title: Does salvage and tranexamic acid reduce the need for blood transfusion in revision hip surgery?
abstract: We carried out a retrospective case-control study in 80 patients who underwent a revision total hip replacement. Group A (40 patients) received tranexamic acid and intra-operative cell salvage. Group B (40 patients) was a matched control group and did not receive this management. Each group was divided into four subgroups: revision of both components, revision of both components with bone grafting, revision of the acetabular component with or without bone graft, and revision of the femoral component with or without bone graft. In group A the total number of units transfused was 52, compared with 139 in group B, representing a reduction in blood usage of 62.5%. The mean amount of blood transfused from cell salvage in each group was 858 ml (113 to 2100), 477 ml (0 to 2680), 228 ml (75 to 315) and 464 ml (120 to 1125), respectively. There was a significant difference in the amount of blood returned between the groups (p < 0.0001). In group A, 22 patients needed transfusion and in group B, 37 (p < 0.0001). A cost analysis calculation showed a total revenue saving of pounds sterling 70 000 and a potential saving throughout our facility of pounds sterling 318 288 per year. Our results show that a significant reduction in blood transfusion can be made using combined cell salvage and tranexamic acid in revision surgery of the hip.
authors.affiliation: Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP, UK. sphillipsdoc@aol.com
authors.forename: S J
authors.initials: SJ
authors.lastname: Phillips
authors.forename: R
authors.initials: R
authors.lastname: Chavan
authors.forename: M L
authors.initials: ML
authors.lastname: Porter
authors.forename: P R
authors.initials: PR
authors.lastname: Kay
authors.forename: J P
authors.initials: JP
authors.lastname: Hodgkinson
authors.forename: B
authors.initials: B
authors.lastname: Purbach
authors.forename: A Hoad
authors.initials: AH
authors.lastname: Reddick
authors.forename: J M
authors.initials: JM
authors.lastname: Frayne
mesh_terms: D000704:Analysis of Variance; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003131:Combined Modality Therapy / Q000379:methods; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D012086:Reoperation; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid