Abstract:

The substantial blood loss that can occur during total hip arthroplasty frequently requires allogeneic transfusions. Both allogeneic transfusions and post-operative anemia are causes of increased morbidity, cardiovascular risks, and length of stay. This anemia can also lead to decreased vigor, suboptimal rehabilitation, and lowered quality of life in patients undergoing total hip arthroplasty. The aim of this review was to analyze recent evidence on nonsurgical intra-operative blood management strategies utilized for total hip arthroplasty. Specifically, we evaluated the use of fibrin sealants, desmopressin, acute normovolemic hemodilution, hypotensive anesthesia, blood salvage, and peri-operative normothermia. No single strategy has been shown to provide superior results over another in reducing the need for allogeneic transfusions. However, a combination of the above blood management strategies may further result in reduced blood loss over one strategy. Larger prospective randomized studies comparing the individual strategies, as well as their combination, are needed to develop the best algorithm that can be the most effective and safe for intra-operative blood management in 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, MD, Samik Banerjee, MD, Research fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Bhaveen H. Kapadia, MD, Research fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Guneet S. Sodhi, BS, Medical Student, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, Kimona Issa, MD , Research fellow , Seton Hall University School of Health , and Medical Sciences , Department of Orthopaedic Surgery , South Orange Village, New Jersey, Steven F. Harwin, MD, Chief of joint reconstruction, Beth Israel Medical Center, Adult Reconstruction and Total Joint Replacement Service, Michael A. Mont, MD, Director of Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD

PMID:  24347481

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