Non-selective Day-1 Haemoglobin Monitoring Following Elective Primary Knee Arthroplasty: Clinical Value or Outdated...

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Hematology

Background:

• Knee arthroplasty is a common elective surgery.
• Day-1 postoperative hemoglobin monitoring is standard but increasingly questioned.
• Advances in perioperative care have reduced blood loss and transfusion rates.

Purpose of the Study:

• To evaluate the necessity of universal, routine Day-1 hemoglobin monitoring post-elective primary knee arthroplasty.
• To assess mean hemoglobin drop, severe anemia incidence, and red blood cell transfusion rates.

Main Methods:

• Retrospective audit of 452 primary knee arthroplasties.
• Standardized surgical techniques including tranexamic acid and avoidance of drains.
• Restrictive transfusion protocol (Hb <70 g/L or symptomatic anemia).

Main Results:

• Mean hemoglobin drop was 23.3 g/L (preop: 137.2 g/L, Day 1: 113.8 g/L).
• Only 1.3% of patients had Day-1 Hb <80 g/L; 2.4% required transfusion.
• No returns to theatre for hemorrhage or transfusion complications occurred.

Conclusions:

• Universal Day-1 hemoglobin monitoring has minimal clinical value in elective primary knee arthroplasty with modern blood conservation.
• Recommend selective Hb testing for patients with low preoperative Hb, comorbidities, or symptoms.
• Selective testing maintains safety while reducing interventions, costs, and environmental impact.