Is blood transfusion really required in simultaneous bilateral Total Knee Replacement: A retrospective observational study.

Simultaneous bilateral TKA (SBTKA) in a single sitting is an attractive option for medically fit patients, with end-stage osteoarthritis (OA) of both the knees. It is a cost-effective procedure but is associated with increased blood loss and requirement for blood transfusion. We present a retrospective observational study of 144 patients who had SBTKA, with the mean age of 63.86 ± 7.38 years. We noted that all the cases of SBTKA would not require a blood transfusion, if the preoperative selection and optimization of the patient is done carefully and with the use of clean surgical technique and adequate thermocoagulation of the bleeders and perioperative use of tranexemic acid (TA) is done in these cases. 2/3rd of our patients did not require any blood transfusion, after SBTKA. We found that preexisting Hypertension and Hypothyroidism were associated with increased blood loss. The use of TA was a useful adjunctive measure to reduce perioperative blood loss. According to other studies which were reviewed there was no significant difference in blood loss with or without the use of a tourniquet. However, tourniquet was used in all patients in our study. The pre-operative level of Hemoglobin was an important factor to contribute to the requirement of blood transfusion after SBTKA. We recommend blood transfusion if the post-operative Hemoglobin level is less than 8.0 gm./dl.