Hip resurfacing arthroplasty and perioperative blood testing.

Andrew Cook,Ian Smith,Patrick Weinrauch,Steven Cook

doi:10.1155/2014/109378

Abstract

It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

Highlights

Hip resurfacing arthroplasty, when indicated, is usually recommended in younger and healthier patient populations with less medical comorbidity
In comparison to conventional total hip replacement, typically requires additional soft tissue releases and surgical dissection and can be associated with increased blood loss [1–5]. In many institutions it is standard management in the perioperative period associated with major interventions such as hip joint arthroplasty to measure haemoglobin levels prior to and just after surgery. The rationale for such measurement is to assist in identification of patients with anaemia that may benefit from allogenic blood transfusion
There are, risks associated with allogenic blood transfusion and a growing trend to rationalise the use of this limited resource [6–9]

Summary

Introduction

Hip resurfacing arthroplasty, when indicated, is usually recommended in younger and healthier patient populations with less medical comorbidity. In comparison to conventional total hip replacement, typically requires additional soft tissue releases and surgical dissection and can be associated with increased blood loss [1–5]. In many institutions it is standard management in the perioperative period associated with major interventions such as hip joint arthroplasty to measure haemoglobin levels prior to and just after surgery. The rationale for such measurement is to assist in identification of patients with anaemia that may benefit from allogenic blood transfusion. In younger patients without significant medical comorbidity, postoperative haemoglobin levels should be considered a relative guide to overall patient assessment and clinical management, rather than an absolute indicator to the requirement of blood transfusion

Methods

Results

Conclusion