Current Trends in Blood Conservation in Total Knee Arthroplasty

There is a lack of consensus with regard to ways to minimize blood transfusions after total knee arthroplasty. We surveyed 434 members of the American Association of Hip and Knee Surgeons, each of whom averaged 18 years in practice and performed an average of between 100 and 150 knee replacements a year, about their preferences and practices regarding blood conservation during total knee arthroplasty. Of those surveyed, only 24% reported that there was a blood conservation program in place at their institutions. Fifty-nine percent of those surveyed routinely asked their patients to donate blood before unilateral and bilateral knee replacements. The amount of blood collected averaged 1.32 units (range, 1-4 units) and 2.04 units (range, 1-4 units) before unilateral and bilateral knee arthroplasty, respectively. Nearly half (47.5%) reported they rarely ever prescribed epoetin alfa because of a combination of cost, time, and labor issues. Furthermore, the majority (84%) has not had any experience with the use of antifibrinolytics. Overall, the mean transfusion rate after unilateral knee replacement was estimated to be less than 5% (range, 0%-20%) whereas the rate after bilateral knee replacement was estimated to be between 10% and 20% (range, 5%-20%).