Analysis of Factors Influencing True Blood Loss in Navigated Total Knee Replacements

Title: Analysis of factors influencing true blood loss in navigated total knee replacements. Objectives: To evaluate true blood loss in total knee replacements and analyze the various factors such as gender, BMI, diagnosis, size of implants, duration of surgery, tourniquet usage etc. on calculated blood loss using formula by Nadler et al. All the cases included have been done using navigation system and no comparison with conventional jig based surgeries has been attempted. Methods: Retrospectively data of primary cemented total knee replacements performed from October 2012 to August 2013 were evaluated. All surgeries were performed using navigation system. The data collected included patient sex, height, weight and preoperative haemoglobin and hematocrit. The patients’ postoperative data of haemoglobin, hematocrit and drains were collected. All patients had their CBC done on 2nd post operative day. Any data on transfusions that patients received were also collected. We also collected data regarding the size of implant used. We calculated true blood based on formula given by Nadler, Hidalgo & Bloch. We excluded patients whose data were incomplete or who received tranexamic acid. Patients who needed stems (femoral or tibial) were also excluded from this study. Results: The average true calculated blood loss was 959.44 ml. BMI did not have any effect on blood loss. But larger size implants were associated with more blood loss. Conclusion: The preoperative haemoglobin is one of the most important factors in determining transfusion following the knee replacement. Male gender and larger implants are associated with more blood loss. BMI, diagnosis of OA or RA, tourniquet usage and time have no significant effect on blood loss. Our calculated blood loss compares favourably with published literature.