Article Type: Original Article

Title:  Blood transfusion incidence in primary Total Knee Arthroplasty of Unilateral vs Bilateral group with a high prevalence of low haemoglobin concentration: A Retrospective Observational Study 

Year: 2021; Volume: 1; Issue: 1; Page No: 8 – 11

Authors:  Jai Thilak Kailathuvalapil1, Madhusudhan Tammanaiah2, Nabeel Mohamed Therakka Parambil3, Sujith Paliath Shaju4, Senthilvel Vasudevan5

Affiliations: 1, 2, 3, 4Department of Orthopaedics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India. 5Assistant Professor of Statistics, Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia.


Background: Blood transfusion is one of the major concerns following Total Knee Arthroplasty. We assessed the incidence rate of blood transfusion (packed red cells) in our geographical group based on age, gender, preoperative Haemoglobin and following both unilateral and bilateral primary TKA done either in single-stage or sequentially after a week.

Materials and Methods:  This was a retrospective observational study that included 200 patients who underwent primary TKA unilateral, bilateral done in single-stage and sequential from June 2015 to May 2016.  Two doses of parenteral Tranexamic acid and periarticular cocktail injection was given. Transfusion was indicated with postoperative Hgb below 8 g/dl associated with or without clinical signs of tissue hypoperfusion.

Results:  The study group was 200 patients with the age group of 50-81 years, of which 154 (77%) were female and 46 (23%) were male and had a mean preoperative Hgb level of 12.6 g/dl. 88 (44%) unilateral, 40 (20%) bilateral and 72 (36%) sequential TKA were performed and 7 (7.95%), 12 (30%) and 26 (36%) patients received blood transfusion respectively.  Among the transfused 45 patients, 38 patients were bilateral group, of which 30 (66.6%) patients had a preoperative Hgb level of 10–12 g/dl, indicating a high incidence of transfusion in bilateral cases compared to unilateral and with preoperative Hgb levels of 10–12g/dl which was statistically significant with p-value <0.05.

Conclusion: In our study, age and gender were not the major factors for blood transfusion, but low preoperative Hgb levels and bilateral single stage and sequential TKA showed a significantly higher incidence of blood transfusion.

Keywords: total knee arthroplasty, blood transfusion, preoperative Hgb

Source of funding: We didn’t get any types of financial support from any financial organization; Conflict of Interest:  The authors declared no conflict of interest

Corresponding Author:
Dr. Madhusudhan Tammanaiah,
Consultant Orthopaedic Surgeon, Kamakshi Multispecialty Hospital,
Mysore, Karnataka, India.
Email ID:
Cell No: +918333873990

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