2018, Vol. 2 Issue 4, Part C
Total joint arthroplasty is the operation of choice and a reliable option for end stage arthritis of the hip and knee. With a growing and aging population, the incidence of total hip and knee arthroplasty is increasing. Total joint arthroplasty surgery carries inherent risks. Anemia due to blood loss remains one of the major complications from joint replacement surgery, and is relatively common. Therefore it is extremely important to improve the safety of this operation and reduce the potential complications to ensure that patients achieve the desired improvement in their quality of life and the costs of care associated with these elective procedures are minimized. This article evaluates the current evidence base for the current strategies employed by orthopedic surgeons to achieve optimal blood transfusion management in total hip and knee arthroplasty.
Aim: The aim of our study was to ascertain if intra-operative cell salvage is effective in negating the need for allogenic transfusion in patients undergoing primary hip and knee arthroplasty.
Methods: The study comprises a retrospective analysis of 371 consecutive patients undergoing primary hip or knee arthroplasty with concomitant use of intra-operative cell salvage. The percentage of patients requiring allogenic transfusion despite cell salvage was the primary outcome. Other factors affecting transfusion risk were analyzed.
Results: The overall transfusion rate was 16%. 24% of hips and 12% of knees received allogenic blood. Despite routinely utilizing cell salvage in all cases, only 59% of hips and 63% of knees received returned red cells. Significantly greater blood loss occurred in the patients who were given returned red cells. Transfused patients had a significantly lower pre-operative hemoglobin, less intra-operative blood loss and were less likely to receive cell salvage blood. Pre-operative hemoglobin less than 120 g/L, female gender, and age greater than 75 was associated with a higher risk of allogenic transfusion. Patients receiving allogeneic transfusion had a longer hospital stay and greater complication rate.
Conclusions: Intra-operative cell salvage reduces but does not eliminate the need for allogeneic blood transfusion in primary hip and knee arthroplasty. The efficacy of cell salvage is related to hematocrit and volume of the blood lost. Intra-operative cell salvage on its own is not effective in patients with a pre-operative haemaglobin less than 120g/L and should be combined with additional strategies such as correcting pre-operative anaemia.