Blood Transfusion in Bilateral Total Knee Arthroplasty: Comparison between Staged and Simultaneous Surgery

Chung, Seung Hyun; Kim, Chong Soo; Do, Sang Hwan; Kim, Kyoung Ok; Park, Hee Yeon; Ryu, Choon Gun

Clinical Research

General Article

Anesthesia and Pain Medicine 2008;3(1):62-66.
Published online January 30, 2008.

Blood Transfusion in Bilateral Total Knee Arthroplasty: Comparison between Staged and Simultaneous Surgery

Seung Hyun Chung, Chong Soo Kim, Sang Hwan Do, Kyoung Ok Kim, Hee Yeon Park, Choon Gun Ryu

¹Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Dongguk University Collge of Medicine, Goyang, Korea.
²Department of Anesthesiology and Pain Medicine, Boramae Municipal Hospital, Seoul National University College of Medicine, Seoul, Korea. cskim@brm.co.kr
³Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
⁴Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
In the case of bilateral total knee replacement arthroplasty (TKA), surgery is performed either simultaneously or in a staged manner. We tried to investigate the differences of blood loss and transfusion practice between the use of simultaneous and staged operations. METHODS: We analyzed retrospectively the medical records of 20 patients undergoing simultaneous TKA (simultaneous group), who received autologous blood via a reinfusion system, and 20 patients undergoing staged TKA (staged group), of which the interval is about three weeks. We compared the amount of blood loss, and the number of transfusions and transfusion-related complications between the two groups of patients. RESULTS: Postoperative total blood loss was 2,174 +/- 460 ml in the simultaneous group and 1,850 +/- 461 ml in the staged group. There was no significant difference for transfusion (simultaneous group 3.5 +/- 1.1 units, staged group 3.9 +/- 1.4 units; P > 0.05). In the simultaneous group, the volume of autologous transfusion was 985 +/- 326 ml, corresponding to 2.5 +/- 0.8 units. The total number of transfused RBC units including autologous blood was 6.1 +/- 1.5 units in the simultaneous group and 3.9 +/- 1.4 units in the staged group. In the staged group, the amount of postoperative drained blood was significantly less in the second knee operation than that in the first knee operation (first knee surgery, 992 +/- 265 ml; second knee surgery, 868 +/- 260 ml: P < 0.05). CONCLUSIONS: Postoperative blood loss and total transfusion were less in the staged TKA group of patients as compared with the simultaneous TKA group of patients. Postoperative blood salvage and reinfusion appear to be safe and effective for patients undergoing simultaneous TKA.

Key Words: costs and cost analysis, knee replacement arthroplasty, transfusion