{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:35:08Z","timestamp":1770899708728,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T00:00:00Z","timestamp":1614902400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the blood loss after procedures of primary unilateral or one\u2010stage bilateral total knee arthroplasty (TKA) caused by open\u2010box prosthesis and closed\u2010box prosthesis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study. Patients undergoing procedures of primary TKA between January 2017 and July 2020 in our institution were assessed for eligibility for this study. Those who were diagnosed with knee osteoarthritis and underwent primary unilateral or one\u2010stage bilateral TKA by using PFC Sigma PS150 (closed\u2010box prosthesis) or Vanguard (open\u2010box prosthesis) knee systems and had complete data of laboratory indexes on postoperative day (POD) 1, POD 3, and POD 5 were the interested population. At last 243 patients were enrolled, among which 88 patients were classified into the unilateral closed\u2010box group, 66 patients into the unilateral open\u2010box group, 47 patients into the one\u2010stage bilateral closed\u2010box group, and 42 patients into the one\u2010stage bilateral open\u2010box group. The perioperative management and operative techniques were almost the same for each patient, except the selection of prosthesis, which was decided according to surgeon's preference. The baseline information, postoperative laboratory indexes tested on POD 1, POD 3, and POD 5 including hemoglobin, hematocrit, platelet, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR), the primary outcome measurements including the maximum decreased value of hemoglobin and the volume of total blood loss, and the secondary outcome measurements including the transfusion rate and the average transfused red blood cell (RBC) units were well compared between the open\u2010box group and the closed\u2010box group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The baseline was comparable between groups, except higher preoperative levels of hemoglobin (134.43\u2009g\/L <jats:italic>vs<\/jats:italic> 126.51\u2009g\/L, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.003) and hematocrit (39.92% <jats:italic>vs<\/jats:italic> 37.37%, <jats:italic>P<\/jats:italic> =\u20090.000) observed in the one\u2010stage bilateral open\u2010box group. The differences of postoperative coagulation function monitored by TT, PT, APTT, and INR were clinically irrelevant between groups. For patients receiving unilateral TKA, significantly higher value of decreased hemoglobin (26.06 g\/L <jats:italic>vs<\/jats:italic> 21.05 g\/L, <jats:italic>P<\/jats:italic> =\u20090.025) and significantly larger amount of total blood loss (920.34 mL <jats:italic>vs<\/jats:italic> 723.19 mL, <jats:italic>P<\/jats:italic> =\u20090.013) were observed in the open\u2010box group. For patients receiving one\u2010stage bilateral TKA, the open\u2010box prosthesis was observed to cause more hemoglobin drop (37.81 g\/L <jats:italic>vs<\/jats:italic> 32.02 g\/L, <jats:italic>P<\/jats:italic> =\u20090.071) and total blood loss (1327.26 mL <jats:italic>vs<\/jats:italic> 1177.42 mL, <jats:italic>P<\/jats:italic> =\u20090.247) compared to the closed\u2010box prosthesis, though the differences were not significant. The transfusion rate and the average transfused RBC units were not significantly different between the open\u2010box group and the closed\u2010box group no matte whether the patients were from the unilateral TKA group or from one\u2010stage bilateral TKA group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The use of open\u2010box prosthesis caused more hemoglobin drop and total blood loss than closed\u2010box prosthesis after primary unilateral or one\u2010stage bilateral TKA, resulting in comparable transfusion rate and average transfused RBC units between groups.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12952","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T11:50:34Z","timestamp":1614945034000},"page":"768-777","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Blood Loss between Open\u2010Box Prosthesis and Closed\u2010Box Prosthesis after Primary Total Knee Arthroplasty"],"prefix":"10.1111","volume":"13","author":[{"given":"Qi","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine Tsinghua University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang\u2010jiao","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine Tsinghua University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sha","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine Tsinghua University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3727-8001","authenticated-orcid":false,"given":"Xu","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine Tsinghua University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,3,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/00003086-198809000-00024","article-title":"Blood loss with total knee arthroplasty","volume":"234","author":"Berman AT","year":"1988","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.101B1.BJJ-2018-0554.R1"},{"key":"e_1_2_6_4_1","first-page":"116","article-title":"Peri\u2010operative blood transfusion increases length of hospital stay and number of postoperative 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