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Blood Conservation Techniques

The research team at Sydney Knee Specialists under the direction of Dr Samuel MacDessi and Dr Darren Chen have performed multiple studies on new medications that reduce bleeding.

The problem in the past with knee replacement has been that up to 20% of patients often will require a blood transfusion because of bleeding from the knee joint during and following the operation. Bleeding also increases knee swelling, has been found to increase pain, and also restricts movement of the joint.

In order to solve this issue, in 2011, the surgeons at Sydney Knee Specialists commenced the use of the medication called tranexamic acid. They initially trialled this medication on a group of 150 patients in varying dosages and found it to be highly effective in both reducing bleeding as well as decreasing the chance of you needing a blood transfusion. Most impressively however, it was found that the knee joint did not significantly swell compared to patients who did not have this injection put into their knee. This initial research has been published in the Journal of Orthopaedic Surgery and has now become a standard of care of giving this medication in the knee.

More recent trials performed by Sydney Knee Specialists have found that this medication is extremely cost effective to the hospital and the health care sector. By giving this medication, in a series of 2,000 patients who were examined who had this medication at our institution, the health care cost dropped dramatically, saving approximately $630 per case. The major cost savings were found to be related to the patients being discharged earlier from hospital as well as cost savings from not needing to give a blood transfusion.

A more recent trial performed at Sydney Knee Specialists has compared the use of tranexamic acid directly given into the knee joint at the time of your surgery as opposed to having it given through an intravenous (IV) drip. The IV method is the most common way of giving this medication around the world. The study of over 166 patients confirmed that giving the injection directly into the knee joint is equivalent to giving it into the vein (IV), however is a safer and more effective route of giving it.

This research work conducted at Sydney Knee Specialists has made revolutionary changes in the way people recover from surgery in terms of pain, swelling and lessening the requirements for needing blood transfusion. It is now a standard of care following surgery and has made recovery faster and less painful.

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  • Australian Orthopaedic Association
  • Australian Society of Orthopaedic Surgeons
  • Royal Australasian College of Surgeons
  • The Harvard Medical School Advise
  • International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine
  • Hospital for Special Surgery Alumni Association
  • Australian Knee Society
  • International Cartilage Repair Society