Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial
Background: Blood loss is among the main complications of total knee arthroplasty (TKA) and oxidative stress, and hemolysis caused by reactive oxygen species are one of the causes of hemoglobin (Hb) drop. Ascorbic acid is a potent antioxidant that can protect against reactive oxygen species. In this...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-04-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344125000056 |
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| author | Pooya Hosseini-Monfared, MD Alireza Mirahmadi, MD Mohammad Mehdi Sarzaeem, MD Soheil Pourshahryari, MD Parisa Aminnia, MD Mohammad Poursalehian, MD Seyed Morteza Kazemi, MD |
| author_facet | Pooya Hosseini-Monfared, MD Alireza Mirahmadi, MD Mohammad Mehdi Sarzaeem, MD Soheil Pourshahryari, MD Parisa Aminnia, MD Mohammad Poursalehian, MD Seyed Morteza Kazemi, MD |
| author_sort | Pooya Hosseini-Monfared, MD |
| collection | DOAJ |
| description | Background: Blood loss is among the main complications of total knee arthroplasty (TKA) and oxidative stress, and hemolysis caused by reactive oxygen species are one of the causes of hemoglobin (Hb) drop. Ascorbic acid is a potent antioxidant that can protect against reactive oxygen species. In this study, we aim to explore the antioxidant effect of ascorbic acid on blood loss and patient-reported outcomes following outpatient TKA. Methods: Patients scheduled for outpatient primary TKA were enrolled in this randomized, double-blind clinical trial and were assigned to 1 of the 2 groups. The patients in the ascorbic acid group received intravenous vitamin C perioperatively. Patients in the placebo group received only normal saline. We calculated the blood loss using the Hb drop. Patient-reported outcomes such as Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, and Forgotten Joint Score were used to evaluate the postoperative pain and function in the 6-month follow-up. Results: The patients who have received ascorbic acid had lower Hb drop (g/dL) (1.30 ± 0.72 vs 1.91 ± 0.84, P value < .001) and total blood loss in the first postoperative day (463.60 ± 274.37 vs 732.11 ± 347.78, P value < .001). Also, fewer patients reached the minimum clinically important difference level for Hb drop in the ascorbic acid group. The patients’ postoperative functional and pain scores were not different between the 2 groups. Conclusions: Our findings demonstrated that perioperative use of ascorbic acid can reduce blood loss by nearly 36% on the first postoperative day and should be considered as an effective blood-preserving agent in conjunction with tranexamic acid during TKA. |
| format | Article |
| id | doaj-art-b3bda8e11e2448deb87869d497cb32a2 |
| institution | Kabale University |
| issn | 2352-3441 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj-art-b3bda8e11e2448deb87869d497cb32a22025-02-02T05:27:41ZengElsevierArthroplasty Today2352-34412025-04-0132101618Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled TrialPooya Hosseini-Monfared, MD0Alireza Mirahmadi, MD1Mohammad Mehdi Sarzaeem, MD2Soheil Pourshahryari, MD3Parisa Aminnia, MD4Mohammad Poursalehian, MD5Seyed Morteza Kazemi, MD6Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranBone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranImam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranBone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranBone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranJoint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, IranBone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Corresponding author. Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1964714953, Iran. Tel.: +98 912 114 1341.Background: Blood loss is among the main complications of total knee arthroplasty (TKA) and oxidative stress, and hemolysis caused by reactive oxygen species are one of the causes of hemoglobin (Hb) drop. Ascorbic acid is a potent antioxidant that can protect against reactive oxygen species. In this study, we aim to explore the antioxidant effect of ascorbic acid on blood loss and patient-reported outcomes following outpatient TKA. Methods: Patients scheduled for outpatient primary TKA were enrolled in this randomized, double-blind clinical trial and were assigned to 1 of the 2 groups. The patients in the ascorbic acid group received intravenous vitamin C perioperatively. Patients in the placebo group received only normal saline. We calculated the blood loss using the Hb drop. Patient-reported outcomes such as Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, and Forgotten Joint Score were used to evaluate the postoperative pain and function in the 6-month follow-up. Results: The patients who have received ascorbic acid had lower Hb drop (g/dL) (1.30 ± 0.72 vs 1.91 ± 0.84, P value < .001) and total blood loss in the first postoperative day (463.60 ± 274.37 vs 732.11 ± 347.78, P value < .001). Also, fewer patients reached the minimum clinically important difference level for Hb drop in the ascorbic acid group. The patients’ postoperative functional and pain scores were not different between the 2 groups. Conclusions: Our findings demonstrated that perioperative use of ascorbic acid can reduce blood loss by nearly 36% on the first postoperative day and should be considered as an effective blood-preserving agent in conjunction with tranexamic acid during TKA.http://www.sciencedirect.com/science/article/pii/S2352344125000056Blood lossAntioxidantsTotal knee arthroplastyAscorbic acid |
| spellingShingle | Pooya Hosseini-Monfared, MD Alireza Mirahmadi, MD Mohammad Mehdi Sarzaeem, MD Soheil Pourshahryari, MD Parisa Aminnia, MD Mohammad Poursalehian, MD Seyed Morteza Kazemi, MD Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial Arthroplasty Today Blood loss Antioxidants Total knee arthroplasty Ascorbic acid |
| title | Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial |
| title_full | Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial |
| title_fullStr | Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial |
| title_full_unstemmed | Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial |
| title_short | Ascorbic Acid Reduces the Blood Boss After Total Knee Arthroplasty: Insights From a Randomized Controlled Trial |
| title_sort | ascorbic acid reduces the blood boss after total knee arthroplasty insights from a randomized controlled trial |
| topic | Blood loss Antioxidants Total knee arthroplasty Ascorbic acid |
| url | http://www.sciencedirect.com/science/article/pii/S2352344125000056 |
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