Short‐term high‐dose intravenous iron reduced peri‐operative transfusion after staggered bilateral total knee arthroplasty: A retrospective cohort study

• Published in: Vox sanguinis Vol. 117; no. 4; pp. 562 - 569
• Main Authors: Park, Hee‐Sun, Bin, Seong‐Il, Kim, Ha‐Jung, Kim, Tae‐Yop, Kim, Jiyoung, Kim, Hyungtae, Ro, Youngjin, Koh, Won Uk
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-04-2022; S. Karger AG
• Subjects: anaemia; Anemia; Arthroplasty (knee); Arthroplasty, Replacement, Knee - adverse effects; bilateral staggered; Blood Transfusion; Cohort analysis; Complications; Dosage; Drug dosages; ferric carboxymaltose; Ferric Compounds - therapeutic use; Hemoglobin; Hemoglobins - analysis; Humans; Intravenous administration; intravenous iron; Iron; Joint replacement surgery; Joint surgery; Knee; Materials recovery; Orthopaedic implants; Patients; Retrospective Studies; Supplements; Surgery; total knee arthroplasty; Transfusion; intravenous iron; bilateral staggered; total knee arthroplasty; transfusion; anaemia; ferric carboxymaltose
• ISSN: 0042-9007; 1423-0410
• DOI: 10.1111/vox.13230

Background and Objectives
Staggered bilateral total knee arthroplasty, two procedures performed 4–7 days apart during a single hospitalization, has an increased risk of blood transfusion. This observational study aimed to evaluate whether immediate post‐operative single, high‐dose intravenous iron supplementation could reduce transfusion requirements and facilitate anaemia recovery in patients.
Materials and Methods
We retrospectively analysed 131 patients who underwent staggered bilateral total knee arthroplasty. The ferric carboxymaltose (FCM) group received 1000 mg of FCM after the first operation. The non‐FCM group did not receive intravenous iron. The transfusion rate and post‐operative complications were compared between the groups. The anaemia rate was evaluated pre‐operatively, during hospitalization, and 5 weeks after the second total knee arthroplasty.
Results
The FCM group comprised 78 patients (59.5%). The rate (21.8% vs. 47.2%, p = 0.004) and amount of transfusion (0 [0–2] vs. 0 [0–0], p = 0.001) was significantly lower in the FCM group than in the non‐FCM group. Although both groups' pre‐operative haemoglobin concentrations were not significantly different, the FCM group demonstrated higher haemoglobin values 5 weeks post surgery (12.25 ± 0.83 mg/dl vs. 11.48 ± 1.36 mg/dl, p < 0.001). More non‐FCM patients developed moderate to severe anaemia at 5 weeks post surgery (p < 0.001). The mortality and complication rates were not significantly different.
Conclusions
Immediate post‐operative, high‐dose, intravenous iron treatment may contribute to reduced transfusion rates, facilitate haemoglobin recovery after staggered bilateral total knee arthroplasty, and minimize the development of moderate to severe anaemia.