Blood salvage and allogenic transfusion needs in revision hip arthroplasty

Abstract

Blood transfusions frequently are required after revision total hip arthroplasty, and although autologous and allogenic transfusions are effective in replacing blood loss, they are not without risks. To reduce the dependency on these types of transfusions, intraoperative blood collection and return by autotransfusion replacement systems are being used as an alternative or conjunctive therapy. We retrospectively reviewed 147 hip revision surgeries to determine if autotransfusion replacement systems return from the Cell Saver or the OrthoPat decreased the need for allogenic blood. We also questioned if components revised and preoperative hematocrit were risk factors for allogenic transfusion. The two blood salvage systems were compared for blood loss, autotransfusion replacement systems collection and return, allogenic use, and the implants replaced. Both systems were found to replace at least 42% of blood lost during surgery, averaging a return of 370 mL. Allogenic blood transfused was reduced by 31% with the use of an autotransfusion replacement systems machine. Risk factors found to be associated with the need for allogenic transfusions are femoral component revision or femoral and acetabular revision, preoperative hematocrit less than 45%, and autotransfusion replacement systems return greater than 300 mL.

Level of evidence: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.