Abstract
PurposePre-operative anaemia treatment has been associated with reduced morbidity in joint arthroplasty. This study examined the impact of a surgical prescription of epoetin (EPO) in contemporary total hip arthroplasty (THA).MethodsWe conducted a comparative study in a series of 1402 primary THAs performed in patients all having a pre-operative haemoglobin (Hb) level documented four to eight weeks before THA surgery. In group A (647 hips), one subcutaneous injection of 40,000 IU EPO once a week for four weeks was prescribed at the discretion of anaesthetist during the pre-operative visit in patients with pre-operative Hb between 10 and 13 g/dl. In group S comprising the remaining 755 hips, an amended EPO therapy including two injections of 20,000 to 40,000 IU was prescribed by the surgeon in patients with Hb less than 12 g/dl deemed at high risks to be transfused following THA. Primary study endpoint was the bleeding index (BI).ResultsEPO therapy was delivered in 43 patients (6.7%) in group A and in 26 patients (3.4%) in group S (p = 0.006). The mean total dose of EPO administrated was 115,349 IU in group A versus 75,200 IU in group S (p < 0.001). The mean BI were 2.7 ± 1.0 in group A and 2.8 ± 1.0 g/dl in group S (p = 0.375). No patient was blood-transfused up to post-operative day seven in group S versus five patients in group A (p = 0.021).ConclusionsThe amended protocol does not lead to increased peri-operative bleeding. Advances in intra-operative methods to reduce the bleeding allow changing indications of EPO in patients undergoing THA with a low level of Hb.
Highlights
Pre-operative anaemia is a well-established risk factor for blood transfusion following total hip arthroplasty (THA) [1]
In group S, comprising the remaining 755 hips, EPO therapy was prescribed by the surgeon via a dose of 20,000 to 40,000 UI epoetin alpha injected at 14 days and seven days before surgery in patients without uncontrolled arterial hypertension having an Hb less than 12 g/dl and deemed at high risk to be transfused following THA
EPO therapy was delivered in 43 patients (6.7%) in group A versus 26 patients (3.4%) in group S (p = 0.006)
Summary
Pre-operative anaemia is a well-established risk factor for blood transfusion following total hip arthroplasty (THA) [1]. Anaemia has been estimated to affect 15 to 44% of the adult population undergoing total joint arthroplasty (TJA), depending on the definition of anaemia [1, 2]. Pre-operative anaemia is associated with increased morbidity, mortality, and costs in non-cardiac surgery [3] and orthopaedic surgery [4], and Investigation performed at the Polyclinique de la Thiérache, Wignehies, France. EPO is approved by our National Health Authorities for hip surgery, and dosage instructions have not been changed for two decades. EPO is recommended by the European Medicinal Agency to reduce the need for blood transfusions in adults with moderate anaemia who are about to undergo major orthopaedic (bone) surgery, such as hip surgery. The organizational burden of EPO application needs to be considered, as EPO therapy needs to be applied well before surgery
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