Bone Density May Be a Promising Predictor for Blood Loss during Total Hip Arthroplasty

Abstract

Background: Total hip arthroplasty (THA), which is performed mostly in elderly individuals, can result in substantial blood loss and thereby imposes a significant physical burden and risk of blood transfusion. The femoral neck cut and reamed acetabulum are the main sites of intraoperative bleeding. Whether the bone density in that region can be used to predict the amount of blood loss in THA is unknown. Methods: We retrospectively analyzed adult patients undergoing primary THA in the Department of Orthopedics, Peking Union Medical College Hospital, from January 2018 to January 2020. All these patients underwent primary unilateral THA. Patients had their bone mineral density (BMD) recorded within the week before surgery and were stratified and analyzed for perioperative blood loss. Multivariable regressions were utilized to adjust for differences in demographics and comorbidities among groups. Results: A total of 176 patients were included in the study. Intraoperative blood loss was 280.1 ± 119.56 mL. Pearson correlation analysis showed a significant correlation between blood loss and preoperative bone density of both the femoral greater trochanter (R = 0.245, p = 0.001) and the Ward’s triangle (R = 0.181, p = 0.016). Stepwise multiple linear regression showed that preoperative bone density of the greater trochanter (p = 0.015, 95% CI: 0.004–0.049) and sex (p = 0.002) were independent risk factors for THA bleeding. The area under the receiver operating characteristic curve (AUROC) of the greater trochanter and Ward’s triangle was 0.593 (95% CI: 0.507–0.678, p = 0.035) and 0.603 (95% CI: 0.519–0.688, p = 0.018), respectively. The cutoff T value on the femoral greater trochanter for predicting higher bleeding was −1.75. Conclusions: In THA patients, preoperative bone density values of the femoral greater trochanter and sex could be promising independent predictors for bleeding during surgery. Osteoporosis and female patients might have lower blood loss in the THA operation.

Establishment and validation of a nomogram to predict postoperative anemia after total hip arthroplasty

“…Blood can enter this space following proximal femoral osteotomy, which leads to blood loss. Additionally, osteoporotic patients have higher levels of oxygen free radicals in their bodies, which might interact with the enterocyte phospholipid membrane, leading to hemolysis and further hemoglobin loss [ 19 ].…”