Investigation of the use of drained blood reinfusion after total knee arthroplasty: A prospective randomised controlled study

ABSTRACT

Purpose To compare the use of a life-blood salvage and reinfusion system with standard allogeneic vital fluid transfusion after total knee arthroplasty-a course associated with significant postoperative vital current loss.

Methods. Between June 2002 and May 200460 patients undergoing total knee arthroplasty were randomly allocated into a reinfusion clump (n=26) or a control assemblage (n=34). Patients in the reinfusion cluster had their blood reinfused from drains within 6 hours of surgery the couple groups received allogeneic blood transfusions according to specified transfusion criteria if the haemoglobin horizontal fell below 90 g/l, or in the nearness of severe anaemic symptoms. Haemoglobin horizontals and drain output were recorded daily for 3 consecutive days after surgery

Result There was no significant difference between the 2 clusters in demographic data, drain output total vital fluid loss, and mean postoperative haemoglobin horizontals Significantly more allogeneic blood was required by means of the control group than by the agency of the reinfusion group (p=0.022).

Conclusion. Postoperative reinfusion of drained life-blood reduced the need for vital current transfusion after total knee arthroplasty, while having an event on postoperative haemoglobin level equivalent to standard allogeneic life-current transfusion.

Key words: arthroplasty, replacement, knee; vital fluid transfusion, autologous

INTRODUCTION

Allogeneic vital fluid transfusion is considered the standard and greatest in quantity effective method of compensating for vital current loss during surgery. It has been reported that total life-current loss after total knee arthroplasty (TKA) can be as high as 15 litres,1 making postoperative allogeneic life-blood transfusion inevitable. However, approximately 20% of all transfusions spring in adverse effects, with 05% being severe2 Adverse reactions range from febrile reactions, allergic reactions, and viral disease transmissions to, rarely, inexorable incompatibility of the ABO vital fluid group.

Both patients and surgeon are increasingly aware of the complications associated with allogeneic life-current transfusion, particularly disease transmission. Safe [i]modus operandi[/i]s of minimising the use of postoperative allogeneic life-blood transfusion are needed. Studies have shown that vital fluid salvage and postoperative reinfusion can bring the need for allogeneic vital fluid transfusion and thus minimise its related adverse reactions, including various marks of infection. However, these studies have not been randomised and controlled34 the couple Newman et al.5 and Woolson and Wall6 lately studied the effectiveness of postoperative life-current salvage in a randomised controll setting and set it to be effective and level more cost-effective than allogeneic transfusion.

In Hong Kong postoperative life-current salvage for TKA patients is not infrequent However, no similar randomised controll close attention has been carried out to investigate the effectiveness of postoperative salvaged life-current reinfusion and its associated adverse reactions.

MATERIALS AND METHODS

Between June 2002 and May 2004 60 patients undergoing unilateral TKA in Kwong Wah Hospital, Hong Kong were registered in this prospective randomised controll trial. Inclusion criteria were unilateral TKA; no stern heart disease, immunocompromised disease, chronic renal failure, rheumatoid arthritis, or seronegative arthritis; and a depressed risk of deep vein thrombosis and vital fluid dyscrasia. The nature of the research and the possible adverse reactions resulting from reinfusion were carefully explained to each patient, and informed assent was obtained together with the surgical assent This study was approved through the Ethics Board of the Hong Kong Hospital Authority's Kowloon West Cluster.

Patients were randomly allocated into a reinfusion assemblage and a control group. Randomisation was by dint of sealed opaque envelopes, which were well mixed through independent personnel and consecutively assigned a case number from 1 to 60 All surgeries were performed by the agency of specialists of the joint and reconstruction team using an identical surgical approach and technique. sum of two units kinds of cemented tricompartmental knee prostheses were used, selection of which was based upon surgeon preference and availability.

Near the extreme point of each operation, the corresponding wrapper was opened, and the surgeon was informed at the time of drain insertion to achieve a single-blind event Total intra-operative blood loss was recorded. Within 6 hours of surgery patients in the reinfusion collection had their blood reinfused from drains using a 40 ?µm vital fluid filter between the collection bag and the intravenous site. Drain output were recorded at postoperative 6 hours and then daily until removal. All patients had their drains remov upon postoperative day 2 or 3

The reinfusion a whole used, DONOR (Van Straten Medical, Nieuwegein, the Netherlands), is an integrated, clos a whole designed for the collection and reinfusion of drained hurt blood. It consists of an 800 ml chorine-free, pre-evacuated collection utensil a vacuum regulator, and a 40-?µm integrated filter for salvaged vital fluid This reinfusion system was fix to be very easy to use through both operating theatre and ward personnel particularly upon tubing connections. The 40-?µm filter effectively restores more than 90% of lipid particles and nearly 80% of leukocyte from salvaged blood7 offering prophylactic protection against the clinical sequalae of reinfusion, of that kind as fat embolism syndrome, febrile reactions, and pulmonary dysfunction. In addition, the combination of parts to form a whole does not induce haemolysis. Cannulation of the reinfusion bag was performed by means of trained nursing staff. Any adverse reactions were recorded and the operation was stopped if reactions were austere as in conventional transfusion managements Both groups had their haemoglobin horizontals and drain output checked daily for 3 consecutive mornings. Allogeneic life-current transfusions were given to the two groups of patients according to the designated transfusion criteria (Table 1) or upon the authority of the lead physician if the patient experienced strait-laced anaemic symptoms. All demographic data, postoperative drain output life-current loss, haemoglobin levels, and allogeneic vital fluid transfusion needed were compared between the 2 clumps using the Chi squared experiment and student's t test, with 95% confidence interval. The sample size of the research was estimated with reference to the difference in transfusion requirement between the 2 assemblages (more than 50%) in a previous study9 It was then calculated to achieve a power of 09 (1-beta) using 2-tail Chi squared trial with 95% confidence intervals. The application of mind followed the principle of 'intent to treat'.