Hematologic effects of total knee arthroplasty. A prospective evaluation

Area of Science:

• Orthopedic Surgery
• Hematology
• Biochemistry

Background:

• Total knee arthroplasty (TKA) is a common orthopedic procedure.
• Perioperative hematologic changes following TKA are not fully understood.
• Coagulation and fibrinolytic system activation may occur during TKA.

Purpose of the Study:

• To investigate perioperative hematologic changes in patients undergoing cemented total knee arthroplasty.
• To compare these changes between unilateral and bilateral procedures.
• To assess the activation of coagulation and fibrinolytic systems.

Main Methods:

• Prospective evaluation of 41 patients (57 knees) undergoing cemented TKA.
• Perioperative blood testing included platelet counts, fibrinogen, and fibrin degradation products (FDP).
• Patients were categorized into unilateral and bilateral procedure groups.

Main Results:

• Postoperative platelet counts significantly decreased (average 32% for unilateral, 64% for bilateral).
• Fibrinogen levels increased significantly (average from 304 mg/dl to 647 mg/dl).
• Fibrin degradation products showed a trend toward greater elevation after bilateral procedures, indicating more pronounced coagulation and fibrinolytic activation.

Conclusions:

• Cemented total knee arthroplasty leads to significant hematologic changes, including thrombocytopenia and activation of coagulation/fibrinolysis.
• Bilateral TKA procedures result in more pronounced hematologic alterations compared to unilateral procedures.
• Preoperative platelet count assessment is crucial for evaluating candidates for bilateral TKA due to the risk of significant thrombocytopenia.