Scholarlink

Background <p>The 1-week staged interval for bilateral total knee arthroplasty (TKA) is favored for cost-efficiency, but the second knee operates on an incompletely recovered hematologic reserve. Whether high-dose perioperative intravenous iron without tranexamic acid (TXA) eliminates the inter-knee transfusion gap is unknown.</p> Methods <p>We retrospectively analyzed 210 consecutive patients undergoing 1-week staged bilateral primary TKA under a high-dose ferric carboxymaltose protocol (1,500&#xa0;mg cumulative) without TXA; the transfusion trigger was hemoglobin ≤ 8.0&#xa0;g/dL or symptomatic anemia. Three hypotheses were pre-specified: that the within-patient second-knee transfusion rate exceeds the first-knee rate; that the lowest tertile of inter-knee hemoglobin recovery has a higher second-knee rate; and that the immediate postoperative hemoglobin after the second operation discriminates second-knee transfusion.</p> Results <p>The second-knee transfusion rate was nearly twice the first-knee rate within the same patient (59.5% vs. 31.0%); inter-knee hemoglobin recovery did not predict second-knee transfusion. The immediate postoperative hemoglobin after the second operation discriminated transfusion (area under the curve 0.718), comparably to the preoperative value. The exploratory Youden-optimal cutoff of 8.8&#xa0;g/dL had a prevalence-dependent positive predictive value and a sensitivity of only 0.62, missing 38% of transfused patients. Preoperative hemoglobin and body mass index were independently associated with second-knee transfusion, and no surgical site infection or thromboembolic complication occurred within 30 days.</p> Conclusions <p>High-dose intravenous iron did not eliminate the second-knee transfusion burden, and inter-knee hemoglobin recovery did not reliably identify high-risk patients. Preoperative hemoglobin was at least as discriminating and is the more practical screen; the 8.8&#xa0;g/dL cutoff is exploratory — not a decision threshold for use outside this cohort — and requires external validation. Because no TXA was used, the absolute transfusion rates exceed contemporary TXA-based practice and are not directly generalizable; adding TXA is the priority next step.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Second-knee transfusion burden persists under a high-dose intravenous iron protocol without tranexamic acid in one-week staged bilateral total knee arthroplasty: a paired cohort study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月13日

查看全文
  • Jaemin Lee,
  • Jaeho Lee,
  • Doo Sup Kim

摘要

Background

The 1-week staged interval for bilateral total knee arthroplasty (TKA) is favored for cost-efficiency, but the second knee operates on an incompletely recovered hematologic reserve. Whether high-dose perioperative intravenous iron without tranexamic acid (TXA) eliminates the inter-knee transfusion gap is unknown.

Methods

We retrospectively analyzed 210 consecutive patients undergoing 1-week staged bilateral primary TKA under a high-dose ferric carboxymaltose protocol (1,500 mg cumulative) without TXA; the transfusion trigger was hemoglobin ≤ 8.0 g/dL or symptomatic anemia. Three hypotheses were pre-specified: that the within-patient second-knee transfusion rate exceeds the first-knee rate; that the lowest tertile of inter-knee hemoglobin recovery has a higher second-knee rate; and that the immediate postoperative hemoglobin after the second operation discriminates second-knee transfusion.

Results

The second-knee transfusion rate was nearly twice the first-knee rate within the same patient (59.5% vs. 31.0%); inter-knee hemoglobin recovery did not predict second-knee transfusion. The immediate postoperative hemoglobin after the second operation discriminated transfusion (area under the curve 0.718), comparably to the preoperative value. The exploratory Youden-optimal cutoff of 8.8 g/dL had a prevalence-dependent positive predictive value and a sensitivity of only 0.62, missing 38% of transfused patients. Preoperative hemoglobin and body mass index were independently associated with second-knee transfusion, and no surgical site infection or thromboembolic complication occurred within 30 days.

Conclusions

High-dose intravenous iron did not eliminate the second-knee transfusion burden, and inter-knee hemoglobin recovery did not reliably identify high-risk patients. Preoperative hemoglobin was at least as discriminating and is the more practical screen; the 8.8 g/dL cutoff is exploratory — not a decision threshold for use outside this cohort — and requires external validation. Because no TXA was used, the absolute transfusion rates exceed contemporary TXA-based practice and are not directly generalizable; adding TXA is the priority next step.