An Effective Bloodless Surgery Protocol

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Abstract

Modern techniques have been successful over the past several years in reducing the amount of transfusions that occur after total joint arthroplasty. Although improvements have been made, transfusion rates after unilateral replacements still range from 4% to 46% and 31% to 72% in bilateral cases. Owing to the high incidence of transfusion rates, there are concerns with regard to acute postoperative anemia and wound complications for the knee arthroplasty patient. In addition, we have entered an era of minimally invasive surgery with rapid recovery and it is felt that limiting the blood loss into the joint can improve patient’s immediate results; if not, the long-term results that occur after a joint arthroplasty procedure. Traditionally, allogeneic transfusions have been used to treat the anemia associated with surgery. Aside from the risks associated with allogeneic transfusions, which include disease transmission, allergic reactions, fluid overload, and transfusion reactions, there is a sense of failure when a patient has to be transfused after a joint replacement procedure. This study will focus on a multimodal blood avoidance protocol and will be divided into 3 sections. The first is the preoperative section in which the patient is evaluated and prepared for the planned total knee arthroplasty procedure. The second section describes intraoperative techniques that help limit blood loss. The third section entails a postoperative rehabilitation protocol that maximizes the patient’s recovery while minimizing blood loss after the procedure. This study will cover current blood conservation techniques and our own blood management protocol.

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