Abstract
Background
The incidence of transfusion in contemporary revision total hip arthroplasty (THA)
remains high despite recent advances in blood management, including the use of tranexamic
acid. The purpose of this prospective investigation was to determine independent risk
factors for transfusion in revision THA.
Methods
Six centers prospectively collected data on 175 revision THAs. A multivariable logistic
analysis was performed to determine independent risk factors for transfusion. Revisions
were categorized into subgroups for analysis, including femur-only, acetabulum-only,
both-component, explantation with spacer, and second-stage reimplantation. Patients
undergoing an isolated modular exchange were excluded.
Results
Twenty-nine patients required at least one unit of blood (16.6%). In the logistic
model, significant risk factors for transfusion were lower preoperative hemoglobin,
higher preoperative international normalized ratio (INR), and longer operative time
(P < .01, P = .04, P = .05, respectively). For each preoperative 1g/dL decrease in hemoglobin, the chance
of transfusion increased by 79%. For each 0.1-unit increase in the preoperative INR,
transfusion chance increased by 158%. For each additional operative hour, the chance
of transfusion increased by 74%. There were no differences in transfusion rates among
categories of revision hip surgery (P = .23). No differences in demographic or surgical variables were found between revision
types.
Conclusion
Despite the use of tranexamic acid, transfusions are commonly required in revision
THA. Preoperative hemoglobin and INR optimization are recommended when medically feasible.
Efforts should also be made to decrease operative time when technically possible.
Keywords
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Article info
Publication history
Published online: March 19, 2021
Accepted:
March 10,
2021
Received in revised form:
March 6,
2021
Received:
November 18,
2020
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2021.03.032.
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