This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow CME: Take the activities for this article:
 Adult Hip Reconstruction Test 9: Topics of Interest in Hip Arthroplasty
CME 3: July, August, September 2004
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pierson, J. L.
Right arrow Articles by Earles, D. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pierson, J. L.
Right arrow Articles by Earles, D. R.
Related Collections
Right arrow Adult Hip
Right arrow Adult Knee
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?
The Journal of Bone and Joint Surgery (American) 86:1512-1518 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

A Blood-Conservation Algorithm to Reduce Blood Transfusions After Total Hip and Knee Arthroplasty

Jeffery L. Pierson, MD1, Timothy J. Hannon, MD2 and Donald R. Earles, MS1

1 St. Vincent Center for Joint Replacement, 8402 Harcourt Road, Suite 128, Indianapolis, IN 46260. E-mail address for J.L. Pierson: jlpierso{at}stvincent.org
2 St. Vincent Hospitals and Health Services, Blood Conservation Services, 2001 West 86th Street, Indianapolis, IN 46260

Investigation performed at St. Vincent Center for Joint Replacement, Indianapolis, Indiana

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. A commercial entity (Zimmer, Inc.) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Donation of autologous blood before total joint arthroplasty is inconvenient and costly, causes a phlebotomy-induced anemia, and may be wasteful and unnecessary for the nonanemic patient. We developed a blood-conservation algorithm that does not require predonation of autologous blood, employs selective use of epoetin alfa, and uses evidence-based transfusion criteria. Our hypothesis was that use of this algorithm would reduce the rate of transfusion after unilateral total hip and knee arthroplasty as compared with the rates described in previous reports.

Methods: We retrospectively reviewed the records of 500 consecutive patients in whom unilateral primary total hip or knee arthroplasty had been performed by a single surgeon. The same blood-conservation algorithm was recommended to all patients. Two groups of patients were identified: the first group consisted of 433 patients in whom the algorithm was followed, and the second group consisted of sixty-seven patients in whom the algorithm was not followed.

Results: In the group in which the algorithm was followed, the rates of allogeneic transfusion after total knee and total hip arthroplasty were 1.4% (three of 220) and 2.8% (six of 213), respectively. The overall rate of transfusion in this group was only 2.1% (nine of 433). The prevalence of transfusion in the group in which the algorithm was not followed was 16.4% (eleven of sixty-seven). This difference was significant (p = 0.0001).

Conclusions: The use of this blood-conservation algorithm resulted in a significant reduction in the need for allogeneic blood transfusions after unilateral total hip and knee arthroplasty, and the results compare favorably with the rates of transfusion described in previous reports.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Am J Health Syst PharmHome page
D. Jaspan
Erythropoietic therapy: Cost efficiency and reimbursement
Am. J. Health Syst. Pharm., August 15, 2007; 64(16_Supplement_11): S19 - S29.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
P. J. Millett, M. Porramatikul, N. Chen, D. Zurakowski, and J. J.P. Warner
Analysis of Transfusion Predictors in Shoulder Arthroplasty
J. Bone Joint Surg. Am., June 1, 2006; 88(6): 1223 - 1230.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. H. Huo and N. F. Gilbert
What's New in Hip Arthroplasty
J. Bone Joint Surg. Am., September 1, 2005; 87(9): 2133 - 2146.
[Full Text] [PDF]

Home page
 JBJSHome page
M. J. Archibeck and R. E. White Jr.
What's New in Adult Reconstructive Knee Surgery
J. Bone Joint Surg. Am., July 1, 2005; 87(7): 1656 - 1666.
[Full Text] [PDF]