Total joint replacement and blood loss: what is the best equation?

Abstract

With the population aging, total joint replacements which are an effective method to restore patient's mobility are an increasing necessity. However, such operations are known to entail serious blood loss, which may have dramatic consequences in patients with chronic diseases or when the prosthesis is revised, a situation where the blood loss is even higher. Therefore, formulas to better estimate the blood loss are available. These formulas may also be used for clinical studies to compare blood loss between different joint replacement techniques. The aim of this review is to provide a clear understanding of the formulas and to help physicians to further improve their blood loss estimation. Moreover, surgeons will then be able to choose the most accurate and user-friendly formula for more comparable data between clinical studies.

Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study

“…We hypothesised that epinephrine in the LIA may decrease bleeding because of its adrenergic effect (vasoconstriction). However, evaluating blood loss in THA is difficult, and few studies report such results [21]For our analysis, we used multiple direct (operative bleeding volume, Hb) and indirect (Mercuriali's formula, red blood cell transfusion) measures reported in the literature [21,22] and found no significant differences for any criteria between study groups. In comparison, studies on the effect of LIA in total knee arthroplasty are more frequent and report significant improvements in regard to bleeding [23], especially when ketorolac is used in the mixture [24].…”

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

“…Hct=hematocrit, preop=preoperative, postop=postoperative, d=day Fig. 1 The haemoglobin levels Data for blood loss after joint replacement in the literature are hardly comparable to each other due to the heterogeneity of patients and the many different equations used to calculate blood loss [27].…”

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

“…To reduce exposure to ABT peri-operative blood management is in general discussed [10][11][12][13]. Some authors recommended pre-operative blood donation [14], correction of preoperative anaemia [15], autologous donation and retransfusion systems [10,[16][17][18][19][20][21][22][23], supplementation of erythropoietin or iron [24,25], pharmacologic agents like tranexamic acid [26,27], plasmapheresis, normovolaemic haemodilution [28][29][30][31] and post-operative red blood cell salvage [32].…”