Skip to main content
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology 6/2018

09.03.2018 | Original Article • KNEE - ARTHROPLASTY

Influence of synovectomy on blood loss and need for transfusion in standard total knee replacement

verfasst von: José Ramón Ausó-Pérez, Gloria María Rodríguez-Blanes

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 6/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

Synovial proliferation is a rather frequent intraoperative finding during the surgery of a total knee replacement. The aim of this study is to asses whether the standard procedure of a synovectomy results in changes in blood loss and in the need for transfusion in the immediate postoperative time after the total knee replacement.

Methods

A prospective cohort study was performed with 120 patients undergoing total knee replacement (60 with synovectomy and 60 without it). Data on gender, age, and hemoglobin concentration prior to and after surgery were obtained. A bivariate and multivariate logistic regression analysis was performed.

Results

The male gender as a protective factor [RR 0.25 (0.06–1.01)] and the low preoperative hemoglobin as a risk factor [RR 6.22 (2.48–15.58)] were significant in bivariate analysis. However, only the presence of low preoperative hemoglobin was shown to have an independent risk factor for the need for transfusion [RR 8.55 (2.77–26.45)].

Conclusion

The practice of synovectomy showed no difference either in blood loss or in the number of transfusions. The findings of this study indicate that the practice of a synovectomy in a standard total knee replacement does not generate any benefit or prejudice as to the blood factor of the total knee arthroplasty.
Literatur
1.
Zurück zum Zitat Wehling P, Moser C, Maixner W (2016) How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: current thoughts. Ther Adv Musculoskelet Dis 8(3):72–85CrossRefPubMedPubMedCentral Wehling P, Moser C, Maixner W (2016) How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: current thoughts. Ther Adv Musculoskelet Dis 8(3):72–85CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Hunter DJ, Guermazi A, Roemer F, Zhang Y, Neogi T (2013) Structural correlates of pain in joints with osteoarthritis. Osteoarthr Cartil 21(9):1170–1178CrossRefPubMed Hunter DJ, Guermazi A, Roemer F, Zhang Y, Neogi T (2013) Structural correlates of pain in joints with osteoarthritis. Osteoarthr Cartil 21(9):1170–1178CrossRefPubMed
3.
Zurück zum Zitat Feeley BT, Gallo RA, Sherman S, Williams RJ (2010) Management of osteoarthritis of the knee in the active patient. J Am Acad Orthop Surg 18(7):406–416CrossRefPubMed Feeley BT, Gallo RA, Sherman S, Williams RJ (2010) Management of osteoarthritis of the knee in the active patient. J Am Acad Orthop Surg 18(7):406–416CrossRefPubMed
4.
Zurück zum Zitat Maempel JF, Riddoch F, Calleja N, Brenkel IJ (2015) Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients: a study of 3,144 primary unilateral total knee replacements. Acta Orthop 86(4):451–456CrossRefPubMedPubMedCentral Maempel JF, Riddoch F, Calleja N, Brenkel IJ (2015) Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients: a study of 3,144 primary unilateral total knee replacements. Acta Orthop 86(4):451–456CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 87(7):1487–1497PubMed Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 87(7):1487–1497PubMed
6.
Zurück zum Zitat Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785PubMed Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785PubMed
7.
Zurück zum Zitat Nichols CI, Vose JG (2016) Comparative risk of transfusion and incremental total hospitalization cost for primary unilateral, bilateral, and revision total knee arthroplasty procedures. J Arthroplasty 31(3):583–589CrossRefPubMed Nichols CI, Vose JG (2016) Comparative risk of transfusion and incremental total hospitalization cost for primary unilateral, bilateral, and revision total knee arthroplasty procedures. J Arthroplasty 31(3):583–589CrossRefPubMed
8.
Zurück zum Zitat Faldini C, Traina F, De Fine M, Pedrini M, Sambri A (2015) Post-operative limb position can influence blood loss and range of motion after total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 23(3):852–859CrossRefPubMed Faldini C, Traina F, De Fine M, Pedrini M, Sambri A (2015) Post-operative limb position can influence blood loss and range of motion after total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 23(3):852–859CrossRefPubMed
9.
Zurück zum Zitat Hart A, Khalil JA, Carli A, Huk O, Zukor D, Antoniou J (2014) Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am 96(23):1945–1951CrossRefPubMed Hart A, Khalil JA, Carli A, Huk O, Zukor D, Antoniou J (2014) Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am 96(23):1945–1951CrossRefPubMed
10.
Zurück zum Zitat Frisch N, Wessell NM, Charters M, Peterson E, Cann B, Greenstein A et al (2016) Effect of Body mass index on blood transfusion in total hip and knee arthroplasty. Orthopedics 39(5):e844–e849CrossRefPubMed Frisch N, Wessell NM, Charters M, Peterson E, Cann B, Greenstein A et al (2016) Effect of Body mass index on blood transfusion in total hip and knee arthroplasty. Orthopedics 39(5):e844–e849CrossRefPubMed
11.
Zurück zum Zitat Bedard NA, Pugely AJ, Lux NR, Liu SS, Gao Y, Callaghan JJ (2017) Recent trends in blood utilization after primary hip and knee arthroplasty. J Arthroplasty 32(3):724–727CrossRefPubMed Bedard NA, Pugely AJ, Lux NR, Liu SS, Gao Y, Callaghan JJ (2017) Recent trends in blood utilization after primary hip and knee arthroplasty. J Arthroplasty 32(3):724–727CrossRefPubMed
12.
Zurück zum Zitat Frisch NB, Wessell NM, Charters MA, Yu S, Jeffries JJ, Silverton CD (2014) Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplast 29(9 Suppl):189–192CrossRef Frisch NB, Wessell NM, Charters MA, Yu S, Jeffries JJ, Silverton CD (2014) Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplast 29(9 Suppl):189–192CrossRef
13.
Zurück zum Zitat Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM et al (2003) Orthopedic surgery transfusion hemoglobin european overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 43(4):459–469CrossRefPubMed Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM et al (2003) Orthopedic surgery transfusion hemoglobin european overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 43(4):459–469CrossRefPubMed
14.
Zurück zum Zitat Tanavalee A, Honsawek S, Rojpornpradit T, Sakdinakiattikoon M, Ngarmukos S (2011) Inflammation related to synovectomy during total knee replacement in patients with primary osteoarthritis: a prospective, randomised study. J Bone Joint Surg Br 93(8):1065–1070CrossRefPubMed Tanavalee A, Honsawek S, Rojpornpradit T, Sakdinakiattikoon M, Ngarmukos S (2011) Inflammation related to synovectomy during total knee replacement in patients with primary osteoarthritis: a prospective, randomised study. J Bone Joint Surg Br 93(8):1065–1070CrossRefPubMed
15.
Zurück zum Zitat Kilicarslan K, Yalcin N, Cicek H, Dogramaci Y, Ugurlu M, Ozkan H et al (2011) The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study. Knee Surg Sports Traumatol Arthrosc 19(6):932–935CrossRefPubMed Kilicarslan K, Yalcin N, Cicek H, Dogramaci Y, Ugurlu M, Ozkan H et al (2011) The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study. Knee Surg Sports Traumatol Arthrosc 19(6):932–935CrossRefPubMed
16.
Zurück zum Zitat Zhaoning X, Xu Y, Shaoqi T, Baiqiang H, Kang S (2013) The effect of synovectomy on bleeding and clinical outcomes for total knee replacement. Bone Joint J 95(9):1197–1200CrossRefPubMed Zhaoning X, Xu Y, Shaoqi T, Baiqiang H, Kang S (2013) The effect of synovectomy on bleeding and clinical outcomes for total knee replacement. Bone Joint J 95(9):1197–1200CrossRefPubMed
17.
Zurück zum Zitat SETS (2015) Guía sobre Transfusión de Componentes Sanguíneos y Derivados Plasmáticos, 5th edn. Sociedad Española de Transfusión Sanguínea y Terapia Celular, Barcelona SETS (2015) Guía sobre Transfusión de Componentes Sanguíneos y Derivados Plasmáticos, 5th edn. Sociedad Española de Transfusión Sanguínea y Terapia Celular, Barcelona
18.
Zurück zum Zitat Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee 7(3):151–155CrossRefPubMed Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee 7(3):151–155CrossRefPubMed
19.
Zurück zum Zitat Levine BR, Haughom B, Strong B, Hellman M, Frank RM (2014) Blood management strategies for total knee arthroplasty. J Am Acad Orthop Surg 22(6):361–371CrossRefPubMed Levine BR, Haughom B, Strong B, Hellman M, Frank RM (2014) Blood management strategies for total knee arthroplasty. J Am Acad Orthop Surg 22(6):361–371CrossRefPubMed
20.
Zurück zum Zitat Zan PF, Yang Y, Fu D, Yu X, Li GD (2015) Releasing of tourniquet before wound closure or not in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplast 30(1):31–37CrossRef Zan PF, Yang Y, Fu D, Yu X, Li GD (2015) Releasing of tourniquet before wound closure or not in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplast 30(1):31–37CrossRef
21.
22.
Zurück zum Zitat Moráis S, Ortega-Andreu M, Rodríguez-Merchán EC, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R et al (2014) Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop 38(2):347–354CrossRefPubMed Moráis S, Ortega-Andreu M, Rodríguez-Merchán EC, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R et al (2014) Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop 38(2):347–354CrossRefPubMed
23.
Zurück zum Zitat Memtsoudis SG, Danninger T, Stundner O, Yoo D, Girardi FP, Boettner F et al (2015) Blood transfusions may have limited effect on muscle oxygenation after total knee arthroplasty. HSS J 11(2):136–142CrossRefPubMedPubMedCentral Memtsoudis SG, Danninger T, Stundner O, Yoo D, Girardi FP, Boettner F et al (2015) Blood transfusions may have limited effect on muscle oxygenation after total knee arthroplasty. HSS J 11(2):136–142CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Park JH, Rasouli MR, Mortazavi SM, Tokarski AT, Maltenfort MG, Parvizi J (2013) Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am 95(19):1777–1783CrossRefPubMed Park JH, Rasouli MR, Mortazavi SM, Tokarski AT, Maltenfort MG, Parvizi J (2013) Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am 95(19):1777–1783CrossRefPubMed
25.
Zurück zum Zitat Yoshihara H, Yoneoka D (2014) Predictors of allogeneic blood transfusion in total hip and knee arthroplasty in the United States, 2000–2009. J Arthroplast 29(9):1736–1740CrossRef Yoshihara H, Yoneoka D (2014) Predictors of allogeneic blood transfusion in total hip and knee arthroplasty in the United States, 2000–2009. J Arthroplast 29(9):1736–1740CrossRef
26.
Zurück zum Zitat Kooner SS, Clark M (2017) The effect of synovectomy in total knee arthroplasty for primary osteoarthritis: a meta-analysis. J Knee Surg 30(4):289–296PubMed Kooner SS, Clark M (2017) The effect of synovectomy in total knee arthroplasty for primary osteoarthritis: a meta-analysis. J Knee Surg 30(4):289–296PubMed
Metadaten
Titel
Influence of synovectomy on blood loss and need for transfusion in standard total knee replacement
verfasst von
José Ramón Ausó-Pérez
Gloria María Rodríguez-Blanes
Publikationsdatum
09.03.2018
Verlag
Springer Paris
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 6/2018
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-018-2160-8

Weitere Artikel der Ausgabe 6/2018

European Journal of Orthopaedic Surgery & Traumatology 6/2018 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.