Abstract:

Total hip arthroplasty is associated with marked blood loss, with the potential for up to 90% of patients requiring allogeneic transfusions. Also, perioperative-induced anemia is associated with lower postoperative functional scores, increased mortality, increased cardiovascular risks, longer hospital stays, and postoperative infections. The purpose of this review was to analyze the recent evidence on preoperative blood management strategies utilized for total hip arthroplasty. Specifically, we evaluated the use of preoperative iron therapy, intravenous erythropoietin, and autologous blood donation. No single strategy was shown to be superior over another in reducing the need for allogeneic transfusions; however, a combination of these blood management strategies may result in improved blood loss outcomes. Larger prospective randomized studies comparing the individual strategies, as well as combination therapies, are needed to develop a concise statement on the most effective and efficient preoperative blood management treatment algorithms for total hip arthroplasty.

Authors:

Jeffrey J. Cherian, DO, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Bhaveen H. Kapadia, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Kimona Issa, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Samik Banerjee, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Vincent K. McInerney, MD, Seton Hall University, Director of the Department of Orthopaedics, Saint Joseph Regional Medical Center, Paterson, New Jersey, Steven F. Harwin, MD, Beth Israel Medical Center, Director of Adult Reconstruction and Total Joint Replacement Service, New York, New York, Michael A. Mont, MD, Director, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland

PMID: 24085509

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