title: Nonsurgical intra-operative blood management strategies for total hip arthroplasty.
abstract: The substantial blood loss that can occur during total hip arthroplasty frequently requires allogeneic transfusions. Both allogeneic transfusions and post-operative anemia are causes of increased morbidity, cardiovascular risks, and length of stay. This anemia can also lead to decreased vigor, suboptimal rehabilitation, and lowered quality of life in patients undergoing total hip arthroplasty. The aim of this review was to analyze recent evidence on nonsurgical intra-operative blood management strategies utilized for total hip arthroplasty. Specifically, we evaluated the use of fibrin sealants, desmopressin, acute normovolemic hemodilution, hypotensive anesthesia, blood salvage, and peri-operative normothermia. No single strategy has been shown to provide superior results over another in reducing the need for allogeneic transfusions. However, a combination of the above blood management strategies may further result in reduced blood loss over one strategy. Larger prospective randomized studies comparing the individual strategies, as well as their combination, are needed to develop the best algorithm that can be the most effective and safe for intra-operative blood management in total hip arthroplasty.
authors.affiliation: Rubin Institute for Advanced Orthopedics Center for Joint Preservation and Replacement Sinai Hospital of Baltimore Baltimore, MD.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Cherian
authors.affiliation: Rubin Institute for Advanced Orthopedics Center for Joint Preservation and Replacement Sinai Hospital of Baltimore Baltimore, MD.
authors.forename: Samik
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Rubin Institute for Advanced Orthopedics Center for Joint Preservation and Replacement Sinai Hospital of Baltimore Baltimore, MD.
authors.forename: Bhaveen H
authors.initials: BH
authors.lastname: Kapadia
authors.affiliation: Rubin Institute for Advanced Orthopedics Center for Joint Preservation and Replacement Sinai Hospital of Baltimore Baltimore, MD.
authors.forename: Guneet S
authors.initials: GS
authors.lastname: Sodhi
authors.affiliation: Seton Hall University School of Health and Medical Sciences Department of Orthopaedic Surgery South Orange Village, New Jersey.
authors.forename: Kimona
authors.initials: K
authors.lastname: Issa
authors.affiliation: Beth Israel Medical Center Adult Reconstruction and Total Joint Replacement Service.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Harwin
authors.affiliation: Sinai Hospital of Baltimore Baltimore, MD.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006438:Hemodilution; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D003894:Deamino Arginine Vasopressin