Perioperative patient blood management in one-stage bilateral calcar-guided short stem hip arthroplasty

Total hip arthroplasty is the standard treatment for end stage osteoarthritis of the hip joint. In Germany about 180.000 procedures are performed every year. While most surgeries are performed unilaterally there is an increasing number of single-stage bilateral (SSBL) hip arthroplasties performed. The goal of this study was to demonstrate the safety of SSBL-procedures in terms of blood loss and blood transfusion rates using specific perioperative protocols.

Data were collected from 469 patients who underwent one-stage bilateral hip arthroplasty in a single institution, between 2020 and 2023. The current study included patients who were operated on using a minimal-invasive anterolateral approach with a cementless calcar-guided short stem hip prosthesis. The patient's age, sex, comorbidities, medication and preoperative laboratory parameters were gathered as well as the intraoperative blood loss, postoperative hemoglobin levels, blood transfusions and the perioperative administration of tranexamic acid.

Out of 469 patients who underwent SSBL hip arthroplasty, nine (1.9%) required blood transfusions after surgery. In total, 14 red blood cell concentrates (RBC) were transfused (0.029 RBCs per patient). The use of tranexamic acid significantly reduced the need for RBCs (p-value 0.018). Female sex, older age (> 76 years), low body mass index and body weight as well as lower preoperative hemoglobin levels were associated with an increased risk of RBC transfusion.

This study demonstrated that SSBL hip arthroplasty, when combined with a minimally invasive approach (anterolateral in supine position), cementless short stem implants, and optimized blood management (including the use of tranexamic acid), is a safe procedure in terms of blood loss and transfusion risk.