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The Journal of Bone and Joint Surgery (American) 85:1795-1800 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Preoperative Use of Recombinant Human Erythropoietin Before Total Joint Arthroplasty

Hari P. Bezwada, MD, David G. Nazarian, MD, David H. Henry, MD and Robert E. Booth, Jr., MD

Investigation performed at the Pennsylvania Hospital, Philadelphia, Pennsylvania

Hari P. Bezwada, MD
David G. Nazarian, MD
David H. Henry, MD
Robert E. Booth Jr., MD
Booth, Bartolozzi, Balderston Orthopaedics, Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA 19107. E-mail address for H.P. Bezwada: hbezwada{at}yahoo.com

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Previous reports have suggested that the use of recombinant human erythropoietin is effective for decreasing the need for perioperative allogeneic blood transfusion. The purpose of this study was to evaluate the efficacy of erythropoietin in combination with, and compared with, preoperative autologous donation for reducing allogeneic blood requirements for total joint arthroplasty.

Methods: Two hundred and forty patients undergoing primary and revision total hip or knee arthroplasty were enrolled into three groups with different treatment regimens: (1) erythropoietin and preoperative autologous donation (Group 1), (2) erythropoietin alone (Group 2), and (3) preoperative autologous donation alone (Group 3). Patients were evaluated with regard to requirements for allogeneic transfusion, change from the baseline to the lowest postoperative hemoglobin value, postoperative complications, and adverse reactions.

Results: The rate of allogeneic transfusion was 11% in Group 1 (erythropoietin and preoperative autologous donation) compared with 28% in Group 2 (erythropoietin alone) and 33% in Group 3 (preoperative autologous donation alone). Within Group 1, patients who had a unilateral primary arthroplasty had an allogeneic transfusion rate of 4% and those who had a bilateral or revision arthroplasty had an allogeneic transfusion rate of 17%. In Groups 2 and 3, the allogeneic transfusion rates were 14% and 15%, respectively, for the patients who had a unilateral primary arthroplasty and 35% and 47%, respectively, for those who had a bilateral or revision arthroplasty.

Conclusions: Preoperative use of erythropoietin in conjunction with preoperative autologous donation reduces the need for allogeneic blood transfusion associated with total joint arthroplasty more effectively than does either erythropoietin or preoperative autologous donation alone.

Level of Evidence: Therapeutic study, Level II-1 (prospective cohort study). See Instructions to Authors for a complete description of levels of evidence.



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Letters to the Editor:

Read all Letters to the Editor

Guidelines Regarding the Use of Erythropoietin Before Total Joint Arthroplasty
William H. Salot, M.D.
JBJS Online, 4 Dec 2003 [Full text]
Dr Bezwada and colleagues respond to Dr. Salot
Hari P. Bezwada, et al.
JBJS Online, 18 Dec 2003 [Full text]