North Shore hospital, Auckland, New Zealand; University hospital of Marburg, Marburg, Germany.
University hospital of Marburg, Marburg, Germany.
Orthop Traumatol Surg Res. 2021 May;107(3):102856. doi: 10.1016/j.otsr.2021.102856. Epub 2021 Feb 12.
There are a number of factors that influence blood loss during and after primary total knee arthroplasty (TKA) and revision TKA (rTKA). The purpose of this study was to provide a factorial assessment that would aid surgeons in managing expected blood loss in rTKA, when compared to TKA. The first question asked was the blood loss and transfusions between TKA and rTKA and the second question was risk factors for blood loss after rTKA.
Blood loss in any rTKA is higher than in TKA by a factor of 2.
A retrospective single-centre consecutive series of rTKA between 2006 and 2018 was performed. Based on the rTKA types identified in joint registries, 4 rTKA cohorts were created: aseptic minor rTKA, aseptic major rTKA, 1st stage, and 2nd stage septic rTKA. A consecutive TKA cohort from the same study period was used to create a propensity score matched cohort with the aseptic major rTKA cohort.
A total of 622 rTKA were identified. Aseptic major rTKA had double the median blood loss than TKA. The lowest blood loss was observed in the TKA group followed by aseptic minor rTKA, and the highest in 2nd stage septic rTKA. The median total blood loss was higher in all rTKA by a factor ranging between 1.38 and 2.17. Higher age, female gender, lower preoperative hemoglobin, chronic heart disease and history of myocardial infarction were risk factors for increased blood loss. The type of rTKA performed was not predictive of blood loss in the linear regression analysis.
Blood loss after rTKA is 1.38 to 2.17-fold higher than after TKA. The blood loss observed in 2nd stage septic rTKA and aseptic major rTKA was the highest. Older female patients, with a low preoperative hemoglobin, were identified to be at the highest risk of blood loss after rTKA. Strategies for further blood loss reductions need to be utilised to the fullest extent for these procedures.
III; retrospective prognostic study.
影响初次全膝关节置换术（TKA）和翻修 TKA（rTKA）期间及之后出血量的因素有很多。本研究的目的是提供一种可以帮助外科医生管理 rTKA 预期出血量的因子评估，与 TKA 进行比较。第一个问题是 TKA 和 rTKA 之间的失血量和输血情况，第二个问题是 rTKA 后出血的危险因素。
任何 rTKA 的失血量都比 TKA 高 2 倍。
回顾性连续研究了 2006 年至 2018 年期间的 rTKA。根据关节登记处确定的 rTKA 类型，创建了 4 个 rTKA 队列：无菌小 rTKA、无菌大 rTKA、1 期和 2 期感染性 rTKA。使用来自同一研究期间的连续 TKA 队列创建了一个倾向评分匹配队列，与无菌大 rTKA 队列进行比较。
共确定了 622 例 rTKA。无菌大 rTKA 的中位数出血量是 TKA 的两倍。TKA 组的失血量最低，其次是无菌小 rTKA，2 期感染性 rTKA 的失血量最高。所有 rTKA 的总失血量中位数均增加了 1.38 至 2.17 倍。较高的年龄、女性、较低的术前血红蛋白、慢性心脏病和心肌梗死史是增加出血的危险因素。在线性回归分析中，进行的 rTKA 类型不是出血的预测因素。
rTKA 后的失血量比 TKA 高 1.38 至 2.17 倍。在 2 期感染性 rTKA 和无菌大 rTKA 中观察到的失血量最高。年龄较大的女性患者，术前血红蛋白较低，被认为是 rTKA 后出血风险最高的人群。需要充分利用进一步减少失血量的策略来进行这些手术。
III；回顾性预后研究。
