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      Effect of a 12-hour natural drainage technique on decreasing blood loss after total knee arthroplasty: a case-control study

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          Abstract

          Background

          Different methods of drainage have been used in patients with osteoarthritis after total knee arthroplasty (TKA), but the ideal strategy is controversial. This retrospective case-control study reported a technique of 12-hour natural drainage and aimed to confirm its efficacy and safety in the treatment for blood loss following TKA.

          Methods

          There were 231 patients divided into three groups who underwent TKA from January 2014 to July 2017: 76 patients underwent 12-hour natural drainage in Group A, 80 patients underwent 4-hour clamping drainage in Group B, and 75 patients underwent continuous drainage in Group C. All perioperative clinical data were reviewed for statistical analysis.

          Results

          The drainage volume and total blood loss after TKA were significantly lower in Group A than that in the other two groups ( P<0.05), and serum level of hemoglobin was significantly higher in Group A than that in the other two groups ( P<0.05). The maximum of active motion of the knee was greater in Group C at 2 days ( P<0.05). Significantly more patients in Group C required blood transfusions ( P<0.05). No difference was found in the complication rate among the three groups.

          Conclusion

          The 12-hour natural drainage is an effective technique for reducing blood loss for patients following TKA. Compared with temporary clamping drainage and continuous negative pressure drainage, 12-hour natural drainage decreases blood loss, reduces post-operative transfusion requirements, and does not increase the risk of complications. Therefore, this technique of 12-hour natural drainage is recommended to be used in patients after TKA.

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          Most cited references 25

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          Prediction of blood volume in normal human adults.

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            Predictors of perioperative blood loss in total joint arthroplasty.

            UPDATE The print version of this article has errors that have been corrected in the online version of this article. In the Materials and Methods section, the sentence that reads as "During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 mg/dL or a hematocrit level of at least 33%." in the print version now reads as "During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 g/dL or a hematocrit level of at least 33%." in the online version. In Table III, the footnote that reads as "The values are given as the estimate and the standard error in milligrams per deciliter." in the print version now reads as "The values are given as the estimate and the standard error in grams per deciliter." in the online version.
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              Tranexamic acid reduces blood loss and blood transfusion after TKA: a prospective randomized controlled trial.

              TKA may be associated with considerable blood loss, and transfusion carries substantial risk of immunologic reaction and disease transmission. Blood transfusion also involves additional cost, therefore a reduction in its use is important. Several methods reportedly reduce postoperative blood loss and avoid homologous blood transfusion with traditional TKA approaches, but it is unclear these reductions apply to a minimally invasive technique. We asked whether tranexamic acid administration could reduce blood loss and blood transfusion requirements after TKA. Between March 2008 and May 2008, we enrolled 100 patients with primary osteoarthritis undergoing a unilateral cemented TKA in a prospective, randomized, double-blind study. Patients were randomized into one of two groups: the control group received a placebo and the study group received tranexamic acid intravenously (10 mg/kg) 10 minutes before inflation of the tourniquet and 3 hours postoperatively and orally (250 mg/capsule; two capsules three times daily) for 5 days. We measured volume of drained blood 48 hours postoperatively, decrease in hemoglobin levels 12 hours postoperatively, amount of blood transfused, and number of patients requiring allogenic blood transfusion. The minimum followup was 6 months (mean, 10.4 months; range, 6-12 months). Mean (± SD) postoperative volume of drained blood was lower in the group receiving tranexamic acid (727.50 ± 234 mL) than in control subjects (1208.77 ± 421 mL). The mean hemoglobin decrease 12 hours postoperatively was lower in patients receiving tranexamic acid (2.12 ± 0.64 g/dL) than in control subjects (3.33 ± 0.88 g/dL). The amount of blood transfused and number of patients requiring blood transfusion were lower in patients receiving tranexamic acid than in control subjects. Tranexamic acid reduced postoperative blood loss after TKA, as reflected in reduction in the number of blood transfusions. We did not observe any change in symptomatic thromboembolic phenomenon. Level 1, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                05 July 2018
                : 14
                : 1169-1174
                Affiliations
                [1 ]Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, People’s Republic of China, 2505014@ 123456zju.edu.cn
                [2 ]Department of Orthopedics, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, People’s Republic of China
                Author notes
                Correspondence: Haobo Wu, Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No 88 Jiefang Road, Hangzhou 310009, People’s Republic of China, Tel +86 139 5812 2387, Fax +86 571 8778 3882, Email 2505014@ 123456zju.edu.cn
                Article
                tcrm-14-1169
                10.2147/TCRM.S170020
                6039074
                © 2018 Shi et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                natural drainage technique, blood loss, total knee arthroplasty, case-control study

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