Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah's Witness patients?

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Transfusion Medicine

Background:

• Jehovah's Witness (JW) patients present unique challenges in surgical procedures like total knee arthroplasty (TKA) due to their refusal of blood transfusions.
• Effective blood management strategies are crucial to minimize estimated blood loss (EBL) and avoid complications in this patient population.

Purpose of the Study:

• To investigate the efficacy of multiple blood management strategies in Jehovah's Witness patients undergoing primary TKA.
• To evaluate the impact of tourniquet use on EBL in this specific patient cohort.

Main Methods:

• Retrospective review of 22 Jehovah's Witness patients who underwent primary TKA.
• Application of a standard blood management protocol including hypotensive anesthesia, tranexamic acid (TXA), and intraoperative cell salvage.
• Comparison of EBL, hemoglobin, and hematocrit levels between patients with and without tourniquet use.

Main Results:

• No significant differences in postoperative hemoglobin, hematocrit, or EBL were observed between groups with and without tourniquet use.
• All patients successfully managed without requiring blood transfusions.
• No wound complications or symptomatic deep vein thrombosis occurred during hospitalization.

Conclusions:

• A comprehensive blood management protocol combining hypotensive anesthesia, TXA, periarticular injection, and cell salvage is effective in controlling blood loss during TKA in JW patients.
• The addition of a tourniquet does not appear to offer significant additional benefit in reducing EBL in this context.