Blood loss in primary total hip arthroplasty with a short versus conventional cementless stem: a retrospective cohort study

Blood loss in primary total hip arthroplasty occurs mainly postoperatively, but current formulas for calculating blood loss are inaccurate: a retrospective study of 208 cases

INTRODUCTION

Total hip arthroplasty (THA) is potentially associated with high blood loss, possibly requiring transfusion. To avoid well-known complications of allogenic transfusions, risk stratification and patient optimization are recommended. This study explores whether bone quality, as evaluated by the Singh Index (SI), impacts blood loss in primary THA, as recently identified in fracture surgery.

METHODS

Retrospective, single-center study conducted to examine intraoperative blood loss (IBL) and total blood loss (TBL) in primary THA performed in adults through an anterior approach between 10/2021 and 05/2022. TBL estimation utilized formulas of Gross, Camarasa, Frankfurt and OSTHEO.

RESULTS

A total of 218 unilateral THA were included. TBL substantially exceeded IBL, primarily occurring within the first postoperative day. The formulas were largely consistent, TBL reaching approximately one-third of the estimated total blood volume, except for the Frankfurt formula, which provided much lower values. However, all four formulas failed when IBL exceeds 1'000 ml, a common threshold in THA. Operation time correlated with increased IBL but not TBL. The body mass index (BMI) appeared to be a risk factor for TBL. The SI had a significant but relatively small influence.

CONCLUSION

TBL after THA is relevant, accounting for approximately one-third of total blood volume, primarily occurring within the first 24 h. Blood counts are recommended on the first postoperative day and should be repeated on the second day in case of clinical suspicion. There is a correlation between bone quality, as evaluated by the SI, and TBL, but the effect is less than for BMI. Considering ease of use and consideration of RBC (re-)transfusion, the formula from Camarasa et al. appears to be the best available. However, the various formulas available for estimation of perioperative TBL fail at blood losses not uncommon in THA. Therefore, there is a need for new instruments to evaluate TBL.

Patient characteristics and procedural variables are associated with length of stay and hospital cost among unilateral primary total hip arthroplasty patients: a single-center retrospective cohort study

BACKGROUND

Total hip arthroplasty (THA) is a successful treatment for many hip diseases. Length of stay (LOS) and hospital cost are crucial parameters to quantify the medical efficacy and quality of unilateral primary THA patients. Clinical variables associated with LOS and hospital costs haven't been investigated thoroughly.

METHODS

The present study retrospectively explored the contributors of LOS and hospital costs among a total of 452 unilateral primary THA patients from January 2019 to January 2020. All patients received conventional in-house rehabilitation services within our institute prior to discharge. Outcome parameters included LOS and hospital cost while clinical variables included patient characteristics and procedural variables. Multivariable linear regression analysis was performed to assess the association between outcome parameters and clinical variables by controlling confounding factors. Moreover, we analyzed patients in two groups according to their diagnosis with femur neck fracture (FNF) (confine THA) or non-FNF (elective THA) separately.

RESULTS

Among all 452 eligible participants (266 females and 186 males; age 57.05 ± 15.99 year-old), 145 (32.08%) patients diagnosed with FNF and 307 (67.92%) diagnosed with non-FNF were analyzed separately. Multivariable linear regression analysis revealed that clinical variables including surgery duration, transfusion, and comorbidity (stroke) among the elective THA patients while the approach and comorbidities (stoke, diabetes mellitus, coronary heart disease) among the confine THA patients were associated with a prolonged LOS (P < 0.05). Variables including the American Society of Anesthesiologists classification (ASA), duration, blood loss, and transfusion among the elective THA while the approach, duration, blood loss, transfusion, catheter, and comorbidities (stoke and coronary heart disease) among the confine THA were associated with higher hospital cost (P < 0.05). The results revealed that variables were associated with LOS and hospital cost at different degrees among both elective and confine THA.

CONCLUSIONS

Specific clinical variables of the patient characteristics and procedural variables are associated the LOS and hospital cost, which may be different between the elective and confine THA patients. The findings may indicate that evaluation and identification of detailed perioperative factors are beneficial in managing perioperative preparation, adjusting patients' anticipation, decreasing LOS, and reducing hospital cost.

Risk factors for failure after cementless femoral revision THA: a consecutive series of 105 cases

INTRODUCTION

Cementless femoral revision total hip arthroplasty (RTHA) after periprosthetic fracture, aseptic loosening or infection is a challenging surgical procedure. The aim of this study was to evaluate the incidence and reasons for failure after two-stage septic revision, periprosthetic fracture or aseptic loosening that may reveal a rationale for cementless RTHA in two-stage revisions.

MATERIALS AND METHODS

A consecutive series of 105 cases using cementless femoral revision prostheses were evaluated retrospectively. Indications for revision were 39 two-stage revisions after infection, 49 aseptic loosenings, and 17 periprosthetic fractures. A Kaplan-Meier analysis was performed using infection with or without removal of the implant as an endpoint.

RESULTS

Incidence of infection with or without implant removal was significantly higher in patients treated for periprosthetic fractures compared to two-stage revisions or aseptic loosening (log-rank P < 0.0001). The mean follow-up period was 6.4 (2.0-13.7) years. Using infection with or without implant removal as the endpoint, 12 patients were diagnosed after the index operation resulting in a cumulative risk after 13.7 years of 29.9% (95% CI 0-61.2).

CONCLUSION

Cementless revision using a modular tapered device is reliable with respect to reinfection risk in two-stage procedures.