title: Cell Salvage in Hip and Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  Cell salvage is used to reduce allogeneic red blood-cell (RBC) transfusions in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We performed a meta-analysis to assess the effectiveness of cell salvage to reduce transfusions in THA and TKA separately, and to examine whether recent trials change the conclusions from previous meta-analyses.
  
  
  METHODS
  We searched MEDLINE through January 2013 for randomized clinical trials evaluating the effects of cell salvage in THA and TKA. Trial results were extracted using standardized forms and pooled using a random-effects model. Methodological quality of the trials was evaluated using the Cochrane Collaboration's tool for risk-of-bias assessment.
  
  
  RESULTS
  Forty-three trials (5631 patients) were included. Overall, cell salvage reduced the exposure to allogeneic RBC transfusion in THA (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.51 to 0.85) and TKA (RR, 0.51; 95% CI, 0.39 to 0.68). However, trials published in 2010 to 2012, with a lower risk of bias, showed no significant effect of cell salvage in THA (RR, 0.82; 95% CI, 0.66 to 1.02) and TKA (RR, 0.91; 95% CI, 0.63 to 1.31), suggesting that the treatment policy regarding transfusion may have changed over time.
  
  
  CONCLUSIONS
  Looking at all trials, cell salvage still significantly reduced the RBC exposure rate and the volume of RBCs transfused in both THA and TKA. However, in trials published more recently (2010 to 2012), cell salvage reduced neither the exposure rate nor the volume of RBCs transfused in THA and TKA, most likely explained by changes in blood transfusion management.
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for L. van Bodegom-Vos: l.vanbodegom-vos@lumc.nl.
authors.forename: Leti
authors.initials: L
authors.lastname: van Bodegom-Vos
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for L. van Bodegom-Vos: l.vanbodegom-vos@lumc.nl.
authors.forename: Veronique M
authors.initials: VM
authors.lastname: Voorn
authors.affiliation: Sanquin Research, Jon J. van Rood Netherlands Center for Clinical Transfusion Research, Plesmanlaan 1a, 2333 BZ Leiden, the Netherlands.
authors.forename: Cynthia
authors.initials: C
authors.lastname: So-Osman
authors.affiliation: Department of Orthopedics, Leiden University Medical Center, J11-R, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
authors.forename: Thea P
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, P5-Q, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Dahan
authors.affiliation: Department of Anesthesiology, Albert Schweitzer Hospital Dordrecht, P.O. Box 444, 3300 AK Dordrecht, the Netherlands.
authors.forename: Ankie W
authors.initials: AW
authors.lastname: Koopman-van Gemert
authors.affiliation: Department of Orthopedics, Reinier de Graaf Hospital Delft, P.O. Box 5011, 2600 GA Delft, the Netherlands.
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Vehmeijer
authors.affiliation: Department of Orthopedics, Leiden University Medical Center, J11-R, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
authors.forename: Rob G
authors.initials: RG
authors.lastname: Nelissen
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for L. van Bodegom-Vos: l.vanbodegom-vos@lumc.nl.
authors.forename: Perla J
authors.initials: PJ
authors.lastname: Marang-van de Mheen
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D017707:Erythrocyte Transfusion; D006801:Humans; D057725:Operative Blood Salvage; D016032:Randomized Controlled Trials as Topic