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

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.