[Blood loss in total hip prosthesis implantation: lateral versus supine position]

We performed a prospective randomized study to determine blood loss differences between supine or lateral patient position, during surgery in elective total hip replacement. Between January and October 1996, 64 consecutive cases of total hip replacements were randomly scheduled for a procedure either in the supine or in the lateral position. Of the 56 cases evaluated, 29 were operated in the supine position (SP) and 27 in the lateral position (LP). The standardized implantations were performed without cement and the blood loss was measured. The calculated loss of Hb on the day of operation was 235 g Hb +/- 17 (mean +/- s.e.) in the SP group and 177 g Hb +/- 14 in the LP group, respectively, (unpaired t-test p = 0.01). The calculated loss of Hb after five postoperative days was 227 g Hb +/- 24 (mean +/- s.e.) in the SP group and 179 g Hb +/- 24 in the LP group, respectively, p < 0.2. The net loss of Hb after five postoperative days was calculated by subtracting all perioperative blood substitutions (Cellsaver, autologous and homologous blood) resulting in 340 g Hb +/- 21 (mean +/- s.e.) in the SP group and 272 g Hb +/- 21 in the LP group, respectively, p = 0.02. The blood loss in primary cementless total hip replacement surgery can be significantly reduced by performing the procedure in the lateral position compared to that in the supine position. The blood loss is limited to the day of operation, as indicated by the stable Hb-levels thereafter.