Revision total hip replacement: predictors of blood loss, transfusion requirements, and length of hospitalisation

Mahadevan, Devendra; Challand, C; Keenan, Jonathan

doi:10.1007/s10195-010-0105-z

Cited by 47 publications

(38 citation statements)

References 17 publications

(21 reference statements)

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“…In that study after correction for confounding variables, only the preoperative hemoglobin concentration and the perioperative blood loss were associated with transfusion [28]. Patients undergoing isolated acetabular revision also had less blood loss and lower transfusion rates than both component revisions with 33% (21 of 63) of the patients undergoing isolated acetabular revision transfused at least one unit [28]. This was similar to the findings in our study.…”

Section: Discussionsupporting

confidence: 88%

“…This finding may be related to a higher proportion of female patients in this cohort, who may have had a lower preoperative hemoglobin concentration or who may have had a lower transfusion threshold. One study of the predictors of blood loss and transfusion requirements after revision THA found greater blood loss in men, elderly patients, and revisions of cemented (presumably polyethylene) components [28]. In that study after correction for confounding variables, only the preoperative hemoglobin concentration and the perioperative blood loss were associated with transfusion [28].…”

Section: Discussionmentioning

confidence: 92%

“…One study of the predictors of blood loss and transfusion requirements after revision THA found greater blood loss in men, elderly patients, and revisions of cemented (presumably polyethylene) components [28]. In that study after correction for confounding variables, only the preoperative hemoglobin concentration and the perioperative blood loss were associated with transfusion [28]. Patients undergoing isolated acetabular revision also had less blood loss and lower transfusion rates than both component revisions with 33% (21 of 63) of the patients undergoing isolated acetabular revision transfused at least one unit [28].…”

Section: Discussionmentioning

confidence: 99%

“…According to one study of the Medicare database, isolated revision of the acetabular component accounted for 13% of all revisions [4]. Isolated acetabular revision can be challenging and is associated with increased complications but has advantages of decreased blood loss and surgical time compared with both-component revisions [28,35,39]. Several studies have shown satisfactory results with isolated revision of the acetabular component in hips with metal-on-polyethylene (MoP) bearing surfaces using an uncemented porous-coated hemispherical shell [9,11,15,19,25,31,34,35].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Penrose

Seyler

Wellman

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that acetabular revision of these hips will have even greater risk of complications. However, no study directly compares the complications of MoM with metal-on-polyethylene (MoP) acetabular revisions. Questions/purposes In the context of a large database analysis, we asked the following questions: (1) Are there differences in early medical or wound complications after isolated acetabular revision of MoM and MoP bearing surfaces? (2) Are there differences in the frequency of dislocation, deep infection, and rerevision based on the bearing surface of the original implant? Methods A review of the 100% Medicare database from 2005 to 2012 was performed using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. We identified 451 patients with a MoM bearing and 628 patients with a MoP bearing who had an isolated acetabular revision and a minimum followup of 2 years. The incidence, odds ratios, and 95% confidence intervals for early medical or wound complications were calculated using a univariate analysis at 30 days with patient sex and age group-adjusted analysis for blood transfusion. The incidence, odds ratio, and 95% confidence intervals for dislocation, deep infection, and rerevision were calculated using a univariate analysis at 30 day, 90 days, 1 year, and 2 years using a subgroup analysis with the Cochran-Mantel-Haenszel test to adjust for patient gender and age groups. Results There were no differences between the MoM and MoP isolated acetabular revisions in the incidence of 30-day local complications.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Penrose

Seyler

Wellman

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…A revision procedure makes the surgery more complex due to the anatomical changes in soft tissue, bone and different types of implanted prostheses. Revision of THA is associated with significant blood loss and subsequent perioperative blood transfusion [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

Hawi

Kendoff

Hessling

et al. 2014

International Orthopaedics (SICOT)

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Purpose The goal of this study was to analyse the efficacy of blood autotransfusion using a continuous autologous transfusion system in revisions of total hip arthroplasty (THA). We looked at whether administration of allogeneic blood units was reduced in these cases and if there is a difference between cemented and non-cemented revisions. Methods Between January 2011 and December 2011, patients being treated with revision THA were included (n=411). The following parameters were analysed: patient age, gender, weight (kg), height (cm), body mass index (BMI, kg/m 2 ), surgical diagnosis, treatment and American Society of Anesthesiologists (ASA) classification score. The difference between pre-and post-operative haemoglobin (Hb, g/dl), amount of peri-operative blood loss (ml), amount of retransfused washed shed blood and amount of allogeneic and/or autologous transfusion (ml) were recorded. Results In both the cemented and non-cemented revision THA groups, there was no significant difference between pre-and post-operative Hb with or without using an autotransfusion system. In 92 of 186 cemented cases using an autologous transfusion system (49.5 %) and 38 of 117 non-cemented cases using an autologous transfusion system (32.5 %), allogeneic blood transfusion (ABT) was required. Cemented procedures using an autologous transfusion system got significantly more ABTs than non-cemented procedures using an autologous transfusion system (p=0.0042, odds ratio=2.035).Conclusions Use of an autologous transfusion system did not reduce the amount of ABT in revision THA in the patient cohort reported here. In our opinion, general blood management is required before and during surgery to reduce administration of ABT.

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Patient Blood Management

Uhl

2011

JAMA

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Globally, more than 81 million units of red blood cells are transfused annually. Of the 15 million red blood cell components transfused annually in the United States, approximately 40% are transfused to patients undergoing elective surgical procedures. Because of concerns about limited blood availability as well as risks of transfusion-related adverse events, blood products should be used judiciously. Using the case of Ms C, a 68-year-old woman considering autologous blood donation prior to knee replacement surgery, the concept of patient blood management is discussed. This approach entails a complete evaluation of the patient in the preoperative period to assess for bleeding risks and anemia, with a goal to optimize a patient's condition prior to surgery; use of various strategies in the operative period to mitigate the need for allogeneic blood transfusion; and meticulous postoperative care to again avoid the need for blood transfusion.

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Revision total hip replacement: predictors of blood loss, transfusion requirements, and length of hospitalisation

Cited by 47 publications

References 17 publications

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

Patient Blood Management

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