Deng Tao, Liang Yongjian, Xu Chi, Hao Libo, Fu Jun, Chen Jiying
Medical School of Chinese PLA, Beijing, People's Republic of China.
Department of Orthopedic Surgery, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
BMC Musculoskelet Disord. 2025 May 3;26(1):439. doi: 10.1186/s12891-025-08698-6.
Total knee arthroplasty (TKA) can cause significant hidden blood loss after surgery, and transfusion or erythropoietin (EPO) treatment may be required. This study aimed to identify the factors associated with blood loss in patients undergoing TKA for osteoarthritis (OA).
We retrospectively enrolled 1444 OA patients undergoing primary TKA from January 2022 to June 2024. The patients were divided into two groups according to the grade of hidden blood loss. To identify the key influencing factors, we conducted a logistic regression analysis.
This study analyzed 1,444 primary arthroplasty cases, identifying 236 patients with high hidden blood loss (HHBL). Coronary artery disease (CAD) was significantly more prevalent in the HHBL group (15.3% vs. 9.4%, p = 0.006). Preoperative EPO use was higher in the low hidden blood loss (LHBL) group (21.9% vs. 9.3%, p < 0.001). Significant preoperative lab differences included hemoglobin, hematocrit, and platelet count. Surgical factors associated with HHBL included left knee TKA, conventional mechanical TKA (CMTKA), longer operation times, and intraoperative blood loss (IBL) > 20%. Postoperatively, the HHBL group had significantly more transfusions and longer hospital stays. Logistic regression identified CAD, platelet count, left knee surgery, CMTKA, operation time, and preoperative EPO use as significant factors influencing HHBL. These findings highlight the need for targeted strategies to manage blood loss in knee arthroplasty patients.
This study identifies several factors associated with high hidden blood loss in patients undergoing TKA for osteoarthritis. CAD, CMTKA, prolonged operation time, left-sided surgery, lower preoperative platelet count, and lack of preoperative erythropoietin (EPO) use were significantly linked to HHBL. While these associations highlight potential targets for intervention, further prospective studies are needed to confirm causality.
全膝关节置换术（TKA）术后可导致大量隐性失血，可能需要输血或促红细胞生成素（EPO）治疗。本研究旨在确定骨关节炎（OA）患者行TKA术后失血的相关因素。
我们回顾性纳入了2022年1月至2024年6月期间行初次TKA的1444例OA患者。根据隐性失血程度将患者分为两组。为确定关键影响因素，我们进行了逻辑回归分析。
本研究分析了1444例初次关节置换病例，确定了236例隐性失血高（HHBL）患者。HHBL组冠状动脉疾病（CAD）的患病率显著更高（15.3%对9.4%，p = 0.006）。低隐性失血（LHBL）组术前EPO使用率更高（21.9%对9.3%，p < 0.001）。术前实验室检查的显著差异包括血红蛋白、血细胞比容和血小板计数。与HHBL相关的手术因素包括左膝TKA、传统机械TKA（CMTKA）、手术时间延长和术中失血（IBL）>20%。术后，HHBL组输血次数显著更多，住院时间更长。逻辑回归确定CAD、血小板计数、左膝手术、CMTKA、手术时间和术前EPO使用是影响HHBL的重要因素。这些发现凸显了针对膝关节置换患者失血管理制定针对性策略的必要性。
本研究确定了骨关节炎患者行TKA术后隐性失血高的几个相关因素。CAD、CMTKA、手术时间延长、左侧手术、术前血小板计数较低以及术前未使用促红细胞生成素（EPO）与HHBL显著相关。虽然这些关联凸显了潜在的干预靶点，但需要进一步的前瞻性研究来证实因果关系。
