Orthopedic surgeons and anesthesiologists with Jewish Orthopaedic Care, a part of KentuckyOne Health, have researched and implemented a new protocol that drastically reduces the number of patients who require a blood transfusion following total joint replacement surgery. They found that the use of transexamic acid with patients undergoing total knee and hip replacement surgeries reduced the number of patients requiring a blood transfusion from 14% to 2% in knee replacement surgeries. Transexamic acid is a medication that works to reduce blood loss.
No More TKA Blood Transfusions?
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“Our research has led us to introduce this treatment protocol to other orthopaedic surgeons in our healthcare system, ” said Arthur Malkani, M.D., orthopedic surgeon, Shea Orthopaedic Group, Jewish Physician Group. “In addition to the overall health benefits to our patients, this protocol benefits our entire system. By reducing the number of transfusions needed, we can preserve blood supply and save valuable health care resources for other patients.”
Jiapeng Huang M.D., Medical Director of Anesthesia, Jewish Hospital Medical Campus, noted, “The mortality rate is higher for patients who require a blood transfusion and those patients don’t do as well. Eliminating the need for a blood transfusion is safer for the patient and reduces overall medical costs affiliated with the procedure.” He added that patients who require a blood transfusion during or after total joint replacement may be hospitalized longer and have a higher risk of prosthetic joint infection.
Jewish Hospital, Louisville, performs more than 800 total knee and hip replacements each year. The institution is an internationally renowned high-tech tertiary referral center and the site of the world’s first successful hand transplant, the world’s first and second successful AbioCor Implantable Replacement Heart procedures, and world’s first trial of cardiac stem cells in chronic heart failure. The hospital is in the select group that performs heart, lung, liver, kidney and pancreas transplantation.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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