Postoperative blood salvage in total knee arthroplasty using the Solcotrans autotransfusion system.

One hundred forty-four patients who underwent primary total knee arthroplasty were examined in a prospective controlled study to determine the efficacy and safety of a postoperative wound drainage autotransfusion system (Solcotrans, Smith & Nephew Richards, Memphis, TN). The patients were divided into two groups: control group 1 comprised 88 (61%) patients who either received a Hemovac disposable drainage system (63 patients) or the Solcotrans system and had inadequate drainage for autotransfusion (25 patients). Experimental group 2 comprised 56 (39%) patients who received a Solcotrans drainage system and were autotransfused. The Solcotrans proved itself safe. No sepsis, transfusion reactions, or coagulopathies were associated with autotransfusion, which averaged 524 mL. There were no significant differences between groups 1 and 2 when comparing preoperative and postoperative hemoglobins and hematocrits. The Solcotrans system did not lower homologous blood requirements. Only 1.6% (2 patients) of all patients who autodonated at least 2 units of autologous blood (122 patients) were in need of a homologous blood transfusion in the postoperative period. Thus, although safe, the Solcotrans system was not proven effective in the management of primary total knee arthroplasty patients.

Prospective randomized evaluation of blood salvage techniques for primary total hip arthroplasty.

A controlled, randomized, prospective study was performed evaluating the need for perioperative blood salvage for primary total hip arthroplasty patients who had donated autologous blood before surgery. One hundred fifty-three patients able to donate at least 2 units of autologous blood were divided into four groups. In group 1 (35 patients), intraoperative and postoperative Cell-Saver (Haemonetics, Braintree, MA) was employed. In group 2 (40 patients), a postoperative Solcotrans (Smith & Nephew Richards, Memphis, TN) reinfusion protocol was followed. In group 3 (40 patients), a closed-suction Hemovac drain (Zimmer, Warsaw, IN) was placed. In group 4, (38 patients), no drain was used. Decisions for transfusion were based on clinical and laboratory parameters and made in conjunction with medical consultation. All autologous blood was routinely reinfused. There was no statistically significant difference in transfusion requirements or wound complications among the four groups. Hemoglobin and hematocrit changes between groups also were not statistically significant, but a power test suggested insufficient patient numbers for absolute reliability of this observation. Only five patients (3.3%) in this study received homologous blood. Four of these patients were in the Solcotrans group and one was in the Cell-Saver group. Two reoperations were performed: one for hematoma (Solcotrans group) and one for a sewn-in drain. It is concluded that expensive perioperative blood salvage techniques are usually not needed in patients who have a primary total hip arthroplasty without cement and who have donated 2 units of blood before operation.