Effectiveness of iron supplementation in the perioperative management of total knee arthroplasty: a systematic review
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(2020) 32:44
Knee Surgery & Related Research
RESEARCH ARTICLE
Open Access
Effectiveness of iron supplementation in the perioperative management of total knee arthroplasty: a systematic review Seung Hoon Lee1, Joong Il Kim2, Wonchul Choi3, Tae Woo Kim4 and Yong Seuk Lee5*
Abstract Introduction/purpose: The purpose of this systematic review was to evaluate the effect of iron supplementation during total knee arthroplasty (TKA): (1) Is the iron supplementation necessary during TKA? (2) When is the optimal timing of iron supplementation? (3) Which is better, between orally and intravenously administered iron supplementation? And (4) What is the optimal dose of iron supplementation? Materials and methods: A rigorous and systematic approach was used and each of the selected studies was evaluated for methodological quality. Data about study design, total number of cases enrolled, iron administration method, timing, and dose were extracted. Change in hemoglobin and transfusion rates were extracted to evaluate the effectiveness of iron supplementation. Results: Eleven studies were included in the final analysis. Most of studies reported that hemoglobin change between iron and control group did not show any difference. Only one study reported that iron supplementation could reduce the decrease in hemoglobin. However, transfusion rate showed a decrease in the iron supplementation group compared with the control group. There was no clear consensus on the optimum timing and dose of iron supplementation and intravenously administered iron was more effective than orally administered iron, especially in anemic patients. Conclusion: Iron supplementation is not clear as a way to raise hemoglobin levels after TKA, but an effective treatment for lowering transfusion rate, especially in patients with anemia. We could not determine the optimal timing and dose of the iron. Intravenously administered iron was similar to, or better than, orally administered iron for improving hemoglobin levels and transfusion rate. Keywords: Total knee arthroplasty, Transfusion, Iron supplement, Hemoglobin, Iron
Introduction Total joint arthroplasty (TJA) is a successful and costeffective treatment option for end-stage osteoarthritis (OA) [1]. However, TJA is an invasive procedure that can cause serious complications, such as blood loss, which is a major concern. Despite numerous studies on blood loss and its management during TJA, but there is * Correspondence: [email protected] 5 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, South Korea Full list of author information is available at the end of the article
little consensus about the amount of blood loss and management strategies for reducing the blood loss. This gap in our knowledge could be the differences in characteristics of the patient groups, surgical method, or the method used for the estimation of blood loss. Although there may be differences in blood loss, the decrease of hemoglobin after TKA is about 3 g/dL [2]. This often lea
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