Multimodal blood management strategy in primary unilateral total knee or hip arthroplasty

Abstract

Objective To evaluate the efficacy and safety of multimodal blood management strategy in blood transfusion during perioperative period of primary unilateral total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods Prospectively recruited 403 patients (285 of whom underwent TKA and 118 of whom underwent THA) were admitted to the Department of Joint Surgery of Xijing Hospital between November 2015 and October 2016 as the study group, while records of 582 patients (393 of whom underwent TKA and 189 of whom underwent THA) between June 2014 and October 2015 were also investigated as the controls. Two groups were basically well-matched on separate index in baseline characteristics (all P values>0.05). Tranexamic acid was used in all patients, and perioperative multimodal blood management was implemented in the study group. Blood transfusion rate, maximum decline of hemoglobin, intraoperative blood loss, drainage volumes and the incidence of deep vein thrombosis, pulmonary thromboembolism and other postoperative complication were assessed. Results Blood transfusion rate of study group and controls were 1.2% (5/403) and 8.2% (48/582). Specifically, blood transfusion rate in patients undergoing TKA was 0.7% (2/285) and 6.9% (27/393) in the study group and controls, while patients underwent THA was 2.5% (3/118) and 11.8% (21/189) in both group (χ2=22.962, 15.353 and 7.402, all P values 0.05)]. Conclusions Multimodal blood management may decrease the need for allogeneic blood transfusion and may contribute to improved hemoglobin level of patients following primary unilateral THA and TKA. Moreover, this strategy does not increase the chance for postoperative complications, leading to a positive effect on outcome. Key words: Arthroplasty, replacement, knee; Arthroplasty, replacement, hip; Blood management; Blood transfusion