Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 11:30:101502.
doi: 10.1016/j.artd.2024.101502. eCollection 2024 Dec.

Routine Postoperative Hemoglobin and Hematocrit Tests Are Unnecessary Following Primary Total Hip and Knee Arthroplasty

Daniel J Howgate  1 , Roman P Austin  1   2 , Joshua S Bingham  1 , Mark J Spangehl  1 , Henry D Clarke  1
Affiliations

Routine Postoperative Hemoglobin and Hematocrit Tests Are Unnecessary Following Primary Total Hip and Knee Arthroplasty

Daniel J Howgate et al. Arthroplast Today. .

Abstract

Background: Acute blood loss and transfusion are recognized risks factors of total hip (THA) and total knee arthroplasty (TKA). This study aimed to investigate the clinical value of immediate postoperative hemoglobin and hematocrit (H&H) tests following primary elective THA and TKA.

Methods: This retrospective observational study was undertaken at a single academic hospital. Medical records were reviewed for a consecutive series of patients undergoing primary elective THA and TKA over a 12-month period. Patient demographic data; the use of preoperative anticoagulants; preoperative and postoperative blood test results; and the incidence of postoperative allogenic blood transfusion (ABT) were collected. The primary outcome measure was the incidence of postoperative ABT prescribed in response to the immediate postoperative H&H result.

Results: Overall, 367 eligible patients were included, with 167 THA (46%) and 200 TKA (54%) cases. Only 3 patients (0.8%) received a postoperative ABT; none on the day of surgery or on postoperative day 1. Immediate postoperative H&H tests were drawn in 246 patients (67%), but it did not influence clinical decision-making with regards to transfusion. No significant differences in ABT were observed in relation to patient age, sex, body mass index, operation (THA or TKA), or the use of preoperative anticoagulation medication. The incidence of ABT was significantly higher in patients with a combined preoperative hemoglobin <12.5 g/dL and hematocrit <40.0% (P = .003).

Conclusions: The incidence of postoperative blood transfusion following primary elective THA and TKA was low at 0.8%. Postoperative H&H tests were drawn in most patients but did not influence clinical management. Immediate postoperative hematological monitoring is unnecessary for most low-risk patients following uncomplicated primary elective THA and TKA.

Keywords: Arthroplasty; Hematology; Investigations; THA; TKA; Transfusion.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Scatterplot demonstrating the relationship between preoperative hemoglobin (Hb) and hematocrit (HCT) results and the incidence of postoperative transfusions (highlighted in red). The dashed lines represent the thresholds of Hb (12.5 g/dL) and HCT (40.0%), which were associated with a higher incidence of postoperative transfusions.
See this image and copyright information in PMC

References

    1. Lau R.L., Gandhi R., Mahomed S., Mahomed N. Patient satisfaction after total knee and hip arthroplasty. Clin Geriatr Med. 2012;28:349–365. doi: 10.1016/j.cger.2012.05.001. - DOI - PubMed
    1. Barahona M., Bustos F., Navarro T., Chamorro P., Barahona M.A., Carvajal S., et al. Similar patient satisfaction and quality of life improvement achieved with TKA and THA according to the goodman scale: a comparative study. J Clin Med. 2023;12:6096. doi: 10.3390/jcm12186096. - DOI - PMC - PubMed
    1. Shichman I., Roof M., Askew N., Nherera L., Rozell J.C., Seyler T.M., et al. Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040-2060. JB JS Open Access. 2023;8 doi: 10.2106/JBJS.OA.22.00112. - DOI - PMC - PubMed
    1. Bedard N.A., Pugely A.J., Lux N.R., Liu S.S., Gao Y., Callaghan J.J. Recent trends in blood utilization after primary hip and knee arthroplasty. J Arthroplasty. 2017;32:724–727. doi: 10.1016/j.arth.2016.09.026. - DOI - PubMed
    1. Tischler E.H., Chen A.F., Matthews C.N., Arnold W.V., Smith E.B. Are preoperative serologic type and screen tests necessary for primary total joint arthroplasty patients in specialty surgical hospitals? J Arthroplasty. 2016;31:2442–2446. doi: 10.1016/j.arth.2016.04.035. - DOI - PubMed

LinkOut - more resources