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

2020 ◽  
Author(s):  
Yong Hu ◽  
Wei-Zhou Jiang ◽  
Cheng-Long Pan ◽  
Tao Wang
Keyword(s):  
Ankylosing Spondylitis ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Disease Activity ◽  
Hip Arthroplasty ◽  
Active Group ◽  
Nutrition Status ◽  
Stable Group ◽  
Total Hip ◽  
Significant Difference

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 in the active group compared to the stable group (P=0.027). There was no significant difference with regard to functional recovery (P>0.05). 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 Less blood loss in supercapsular percutaneously assisted versus posterolateral total hip arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yong Hu ◽  
Min-Cong Wang ◽  
Tao Wang ◽  
Yue Meng ◽  
Xiao-Min Chao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Total Blood Loss ◽  
Transfusion Rate ◽  
Operative Blood Loss ◽  
Total Blood ◽  
Radiographic Findings ◽  
Total Hip ◽  
Affected Side

Abstract Background Although excellent clinical outcomes of supercapsular percutaneously assisted total hip arthroplasty (SuperPath) have been reported, the peri-operative blood loss has rarely been reported. The current study determined the blood loss during SuperPath and compared the blood loss with conventional posterolateral total hip arthroplasty (PLTH). Methods This retrospective study enrolled patients who underwent unilateral primary THA between January 2017 and December 2019. The demographic data, diagnoses, affected side, radiographic findings, hemoglobin concentration, hematocrit, operative time, transfusion requirements, and intra-operative blood loss were recorded. The peri-operative blood loss was calculated using the OSTHEO formula. Blood loss on the 1st, 3rd, and 5th post-operative days was calculated. Hidden blood loss (HBL) was determined by subtracting the intra-operative blood loss from the total blood loss. Results Two hundred sixty-three patients were included in the study, 85 of whom were in the SuperPath group and 178 in the posterolateral total hip arthroplasty (PLTH) group. Patient demographics, diagnoses, affected side, operative times, and pre-operative hemoglobin concentrations did not differ significantly between the two groups (all P > 0.05). Compared to the PLTH group, the SuperPath group had less blood loss, including intra-operative blood loss, 1st, 3rd, and 5th post-operative days blood loss, and HBL (all P < 0.05). Total blood loss and HBL was 790.07 ± 233.37 and 560.67 ± 195.54 mL for the SuperPath group, respectively, and 1141.26 ± 482.52 and 783.45 ± 379.24 mL for the PLTH group. PLTH led to a greater reduction in the post-operative hematocrit than SuperPath (P < 0.001). A much lower transfusion rate (P = 0.028) and transfusion volume (P = 0.019) was also noted in the SuperPath group. Conclusion SuperPath resulted in less perioperative blood loss and a lower transfusion rate than conventional PLTH.

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

Two Doses of Intravenous Tranexamic Acid Offers No Benefit over One Dose in Total Hip Arthroplasty

2019 ◽  
Vol 04 (01) ◽  
pp. 001-006
Author(s):  
Ryan S. Charette ◽  
Jenna A. Bernstein ◽  
Matthew Sloan ◽  
Corbyn M. Nchako ◽  
Atul F. Kamath ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Univariate Analysis ◽  
High Volume ◽  
Primary Outcome Measure ◽  
Transfusion Rate ◽  
Total Hip ◽  
Significant Difference

AbstractTranexamic acid (TXA) has been shown to reduce blood loss and transfusions in total hip arthroplasty (THA). There is no consensus on the ideal number of doses that best reduces blood loss while limiting complications. Our study compared one versus two doses of intravenous TXA in primary THA and its effect on blood transfusion rate. We retrospectively reviewed patients undergoing primary THA at our two high-volume arthroplasty centers from 2013 to 2016. Patients were included if they underwent unilateral primary THA, and received one or two doses of TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome measure was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay (LOS), rate of deep vein thrombosis/pulmonary embolism (DVT/PE), readmission, and reoperation. A total of 1,273 patients were included; 843 patients received one dose of TXA and 430 patients received two TXA doses. Univariate analysis demonstrated no significant difference in transfusion rate when administering one versus two doses. There was no significant difference in LOS, or rates of DVT/PE, readmission, and reoperation. When comparing patients receiving aspirin prophylaxis, there was a significantly decreased blood volume loss with two doses (1,360 vs. 1,266 mL, mean difference = 94 mL; p = 0.017). In patients, undergoing primary unilateral THA, there is no difference in postoperative transfusion rate with one or two doses of intravenous TXA. There was no difference in thromboembolic events. Given the added cost without clear benefit, these findings support one rather than two doses of TXA during primary THA.

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 Low Transfusion Rate Attainable in Anterior Approach Total Hip Arthroplasty Utilizing a Modern Protocol

2021 ◽  
Vol 11 ◽  
Author(s):  
Joseph Gondusky ◽  
Benjamin Campbell ◽  
Christian Coulson
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Operative Time ◽  
Transfusion Rate ◽  
Total Hip ◽  
Estimated Blood Loss ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: Transfusion is a known risk of total hip arthroplasty (THA).  It has been associated with a multitude of medical complications and increased cost.  Prior studies report transfusion rates associated with THA, with wide variation, but most cannot differentiate the surgical approach utilized.  The anterior approach (AA) for THA has been associated with increased operative time, complications, and blood loss, but little data exists regarding the actual transfusion rate associated with the approach. Methods: We performed a retrospective review of 390 consecutive, elective, primary unilateral AA THA procedures.  Patient demographic, clinical and perioperative data was analyzed.  A modern perioperative pathway, including a simple protocol to limit blood loss, is defined. Results: The group consisted of a typical inpatient arthroplasty population, with wide ranges of age, body mass index (BMI), and health status.  The average age was 64.05 years (+ 10.67, range 27-94).  BMI averaged 29.76 kg/m2 (+ 5.98, range 16-47).  The majority of patients were American Society of Anesthesiologists (ASA) class 2 (45.6%) or 3 (50.3%), with 10 patients ASA 4 (2.6%).  Average preoperative hemoglobin was 13.48 g/dL (+ 1.47, range 9.1-18.2).  Operative time averaged 91.22 minutes (+ 14.2).  83.3% of patients received a spinal anesthetic.  Most patients were discharged on postoperative day one (93.1%) to home (99%).  Estimated blood loss averaged 264mL (+ 95.19, range 100-1000).  No patient required perioperative transfusion or readmission for symptomatic anemia within 30 days postoperative.  Conclusion:  A modern protocol we utilize and define is capable of limiting blood loss and transfusion risk in anterior approach total hip arthroplasty. 

scholarly journals To Investigate the Effect of Glucocorticoids on Blood Loss during and after First Total Hip Arthroplasty and Its Safety Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Chaoqun Wang ◽  
Fulin Li ◽  
Wenhui Liu ◽  
Wenwen Huang ◽  
Qinglong Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Control Group ◽  
Transfusion Rate ◽  
Total Hip ◽  
Topical Glucocorticoids ◽  
The Difference

Objective. To evaluate the efficacy and safety of topical glucocorticoids for total hip arthroplasty by meta-analysis. Methods. A computerized search of the Cochrane Library, MEDLINE, EMBASE, and PubMed English databases, as well as Chinese Biomedical Literature Database, vipu Chinese Science and Technology Journal Database, Wanfang database, and Chinese Knowledge Net Database, was performed to include all randomized controlled trials (RCTs) regarding topical glucocorticoid therapy for postoperative bleeding after THA according to the inclusion criteria. The quality evaluation criteria of RCTs, as stated in the Cochrane Handbook for Systematic Reviews of Interventions 4.2.5, were adopted for evaluation, and the meta-analysis was performed using RevMan 5.3. Results. A total of 10 articles were included, including 1,112 patients: 566 in the topical glucocorticoid group and 546 in the control group. The transfusion rate was 8.43% for topical glucocorticoids and 30.05% for the control group ( P < 0.001 ), and topical glucocorticoids reduced 317.89 ml total blood loss and 76.82 ml invisible blood loss, with statistically significant differences ( P < 0.001 ). The amount of intraoperative blood loss was reduced by topical glucocorticoids, but the difference was not statistically significant ( P = 0.83 ), and the postoperative HB value was increased by topical glucocorticoids, although the difference was statistically significant ( P < 0.001 ). The incidence of DVT and PE after topical glucocorticoid application (3.03%) was greater than that of the control group (2.40%), the difference was not statistically significant ( P = 0.54 ), and the incidence of infection after topical glucocorticoid application (3.03%) was greater than that of the control group (2.40%). The difference was not statistically significant ( P = 0.39 ). Conclusions. Topical glucocorticoids can reduce the transfusion rate and blood loss in THA patients without increasing their risk of thrombosis.

scholarly journals Perioperative protocol to reduce blood transfusions in ankylosing spondylitis patients undergoing total hip arthroplasty

2021 ◽  
Author(s):  
Yu Huang ◽  
Xiao Huang ◽  
Fulin Li ◽  
Wenwen Huang ◽  
Dong Yin
Keyword(s):  
Ankylosing Spondylitis ◽  
Total Hip Arthroplasty ◽  
Blood Transfusion ◽  
Adverse Events ◽  
Hip Arthroplasty ◽  
Transfusion Rate ◽  
Blood Management ◽  
Total Hip ◽  
Group A ◽  
Group B

Abstract Introduction: Although tranexamic acid (TXA) can reduce bleeding during total hip arthroplasty (THA), the amount of perioperative bleeding is greater in patients with ankylosing spondylitis (AS); So blood management is more challenging. Patient Blood Management (PBM) program can improve AS patients care and reduce health costs in THA. The purpose of this study is to assess the effects of PMB program on allogeneic transfusion rate, length of hospital stay(LOS), hospitalization expenses and adverse events. Methods : We conducted a retrospective observational study of patients with AS who underwent THA. All patients were treated with tranexamic acid before and after operation. Our PBM program included preoperative evaluation, preoperative acute normovolemic hemodilution and intraoperative recovery autotransfusion. We compared results between the group of patients before and the one after the PBM program implementation. Result: We included 68 as patients who underwent total hip arthroplasty before PBM program from January 2013 to December 2015 (group A) and 84 as patients who underwent total hip arthroplasty after PBM program from January 2016 to December 2019 (group B). In the comparison of intraoperative blood transfusion volume, intraoperative blood transfusion rate and total blood transfusion rate between the two groups, the group B was significantly lower than the group A (P ≤ 0.05); The length of stay and hospitalization expenses of the group B were lower than the group A (P ≤ 0.05). No adverse events were recorded. Conclunsions: Our PMB program can reduce allogeneic blood transfusion, hospital stay and hospitalization expenses, without risking patients to higher number of com- plications in AS patients undergoing THA.

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
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