The journal of knee surgery
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Primary or revision total knee arthroplasties (TKAs) may be associated with a marked amount of intraoperative or postoperative blood loss that potentially may lead to the need for blood transfusions. However, Jehovah's Witnesses usually refuse blood transfusions because of their religious beliefs. ⋯ In this report, we provide an overview of various potential preoperative, intraoperative, and postoperative blood management measures that may be used for the care of Jehovah's Witnesses who undergo knee arthroplasty procedures. In addition, we review reported outcomes of primary and revision TKAs in these patients.
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Elective total knee arthroplasty is frequently associated with considerable blood loss and a concomitant decline in hemoglobin postoperatively. This often leads to high rates of allogeneic transfusions, with reports of up to 69%, to treat postoperative anemia. Allogeneic blood transfusions have been shown to be an independent risk factor for increased adverse outcomes, such as prolonged length of hospital stay and postoperative infections. ⋯ Specifically, we evaluated preoperative autologous blood donation, iron therapy, and intravenous erythropoietin. Current evidence suggests that these techniques independently may be effective at reducing the incidence of allogeneic blood transfusions, correcting preoperative, and preventing postoperative anemia. However, more studies are necessary to evaluate combination protocols, as well as the cost-effectiveness and safety of these practices as part of routine preoperative blood management for total knee arthroplasty.
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We present a case of a 24-year-old, otherwise healthy, man who sustained a right knee injury after a fall. A small, comminuted inferior pole patella fracture with medial and lateral retinacular tears was encountered that required a small, nonarticular partial patellectomy and patellar tendon repair. ⋯ The patellar tendon was reconstructed with semitendinosus and gracilis autograft. At 1 year follow-up, the patient had regained a normal gait, had no pain, and had full range-of-motion without extensor lag.
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Multicenter Study Comparative Study
Outcomes of total knee replacement after patellofemoral arthroplasty.
There is increasing interest in the use of patellofemoral joint replacements and the cohort receiving them are the youngest of any of the groups of patients undergoing a knee arthroplasty. With more contemporary prostheses, progression of arthritis in other parts of the knee joint is becoming the predominant mechanism of failure. We conducted a multicenter retrospective comparative cohort study to discover whether the outcome of total knee replacement is compromised by prior patellofemoral joint arthroplasty. ⋯ At a mean follow-up of 2.4 years, the primary total knee replacement cohort had significantly better Oxford Knee Scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scores, pain visual analog scores, and EQ-5D scores. There was no significant difference in patient satisfaction or EQ-5D visual analog scale. Our results indicate that although the revision of a patellofemoral joint replacement to a total knee replacement is a technically straightforward procedure, the eventual outcome may be less satisfactory when compared with a primary total knee replacement.
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Revision total knee arthroplasty (TKA) can be quite challenging in Jehovah's Witness patients because blood transfusion is often needed, however, these patients do not accept allogeneic or autologous blood due to religious convictions. We reported our clinical experiences with a special blood management protocol for Jehovah's Witnesses who underwent a revision TKA. There were 12 self-reported Jehovah's Witness patients (12 total knee arthroplasties) who had a mean age of 69 years (range: 55 to 79 years) and who underwent revision TKA between 1998 and 2009. ⋯ Implant survivorship was 100% over a mean follow-up of 62 months (range: 24 to 120 months). The Knee Society objective and function scores improved to a mean of 83 and 82 points, respectively. The authors believe that the use of this blood management protocol was responsible for the excellent clinical outcomes.