Infection Is Not a Risk Factor for Perioperative and Postoperative Blood Loss and Transfusion in Revision Total Hip Arthroplasty

2017 ◽  
Vol 32 (1) ◽  
pp. 214-219.e1 ◽  
Author(s):  
Jaiben George ◽  
Matthew Sikora ◽  
Jessica Masch ◽  
Mario Farias-Kovac ◽  
Alison K. Klika ◽  
...  
Keyword(s):  
Risk Factor ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Postoperative Blood Loss ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip

Reducing Perioperative Blood Loss in Patients Undergoing Total Hip Arthroplasty

1998 ◽  
Vol 21 (1) ◽  
pp. 47-51
Author(s):  
A. D'Ambrosio ◽  
B. Borghi ◽  
A. Damato ◽  
G. D'Amato ◽  
D. Antonacci ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
General Anesthesia ◽  
General Anaesthesia ◽  
Hip Arthroplasty ◽  
Epidural Anaesthesia ◽  
Postoperative Blood Loss ◽  
Total Hip ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements

In this prospective, randomised, double-blind study, we investigated the effect of epidural anaesthesia and an antifibrinolytic agent, Aprotinin (500,000 KIU in bolus before surgery and 500,000 KIU h-1 in drip form during surgery), on intra and postoperative blood loss and transfusion requirements in total hip arthroplasty. Sixty patients were allocated randomly to four groups (A: epidural + general anesthesia + Aprotinin, B: epidural + general anesthesia + placebo (equal volume), C: general anaesthesia + Aprotinin, D: general anaesthesia + placebo). Postoperative analgesia: epidural analgesia in groups A and B, systemic analgesia with opiates in groups C and D. Blood loss during surgery was monitored and salvaged with the Compact-A Dideco, and postoperative blood loss with the BT 797 Recovery Dideco for the first 24 hours. Perioperative blood loss, frequency and quantity of transfusions were significantly higher in group D (p < 0.0001). Total blood loss was reduced by 31.3% by epidural anaesthesia, 20.4% by Aprotinin and 51.4% using a combination of the two techiniques.

scholarly journals Use of Topical Tranexamic Acid Reduces Direct and Indirect Blood Loss and Transfusion Rates in Revision Total Hip Arthroplasty

2019 ◽  
Vol 16 (S2) ◽  
pp. 285-292
Author(s):  
Elina Huerfano ◽  
Manuel Huerfano ◽  
Kate Shanaghan ◽  
Maureen Barlow ◽  
Stavros Memtsoudis ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Topical Tranexamic Acid

The Use of Cryotherapy in the Early Postoperative Period after Total Hip Arthroplasty

2019 ◽  
Vol 21 (5) ◽  
pp. 339-348 ◽  
Author(s):  
Tosan Okoro ◽  
Yousef Ibrahim ◽  
Nadia Mansour ◽  
Phillip Alderman ◽  
Aled Evans
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Blood Loss ◽  
Outcome Measures ◽  
Hip Arthroplasty ◽  
Early Period ◽  
Postoperative Blood Loss ◽  
Secondary Outcome ◽  
Postoperative Phase ◽  
Total Hip

Background. Recent evidence suggests that cryotherapy may be beneficial in reducing postoperative pain and blood loss in joint arthroplasty. The objective of this study was to review the use of cryotherapy in the early postoperative phase after total hip arthroplasty to assess the benefits in terms of pain relief and reduction in postoperative blood loss. Material and methods. A prospective cohort study of the use of a cryotherapy device (Hilotherm) was performed in patients following total hip arthroplasty. The primary outcome measures were visual analogue score (VAS) for pain (at 24 and 48 hours postoperatively), and amount of postoperative blood loss, measured by change in haemoglobin (g/L). The secondary outcome measures were length of stay (days), duration of patient controlled analgesia (PCA) administered postoperatively (hours) and amount of analgesia used (mg) in the first 48 hours. Results. 28 patients were recruited (n=13 Hilotherm; n= 15 non-Hilotherm). Hilotherm application reduced pain in the first 24 hours, non-significantly, (3.50±2.41 vs 4.90±2.95; p=0.185). This effect was not carried through at 48 hours postoperatively (5.68±1.94 vs 3.72±2.46; p=0.029). Hilotherm application significantly reduced postoperative blood loss (22.38±5.71 g/L vs 29.13±10.22 g/L; p=0.045). Hilotherm reduced length of stay by almost 1 day; however, this was not statistically significant (4.46±2.33 vs 5.20±3.55; p=0.528). There was no difference in the length of time PCA was administered (22.30±0.75 vs 22.02±3.26; p=0.763). Patients in the non-Hilotherm group required more paracetamol on average (p=0.001). Conclusions. 1. Hilotherm application does not appear to significantly reduce pain postoperatively but re­sults in less postoperative blood loss. 2. There may be a role for the continued use of cryotherapy in the early period of rehabilitation following total hip arthroplasty, as it appears to result in more rapid ambulatory rehabilitation in patients, resulting in reduced length of stay.

Pharmacological reduction of bleeding during hip endoprosthetic replacement

2012 ◽  
Vol 153 (41) ◽  
pp. 1607-1612 ◽  
Author(s):  
Tamás de Jonge
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Red Cells ◽  
Postoperative Blood Loss ◽  
Total Hip ◽  
Group 2 ◽  
Primary Total Hip Arthroplasty ◽  
Group 1

Introduction: Endoprosthetic replacement of the large joints is accompanied by major bleeding. During the last few years several authors reported the perioperative administration of tranexamic acid and its beneficial effect on reducing the blood loss. Objectives: In the present study, the author studied the effect of intravenously administered tranexamic acid in patients undergoing primary total hip arthroplasty in order to examine whether this treatment could reduce postoperative blood loss, the amount of transfused packed red cells, and the cost of the blood saving and/or transfusion. Methods: The author compared retrospectively the data of 104 patients undergoing primary total hip arthroplasty between April, 2010 and December, 2011. 54 patients were administered tranexamic acid (Group 1) and 50 patients were treated without tranexamic acid (Group 2). The amount of postoperative bleeding, haemoglobin, hematocrit, red blood cell count, and the number of units of the transfused packed red cells were recorded. Cost effectiveness of treatment with tranexamic acid was calculated. Results: Postoperative blood loss in Group 1 was 732 ml (210–1280 ml), and in Group 2 1092 ml (420–2640 ml). Ten of the 54 patients in Group 1 had to be transfused, and the all-over need was 20 units of packed red cells. 49 of the 50 patients in Group 2 received 98 units of allogenic blood. Thromboembolic complication was not observed in connection with the use of tranexamic acid. The reduction of blood loss with the application of tranexamic acid and the transfused packed red cells cost in average 5,180 HUF per patient in Group 1 and 15,850 HUF in Group 2. Conclusions: Intravenous administration of tranexamic acid reduces effectively the transfusion rate and the blood loss in the postoperative period in patients undergoing primary total hip arthroplasty. More than 1.5 million HUF and 240 units of packed red cells could be yearly saved with the introduction of this simple, safe and cheap method of drug administered blood conservation. Orv. Hetil., 2012, 153, 1607–1612.

Preoperative opioid use is a risk factor for complication following revision total hip arthroplasty

2020 ◽  
pp. 112070002094740
Author(s):  
Jacob M Wilson ◽  
Kevin X Farley ◽  
Greg A Erens ◽  
Thomas L Bradbury ◽  
George N Guild
Keyword(s):  
Risk Factor ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Healthcare Utilisation ◽  
Revision Total Hip Arthroplasty ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Total Hip ◽  
Increased Risk ◽  
Revision Tha

Background: The demand for revision total hip arthroplasty (THA) procedures continues to increase. A growing body of evidence in primary THA suggests that preoperative opioid use confers increased risk for complication. However, it is unknown whether the same is true for patients undergoing revision procedures. The purpose of this study was to investigate whether or not there was a relationship between preoperative opioid use and surgical complications, medical complications, and healthcare utilisation following revision THA. Methods: This is a retrospective cohort study using the Truven Marketscan database. Patients undergoing revision THA were identified. Preoperative opioid prescriptions were queried for 1 year preoperatively and were used to divide patients into cohorts based on temporality and quantity of opioid use. This included an opioid naïve group as well as an “opioid holiday” group (6 months opioid naïve period after chronic use). Demographic and complication data were collected and both univariate and multivariate analysis was then performed. Results: 62.5% of patients had received an opioid prescription in the year preceding surgery. Patients with continuous preoperative opioid use had higher odds of the following: infection (superficial or deep surgical site infection; OR 1.29; 95% CI, 1.03–1.62, p  = 0.029), wound complication (OR 1.36; 95% CI, 1.02–1.82, p = 0.037), sepsis (OR 1.90; 95% CI 1.08–3.34, p = 0.026), and revision surgery (OR 1.54, 95% CI, 1.28–1.85, p < 0.001). This group also had higher care utilisation including extended length of stay, non-home discharge, 90-day readmission, and emergency room visits ( p < 0.001). An opioid holiday mitigated some of this increased risk as this cohort has baseline (i.e. same as opioid naïve) risk ( p > 0.05 for all comparison). Conclusions: Opioid use prior to revision THA is common and is associated with increased risk of postoperative complication. Given that risk was reduced by a preoperative opioid holiday, this represents a modifiable risk factor which should be discussed and addressed preoperatively to optimise outcomes.

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