Clinical Effectiveness of 3 days Preoperative Treatment with Recombinant Human Erythropoietin in Total Knee Arthroplasty Surgery - A Clinical Trial.

AIMS The purpose of study is to evaluate the effect and complication of preoperative short-term daily recombinant human erythropoietin (rhEPO) treatment for blood-saving in patients undergoing unilateral primary total knee arthroplasty (TKA). METHODS This three-arm randomized clinical trial compared three different rhEPO-based treatment protocols for unilateral primary total knee arthroplasty. Group A: application of daily doses of rhEPO combined with iron supplement starting 3 days before surgery; Group B: application of daily doses of rhEPO combined with iron supplement starting the day of surgery; Group C: iron supplement alone. Perioperative hemoglobin (Hb) level gaps, total perioperative blood loss, reticulocyte levels and treatment-related complications were studied. RESULTS 102 patients were included (35, 35, and 32 patients in group A, B, and C, respectively). Total blood loss in group A, B, and C was 490.84ml, 806.76ml, and 924.21ml respectively. Patients in group A had a significant lower total blood loss than group B and C (A vs B: P = 0.010; A vs C: P < 0.001). There was no difference as for total blood loss between group B and C (P = 0.377). Group A patients had significant smaller Hb decline than group C on the 3rd and 5th postoperative day (P = 0.049, P = 0.037), as well as than group B on the 5th postoperative day (P = 0.048). There was no difference as for Hb decline between group B and C. No difference was shown in levels of inflammatory biomarkers or blood-saving protocol-related complications among three groups. CONCLUSIONS Daily dose of rhEPO combined with iron supplement administered 3 days before TKA procedures could significantly decrease perioperative blood loss and improve postoperative Hb levels, without significantly elevating risks of complication, when compared with admission of rhEPO on the day of surgery and iron supplement alone. Preoperative daily rhEPO treatment could be a more effective blood-saving protocol in TKA procedures.

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