Blood loss and allogeneic transfusion for surgical treatment of periprosthetic joint infection: a comparison of one- vs. two-stage exchange total hip arthroplasty

Abstract

Two-stage septic revision of total hip arthroplasty has higher rates of blood loss and transfusion rates than one-stage revision. Therefore, the authors believe that blood loss rate, including its complications, should be considered when decision for the type of staged septic exchange is made.

Comparison of efficacy and safety between oral and intravenous administration of tranexamic acid for primary total knee/hip replacement: a meta-analysis of randomized controlled trial

“…As we all know, transfusions extend not only the patient's rehabilitation time but also the length of hospital stay. They incur a considerable cost and are also associated with the risk of transfusion reactions, infectious diseases, and inhibition of the immune system [7][8][9]. Tranexamic acid (TXA) is a synthetic agent that exerts its anti-fibrinolytic effects by inhibiting plasminogen.…”

Intravenous tranexamic acid is associated with safe reduced blood loss and transfusion rate in one-stage exchange for infected hip arthroplasty

“…Despite the relatively lower blood loss and transfusion rates in one-stage compared to two-stage exchange for PJI of the hip, [8] the orthopedic surgeon should consider every tool, method, and technique to decrease blood loss during joint replacement surgery, hence reducing the need for perioperative blood transfusion, the risk of delayed ambulation, and postoperative hospital stay. Furthermore, patients receiving allogeneic blood transfusion are at increased risk of PJI.…”

“…We have demonstrated lower blood loss and transfusion rates of patients undergoing one-stage exchange compared to the two-stage exchange of the hip in a previous study. [8] In the current study, conducted at Helios ENDO-Klinik in Hamburg, we included 190 patients of that study (106 males, 84 females; mean age 71±10.1; range, 39 to 92 years) who underwent one-stage exchange of the hip between January 2006 and December 2012 without perioperative IV administration of TXA, and compared them to another group of 163 patients (90 males, 73 females; mean age 68±10.3; range, 25 to 90 years) who underwent one-stage exchange of the hip between January 2015 and December 2016 with perioperative IV administration of TXA. Patients with bleeding disorders or following surgeries within the last six months were excluded.…”

“…[4][5][6][7] Regarding hip revision for periprosthetic joint infection (PJI), two-stage procedures have higher intraoperative blood loss and allogeneic blood transfusion rate compared to one-stage exchange. [8] Objectives: This study aims to investigate if the use of intravenous (IV) tranexamic acid (TXA) during one-stage exchange for periprosthetic joint infection (PJI) of the hip that necessitates an extensive debridement is associated with decreased blood loss, if the rate of blood transfusion that may lead to side effects can be lowered with IV TXA, and if there is any difference regarding the occurrence of postoperative venous thromboembolism (VTE).…”

Improved treatment strategies can result in better outcomes following one-stage exchange surgery for MRSA periprosthetic joint infection

“…One-stage exchange surgery is a reliable option in the management of PJIs. Its advantages include decreasing the number of surgeries, duration of antibiotic exposure, length of hospital stay, less blood loss, hospitalization costs and promoting early patient rehabilitation [13–15]. Currently, there are only few studies directly comparing one-stage and two-stage exchange surgeries.…”