The requirement of allogeneic transfusion and risk of perioperative systemic complications in elderly patients undergoing total knee arthroplasty with contemporary blood conservation strategies.

Abstract

Improvements in perioperative management may have mitigated complications in elderly patients who underwent total knee arthroplasty (TKA). The purpose of this study was to compare the rates of allogeneic blood transfusion and perioperative complication rates in the elderly patients who underwent primary TKA with contemporary blood conservation strategies with those in the younger patients. We assessed 800 patients who underwent unilateral primary TKA, with 235 patients aged 80 or older (Elderly group) and 565 patients aged 79 or younger (Control group). All TKAs followed a standardized blood conservation protocol including combined intravenous and intra-articular tranexamic acid administration, and no use of a pneumatic tourniquet. For patients on chronic antithrombotic therapy, the medication was continued throughout the perioperative period. The primary outcome was the requirement for allogeneic blood transfusion. Propensity score matching (1:2 matching ratio) was used to balance the study groups. The propensity score-matched population comprised 190 patients in the Elderly group and 380 patients in the Control group. Allogeneic blood transfusion was required in 1 of 190 patients in the Elderly group (0.5 %) versus 2 of 380 patients in the Control group (0.5 %), respectively (p > 0.99). There were no differences between two groups in the systemic event within one year after TKA (5.3 % versus 6.3 %; p = 0.71), the total number of the death within one year after TKA (1.1 % versus 0.3 %; p = 0.26), and requirement of the revision TKA (1.1 % versus 0 %; p = 0.11). We found no significant differences between elderly patients and younger patients in the requirement of the allogeneic transfusion in the cohort underwent primary TKA with contemporary blood conservation strategies.