Skip to main content
SpringerLink
Log in

Autologous bone plugs in unilateral total knee arthroplasty

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background: The purpose of this study was to compare blood loss, declines in hemoglobin (HgB) and hematocrit (HcT) levels, and required homologous transfusions for patients who either had the femoral intramedullary defect left open or filled with an autologous bone plug during total knee arthroplasty (TKA). We hereby present our results of autologous bone plugs in unilateral TKA.

Materials and Methods: A retrospective chart review was performed on 55 patients diagnosed with osteoarthritis (OA) who had undergone unilateral TKA. Twenty six patients had the femoral defect filled with an autologous bone plug and 29 did not. Lateral releases and patella replacements were not performed. Drained blood was reinfused when appropriate.

Results: Mean blood loss and mean blood reinfused were similar for the plugged (loss: 960.8 ± 417.3 ml; reinfused: 466.7 ± 435.9 mL) and unplugged groups (loss: 1065.9 ± 633.5 ml, P = 0.38; reinfused: 528.4 ± 464.8 ml, P = 0.61). Preoperative HgB (14.3 ± 1.4 g/dL, P = 0.93) and HcT levels (42.2 ± 4.6%, P = 0.85) were similar across plug conditions. HgB and HcT levels declined similarly for the plugged (2.7 ± 1.2 g/dl and 7.9 ± 4.0%) and unplugged groups (3.0 ± 0.9 g/dl, P = 0.16 and 9.0 ± 2.6%, P = 0.16), respectively. Of patients, one in the plugged group and none in the unplugged group required homologous transfusions (P = 0.5).

Conclusion: The autologous bone plug does not appear to reduce the need for homologous blood transfusions following unilateral TKA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999;81:2–10.

    Article  CAS  Google Scholar 

  2. Raut VV, Stone MH, Wroblewski BM. Reduction of postoperative blood loss after press-fit condylar knee arthroplasty with use of a femoral intramedullary plug. J Bone Joint Surg Am 1993;75:1356–7.

    Article  CAS  Google Scholar 

  3. Kumar N, Saleh J, Gardiner E, Devadoss VG, Howell FR. Plugging the intramedullary canal of the femur in total knee arthroplastyReduction in postoperative blood loss. J Arthroplasty 2000;15:947–9.

    Article  CAS  Google Scholar 

  4. Ko PS, Tio MK, Tang YK, Tsang WL, Lam JJ. Sealing the intramedullary femoral canal with autologous bone plug in total knee arthroplasty. J Arthroplasty 2003;18:6–9.

    Article  CAS  Google Scholar 

  5. Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: Indications and complications. Am Fam Physician 2011;83:719–24.

    PubMed  Google Scholar 

  6. Klein HG, Spahn DR, Carson JL. Red blood cell transfusion in clinical practice. Lancet 2007;370:415–26.

    Article  Google Scholar 

  7. Consensus conference. Perioperative red blood cell transfusion. JAMA 1988;260:2700–3.

    Article  Google Scholar 

  8. Klein MP, Rahn BA, Frigg R, Kessler S, Perren SM. Reaming versus nonreaming in medullary nailing: Interference with cortical circulation of the canine tibia. Arch Orthop Trauma Surg 1990;109:314–6.

    Article  CAS  Google Scholar 

  9. Krackow KA. Surgical Procedure. The Technique of Total Knee Arthroplasty. St. Louis: C.V. Mosby Company; 1990. p. 440.

    Google Scholar 

  10. Spencer J, Thomas SR, Yardy G, Mukundan C, Barrington R. Are we overusing blood transfusing after elective joint replacement?–A simple method to reduce the use of a scarce resource. Ann R Coll Surg Engl 2005;87:28–30.

    Article  CAS  Google Scholar 

  11. Marmor L, Avoy DR, McCabe A. Effect of fibrinogen concentrates on blood loss in total knee arthroplasty. Clin Orthop Relat Res 1991;273:136–8.

    Google Scholar 

  12. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee 2000;7:151–5.

    Article  CAS  Google Scholar 

  13. Lotke PA, Faralli VJ, Orenstein EM, Ecker ML. Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am 1991;73:1037–40.

    Article  CAS  Google Scholar 

  14. Cheng SC, Hung TS, Tse PY. Investigation of the use of drained blood reinfusion after total knee arthroplasty: A prospective randomised controlled study. J Orthop Surg (Hong Kong) 2005;13:120–4.

    Article  CAS  Google Scholar 

  15. Peter VK, Radford M, Matthews MG. Re-transfusion of autologous blood from wound drains: The means for reducing transfusion requirements in total knee arthroplasty. Knee 2001;8:321–3.

    Article  CAS  Google Scholar 

  16. Sinha A, Sinha M, Burgert S. Reinfusion of drained blood as an alternative to homologous blood transfusion after total knee replacement. Int Orthop 2001;25:257–9.

    Article  CAS  Google Scholar 

  17. Henderson MS, Newman JH, Hand GC. Blood loss following knee replacement surgery, use it don’t lose it. Knee 1999;6:125–9.

    Article  Google Scholar 

  18. Newman JH, Bowers M, Murphy J. The clinical advantages of autologous transfusion. A randomized, controlled study after knee replacement. J Bone Joint Surg Br 1997;79:630–2.

    Article  CAS  Google Scholar 

  19. Majkowski RS, Currie IC, Newman JH. Postoperative collection and reinfusion of autologous blood in total knee arthroplasty. Ann R Coll Surg Engl 1991;73:381–4

    PubMed  PubMed Central  CAS  Google Scholar 

  20. Christodoulou AG, Ploumis AL, Terzidis IP, Chantzidis P, Metsovitis SR, Nikiforos DG. The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement. Knee 2004;11:313–7.

    Article  Google Scholar 

  21. Burkart BC, Bourne RB, Rorabeck CH, Kirk PG, Nott L. The efficacy of tourniquet release in blood conservation after total knee arthroplasty. Clin Orthop Relat Res 1994;299:147–52.

    Google Scholar 

  22. Heddle NM, Brox WT, Klama LN, Dickson LL, Levine MN. A randomized trial on the efficacy of an autologous blood drainage and transfusion device in patients undergoing elective knee arthroplasty. Transfusion 1992;32:742–6.

    Article  CAS  Google Scholar 

  23. Semkiw LB, Schurman DJ, Goodman SB, Woolson ST. Postoperative blood salvage using the Cell Saver after total joint arthroplasty. J Bone Joint Surg Am 1989;71:823–7.

    Article  CAS  Google Scholar 

  24. Mylod AG Jr, France MP, Muser DE, Parsons JR. Perioperative blood loss associated with total knee arthroplasty. A comparison of procedures performed with and without cementing. J Bone Joint Surg Am 1990;72:1010–2.

    Article  Google Scholar 

  25. Rama KR, Apsingi S, Poovali S, Jetti A. Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 2007;89:699–705.

    Article  Google Scholar 

  26. Hersekli MA, Akpinar S, Ozkoc G, Ozalay M, Uysal M, Cesur N, et al. The timing of tourniquet release and its influence on blood loss after total knee arthroplasty. Int Orthop 2004;28:138–41.

    Article  Google Scholar 

  27. Jorn LP, Lindstrand A, Toksvig-Larsen S. Tourniquet release for hemostasis increases bleeding. A randomized study of 77 knee replacements. Acta Orthop Scand 1999;70:265–7.

    Article  CAS  Google Scholar 

  28. Harvey EJ, Leclerc J, Brooks CE, Burke DL. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty 1997;12:291–6.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Coordinated Health, St. Luke’s Hospital, Easton Hospital, Sacred Heart Hospital, Lehigh Valley Hospital, Temple University, School of Medicine, DeSales University, USA

    Nicholas J. Buck & Carl B. Weiss

  2. Department of Clinical Education and Research, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA, 18045, USA

    Nicole M. Protzman

Authors
  1. Nicole M. Protzman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicholas J. Buck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carl B. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicole M. Protzman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Protzman, N.M., Buck, N.J. & Weiss, C.B. Autologous bone plugs in unilateral total knee arthroplasty. IJOO 47, 182–187 (2013). https://doi.org/10.4103/0019-5413.108914

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.108914

Key words

Search

Navigation