Is total hip arthroplasty a successful and safe procedure in Jehovah's Witnesses? Mean five-year results

Abstract

Total hip arthroplasty (THA) can be challenging in Jehovah's Witnesses because of the potential for blood loss. Because these patients will not accept blood transfusions, multiple strategies to prevent blood loss have been developed. The purpose of this study was to report implant survivorship, clinical outcomes, radiographic outcomes, morbidity, and mortality of Jehovah's Witnesses undergoing primary THA. Databases from two institutions were reviewed to identify 53 patients (55 hips) who were Jehovah's Witnesses and had a primary total hip arthroplasty. There were 27 women and 26 men who had a mean age of 63 years (range 35-94 years), and a mean follow-up of 63 months (range 24-120 months). All Jehovah's Witnesses had a comprehensive perioperative blood management strategy employed by a coordinated medical and surgical team. Mean post-operative Harris Hip Scores were 86 points, and implant survivorship was 97%. There were two aseptic revisions for osteolysis and component loosening. There were no mortalities, and three minor surgical and two minor medical complications occurred during the study. Excellent clinical outcomes were found for Jehovah's Witness undergoing total hip arthroplasty using a comprehensive blood management protocol. We believe that the use of a specialised blood management protocol involving a team approach to preoperative evaluation, appropriate anaesthesia, and surgical and postoperative management was responsible for minimising complications. Total hip arthroplasty is safe and efficacious in this patient group if proper preoperative safeguards are utilised.

Management of severe perioperative bleeding

“…82 Other groups have successfully used PBM programmes with testing at about 3 weeks preoperatively. [83][84][85] Assessment of patients 3 to 8 weeks before elective surgery provides enough time to initiate treatment and for this to take effect. This recommendation is also in agreement with current consensus 86 and practical recommendations.…”

“…Results from a retrospective study described total hip arthroplasty in Jehovah's Witnesses following a perioperative blood management strategy. 84 Patients with preoperative haemoglobin (Hb) less than 12.0 g dl À1 were treated with erythropoietin for 3 weeks before surgery, plus oral iron and folate. None of the 53 patients received blood transfusion and there were no mortalities.…”

Outcomes of perioperative management in Jehovah's Witness patients undergoing surgeries with a risk of bleeding: a retrospective, single-center, observational study

“…These BCSs include the administration of erythropoietin, prothrombin complex concentrate, oral or intravenous iron preparations, and antifibrinolytics; preoperative autologous donation; acute normovolemic hemodilution; autologous blood transfusion after cell salvage; and use of various anesthetic techniques, such as intraoperative induction of mild hypothermia and application of permissive hypotension [14][15][16][28][29][30]. Many studies have shown that patients who refuse blood transfusion, such as JWs, can safely undergo surgery with the application of aggressive BCSs [16,[31][32][33].…”

Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah’s Witness patients?

“…Besides, blood transfusion carries many risks, including fatal anaphylactic reactions and transmission of infectious diseases. [ 8 ]…”

“…Due to their religious beliefs, Jehovah's Witnesses (JWs) do not allow blood transfusion, thus the use of blood management strategies, either alone or in combination, becomes more critical in these patients. [ 8 - 10 ] However, there is no consensus or accepted algorithms about the methods to be used in the management of these patients. [ 11 ] There are contradictory studies on whether tourniquet use reduces blood loss in TKA.…”