Bloodless Surgery by a Regional Intra-arterial Tourniquet During Primary and Revision THA

Abstract

Primary total hip arthroplasty (THA) and revision THA are associated with blood loss that can be significant. The purpose of this retrospective study was to compare the efficacy of intra-arterial occlusive balloons in reducing blood loss during primary and revision THA. Twelve patients (Jehovah’s Witnesses) scheduled for a primary (n=6) or revision (n=6) THA who refused blood transfusions were compared with 48 control-matched patients (primary THA, n=24; revision THA, n=24). All Jehovah’s Witnesses received an intra-arterial balloon preoperatively, and all control patients underwent conventional surgery. Intraoperatively, balloons were periodically inflated to reduce blood loss and deflated to prevent limb ischemia. Endpoints for the study were estimated blood loss, perioperative hemoglobin, mean hospital stay, mean operative time, amount of intraoperative fluid or blood administered, and complications. None of the patients with an occlusive balloon received blood, whereas the primary THA group received an average of 0.6 units (P=.08) and the revision THA group received an average of 1.9 units (P=.02). Estimated blood loss was significantly decreased in the balloon group compared with the primary THA group (145 vs 402 mL, respectively; P<.01) and the revision THA group (333 vs 767 mL, respectively; P<.01). No complications were associated with the intra-arterial balloons. All patients showed a significant reduction in hemoglobin immediately postoperatively compared with preoperative values. No statistically significant differences existed in the amount of fluids given intraoperatively or the mean hospital stay among all groups. Temporary internal tourniquets used as an adjuvant to surgery significantly reduce intraoperative blood loss during primary and revision THA.

Mortality and morbidity in non‐transfusable and transfusable patients: A systematic review and meta‐analysis

“…Of the 41 included studies, all were retrospective cohort studies by design, and seven were abstracts 16,22,23,34,39,45,46 . In the majority of studies, the non‐transfusable cohort referred to those declining transfusions for personal or religious reasons 14,16–54 . We identified one study where patients did not receive an option for transfusion, potentially due to limited resources 15 .…”

“…The number of patients in the non‐transfusable cohort ranged from four to 322, and from 14 to 136,326 in the transfusable cohort. The most common clinical setting studied was cardiac surgery ( n = 16), 14,18,22,25,29,34,37,38,42–45,48–50,52 followed by orthopedic surgery ( n = 8) 17,20,27,28,33,40,53,54 and urology ( n = 4) 16,26,31,35 . Other disciplines included in our systematic review were obstetrics and gynecology, hematology, critical care, internal medicine, cardiology, and trauma.…”

Complex Total Hip Arthroplasty in a Patient with Klippel-Trénaunay Syndrome

“…Minimizing catastrophic blood loss is critical and was accomplished by preoperative vessel embolization of the surgical site and the use of a common iliac intra-arterial occlusive balloon during the THA. The internal iliac artery "tourniquet" has been shown to decrease estimated blood loss without complications 7 . Although this technique has previously been described for "bloodless" surgery in patients with religious objections to transfusions, it may also have a role for complex primary and revision THA with the potential for excessive intraoperative hemorrhage, as demonstrated here.…”

Major abdominal surgery in Jehovah’s Witnesses

“…The reluctance to use whole blood and its main fractions (both by Jehovah's Witnesses and on rare occasions when other individuals prefer to avoid blood transfusions) has spurred the development of perioperative protocols to improve patients' haematological markers, including haemoglobin prior to surgery, and to conserve blood during surgery (Table 2). [13][14][15][16][17][18][19][20][21][22][23] There is variability in the products deemed unacceptable by Jehovah's Witnesses and the acceptability of products should be established prior to any intervention. 4 Products that are generally acceptable include recombinant erythropoietin, recombinant factor VIIa and artificial Only flesh with its lifeits bloodyou must not eat.…”