Blood salvage in total hip and knee arthroplasty in a community hospital: a retrospective study

To assess the results of postoperative and intra-operative blood salvage in patients undergoing total knee and hip arthroplasty, respectively, and to determine if both methods of blood salvage reduce allogeneic transfusion.

Of 229 patients who attempted blood salvage, 114 of 152 patients who underwent total knee arthroplasty received the salvaged blood postoperatively, 35 of 77 patients who underwent total hip arthroplasty received the salvaged blood intra-operatively. Various data were collected to assess whether certain factors resulted in autologous and/or allogeneic blood transfusions.

Patients that received postoperative salvaged blood after total knee arthroplasty generally had higher postoperative levels of haemoglobin and haematocrit compared to those who did not. Patients with autologous blood transfusion following cemented knee surgery were less likely to require allogeneic blood transfusion. For hip arthroplasty patients, postoperative levels of haemoglobin and haematocrit were similar in both groups who received and did not receive salvaged blood. Lower preoperative haemoglobin and haematocrit levels correlated with a greater likelihood of autologous and/or allogeneic blood transfusion for both knee and hip arthroplasty patients.

Although total knee arthroplasty patients who received salvaged blood had higher haemoglobin levels on the first postoperative day, the receipt of salvaged blood did not significantly reduce the incidence of allogeneic blood transfusion, because salvaged blood was a kind of blood loss. However, reinfusion of salvaged blood may reduce the number of units of allogeneic blood used. Given the short supply of allogeneic blood and its risks of transmitting disease, intra-operative and postoperative blood salvage carries clear advantages.