Abstract
Purpose
To evaluate the effectiveness of the perioperative erythropoietin administration, as an alternative to homologous banked blood transfusions, in total hip arthroplasty.
Material and Methods
In a prospective randomized, controlled study, 101 patients who underwent unilateral total hip replacement, during the period 2004–2009, were evaluated. In all these patients, the same surgical team applied the same surgical technique (hybrid THA) and they followed the same rehabilitation program. In 50 patients (group A or study group) we administered 40,000 units of erythropoietin subcutaneously one day before the operation followed by 40,000 units (sc) every 3 days in a total scheme of 4 doses. All these patients received intraoperatively one unit of homologous blood transfusion (1 unit/patient) and additional blood transfusions postoperatively when required. A control group of 51 patients (group B) received intraoperatively one or two units of homologous blood transfusion (1.35 units/patient), according to the volume of blood collected in the suction device and to the anaesthesiologists estimation, and also additional blood transfusions postoperatively when required. The admission of banked blood transfusion was determined by the haemoglobin value (< 9mg/dl) and/or clinical signs (blood pressure, pulse etc.). The values of haemoglobin, haematocrit and platelets were recorded preoperatively and the 1st, 5th, and 15th day postoperatively.
Results
15 patients of group A required postoperatively 15 units of homologous blood (total amount for group A 65 banked blood units 1.3 units/patient). 20 patients of group B required additional 26 banked blood units postoperatively (totally 95 banked blood units, or 1.86 units/patient). In the group A (study group), the total homologous blood requirements were reduced by 30%, the postoperative blood requirements were reduced by 42% and the number of patients that required additional blood transfusion was reduced by 25%. There was no significant difference in the postoperative haematocrit and haemoglobin values between the two groups.
Conclusions
The perioperative use of erythropoietin reduces effectively the total demands of homologous banked blood transfusion in total hip arthroplasty.
