Blood Conservation Strategies in Total Hip and Knee Arthroplasty

Abstract

Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

Patient Blood Management in Hip Replacement Arthroplasty

“…Judicious fluid management enables the low Hb trigger. Careful monitoring of a patient's physical condition is essential, including pulse rate, blood pressure, and the presence of dyspnea symptoms 41) ( Table 3 , Fig. 2 ).…”

Blood transfusions increase the risk for venous thromboembolism events following total joint arthroplasty

“…In addition to greater awareness, additional blood management strategies should be employed for TJA with the aim of reducing the need for blood transfusion. These efforts may encompass pre-operative identification of patients at high risk for transfusion, correcting pre-operative anemia with haemopoietic agents, salvaging blood lost during the peri-operative period, limiting post-operative blood loss with haemostatic measures and individualizing transfusion triggers according to a patient’s symptoms and medical co-morbidities 35 .…”

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

“… 323 Recommendations for screening and intervention are mixed, and some experts have recommended anemia work up for Hgb <11 g/dL, but the majority of literature has focused on minimizing perioperative blood loss as a means of preventing symptomatic post-operative acute surgical blood loss anemia. 314 , 324 …”

“…323 Recommendations for screening and intervention are mixed, and some experts have recommended anemia work up for Hgb <11 g/dL, but the majority of literature has focused on minimizing perioperative blood loss as a means of preventing symptomatic post-operative acute surgical blood loss anemia. 314,324 In summary, modifiable risk factors exist in the arthroplasty population that warrant further work on evidence-based protocols for clearance for these elective procedures. It is estimated that >43% of the patients undergoing revision total knee surgery had at least one modifiable risk factor unoptimized at the time of index surgery.…”