Blood management after total joint arthroplasty in the United States: 19-year trend analysis.

BACKGROUND: Recent studies have failed to show reductions in rates of red blood cell (RBC) transfusion after total joint arthroplasty (TJA) in the United States. This study aims to report the 19-year trend analysis of blood use in TJA, to determine predictors of RBC transfusion and association between RBC transfusion and in-hospital mortality after TJA using a nationally representative database. STUDY DESIGN AND METHODS: Nationwide inpatient sample (NIS) data from 1993 to 2011 were used. ICD-9-CM codes were used to identify TJA cases, RBC transfusion, autologous blood transfusion, and/or transfusion from cell salvage. Logistic regression analysis was performed to determine predictors of RBC transfusion and if transfusion increases risk of in-hospital mortality. RESULTS: A total of 2,225,054 TJA cases were identified. Using multivariate analysis, there was an increase in the rate of RBC transfusion over the study period (odds ratio [OR], 1.049; 95% confidence interval [CI], 1.048-1.050; p < 0.001). One-stage bilateral TJA (OR, 3.30; 95% CI, 3.24-3.37; p < 0.001), anemia due to chronic blood loss (OR, 2.69; 95% CI, 2.59-2.74, p < 0.001), deficiency anemia (OR, 2.59; 95% CI, 2.56-2.62; p < 0.001), and Charlson comorbidity index (OR, 1.24; 95% CI, 1.23-1.24; p < 0.001) were independent predictors of allogeneic blood transfusion. Transfusion of autologous blood reduced need for RBC transfusion (OR, 0.84; 95% CI, 0.82-0.85; p < 0.001). RBC transfusion was an independent predictor of in-hospital mortality (OR, 1.537; 95% CI, 1.395-1.694; p < 0.001). CONCLUSION: An increase in the rate of RBC use after TJA and the association between allogeneic blood transfusion and mortality are worrisome. Implementing more effective blood conservation strategies is recommended.

The effect of tibial polyethylene insert design on range of motion: evaluation of in vivo knee kinematics by a computerized navigation system during total knee arthroplasty.

Computer-assisted navigation for total knee arthroplasty offers the unique opportunity to assess in vivo knee kinematics during surgery and implement changes whenever appropriate. Using a computerized navigation system, the effect of 2 tibial polyethylene insert designs on knee kinematics in general and knee range of motion (ROM) in particular was evaluated in 37 knee arthroplasties in 30 patients. The Scorpioflex tibial insert was found to provide a significant increase in mean extension, mean flexion, and overall ROM of the knee compared with the standard tibial insert (P<.005) without affecting knee ligamentous balance. Navigation is a very effective and useful tool for intraoperative assessment of knee kinematics and accurate recording of ROM. Based on the information obtained from the navigation software, the surgeon can implement changes in selection of the knee components with beneficial effects in knee kinematics in general and knee ROM in particular. This may, in turn, translate to better clinical outcome of the knee arthroplasty.