Extremely Low Transfusion Rates: Contemporary Primary Total Hip and Knee Arthroplasties

Lindman, Ida; Carlsson, Lars

doi:10.1016/j.arth.2017.07.034

Cited by 26 publications

(23 citation statements)

References 28 publications

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“…Recent studies indicate that minimally invasive techniques and short stems give better early postoperative results than with conventional accesses and implants [23,24]. The present study confirms that intra-operative blood loss is extremely low, due to the short operating time, together with the lack of damage to soft tissue during surgery and perioperative medicationas in the concept [25].…”

Section: Discussionsupporting

confidence: 80%

Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

et al. 2019

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Background An inpatient hospital stay of up to 10 days after total hip arthroplasty (THA) is still common in Germany, mostly followed by inpatient rehabilitation. Internationally already widespread concepts for enhanced recovery are increasingly gaining popularity in Germany. Objectives The presentation of content and results of a newly implemented enhanced recovery concept in THA. Materials and Methods In this single-center, prospective observational study of a consecutive patient collective of a single surgeon, between January 2016 and July 2016, 103 short-stem THA patients were enrolled and treated using a newly introduced enhanced recovery concept. After 6 weeks and 6 months clinical examination was performed regarding function, pain, satisfaction and possible complications. Results The goal of discharge on day 4 after operation was reached in 61.2% of the patients with a mean postoperative inpatient stay of 4.9 days. After 6 weeks and 6 months respectively, excellent clinical results were achieved with high patient satisfaction. The complication rate was found to be low. Mean hemoglobin concentration decreased by 2.1 g/dl. A fissure of the femur below the implant healed conservatively applying no weight bearing for a total of 6 weeks. A pulmonary embolism that occurred during rehabilitation was also successfully treated. After 6 months one case showed a bursitis trochanterica. Conclusions Inpatient length of stay can be reduced by enhanced recovery concepts without increasing the risks to patients. Thus, in Germany these concepts will be applied increasingly.

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Section: Discussionsupporting

confidence: 80%

Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

et al. 2019

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“…THA is characterized by significant blood loss, and blood transfusions have always been inevitable, especially among hip fracture patients. The transfusion rate was once as high as 30–70%, but has fallen precipitously since the 2010s; it is as low as 9% for THA [ 42 – 46 ]. Blood conservation strategies, including new surgical techniques, Hb optimization, induced hypotension, and in particular, application of TXA, have fundamentally changed perioperative blood management [ 18 , 23 – 25 , 28 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

The necessity of routine postoperative laboratory tests after total hip arthroplasty for hip fracture in a semi-urgent clinical setting

Liu

et al. 2020

J Orthop Traumatol

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Background Recent studies suggest that routine postoperative laboratory tests are not necessary after primary elective total hip arthroplasty (THA). This study aims to evaluate the utility of routine postoperative laboratory tests in patients undergoing THA for hip fracture in a semi-urgent clinical setting. Materials and methods This retrospective study included 213 consecutive patients who underwent primary unilateral THA for hip fractures. Patient demographics, clinical information, and laboratory tests were obtained from the electronic medical record system. Multivariate logistic regression analysis was performed to identify risk factors associated with abnormal laboratory test-related interventions. Results A total of 207 patients (97.18%) had abnormal postoperative laboratory results, which were mainly due to anemia (190/213, 89.20%) and hypoalbuminemia (154/213, 72.30%). Overall, 54 patients (25.35%) underwent a clinical intervention, 18 patients received blood transfusion, and 42 patients received albumin supplementation. Factors associated with blood transfusion were long operative time and low preoperative hemoglobin levels. Factors associated with albumin supplementation were long operative time and low preoperative albumin levels. Of the 33 patients with abnormal postoperative creatinine levels, 7 patients underwent a clinical intervention. For electrolyte abnormalities, sodium supplementation was not given for hyponatremia, three patients received potassium supplementation, and one patient received calcium supplementation. Conclusions This study demonstrated a high incidence of abnormal postoperative laboratory tests and a significant clinical intervention rate in patients who underwent THA for hip fracture in a semi-urgent clinical setting, which indicates that routine laboratory tests after THA for hip fracture are still necessary for patients with certain risk factors. Level of Evidence Level III. Trial registration Clinical trial registry number ChiCTR1900020690.

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“…The importance of this preoperative optimization has been previously discussed in the literature [ 24 ]. Indeed, studies have shown that with adequate perioperative protocols, blood loss in modern elective arthroplasty can be almost eliminated [ 25 ]. This includes the use of tranexamic acid and preoperative optimization including Hb levels and cessation of anticoagulants, as well as techniques such as hypotensive anesthesia and adequate intraoperative surgical hemostasis.…”

Section: Discussionmentioning

confidence: 99%

Is Routine Hemoglobin Monitoring Necessary after Elective Hip and Knee Arthroplasty?

Hennessy

McSorley

2020

Arthroplasty Today

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Background Many orthopaedic units measure hemoglobin (Hb) levels after primary joint arthroplasty to identify patients with postoperative anemia. With the refinement of surgical techniques, blood loss in primary arthroplasty has decreased. The aim of this study was to investigate the postoperative Hb monitoring and transfusion practices in our own institution after elective hip or knee arthroplasty. Methods We conducted a retrospective audit of all patients who underwent elective total hip or knee arthroplasty in Galway University Hospital between March 1 and June 1, 2019. We recorded when they underwent postoperative Hb testing, whether or not they had a drop of Hb, which would indicate transfusion (<8 g/dL), and whether or not they were transfused. In patients who underwent transfusion, a chart review was performed to establish the presence of factors that would have triggered repeat Hb testing. Results One hundred thirty-six patients underwent elective primary hip or knee arthroplasty in the period. All had a full blood count sent on the first postoperative day. None (0%) had a clinically significant (to < 8g/dL) postoperative Hb drop on day 1. Eighteen (13.2%) patients underwent repeat testing on day 2 or subsequently. Eight (5.9%) exhibited a drop in Hb to less than 8 g/dL, with a mean Hb drop of 4.26 (standard error of the mean ± 0.862, standard deviation ± 0.98), and 5 (3.7%) proceeded to undergo allogenic blood product transfusion. All 5 underwent documented indications for repeat Hb testing. Conclusions There is no evidence for performing routine Hb testing on day 1 after elective hip or knee arthroplasty. We recommend that postoperative Hb testing should only be carried out on patients with additional indications.

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Extremely Low Transfusion Rates: Contemporary Primary Total Hip and Knee Arthroplasties

Cited by 26 publications

References 28 publications

Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

The necessity of routine postoperative laboratory tests after total hip arthroplasty for hip fracture in a semi-urgent clinical setting

Is Routine Hemoglobin Monitoring Necessary after Elective Hip and Knee Arthroplasty?

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