Transfusions and blood loss in total hip and knee arthroplasty: a prospective observational study

Abstract

BackgroundThere is a high prevalence of blood product transfusions in orthopedic surgery. The reported prevalence of red blood cell transfusions in unselected patients undergoing hip or knee replacement varies between 21% and 70%. We determined current blood loss and transfusion prevalence in total hip and knee arthroplasty when tranexamic acid was used as a routine prophylaxis, and further investigated potential predictors for excessive blood loss and transfusion requirement.Methods/materialsIn total, 193 consecutive patients undergoing unilateral hip (n = 114) or knee arthroplasty (n = 79) were included in a prospective observational study. Estimated perioperative blood loss was calculated and transfusions of allogeneic blood products registered and related to patient characteristics and perioperative variables.ResultsOverall transfusion rate was 16% (18% in hip patients and 11% in knee patients, p = 0.19). Median estimated blood loss was significantly higher in hip patients (984 vs 789 mL, p < 0.001). Preoperative hemoglobin concentration was the only independent predictor of red blood cell transfusion in hip patients while low hemoglobin concentration, body mass index, and operation time were independent predictors for red blood cell transfusion in knee patients.ConclusionsThe prevalence of red blood cell transfusion was lower than previously reported in unselected total hip or knee arthroplasty patients. Routine use of tranexamic acid may have contributed. Low preoperative hemoglobin levels, low body mass index, and long operation increase the risk for red blood cell transfusion.

Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study

“…The transfusion rate in this study was 15.6% in group 2 (straight-stem) and 8% in group 1 (short-stem), which are both lower than in most previously published studies [9,10,22,23]. There is a wide variation of reported transfusion rates after THA in the literature, ranging from 10 to 69% [9,10,22,23].…”

“…There is a wide variation of reported transfusion rates after THA in the literature, ranging from 10 to 69% [9,10,22,23]. In a prospective observational study of 114 THA, the allogeneic transfusion rate was 18% [22].…”

Analysis of red blood cell use in elective surgeries over 12 years in Korea

“…Meanwhile, several previous studies reported that RBC transfusion rates in hip or knee arthroplasties varied between 16 and 69% . In our study, the transfusion rates in total arthroplasties of joints except fingers and toes were relatively high at approximately 78%, but the transfusion rates and mean number of RBC units used in arthroplasties were relatively lower in general hospitals than those in other types of medical institutions.…”

“…Thus, understanding the current situation on the blood usage according to the types of surgeries and hospitals would be helpful in effective perioperative blood management. The use of tranexamic acid has been known to reduce the usage of RBC units . Also, preoperative Hb levels and operation time affect the amount of intraoperative RBC transfusion.…”

Comparison of intravenous and intra-articular tranexamic acid in reducing blood loss in primary total knee replacement

“…The prevalence of BTs after total knee arthroplasty has been reported to be between 11% to 69%. [23,24] However, overall postoperative losses were significantly lower in patients with IV administration of TA (200 mL of blood less compared to group that did not receive TA). Also, the local means of TA administration was associated with lower overall losses, by 150 mL of blood.…”