Original article
Postoperative blood salvage and reinfusion after total joint arthroplasty

https://doi.org/10.1016/S0883-5403(97)90173-XGet rights and content

Abstract

The purpose of this prospective study was to evaluate the safety of salvage and reinfusion of postoperative sanguineous wound drainage using the ConstaVac Blood Conservation System (Stryker, Kalamazoo, MI). A prospective analysis of 135 primary total hip and total knee arthroplasties was carried out. The collection time for reinfusion was limited to 6 hours, and suction pressure was kept to a minimum by using the lowest setting on the device. For all patients, no citrate-phosphate-dextrose anticoagulant was added to the reservoir. To evaluate the effect of reinfusion on hemostasis and the blood coagulation system, antithrombin III, fibrinogen, and d-dimer levels of 40 of 135 patients were measured before surgery and on the first and seventh days after the operation. The mean volume of reinfusion of postoperative drainage was 437 mL for the patients with total hip arthroplasties, 883 mL for those with total knee arthroplasties, and 1,713 mL for those with bilateral total knee arthroplasties. Ninety-nine of 135 patients underwent operations without homologous blood replacement. Transient chills with mild fever were seen in 2 patients during reinfusion. No complications related to air embolism, coagulopathy, renal failure, or sepsis were recognized in any of the patients. This study suggests that postoperative blood salvage and reinfusion appear to be safe and effective in patients undergoing primary total hip and knee arthroplasties.

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Cited by (68)

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    The biggest drawback to the use of erythropoietin is in the cost, often not covered by insurance, which ranges from $2000 to $4500 depending on the protocol used [26,34,35]. Intraoperative blood salvage in primary THA and TKA has not been proven to be efficacious [32] and although post-operative reinfusion drains are still popular in many centers, there is little compelling evidence that their use results in a lower incidence of autologous transfusion [32,36–41]. There is little evidence in the literature to support the use of a bipolar sealer, over traditional electro-cautery, in its ability to provide improved hemostasis and decreased postoperative blood loss in total joint arthroplasty (TJA).

  • Cerebral Fat Embolism Syndrome After Simultaneous Bilateral Total Knee Arthroplasty. A Case Series.

    2012, Journal of Arthroplasty
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    Benefits and risks of reinfusion of unwashed wound drainage for the purpose of saving allogeneic blood transfusions (postoperative blood conservation system) continue to be debated on. The effects of inflammatory cytokines and fat globules not filtered by the pass-through filter can be harmful to the patient [27-30]. For a closed wound drainage system, 3 of the cases in this study used the postoperative blood conservation system with an inner 250 micron filter and outer 40 micron filter.

  • Safety of Combined Use of Local Anesthetic Infiltration and Reinfusion Drains in Total Knee Arthroplasty

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    Blood loss associated with TKA is known to be sufficient to require transfusion in up to 30% to 50% of cases [17]. The use of a reinfusion type drain has been demonstrated by several authors to be effective in reducing the need for allogenic transfusion and therefore in avoiding the associated risks [11-15]. Steinberg et al [13] demonstrated a 65% reduction in the need for allogenic transfusion in a series of 365 patients undergoing TKA.

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