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Defining Preoperative Anemia Thresholds for Revision Total Knee Arthroplasty
Ryan Sutton1, Jessica H Leipman1, Alexander Linton1
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
The Journal of Arthroplasty
|January 11, 2026
Summary
Optimizing anemia before revision total knee arthroplasty (TKA) by setting preoperative hematocrit thresholds can reduce readmissions, transfusions, and complications. A 33.3% hematocrit threshold showed high sensitivity and specificity for intraoperative transfusions.
Area of Science:
- Orthopedic Surgery
- Anemia Management
- Value-Based Healthcare
Background:
- Anemia optimization before revision total knee arthroplasty (TKA) is crucial in value-based care.
- Simulation models can evaluate the impact of preoperative anemia thresholds on TKA outcomes.
Purpose of the Study:
- To assess the impact of incremental preoperative anemia thresholds on revision TKA outcomes.
- To determine optimal hematocrit thresholds for improving patient outcomes and reducing adverse events.
Main Methods:
- Retrospective review of revision TKA patients (2019-2024).
- Simulation of sequential preoperative hematocrit cutoffs (39% to 33%).
- Evaluation of transfusion rates, discharge disposition, readmissions, and complications.
Main Results:
- Stricter thresholds (e.g., 39%) excluded more patients but showed significantly better outcomes.
- Lenient thresholds (e.g., 33%) excluded fewer patients but had higher rates of adverse events.
- A hematocrit threshold of 33.3% demonstrated high sensitivity (86.1%) and specificity (87.8%) for intraoperative transfusion.
Conclusions:
- Preoperative anemia thresholds can decrease readmissions, transfusions, complications, and non-home discharges in revision TKA.
- Hematocrit thresholds are sensitive and specific predictors of transfusion rates.
- Optimizing these thresholds enhances successful outcomes and value-based care.
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