Outcomes of bloodless revision total knee arthroplasty in Jehovah’s Witness patients

Revision total knee arthroplasty (rTKA) in patients who refuse blood transfusion due to personal or religious convictions, such as Jehovah’s Witnesses (JW), poses a challenge due to the elevated risk of substantial blood loss. This study describes the clinical and functional outcomes of bloodless rTKAs performed at a single institution using a standardized protocol. We retrospectively reviewed all JW patients undergoing rTKA at our institution from 2011 to 2022. Patient demographics, revision indications, and comorbidities were collected. Consent forms were analyzed for acceptance of blood derivatives and conservation techniques. Clinical outcomes included pre- and postoperative hemoglobin, complications, and 90-day mortality. Functional outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), visual analog scale (VAS) pain scores, and knee range of motion (ROM). Ten JW patients undergoing 12 rTKAs were included. Mean follow-up was 4.3±2.5 years. Most patients accepted blood management strategies including cell saver (60%) and erythropoietin (47%). Tranexamic acid was used in 73% of cases. Cell saver was used in one case. One patient’s hemoglobin fell below 7 g/L postoperatively, likely due to hemodilution. One patient developed a surgical site infection. There were no 90-day readmissions, deep vein thrombosis, or deaths. KOOS, JR scores improved from a median of 39.7 to 51.2 (p=0.028) and ROM improved from 80° to 100° (p=0.036). VAS pain scores decreased but did not reach significance. Bloodless rTKA can be safely performed in JW patients, with low complication rates and improvement in functional outcomes.