J Knee Surg 2013; 26(03): 151-154
DOI: 10.1055/s-0032-1324812
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Excellent Results of Revision TKA in Jehovah's Witness Patients

Steven F. Harwin
1   Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, New York
Kimona Issa
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
Qais Naziri
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
Robert Pivec
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
Aaron J. Johnson
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
Michael A. Mont
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

11 January 2012

23 June 2012

Publication Date:
21 September 2012 (online)


Revision total knee arthroplasty (TKA) can be quite challenging in Jehovah's Witness patients because blood transfusion is often needed, however, these patients do not accept allogeneic or autologous blood due to religious convictions. We reported our clinical experiences with a special blood management protocol for Jehovah's Witnesses who underwent a revision TKA. There were 12 self-reported Jehovah's Witness patients (12 total knee arthroplasties) who had a mean age of 69 years (range: 55 to 79 years) and who underwent revision TKA between 1998 and 2009. All revision surgeries were due to aseptic component failure. Implant survivorship was 100% over a mean follow-up of 62 months (range: 24 to 120 months). The Knee Society objective and function scores improved to a mean of 83 and 82 points, respectively. The authors believe that the use of this blood management protocol was responsible for the excellent clinical outcomes.

  • References

  • 1 Keep Yourself in God's Love, Watch Tower Bible & Tract Society. 2008; 77
  • 2 Statistics. Report of Jehovah's Witnesses Worldwide. 2010. Available at: http://www.watchtower.org/e/statistics/worldwide_report.htm
  • 3 Sniecinski R, Levy JH. What is blood and what is not? Caring for the Jehovah's Witness patient undergoing cardiac surgery. Anesth Analg 2007; 104 (4) 753-754
  • 4 The Watchtower. Oct 15, 2000; 30-31
  • 5 The Watchtower. June 15, 2000; 29-31
  • 6 Muramoto O. Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah's witnesses. BMJ 2001; 322 (7277) 37-39
  • 7 Knight JL, Sherer D, Guo J. Blood transfusion strategies for total knee arthroplasty: minimizing autologous blood wastage, risk of homologous blood transfusion, and transfusion cost. J Arthroplasty 1998; 13 (1) 70-76
  • 8 Mylod Jr AG, France MP, Muser DE, Parsons JR. Perioperative blood loss associated with total knee arthroplasty. A comparison of procedures performed with and without cementing. J Bone Joint Surg Am 1990; 72 (7) 1010-1012
  • 9 Kourtzis N, Pafilas D, Kasimatis G. Blood saving protocol in elective total knee arthroplasty. Am J Surg 2004; 187 (2) 261-267
  • 10 Zurriarían EM, Elizondo ME, Knorr JIE, Zarranz JU. Bloodless surgery total knee arthroplasty. Revista Española de Cirugía Ortopédica y Traumatología 2008; 52 (6) 372-380
  • 11 Bolliger D, Sreeram G, Duncan A , et al. Prophylactic use of factor IX concentrate in a Jehovah's Witness patient. Ann Thorac Surg 2009; 88 (5) 1666-1668
  • 12 Hughes DB, Ullery BW, Barie PS. The contemporary approach to the care of Jehovah's witnesses. J Trauma 2008; 65 (1) 237-247
  • 13 Hsieh A, Cheong I. Use of recombinant activated factor VII in a Jehovah's Witness patient. Am J Emerg Med 2007; 25 (9) 1085
  • 14 Laupacis A, Feagan B, Wong C. COPES Study Group. Effectiveness of perioperative recombinant human erythropoietin in elective hip replacement. Lancet 1993; 342 (8867) 378
  • 15 Sparling EA, Nelson CL, Lavender R, Smith J. The use of erythropoietin in the management of Jehovah's Witnesses who have revision total hip arthroplasty. J Bone Joint Surg Am 1996; 78 (10) 1548-1552
  • 16 Josefsson G. [Primary hip arthroplasty in 14 Jehovah's witnesses. No complications related to bleeding were reported]. Lakartidningen 1996; 93 (38) 3237-3238
  • 17 Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br 1995; 77 (2) 250-253
  • 18 Siddiqui FM, Slater RM, Razzaq I, Atkinson M, Ryan K. Tourniquet use during total knee replacement in a Jehovah's Witness with sickle cell trait: a case report. Eur J Anaesthesiol 2010; 27 (6) 581-582
  • 19 Kiss H, Raffl M, Neumann D, Hutter J, Dorn U. Epinephrine-augmented hypotensive epidural anesthesia replaces tourniquet use in total knee replacement. Clin Orthop Relat Res 2005; (436) 184-189
  • 20 Juelsgaard P, Larsen UT, Sørensen JV, Madsen F, Søballe K. Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion. Reg Anesth Pain Med 2001; 26 (2) 105-110
  • 21 Connolly JR, Wingard DW. Total hip replacement in a Jehovah's Witness using hypotensive anesthesia. Nebr Med J 1977; 62 (8) 287-290
  • 22 Stoye A, Chapin JW, Botha J, Grant W. Bloodless liver transplantation in a Jehovah's Witness. Int Anesthesiol Clin 2011; 49 (2) 108-115
  • 23 Chigbu B, Onwere S, Kamanu C , et al. Lessons learned from the outcome of bloodless emergency laparotomies on Jehovah's Witness women presenting in the extremis with ruptured uterus. Arch Gynecol Obstet 2009; 279 (4) 469-472
  • 24 Reyes G, Nuche JM, Sarraj A , et al. [Bloodless cardiac surgery in Jehovah's witnesses: outcomes compared with a control group]. Rev Esp Cardiol 2007; 60 (7) 727-731
  • 25 Rosengart TK, Helm RE, DeBois WJ, Garcia N, Krieger KH, Isom OW. Open heart operations without transfusion using a multimodality blood conservation strategy in 50 Jehovah's Witness patients: implications for a “bloodless” surgical technique. J Am Coll Surg 1997; 184 (6) 618-629
  • 26 Gromova VV, Lubnin AIu. [Analysis of modern blood reinfusion apparatuses]. Anesteziol Reanimatol 2009; (5) 71-76
  • 27 Matsuda K, Nozawa M, Katsube S, Maezawa K, Kurosawa H. Reinfusion of unwashed salvaged blood after total knee arthroplasty in patients with rheumatoid arthritis. Int Orthop 2009; 33 (6) 1615-1618
  • 28 Kolt JD, Robin DA, Carr AM, Chew DK, Critchley IJ, Horton RW. Safety of autologous drainage blood reinfusion following total knee arthroplasty prepared with hydrogen peroxide. Knee 2007; 14 (1) 12-18
  • 29 Nelson CL, Bowen WS. Total hip arthroplasty in Jehovah's Witnesses without blood transfusion. J Bone Joint Surg Am 1986; 68 (3) 350-353
  • 30 Rab GT, Gorin LJ, Eisele JH. Bilateral total hip arthroplasty in a Jehovah's Witness with chronic anemia. Clin Orthop Relat Res 1982; (163) 134-136
  • 31 Nelson CL, Stewart JG. Primary and revision total hip replacement in patients who are Jehovah's Witnesses. Clin Orthop Relat Res 1999; (369) 251-261
  • 32 Juraszek A, Dziodzio T, Roedler S , et al. Results of open heart surgery in Jehovah's Witnesses patients. J Cardiovasc Surg (Torino) 2009; 50 (2) 247-250
  • 33 Shalhoub J, Pakzad F, Matravers PJ, Franklin IJ. Endovascular repair of ruptured abdominal aortic aneurysm in a Jehovah's Witness without blood transfusion. Int J Surg 2010; 8 (1) 79-80
  • 34 Jabbour N, Gagandeep S, Mateo R , et al. Live donor liver transplantation without blood products: strategies developed for Jehovah's Witnesses offer broad application. Ann Surg 2004; 240 (2) 350-357
  • 35 Cushner FD, Foley I, Kessler D, Scuderi G, Scott WN. Blood management in revision total knee arthroplasty. Clin Orthop Relat Res 2002; (404) 247-255
  • 36 Pagnano M, Cushner FD, Hansen A, Scuderi GR, Scott WN. Blood management in two-stage revision knee arthroplasty for deep prosthetic infection. Clin Orthop Relat Res 1999; (367) 238-242