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Prognostic Factors of Perioperative Hemorrhage, Blood Transfusion and Tranexamic Acid Infusion in Bilateral Total Knee Replacement: A Prospective Comparative Study

Kumar SV and Lakhwani OP

Background: Perioperative hemodynamic control is considered critical for intra-operative and post-operative outcomes in bilateral Total Knee Replacement (TKR). We carried out a prospective study to determine the factors affecting the perioperative blood loss, blood transfusion, and tranexamic acid requirement in bilateral total knee replacement. The factors analyzed were gender, blood pressure, and body mass index (BMI).

Methods: Selected primary osteoarthritis knee patient's gender and comorbidities such as hypertension, obesity, diabetic mellitus, thyroid disorders, etc., were recorded. We prospectively recorded total blood loss, blood transfusions and tranexamic acid infusion in 21 patients who have undergone staged bilateral TKR and 20 patients who have undergone simultaneous bilateral TKR randomly.

Results: Male patients among bilateral TKR have significantly more average total blood loss compared to female patients (p<0.001). Hypertensive and obese patients among bilateral TKR have significantly more average total blood loss compared to non-hypertensive and non-obese patients respectively (p<0.001). Male patients more blood transfusion prevalence rate compared to female patients, but this difference is not of statistical significance (p=0.08). Hypertensive and obese patients have more but not significant blood transfusion prevalence rate compared to non-hypertensive (p=0.09) and non-obese (p=0.08) patients respectively. Male patients more intravenous tranexamic acid infusion rates compared to female patients, but this difference is not of statistical significance (p=0.79). Hypertensive and obese patients have more but not significant tranexamic acid infusion rates compared to nonhypertensive (p=0.50) and non-obese (p=0.70) patients respectively.

Conclusion: Male gender, patients with hypertensive and obesity has significantly higher average blood loss, higher blood transfusion rate and higher tranexamic acid infusion rate. Hence staged bilateral procedure is preferred in the male gender, comorbidities like hypertension and obesity instead of simultaneous procedure in those patients.