Blood management in total knee arthroplasty

Talk to any number of knee surgeons about the perioperative management of the knee arthroplasty patient and you will get a similar number of different opinions. Should blood be cross-matched? Should a tourniquet be used and if so when should it be deflated? Should a drain be used? Should this blood be salvaged and reinfused? What are the triggers for ordering a transfusion? The implications of these variables become apparent when we see that some centres use allogenic blood in over half their knee arthroplasty patients whereas others transfuse almost none!