Blood management in direct anterior versus posterior primary total hip arthroplasty using tranexamic acid: a matched cohort study.

Abstract

Proponents of the direct anterior approach (DAA) for THA claim patients recover faster compared to primary THA through the posterior approach (PA). Blood loss and transfusion have substantially declined with the use of tranexamic acid (TXA). However, it is still controversial if hemoglobin drops and transfusion rates are affected by the surgical approach when TXA is routinely used. 2418 patients undergoing DAA THA were matched 1:1 with patients undergoing PA THA according to preoperative hemoglobin (± 1g/dl), age (± 5years), sex, BMI (± 5kg/m2) and year of surgery (± 2years). All patients received perioperative TXA. None of the patients donated autologous blood. Hemoglobin levels, drain placement and output, blood transfusion rates and volume as well as length of stay were recorded. A closed suction drain was used in 121 (5.0%) DAA and in 135 (5.6%) PA THAs (p = 0.369). Mean drain output was higher in the DAA compared to the PA group (134ml (0-520ml) versus 92.3ml (0-600ml), p = 0.004). There was no difference in hemoglobin drop [2.6g/dl versus 2.6g/dl (p = 0.143)] and transfusion rate [n = 31 (1.3%) versus n = 29 (1.2%), p = 0.793)] between DAA and PA THA. Mean transfusion amounts were 421.8ml (250-1120.8ml) in the DAA and 353.9ml (250-560ml) in the PA group (p = 0.801). The length of stay was shorter in the DAA group with a mean 1.6days versus 2.1days in the PA group (p ≤ 0.001). In this large matched cohort study, there was no difference in the perioperative hemoglobin drop, the transfusion rate and the transfusion amount between DAA and PA THA.