Perioperative Blood Loss During Total Hip Arthroplasty Among Patients With Ankylosing Spondylitis

Orthopedics ◽  
2017 ◽  
Vol 40 (5) ◽  
pp. e904-e910 ◽  
Author(s):  
Yong Hu ◽  
Wei-Zhou Jiang ◽  
Zhi-Fa Huang ◽  
Tahsin Tarik Torsha ◽  
De-Sheng Yang ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Perioperative Blood Loss

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.

Comparison of Oral and Intravenous Tranexamic Acid for Prevention of Perioperative Blood Loss in Total Knee and Total Hip Arthroplasty

2017 ◽  
Vol 52 (3) ◽  
pp. 246-250 ◽  
Author(s):  
Mary Alice Gortemoller ◽  
Bryan Allen ◽  
Rochelle Forsyth ◽  
Kimberly Theiss ◽  
Kristal Cunningham ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Retrospective Chart Review ◽  
Study Groups ◽  
Total Hip ◽  
Perioperative Blood Loss ◽  
Total Knee ◽  
Noninferiority Margin

Background: Tranexamic acid (TA) is an antifibrinolytic agent that prevents perioperative blood loss in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). This benefit has been established with the intravenous (IV) dosage form, but there is limited evidence evaluating oral TA in this setting. Objective: To compare the effect of oral versus IV TA on perioperative blood loss in those undergoing TKA or THA. Methods: In this single-centered retrospective chart review, participants at least 18 years of age who received IV or oral TA from a single surgeon who performed their THA or TKA were included. The primary outcome evaluated hemoglobin (Hgb) reduction. Power analysis determined that 165 participants were required in each group to achieve 80% power, with a noninferiority margin of 0.3 mg/dL. Results: Both study groups included 165 participants. Oral TA was noninferior to IV TA (Hgb difference = −0.12 g/dL [95% CI = −0.28 to 0.05; P = 0.0250]). A subgroup analysis of THA and TKA revealed that oral TA was noninferior to IV TA in THA (Hgb difference = 0.24 g/dL [95% CI = −0.17 to 0.5]), but oral TA failed to meet the noninferiority margin in the TKA subgroup (Hgb difference = −0.20 [95% CI = −0.38 to −0.02]). Conclusion: This study provides evidence that oral TA is a clinically effective and cost-efficient alternative to IV TA in the setting of THA and TKA.

Comparison of Blood Loss After Total Hip Arthroplasty Between Ankylosing Spondylitis and Osteoarthritis

2016 ◽  
Vol 31 (7) ◽  
pp. 1504-1509 ◽  
Author(s):  
Jia Li ◽  
Jinzhu Zhao ◽  
Chongru He ◽  
Wenwen Tong ◽  
Yuming Zou ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Total Hip

scholarly journals Active Ankylosing Spondylitis Increases Blood Loss during Total Hip Arthroplasty for a Stiff Hip Joint

2019 ◽  
Author(s):  
Yong Hu ◽  
Wei-Zhou Jiang
Keyword(s):  
Ankylosing Spondylitis ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Disease Activity ◽  
Hip Arthroplasty ◽  
Active Group ◽  
Nutrition Status ◽  
Transfusion Rate ◽  
Stable Group ◽  
Total Hip

Abstract Background: Total hip arthroplasty (THA) has been highlighted as the best treatment option for ankylosing spondylitis (AS) patients with advanced hip involvement. The huge blood loss associated with THA is a common concern of postoperative complications. Disease activity is a specific reflection of systematic inflammation of AS. The purpose of this study was to determine the effect of disease activity on blood loss during THA in patients with AS. Methods: Forty-nine patients with AS who underwent unilateral THAs were retrospectively studied. Ankylosing Spondylitis Disease Activity Score (ASDAS) was employed to evaluate the disease activity. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) formula was used to assess the surgical blood loss. The patients were divided into active group (ASDAS≥1.3; n=32) and stable groups (ASDAS<1.3; n=17) based on the ASDAS. Peri-operative laboratory values, plain radiographs, intra-operative data, transfusion volume, and use of hemostatic agents were recorded and statistically analyzed. Results: The ASDAS, pre-operative C-reactive protein level, erythrocyte sedimentation rate, and fibrinogen concentration in the active group were higher than the stable group (all P <0.05); however, the pre-operative hemoglobin concentration and albumin level were higher in the stable group (both P <0.05). The total blood loss during THA in stable patients was 1415.31 mL and 2035.04 mL in active patients ( P =0.006). The difference between the two groups was shown to be consistent after excluding the gender difference ( P =0.030). A high transfusion rate existed in both groups (stable group, 76.47% with an average of 1.53 units; active group, 84.37% with an average of 2.31 units), but there was no significant difference between the two groups (both P >0.05). Compensated blood loss, corresponding to transfusion, was noted significantly more often in the active group compared to the stable group ( P =0.027). Conclusion: Active AS patients are at high risk for increased blood loss during THA compared to stable patients. The underlying mechanism includes disorders of the coagulation and fibrinolytic systems, poor nutrition status, osteoporosis, imbalance of oxidative–antioxidative status and local inflammatory reaction. It is strongly recommended to perform THA in AS patients with stable disease.

scholarly journals Effect of carbazochrome sodium sulfonate combined with tranexamic acid on blood loss and inflammatory response in patients undergoing total hip arthroplasty

2021 ◽  
Vol 10 (6) ◽  
pp. 354-362
Author(s):  
Yue Luo ◽  
Xin Zhao ◽  
Zhouyuan Yang ◽  
Releken Yeersheng ◽  
Pengde Kang
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Inflammatory Response ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Transfusion Rate ◽  
Sodium Sulfonate ◽  
Total Hip ◽  
Perioperative Blood Loss ◽  
Group D

Aims The purpose of this study was to examine the efficacy and safety of carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) on blood loss and inflammatory responses after primary total hip arthroplasty (THA), and to investigate the influence of different administration methods of CSS on perioperative blood loss during THA. Methods This study is a randomized controlled trial involving 200 patients undergoing primary unilateral THA. A total of 200 patients treated with intravenous TXA were randomly assigned to group A (combined intravenous and topical CSS), group B (topical CSS), group C (intravenous CSS), or group D (placebo). Results Mean total blood loss (TBL) in groups A (605.0 ml (SD 235.9)), B (790.9 ml (SD 280.7)), and C (844.8 ml (SD 248.1)) were lower than in group D (1,064.9 ml (SD 318.3), p < 0.001). We also found that compared with group D, biomarker level of inflammation, transfusion rate, pain score, and hip range of motion at discharge in groups A, B, and C were significantly improved. There were no differences among the four groups in terms of intraoperative blood loss (IBL), intramuscular venous thrombosis (IMVT), and length of hospital stay (LOS). Conclusion The combined application of CSS and TXA is more effective than TXA alone in reducing perioperative blood loss and transfusion rates, inflammatory response, and postoperative hip pain, results in better early hip flexion following THA, and did not increase the associated venous thromboembolism (VTE) events. Intravenous combined with topical injection of CSS was superior to intravenous or topical injection of CSS alone in reducing perioperative blood loss. Cite this article: Bone Joint Res 2021;10(6):354–362.

scholarly journals Factors associated with blood loss in ankylosing spondylitis patients with hip involvement undergoing primary total hip arthroplasty: a cross-sectional retrospective study of 243 patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Liangliang Li ◽  
Jun Fu ◽  
Chi Xu ◽  
Haitao Guan ◽  
Ming Ni ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ankylosing Spondylitis ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Operating Time ◽  
Ordinal Logistic Regression ◽  
Factors Associated ◽  
Total Hip ◽  
Male Sex

Abstract Background Total hip arthroplasty (THA) can cause considerable blood loss and perioperative transfusion in ankylosing spondylitis (AS) patients. This study aimed to identify the factors related to blood loss in AS patients with hip involvement undergoing THA. Methods We analyzed 243 AS patients with advanced hip involvement undergoing primary THA from 2012 to 2017. Bilateral THA was performed by a one-stage operation during one general anesthesia session. The patients were divided into three groups according to the grade of blood loss, as determined by the Advanced Trauma Life Support hypovolemic shock classification system. Ordinal logistic regression was used to identify factors associated with blood loss in the patients. Results The proportion of patients who were male, underwent bilateral THA, had a hip range of motion (ROM) = 0°, had a BASRI-hip score of 4, underwent iliopsoas and adductor release, and underwent autologous or allogenic transfusion increased significantly with the grade of blood loss, while that of the patients who received tranexamic acid (TXA) decreased significantly (P < 0.05). The preoperative hemoglobin (Hb) level, hematocrit level, and operating time also increased significantly with the grade of blood loss (P < 0.05). The ordinal logistic regression results identified the factors related to blood loss during THA in AS patients with hip involvement to be the male sex (odds ratio [OR] = 3.287; 95% confidence interval [CI] 1.022, 10.567), bilateral THA (OR = 13.896; 95% CI 4.950, 39.011), hip ROM = 0° (OR = 2.513; 95% CI 1.277, 4.946), an elevated erythrocyte sedimentation rate (ESR) level (OR = 3.042; 95% CI 1.320, 7.014), an elevated preoperative Hb level (OR = 1.043; 95% CI 1.017, 1.070), a long operating time (OR = 1.009; 95% CI 1.003, 1.016), and the administration of TXA (OR = 0.252; 95% CI 0.134, 0.472). Conclusions The male sex, bilateral THA, a hip ROM = 0°, an elevated ESR level, a high preoperative Hb level, and a long operating time are risk factors associated with blood loss in AS patients with hip involvement undergoing THA, while the administration of TXA is a protective factor. These results might help determine the risk of bleeding in the perioperative assessment and develop more efficient blood management strategies for THA in AS patients with hip involvement.

scholarly journals Local infiltration analgesia with bupivacaine and adrenaline does not reduce perioperative blood loss in total hip arthroplasty

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257202
Author(s):  
Marcin Ceynowa ◽  
Tomasz Sikora ◽  
Marek Rocławski ◽  
Mariusz Treder ◽  
Krzysztof Kolarz ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Soft Tissues ◽  
Blood Transfusions ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Total Hip ◽  
Perioperative Blood Loss ◽  
Infiltration Analgesia

This study evaluates the effect of local infiltration analgesia with bupivacaine and adrenaline on perioperative blood loss in total hip arthroplasty. Patients who had primary total hip arthroplasty were retrospectively assigned to two groups. One group had 100 ml of bupivacaine/adrenaline solution injected into periarticular soft tissues at the end of the procedure. There were 55 patients in the infiltrated hip group and 44 patients in the not infiltrated group. Patients’ hemoglobin level (Hb), hematocrit (HTC), red blood count (RBC), platelet count (PLT) and International Normalized Ratio (INR) as well as the need for blood transfusions were compared statistically between groups preoperatively and postoperatively. There were no significant differences between Hb, HTC or RBC levels as well as the rate and amount of blood transfusions on the 1st, 4th postoperative days or at patients’ discharge between infiltrated and not infiltrated groups. This study does not support the hypothesis that the use of local infiltration analgesia with adrenaline may reduce perioperative blood loss in total hip arthroplasty.

scholarly journals Perioperative blood loss and diclofenac in major arthroplastic surgery

2011 ◽  
Vol 1 (1) ◽  
pp. 14-17
Author(s):  
Ljiljana Gvozdenović ◽  
Vesna Pajtić ◽  
Nemanja Gvozdenović ◽  
Saša Milić ◽  
Zoran Gojković
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Hip Arthroplasty ◽  
Control Group ◽  
Total Hip ◽  
Perioperative Blood Loss ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Introduction: Contemporary literature indicates precaution over the perioperative use of non-steroidal anti-inflammatory drugs, since they can potentially increase perioperative blood loss related to their mechanism of action. The aim of this study was to assess the influence of non-steroidal anti-inflammatory drugs on perioperative blood loss undergoing hip arthroplasty and its correlation with general and regional anesthesia.Methods: This prospective study included 120 patients who had undergone elective unilateral total hip arthroplasty. Patients were allocated into four groups. Groups 1 and 2 were pretreated with diclofenac and operated in general and regional anesthesia. Group 3 and 4 weren’t pretreated with any non-steroidal anti-inflammatory drug and were, as well, operated in general and regional anesthesia. Diclofenac was administered orally two times a day 75 mg (total 150 mg) and also as intramuscular injection (75 mg) preoperatively and 12 hours later on a day of surgery.Results: The perioperative blood loss in the rst 24 hours showed an increase of 29.4% in the diclofenac group operated in general anesthesia and increase of 26.8% in patients operated in regional anesthesia (P < 0.05) compared to control group. Statistical data evaluation of patients operated in general anesthesia compared to regional anesthesia, the overall blood loss in the rst 24 h after surgery, showed an increase of 6.4% in the diclofenac group and increase of 3.6% in placebo group. This was not statistically significant.Conclusion: Pretreatment with non-steroidal anti-inflammatory drugs (diclofenac) before elective unilateral total hip arthroplasty increases the perioperative blood loss signficantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.

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