Low Body Mass Index and Blood Loss in Primary Total Hip Arthroplasty: Results from 236 Consecutive Ankylosing Spondylitis Patients

Zhao, Jun-Wu; Li, Jia; Zheng, Wei; Denghui, Liu; Sun, Xinghuai; Xu, Weidong

doi:10.1155/2014/742393

Cited by 30 publications

(31 citation statements)

References 27 publications

(14 reference statements)

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“…We suggested that the disease activity of AS might be another important influential factor correlated with the surgical blood loss because disease activity is easily ignored by surgeons. This issue was not considered by Jia et al [5] and Zhao et al [26].…”

Section: Discussionmentioning

confidence: 96%

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Active ankylosing spondylitis increases blood loss during total hip arthroplasty for a stiff hip joint

Jiang

Pan

et al. 2020

BMC Musculoskelet Disord

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Background: Total hip arthroplasty (THA) has been highlighted as the best treatment option for ankylosing spondylitis (AS) patients with advanced hip involvement. The huge blood loss associated with THA is a common concern of postoperative complications. Disease activity is a specific reflection of systematic inflammation of AS. The purpose of this study was to determine the effect of disease activity on blood loss during THA in patients with AS. Methods: Forty-nine patients with AS who underwent unilateral THAs were retrospectively studied. Ankylosing Spondylitis Disease Activity Score (ASDAS) was employed to evaluate the disease activity. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) formula was used to assess the surgical blood loss. The patients were divided into active group (ASDAS≥1.3; n = 32) and stable groups (ASDAS< 1.3; n = 17) based on the ASDAS. Peri-operative laboratory values, plain radiographs, intra-operative data, transfusion volume, and use of hemostatic agents were recorded and statistically analyzed. Results: The ASDAS, pre-operative C-reactive protein level, erythrocyte sedimentation rate, and fibrinogen concentration in the active group were higher than the stable group (all P < 0.05); however, the pre-operative hemoglobin concentration and albumin level were higher in the stable group (both P < 0.05). The total blood loss during THA in stable patients was 1415.31 mL and 2035.04 mL in active patients (P = 0.006). The difference between the two groups was shown to be consistent after excluding the gender difference (P = 0.030). A high transfusion rate existed in both groups (stable group, 76.47% with an average of 1.53 units; active group, 84.37% with an average of 2.31 units), but there was no significant difference between the two groups (both P > 0.05). Compensated blood loss, corresponding to transfusion, was noted significantly more in the active group compared to the stable group (P = 0.027). There was no significant difference with regard to functional recovery (P > 0.05). Conclusion: Active AS patients are at high risk for increased blood loss during THA compared to stable patients. The underlying mechanism includes disorders of the coagulation and fibrinolytic systems, poor nutrition status, osteoporosis, imbalance of oxidative-antioxidative status and local inflammatory reaction. It is strongly recommended to perform THA in AS patients with stable disease.

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Section: Discussionmentioning

confidence: 96%

“…During THA, the acetabula were more likely to be over-reamed and the risk of proximal femur fracture increased because of osteoporosis [7]. Zhao et al [26] suggested that the osteoporosis might contribute to more blood loss due to periprosthetic microfracture. The impact of osteoporosis on surgical blood loss needs further discussion.…”

Section: Discussionmentioning

confidence: 99%

Active ankylosing spondylitis increases blood loss during total hip arthroplasty for a stiff hip joint

Jiang

Pan

et al. 2020

BMC Musculoskelet Disord

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show abstract

“…During THA, the acetabula were more likely to be over-reamed and the risk of proximal femur fracture increased because of osteoporosis(7). Zhao et al (26) suggested that the osteoporosis might contribute to more blood loss due to periprosthetic microfracture. The impact of osteoporosis on surgical blood loss needs further discussion.…”

Section: Discussionmentioning

confidence: 99%

Active Ankylosing Spondylitis Increases Blood Loss during Total Hip Arthroplasty for a Stiff Hip Joint

Jiang

Pan

et al. 2020

Preprint

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Background: Total hip arthroplasty (THA) has been highlighted as the best treatment option for ankylosing spondylitis (AS) patients with advanced hip involvement. The huge blood loss associated with THA is a common concern of postoperative complications. Disease activity is a specific reflection of systematic inflammation of AS. The purpose of this study was to determine the eﬀect of disease activity on blood loss during THA in patients with AS. Methods: Forty-nine patients with AS who underwent unilateral THAs were retrospectively studied. Ankylosing Spondylitis Disease Activity Score (ASDAS) was employed to evaluate the disease activity. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) formula was used to assess the surgical blood loss. The patients were divided into active group (ASDAS≥1.3; n=32) and stable groups (ASDAS<1.3; n=17) based on the ASDAS. Peri-operative laboratory values, plain radiographs, intra-operative data, transfusion volume, and use of hemostatic agents were recorded and statistically analyzed. Results: The ASDAS, pre-operative C-reactive protein level, erythrocyte sedimentation rate, and fibrinogen concentration in the active group were higher than the stable group (all P<0.05); however, the pre-operative hemoglobin concentration and albumin level were higher in the stable group (both P<0.05). The total blood loss during THA in stable patients was 1415.31 mL and 2035.04 mL in active patients (P=0.006). The difference between the two groups was shown to be consistent after excluding the gender difference (P=0.030). A high transfusion rate existed in both groups (stable group, 76.47% with an average of 1.53 units; active group, 84.37% with an average of 2.31 units), but there was no significant difference between the two groups (both P >0.05). Compensated blood loss, corresponding to transfusion, was noted significantly more in the active group compared to the stable group (P=0.027). There was no significant difference with regard to functional recovery (P>0.05). Conclusion: Active AS patients are at high risk for increased blood loss during THA compared to stable patients. The underlying mechanism includes disorders of the coagulation and fibrinolytic systems, poor nutrition status, osteoporosis, imbalance of oxidative–antioxidative status and local inflammatory reaction. It is strongly recommended to perform THA in AS patients with stable disease.

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“…Total hip arthroplasty (THA) is an effective treatment for osteoarthritis of the hip, femoral neck fracture, aseptic necrosis of femoral head and congenital developmental dysplasia of the hip. However, THA is associated with considerable perioperative blood loss and subsequently requires allogenic transfusion (1,2). Such allogenic transfusions may carry potential hazards of adverse immunological reactions, intravascular hemolysis, transfusion-related acute lung injury, disease transmission, transfusion-induced coagulopathy, renal failure, and even increased mortality (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Topical administration of tranexamic acid in total hip arthroplasty: A meta-analysis of Randomized Controlled Trials

Xiong

Wang

et al. 2015

DD&T

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Tranexamic acid (TXA) is an antifibrinolytic drug which has been widely used in many areas of surgery. The purpose of our meta-analysis was to review randomized controlled trials (RCT) of the effectiveness and safety of topical TXA treatment in reducing total blood loss and transfusion rate for patients undergoing primary total hip arthroplasty (THA). A literature search was undertaken. Five eligible reports match the inclusion and exclusion standard. The topical administration of TXA groups revealed lower total blood loss(mean difference - 347 ml, 95% CI, - 411 to - 282 mL; p < 0.00001) and transfusion rate (OR, 0.23 (p < 0.00001; 95% CI, 0.14-0.38)) compared with control groups. Meanwhile there was no statistically significant difference in the risk of developing thromboembolic events (OR, 1.64 (95% CI, 0.39-6.97); p = 0.5). Topical administration of TXA could significantly reduce total blood loss and transfusion requirements in primary THA, without increased thromboembolic complications.

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Low Body Mass Index and Blood Loss in Primary Total Hip Arthroplasty: Results from 236 Consecutive Ankylosing Spondylitis Patients

Cited by 30 publications

References 27 publications

Active ankylosing spondylitis increases blood loss during total hip arthroplasty for a stiff hip joint

Active ankylosing spondylitis increases blood loss during total hip arthroplasty for a stiff hip joint

Active Ankylosing Spondylitis Increases Blood Loss during Total Hip Arthroplasty for a Stiff Hip Joint

Topical administration of tranexamic acid in total hip arthroplasty: A meta-analysis of Randomized Controlled Trials

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