range 1–26, SD ±5.9), with a mean post operatively haemoglobin level of 125.1 g/l (range 107-142, SD ±8.7). No patients required a blood transfusion.

Conclusions: A low level of blood loss is encountered when UKR is undertaken without a tourniquet and with our standard interventions to reduce bleeding. The level of post-operative haemoglobin and absence of requirement for blood transfusion suggests that this operation can be undertaken without the need for a group and save. It is our hope that surgeons will be encouraged to perform this procedure without a tourniquet and benefit from the cost-saving opportunity of not performing a group and save.

Author Biography

Sayyied J. Kirmani, Department of Trauma and Orthopaedics, South West London Elective Centre, Epsom, Surrey, UK

ST8 registrar in Trauma and Orthopaedics

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Published

2018-12-25

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Original Research Articles