The amount of blood lost is small and transfusion is rarely required. We routinely use a thigh tourniquet for the operation. Occasionally, in a patient with a compromised circulation, we have carried out the procedure without a tourniquet but it is much more difficult.
We insert a vacuum drain into the joint at the end of the operation. It is placed in the lateral gutter of the knee so that it does not interfere with early knee flexion. Occasionally, in the absence of a drain, there are acute haemarthroses in the postoperative period which can delay rehabilitation. The drain is removed the morning after surgery (or 4–5 hours postoperatively if the patient is to go home on the day of operation).
We have recently started to use Tranexamic acid. The evidence suggests that whether this is used topically or intravenously just before the tourniquet is released, it is effective at decreasing blood loss (Patel et al, 2014). With this approach a drain is not necessary (Zhang et al, 2015).
It is our belief that unless patients are very high risk, and have for example had a previous DVT/PE, that anticoagulent drugs such as Warfarin or Low Molecular Weight Heparin are not necessary. This is because the risk of thromboembolism is low with rapid mobilisation the UKA patient. Furthermore they tend to cause knee and leg swelling and bruising which slows recovery. Unfortunately we currently are required to use this kind of medication.
