Blood transfusions in total knee arthroplasty: a retrospective analysis of a multimodal patient blood management programme

Hong Kong Med J. 2020 Jun;26(3):201-207. doi: 10.12809/hkmj198289. Epub 2020 May 6.


Purpose: Transfusion is associated with increased perioperative morbidity and mortality in patients undergoing total knee arthroplasty (TKA). Patient blood management (PBM) is an evidence-based approach to maintain blood mass via haemoglobin maintenance, haemostasis optimisation, and blood loss minimisation. The aim of the present study was to assess the effectiveness of a multimodal PBM approach in our centre.

Methods: This was a single-centre retrospective study of patients who underwent primary TKA in Queen Mary Hospital in Hong Kong in 2013 or 2018, using data from the Clinical Data Analysis and Reporting System and a local joint registry database. Patient demographics, preoperative haemoglobin, length of stay, readmission, mean units of transfusion, postoperative prosthetic joint infection, and mortality data were compared between groups.

Results: In total, 262 and 215 patients underwent primary TKA in 2013 and 2018, respectively. The mean transfusion rate significantly decreased after PBM implementation (2013: 31.3%; 2018: 1.9%, P<0.001); length of stay after TKA also significantly decreased (2013: 14.49±8.10 days; 2018: 8.77±10.14 days, P<0.001). However, there were no statistically significant differences in readmission, early prosthetic joint infection, or 90-day mortality rates between the two groups.

Conclusion: Our PBM programme effectively reduced the allogeneic blood transfusion rate in patients undergoing TKA in our institution. Thus, PBM should be considered in current TKA protocols to reduce rates of transfusions and related complications.

Keywords: Arthroplasty, replacement, knee; Blood transfusion; Patient readmission.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee*
  • Blood Transfusion / statistics & numerical data*
  • Female
  • Hemoglobins / analysis
  • Hemostasis, Surgical / methods*
  • Hong Kong
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Patient Readmission / statistics & numerical data
  • Postoperative Period
  • Preoperative Period
  • Program Evaluation
  • Prosthesis-Related Infections / epidemiology
  • Prosthesis-Related Infections / etiology
  • Registries
  • Retrospective Studies
  • Treatment Outcome


  • Hemoglobins