Enhancing bleeding control in total knee arthroplasty for osteoarthritis and rheumatic diseases: strategies and insights

Total knee arthroplasty (TKA) is effective for treating end-stage osteoarthritis but often results in significant blood loss, necessitating optimized management strategies. A literature review of meta-analyses, systematic reviews, and clinical trials was conducted using PubMed and Google Scholar. The acronym TKA-BLED encapsulates effective blood loss management strategies. Tranexamic acid: reduces blood loss by 591 ml and decreases transfusion rates. Keep femoral canal closed: saves 381 ml by minimizing hidden loss. Apply cryotherapy: conserves 264 ml while reducing pain and swelling. Be aware of tourniquet use: limits intraoperative loss but increases total postoperative blood loss and complications. Limit drain use: retains 318 ml through the tamponade effect. Elevate the knee: decreases blood loss by up to 257 ml. Decrease operative time: saves 14 ml per minute. The TKA-BLED protocol effectively reduces blood loss and transfusion needs, improving patient outcomes. More research is needed to validate its long-term efficacy.