Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus

Abstract

The volume of hip arthroplasty is stiffly increasing because of excellent clinical outcomes, however it has not been shown to decrease the incidence of transfusions due to bleeding related to this surgery. This is an important consideration since there are concerns about the side effects and social costs of transfusions. First, anemia should be assessed at least 30 days before elective hip arthroplasty, and if the subject is diagnosed as having anemia, an additional examination of the cause of the anemia should be carried and steps taken to address the anemia. Available iron treatments for anemia take 7 to 10 days to facilitate erythropoiesis, and preoperative iron supplementation, either oral or intravenous, is recommended. When using oral supplements for iron storage, administer elemental iron 100 mg daily for 2 to 6 weeks before surgery, and calculate the dose using intravenous supplement. Tranexamic acid (TXA) is a synthetic derivative of the lysine component, which reduces blood loss by inhibiting fibrinolysis and clot degradation. TXA is known to be an effective agent for reducing postoperative bleeding and reducing the need for transfusions in primary and revision total hip arthroplasties. Patient blood management has improved the clinical outcome after hip arthroplasty through the introduction and research of various agents, thereby reducing the need for allogeneic blood transfusions and reducing the risk of transfusion-related infections and the duration of hospitalizations.

Transfusion trends in hip arthroplasty in Korea: a nationwide study by the Korean National Health Insurance Service

“…As the elderly population increases, the number of patients who need arthroplasty also increases. Most patients who undergo THA are older, with inadequate ability to recover from perioperative bleeding, often warranting blood transfusion after surgery . Furthermore, the blood donor population will decrease in an elderly society, despite the increased need for blood .…”

“…Total joint arthroplasties may be associated with blood loss, which necessitates transfusion . Hip arthroplasties especially are highly associated with transfusion to compensate for perioperative bleeding .…”

“…Total joint arthroplasties may be associated with blood loss, which necessitates transfusion . Hip arthroplasties especially are highly associated with transfusion to compensate for perioperative bleeding . Hip arthroplasties are among the most frequent procedures requiring transfusions, with reported transfusion rates ranging from 18% to 68% in the United States .…”

“…The aging arthroplasty population is less tolerant of prolonged postoperative anemia and is therefore more likely to require perioperative transfusion . Orthopedic surgeons and patients have expressed increasing concerns regarding complications of blood transfusions, including perioperative systemic or local infection, prolonged hospital stay, venous thromboembolic events, and mortality …”

“…In contrast to the advances in knowledge of patient blood management, efforts to reduce blood transfusion have improved in clinical practice. In addition, various methods to reduce transfusion have been attempted in hip arthroplasty recently, with a high percentage of patients requiring transfusion during and after the procedures …”