[Blood loss in total hip prosthesis implantation: lateral versus supine position]

Direct anterior approach for total hip arthroplasty with patients in the lateral decubitus versus supine positions: A prospective, double-blinded, randomized clinical trial

PURPOSE

The direct anterior approach (DAA) for total hip arthroplasty (THA) can be performed with patients in either in the lateral decubitus or supine position. Prompted by the lack of studies addressing differences between the two positions, this investigation aimed to examine clinical and radiographic outcomes and compare the lateral decubitus versus the supine position for THA using the DAA.

METHODS

Between January 1 and October 1, 2020, 90 patients who underwent primary unilateral THA using the DAA were recruited, with 54 (60%) undergoing THA in the supine position (SP group) and 36 (40%) in the lateral decubitus position (LP group). Technical information, clinical and radiographic outcomes, and patient-reported outcomes, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short-Form-12 (SF-12) were evaluated. All data were subjected to several statistical tests.

RESULTS

There were no preoperative differences in baseline characteristics between the LP and SP groups, which were also similar in terms of operative duration, length of hospital stay, and blood loss. Radiographic assessment confirmed satisfactory positioning of the prosthesis in both groups. There were no significant differences in terms of CK-MB and hemoglobin levels, Harris Hip Score, WOMAC, UCLA, visual analog scale score, and SF-12. The incidence of complications in the LP group was lower than in the SP group.

CONCLUSION

Total hip arthroplasty performed via DAA in the LP and SP groups yielded excellent clinical outcomes, although the incidence of complications in the former was lower than in the latter.

Does patient positioning influence blood loss and transfusion rate in hip replacement for femoral neck fractures? A single-centre, retrospective chart review

Background

We compared blood loss and transfusion frequency between the lateral decubitus and the supine position in patients undergoing hip replacement surgery due to femoral neck fractures.

Methods

We retrospectively included femoral neck fracture patients treated with either hemi (HA) or total hip arthroplasty (THA). We included a total of 626 patients, of which 313 patients underwent surgery in the lateral decubitus position and 313 patients in the supine position. Preoperative and day 1 postoperative blood measures including hemoglobin (Hb), hematocrit (Hct), and red blood cell count (RBC) were evaluated, as well as transfusion records analyzed.

Results

The following decrease of laboratory parameters between pre- and 1st day postoperative measures was noted: RBC: -0.77 G/L (± 0.5 G/L, median = -0.80 G/L; range: -0.50 – -1.10 G/L); Hct: -7.08 % (± 4.7 %, range: -4.70 – -9.90 G/L); Hb: -2.36 g/dL (± 1.6 g/dL, range: -1.50. – -3.40 g/dL). We did not observe significant differences in transfusion frequency between the two study cohorts (p = 0.735 for THA, p = 0.273 for HA). No influence of patient positioning on Hb-decrease, Hct-decrease, or RBC-decrease was noted in our two-way ANOVA models with consideration of implant type and fixation technique (F(3,618) = 1.838, p = 0.139; F(3,618) = 2.606, p = 0.051; F(3,618) = 1.407, p = 0.240).

Conclusions

We did not observe  significant differences in perioperative blood values and transfusion rates in association with patient positioning in patients undergoing hip replacement surgery for femoral neck fractures.

Level of evidence

Level III, retrospective cohort study.

Comparison of markers for muscle damage, inflammation, and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty: A prospective, randomized, controlled trial

It is proposed that the use of biochemical markers for muscle damage and inflammation provides an objective measure on invasiveness in total hip arthroplasty. We analyzed levels of creatine kinase and C-reactive protein (CRP) after total hip arthroplasty in patients randomized to minimally invasive direct anterior approach or direct lateral approach, also recording consumption of pain medication and levels of pain postoperatively. Eighty-three patients were operated by the use of anterior approach and eighty using lateral. Creatine kinase and CRP levels were measured preoperatively, creatine kinase directly after surgery, and both creatine kinase and CRP on postoperative day 1 through 4. The use of pain medication and levels of pain were recorded. Creatine kinase were higher in the anterior group compared to the lateral group, reaching statistical significance directly postoperative and on day 4. Levels of CRP did not differ, reaching a maximum of mean 52 mg/L on day 3. The use of pain medication was higher in the lateral group on the day of surgery (p = 0.011), and pain levels were higher on all days in the lateral group (p < 0.007). In conclusion, the use of minimally invasive anterior approach caused less pain, but higher postoperative levels of CK, than the use of direct lateral approach.

Tackling the learning curve: comparison between the anterior, minimally invasive (Micro-hip®) and the lateral, transgluteal (Bauer) approach for primary total hip replacement

BACKGROUND AND PURPOSE

There is still conflicting evidence about the true benefit of minimally invasive (MI) techniques in total hip replacement (THR). The aim of this prospective study was to evaluate the safeness of a MI approach during the learning curve of a single surgeon. Second, clinical and radiographic results among the MI THR group were compared with the results using a standard transgluteal (Bauer) approach.

METHODS

86 primary unilateral total hip arthroplasties (THAs) through a MI, anterior (Micro-hip(®)) approach were performed by a single senior surgeon (ES), representing a consecutive series of patients after beginning with the MI technique. Cases were compared to a matched cohort of patients who were treated with a standard transgluteal (Bauer) approach. Operation time, incision length, perioperative blood loss, haemoglobin level and blood transfusions were monitored. Complications were documented and followed up 1 year postoperatively. The Harris Hip Score (HHS), range of motion, use of analgetics, the Trendelenburg sign, sensibility of the lateral femoral cutaneous nerve and the acetabular/femoral component placement as well as potential heterotopic ossifications were analysed in both the groups after 12 months postoperatively.

RESULTS

74 MI THR patients and 60 standard THR patients were available for the one year follow-up. Operative time was significantly longer in the MI group, reduction in the haemoglobin level during the first 24 h was significant and the length of skin incision was significantly shorter. No significant differences were found for HHS, range of motion, use of analgetics, the Trendelenburg sign, and the acetabular/femoral component placement, heterotopic ossifications and intra- and postoperative complications. Sensibility of the lateral femoral cutaneous nerve was affected in three patients in the MI group. Radiographic evaluation revealed no component migration, implant subsidence or radiolucency signs in both the groups.

DISCUSSION

Consistent with recent meta-analysis we found reduced blood loss, similar clinical/radiographic outcome and similar complication rates compared to standard THA. Our study shows, that MI THR is a safe procedure during the learning curve of an experienced surgeon.

The Aquamantys system--an alternative to reduce blood loss in primary total hip arthroplasty?

To evaluate the effectiveness of the Bipolar Sealer 6.0-VT (BPS 6.0-VT) (Tissue Link Medical, Inc, Dover, NH) in reducing blood loss compared with a conventional electrocautery (Erbe ICC 350) (Erbe ICC 350 (ERBE Elektromedizin GmbH, Tübingen, Germany). A prospective randomized trial of 105 patients with primary total hip arthroplasty (Erbe ICC 350: 50 patients; BPS 6.0-VT: 55 patients). On the basis of the calculation of the preoperative blood volume the total and postoperative blood loss were calculated. No statistically significant difference could be shown for total intraoperative and postoperative blood loss (group A 1846 mL; group B 1740 mL) (t test). Due to the lack of reduction of blood loss and the high costs of the BPS 6.0-VT, its use is not recommended in primary total hip arthroplasty.

The effect of patient position on blood loss in primary cemented total hip arthroplasty

INTRODUCTION

The total blood loss of 101 cemented primary total hip arthroplasties was studied in a prospective randomised study.

MATERIALS AND METHOD

Fifty of them were implanted in the supine position and 51 in the lateral position. The patients were matched for sex, height, weight and ASA grade. Only one surgeon carried out the operations using the same operative technique and identical prosthesis in both groups.

RESULTS

The intraoperative blood loss associated with the supine position was 1,156 ml (954-1,265 ml) and 1,129 ml (989-1,310 ml) in the lateral position. There was no difference when comparing the two groups (P = 0.41).

CONCLUSION

Patient positioning in supine or lateral during total hip arthroplasty surgery has no bearing on the total amount of blood loss.

Strategies for blood management in orthopaedic and trauma surgery

Several aspects of the management of an orthopaedic surgical patient are not directly related to the surgical technique but are nevertheless essential for a successful outcome. Blood management is one of these. This paper considers the various strategies available for the management of blood loss in patients undergoing orthopaedic and trauma surgery.