Hip Pelvis.  2017 Jun;29(2):81-90. 10.5371/hp.2017.29.2.81.

Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus

Affiliations
  • 1Department of Orthopaedics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
  • 2Department of Orthopaedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
  • 3Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 4Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
  • 5Department of Orthopaedic Surgery, Soonchunhyang University Hospital, Seoul, Korea.
  • 6Department of Orthopaedic Surgery, Keimyung University School of Medicine, Daegu, Korea.
  • 7Department of Orthopaedic surgery, Yonsei University, College of Medicine, Seoul, Korea.
  • 8Department of Orthopaedic Surgery, School of Medicine, Hanyang University, Seoul, Korea.
  • 9Department of Orthopaedic surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 10Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Korea. oshan@korea.ac.kr

Abstract

The volume of hip arthroplasty is stiffly increasing because of excellent clinical outcomes, however it has not been shown to decrease the incidence of transfusions due to bleeding related to this surgery. This is an important consideration since there are concerns about the side effects and social costs of transfusions. First, anemia should be assessed at least 30 days before elective hip arthroplasty, and if the subject is diagnosed as having anemia, an additional examination of the cause of the anemia should be carried and steps taken to address the anemia. Available iron treatments for anemia take 7 to 10 days to facilitate erythropoiesis, and preoperative iron supplementation, either oral or intravenous, is recommended. When using oral supplements for iron storage, administer elemental iron 100 mg daily for 2 to 6 weeks before surgery, and calculate the dose using intravenous supplement. Tranexamic acid (TXA) is a synthetic derivative of the lysine component, which reduces blood loss by inhibiting fibrinolysis and clot degradation. TXA is known to be an effective agent for reducing postoperative bleeding and reducing the need for transfusions in primary and revision total hip arthroplasties. Patient blood management has improved the clinical outcome after hip arthroplasty through the introduction and research of various agents, thereby reducing the need for allogeneic blood transfusions and reducing the risk of transfusion-related infections and the duration of hospitalizations.

Keyword

Transfusion; Blood management; Hip arthroplasty
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