The Role Of Continuous Optimization Program In Perioperative Blood Loss During Primary Total Knee Arthroplasty

[Objective] To evaluate the clinical effect of continuous optimization technique on perioperative blood loss control of primary unilateral and bilateral knee arthroplasty[Methods] A retrospective analysis was conducted on total 272(includes 177 unilateral and 95 bilateral)primary TKA cases that met the inclusion and exclusion criteria in our joint center from January 2017 to July 2019,Both of them are according to the use of different types of prosthesis,the test was divided into two groups,and each group was divided into three groups according to the use of different surgical techniques and perioperative management,as follows: In trail 1,the posterior cruciate ligament replacement prosthesis(PS)and surgical techniques were used.The control group 1 was given traditional cocktail(epinephrine 5mg,ropivacaine 300 mg,compound betamethasone7 mg,morphine 10 mg,and prepared to 50 m L with normal saline).Trail group 1.1 was treated with a modified cocktail(1g tranexamic acid,300 mg ropivacaine,7mg compound betamethasone and 10 mg morphine,prepared to 100 mL with normal saline),while trail group 1.2 was treated with tranexamic acid sequential therapy.In trail 2,posterior cruciate ligament retained prosthesis(posterior retaining(CR))and surgical technique were used,including routine CR surgical technique in control group 2,computer navigation-assisted CR surgical technique in trail group 2.1(there is no computer navigation-assisted group in the bilateral TKA group),and minimally invasive CR surgical technique in trail group 2.2through subfemoral medial approach.The blood routine results of patients in each group were collected one day before and three days after surgery,and the red blood cell hematocrit(HCT),hemoglobin(HB)and blood transfusion rate were recorded.The perioperative blood loss was calculated by GROSS equation and HB-balance.[Results] Unilateral TKA trail 1: Compared with the control group 1,the average perioperative blood loss in the trail group 1.1 decreased by 198.6mL(GROSS equation)and153.6mL(HB-balance equation),and the decreasing amplitude is 19.9% and 17.0%respectively.The difference was statistically significant.(P=0.018,P=0016).The mean perioperative blood loss in the trail group 1.2 was 203.9mL(GROSS equation)and141.9mL(HB balance equation)lower than that in the control group 1(20.4% and 15.6%,respectively).The difference was statistically significant.(P=0.028,P=0.041).Unilateral TKA trail 2: The mean perioperative blood loss in the trail group 2.1 increased by 61.6 mL(GROSS equation)and 41.3 mL(HB-balance equation)compared with the control group 2,but there was no statistically significant difference(P=0.479,P=0.634).The mean perioperative blood loss in the trail group 2.2 was 159.8ml(GROSS equation)and 116.0mL(HB-balance equation)lower than that in the control group 2(24.3% and 18.5%,respectively),with statistically significant differences(P=0.046,P=0.031).There was no statistical difference in the transfusion rate among the groups with unilateral TKA.Bilateral TKA trail 1: compared with control group 1,the average perioperative blood loss in the test group 1.1 decreased by 320.9mL(GROSS equation)and 306.2mL(HB-balance equation),respectively,by 21.9% and 19.3%,with statistically significant differences(P=0.024,P=0006).There was no statistical difference in the transfusion rate(P=0.861).Compared with control group 1,the average perioperative blood loss in the trail group 1.2 decreased by 382.1ml(GROSS equation)and 433.3ml(HB-balance equation),respectively,by 26.2%and 27.3%(P=0.004,P=0.001).Compared with control group 1,the transfusion rate of trail group 1.2 decreased by 38.5%,and the difference was statistically significant(P=0.010).Bilateral TKA trail 2: Compared with control group 2,the average perioperative blood loss in trail group 2.1 decreased by 314.9 mL(GROSS equation)and 367.9m L(HB-balance equation),with a decrease of 28.3% and 33.7%,respectively(P=0.041,P=0.035).There was no statistical difference in blood transfusion rate(P=0.148).[Conclusion] There are three key technologies in the continuous optimization program,including the improved "cocktail" formula,tranexamic acid continuous penetration therapy,and minimally invasive surgery through the midvastus approach,which have a significant effect on the reduction of perioperative blood loss of the first TKA,while there is no significant difference in the computer-assisted osteotomy TKA.