Intraoperative nonpharmacotherapeutic blood management strategies in total knee arthroplasty.

Samik Banerjee, Kimona Issa, Bhaveen H. Kapadia, Harpal S. Khanuja, Steven F. Harwin, Vincent K. McInerney, Michael A. Mont

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations


Substantial amounts of perioperative blood loss occur during total knee arthroplasty (TKA) that may require allogeneic transfusion in more than 30% of patients. Increased blood loss leads to poor physical functioning, increases infection risks, and prolongs hospitalization, which may eventually affect the overall clinical outcomes of TKA. In addition, allogeneic blood transfusions are associated with increased risks of transfusion reactions, immunosuppression, and a variety of immunological reactions. These concerns have led surgeons and anesthesiologists to develop various strategies to conserve blood, reduce costs, and decrease complications related to blood transfusions. Multiple nonpharmacologic intraoperative blood-saving measures have been used including acute normovolemic hemodilution, hypotensive anesthesia, tourniquets, bipolar sealants, intraoperative blood salvage systems, intramedullary femoral plugs, computer-assisted surgery, and the use of patient-specific instrumentation. However, no clear protocol exists currently to help surgeons choose the appropriate method for blood preservation. The aim of this article was to review the various nonpharmacologic intraoperative blood management strategies that have been used in TKA and to analyze their effectiveness and potential complications according to current evidence. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Original languageEnglish
Pages (from-to)387-393
Number of pages7
JournalThe journal of knee surgery
Issue number6
StatePublished - Dec 2013


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