I am one of Jehovah's Witnesses and will have a total knee replacement April 1, 2008. I have heard, although quite some time ago, that this surgery is one of the bloodiest. Is this still true?

Hi TimTim

My Husband an I are oth JW . He had 2 total knees replaced using computer asssited technology and blood was not an issue one in August the other this past January.. He did not have much blood loss at all. If you would like more information and guidance I'd be more than happy to chat with you. Feel free to contact me directly at dgporkchop@cox.net.
I'm in healthcare an would be happy to further assist you in anyway.

Donna

We had two Jehovah's Witnesses who came in for knee replacement surgeries this week, and are ready to go home after 3 days. The surgeon does meticulous surgery, and the estimated blood loss on both surgeries was just 50cc each. However, there is usually a bit more blood loss from drainage after the surgery, so it's not unusual to see the overall hemoglobin drop off a couple of days post-op. Our orthopedic surgeons do knees and hips on a regular basis at our facility without the use of blood for patients who choose non-blood management, so they have come a long ways in doing these types of surgery. They are also quick to use alternatives like EPO and Iron if blood levels do drop off, as EPO is indicated for patients having ortho surgery. I think if a person is having this kind of surgery as an elective procedure, the doctor can do a pretty good job of controlling blood loss before, during, and after surgery. Hope your upcoming surgery goes well.

There are also postoperative blood reinfusion systems that can capture the blood that drains from the wound, filter it, and return it through an IV line in a more or less closed circuit. That may be an option for you as well.

We had a recent independent audit of blood usage in total knee replacements performed by 8 different surgeons at our hospital. We had two groups of patients. Between 30 and 40 cases were done under tourniquet by 6 surgeons and a roughly similar number were done with no tourniquet by 2 other surgeons. The results were interesting:

The 6 surgeons who used a tourniquet cross matched (ie ordered) 40 times more blood (average 2 units per case) than the 2 surgeons who used the non-tourniquet technique (average 0.05 units per case).

The 6 surgeons who used a tourniquet transfused (ie used) 10 times more blood (average 0.50 units per case) than the 2 surgeons who used the non-tourniquet technique (average 0.05 units per case).

The 2 non-tourniquet users only requested blood in exceptional cases and all units ordered were actually used.

The conclusion is that doing a knee replacement without a tourniquet is the safest technique with lowest blood loss. Indeed the above averages don't tell the whole story as only 2 of 38 patients in the non-tourniquet group received any blood at all.

In conclusion there are clear advantages in not using a tourniquet. Not only is a tourniqet unnecessary, they are positively harmful in terms of blood loss. Without a tourniquet any vessels that are cut can be immediately identified and coagulated. With a tourniquet the surgeon is unaware of cutting small vessels. The result is no bleeding during the actual surgery but a large increase in blood loss once the touniquet is released.

Why then do surgeons still use tourniquets in knee replacement? Good question. We have asked this many times at meetings and the usual reply is: Because they stop bleeding!

Good luck with your knee replacement.