Transfusion Rates in Total Hip Arthroplasty Are lower in Patients with Direct Anterior Approach

Publish Year: 1400
نوع سند: مقاله ژورنالی
زبان: English
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JR_TABO-9-6_007

تاریخ نمایه سازی: 23 آبان 1400

Abstract:

Background: Blood conservation and reduction in the need for allogeneic blood transfusion (ABT) has been a subject of importance in total hip arthroplasty. There are a number of well-recognized parameters that influence blood loss during total hip arthroplasty (THA). The role of surgical approach on blood loss and the rate of ABT during THA is not well studied. The hypothesis of this study was that blood loss and the need for ABT is lower with direct anterior (DA) approach. Methods: In a case-control retrospective cohort study, we analyzed ۱,۵۲۴ primary THAs performed at a single institution by seven fellowship-trained surgeons between January ۲۰۱۵ to March ۲۰۱۷. All patients received THA using either the modified direct lateral (DL) or direct anterior (DA) approach using a standard operating table. The overall ABT rate was ۱۰.۲% (۱۵۵/۱,۵۲۴) in the cohort. Demographic, surgical, and postoperative data were extracted and analyzed. Logistic regression was used to identify independent risk factors for transfusion. Results: Higher preoperative hemoglobin (p<۰.۰۰۱), use of DA approach (p<۰.۰۱۶) and administration of tranexamic acid TXA, (p=۰.۰۲۴) were identified as independent factors which reduced the odds of ABT. Operative time (p<۰.۰۰۱) was associated with an increased odd of ABT, while age, BMI and type of anesthesia were not statistically significant. Conclusion: Based on the findings of this study, direct anterior approach for THA appears to be protective against blood loss and reduced ABT rate, when controlling for confounding variables. Level of evidence: III

Authors

George A. Komnos

Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA

Jorge Manrique

۱ Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA ۲ Cleveland Clinic Florida, Weston, FL, USA

Carol Foltz

Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA

Mitchell Klement

Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA

Camilo Restrepo

Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA

JavadJ Parvizi

Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA