Many orthopedic surgeons decline to perform total knee arthroplasty on patients for whom the use of blood components are not an option due to the perceived risk of acute blood loss-related anemia and subsequent mortality. While tourniquets were previously believed to reduce blood loss during total knee arthroplasty, recent studies suggest similar volumes of blood loss and increased risk of other complications when performed with using a tourniquet. Antifibrinolytics are a safe alternative to tourniquets in reducing blood loss in total knee arthroplasty.
The current study analyzed the use of antifibrinolytics in Jehovah’s Witness patients for total knee arthroplasty performed without a tourniquet. Hemoglobin values were measured on 64 patients preoperatively, 1 hour postoperative, and 72 hours postoperatively. Relative change in hemoglobin was analyzed by the t-test.
The average drop in hemoglobin from preoperatively to postoperatively was 1.61 g/dl (p < 0.001). At a mean follow-up of 20 months (range: 1 to 73 months) there was one incidence of a deep vein thrombosis, one deep infection requiring a two-stage revision, and three patients requiring manipulation for stiffness. There were no pulmonary embolisms (PEs) and a 0% mortality rate.
Total knee arthroplasty in Jehovah’s Witness patients can be done safely and efficiently using antifibrinolytic therapy without a tourniquet.