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Does the surgical approach in one stage bilateral total hip arthroplasty affect blood loss?

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Abstract

Purpose

It is not clear whether type of surgical approach affects the amount of blood loss in one-stage bilateral total hip arthroplasty (THA). This study therefore aims to examine if type of surgical approach can affect peri-operative blood loss and allogeneic blood transfusion in patients undergoing one-stage bilateral THA.

Methods

Records of 319 patients who underwent one-stage bilateral THA from January 2004 to June 2011 were retrospectively reviewed. Patients were divided into two groups: direct anterior (DA) approach (75 patients) and direct lateral (DL) approach (244 patients). Blood loss was calculated using a previously validated formula. Blood loss and need for allogeneic blood transfusion were compared between the two groups. Additionally, the effects of using cell saver and surgical approach were evaluated in a multivariate analysis.

Results

Compared to the DL approach, calculated blood loss was significantly lower in the DA group (2,813.90 ± 804.13 ml vs 3,617.03 ± 1,148.47 ml) and a significantly lower per cent of patients needed allogeneic blood transfusion in the DA group (26.6 vs 52.4 %). Intra-operative cell saver was used in 36 patients. Compared to the non-cell saver group, mean blood loss was significantly higher in the cell saver group (4,061.0 ± 1,285.55 ml vs 3,347.71 ± 1,083.85 ml), whereas the difference between the two groups regarding allogeneic blood transfusion was not statistically significant. The DA approach was an independent predictor of lower peri-operative blood loss and allogeneic blood transfusion while using cell saver was not.

Conclusions

Our results may be explained by the lower extent of muscular dissection performed in the DA approach. Our findings also indicate that intra-operative cell salvage might not be justified in bilateral THA performed expeditiously.

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References

  1. Saito S, Tokuhashi Y, Ishii T, Mori S, Hosaka K, Taniguchi S (2010) One- versus two-stage bilateral total hip arthroplasty. Orthopedics 33(8). doi: 10.3928/01477447-20100625-07

  2. Reuben JD, Meyers SJ, Cox DD, Elliott M, Watson M, Shim SD (1998) Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty. J Arthroplasty 13:172–179

    Article  PubMed  CAS  Google Scholar 

  3. Aghayev E, Beck A, Staub LP, Dietrich D, Melloh M, Orljanski W, Röder C (2010) Simultaneous bilateral hip replacement reveals superior outcome and fewer complications than two-stage procedures: a prospective study including 1819 patients and 5801 follow-ups from a total joint replacement registry. BMC Musculoskelet Disord 11:245. doi:10.1186/1471-2474-11-245

    Article  PubMed  Google Scholar 

  4. Parvizi J, Tarity TD, Sheikh E, Sharkey PF, Hozack WJ, Rothman RH (2006) Bilateral total hip arthroplasty: one-stage versus two-stage procedures. Clin Orthop Relat Res 453:137–141

    Article  PubMed  Google Scholar 

  5. Parvizi J, Chaudhry S, Rasouli MR, Pulido L, Joshi A, Herman JH, Rothman RH (2011) Who needs autologous blood donation in joint replacement? J Knee Surg 24:25–31

    Article  PubMed  Google Scholar 

  6. Marcucci C, Madjdpour C, Spahn DR (2004) Allogeneic blood transfusions: benefit, risks and clinical indications in countries with a low or high human development index. Br Med Bull 70:15–28

    Article  PubMed  Google Scholar 

  7. Park JH, Rasouli MR, Mortazavi SMJ, Tokarski AT, Maltenfort MG, Parvizi J (2013) Predictors of perioperative blood loss in total joint arthroplasty J Bone Joint Surg Am (in press)

  8. Hu S, Zhang ZY, Hua YQ, Li J, Cai ZD (2009) A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br 91:935–942

    PubMed  CAS  Google Scholar 

  9. Feagan BG, Wong CJ, Kirkley A, Johnston DW, Smith FC, Whitsitt P, Wheeler SL, Lau CY (2000) Erythropoietin with iron supplementation to prevent allogeneic blood transfusion in total hip joint arthroplasty. A randomized, controlled trial. Ann Intern Med 133:845–854

    Article  PubMed  CAS  Google Scholar 

  10. Sukeik M, Alshryda S, Haddad FS, Mason JM (2011) Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br 93:39–46

    PubMed  CAS  Google Scholar 

  11. Zhou XD, Tao LJ, Li J, Wu LD (2013) Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials. Arch Orthop Trauma Surg 133:1017–1027. doi:10.1007/s00402-013-1761-2

    Article  PubMed  Google Scholar 

  12. Huët C, Salmi LR, Fergusson D, Koopman-van Gemert AW, Rubens F, Laupacis A (1999) A meta-analysis of the effectiveness of cell salvage to minimize perioperative allogeneic blood transfusion in cardiac and orthopedic surgery. International Study of Perioperative Transfusion (ISPOT) Investigators. Anesth Analg 89:861–869

    Article  PubMed  Google Scholar 

  13. Smith TO, Blake V, Hing CB (2011) Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes. Int Orthop 35:173–184

    Article  PubMed  Google Scholar 

  14. Martin R, Clayson PE, Troussel S, Fraser BP, Docquier PL (2011) Anterolateral minimally invasive total hip arthroplasty: a prospective randomized controlled study with a follow-up of 1 year. J Arthroplasty 26:1362–1372

    Article  PubMed  Google Scholar 

  15. Fink B, Mittelstaedt A, Schulz MS, Sebena P, Singer J (2010) Comparison of a minimally invasive posterior approach and the standard posterior approach for total hip arthroplasty A prospective and comparative study. J Orthop Surg Res 5:46. doi:10.1186/1749-799X-5-46

    Article  PubMed  Google Scholar 

  16. Restrepo C, Parvizi J, Pour AE, Hozack WJ (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty 25:671–679

    Article  PubMed  Google Scholar 

  17. Kennon RE, Keggi JM, Wetmore RS, Zatorski LE, Huo MH, Keggi KJ (2003) Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am 85-A:39–48

    PubMed  Google Scholar 

  18. Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg Br 64:17–19

    PubMed  CAS  Google Scholar 

  19. Moskal JT, Mann JW 3rd (1996) A modified direct lateral approach for primary and revision total hip arthroplasty. A prospective analysis of 453 cases. J Arthroplasty 11:255–266

    Article  PubMed  CAS  Google Scholar 

  20. Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM, Cremers S, Abraham IL, OSTHEO Investigation (2003) Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 43:459–469

    Article  PubMed  Google Scholar 

  21. Garvin KL, Feschuk CA, Sekundiak TD, Lyden ER (2005) Blood salvage and allogenic transfusion needs in revision hip arthroplasty. Clin Orthop Relat Res 441:205–209

    Article  PubMed  Google Scholar 

  22. Bottner F, Pavone V, Johnson T, Heitkemper S, Sculco TP (2003) Blood management after bilateral total knee arthroplasty. Clin Orthop Relat Res 410:254–261

    Article  PubMed  Google Scholar 

  23. Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD (2011) Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12:123–129

    Article  PubMed  Google Scholar 

  24. Mayr E, Nogler M, Benedetti MG, Kessler O, Reinthaler A, Krismer M, Leardini A (2009) A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Clin Biomech (Bristol, Avon) 24:812–818

    Article  Google Scholar 

  25. Anterior Total Hip Arthroplasty Collaborative Investigators, Bhandari M, Matta JM, Dodgin D, Clark C, Kregor P, Bradley G, Little L (2009) Outcomes following the single-incision anterior approach to total hip arthroplasty: a multicenter observational study. Orthop Clin North Am 40:329–342

    Article  PubMed  Google Scholar 

  26. Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124

    Article  PubMed  Google Scholar 

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Correspondence to Javad Parvizi.

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Parvizi, J., Rasouli, M.R., Jaberi, M. et al. Does the surgical approach in one stage bilateral total hip arthroplasty affect blood loss?. International Orthopaedics (SICOT) 37, 2357–2362 (2013). https://doi.org/10.1007/s00264-013-2093-0

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  • DOI: https://doi.org/10.1007/s00264-013-2093-0

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