Defining Preoperative Hemoglobin Thresholds Can Help Avoid Transfusion or Adverse Events for Revision Total Joint...

Area of Science:

• Orthopaedic Surgery
• Anesthesiology
• Hematology

Background:

• Optimizing hemoglobin levels before revision total joint arthroplasty (rTJA) is crucial for improving surgical outcomes.
• Limited research exists on specific hemoglobin optimization strategies prior to rTJA.
• Preoperative parameter thresholds are used in orthopaedic simulation models to predict surgical success.

Purpose of the Study:

• To establish preoperative hemoglobin thresholds for revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA).
• To predict the likelihood of intraoperative or postoperative transfusion.
• To predict the likelihood of perioperative adverse events.

Main Methods:

• Retrospective review of consecutive rTKA and rTHA patients (2019-2024).
• Exclusion criteria included primary arthroplasty, missing preoperative hemoglobin, and incomplete 1-year follow-up.
• Analysis of preoperative hemoglobin values to determine transfusion and adverse event likelihood.

Main Results:

• Preoperative hemoglobin demonstrated higher sensitivity and specificity in predicting perioperative transfusion than adverse events.
• Distinct hemoglobin thresholds were identified for men and women in both rTKA and rTHA for transfusion and adverse event prediction.
• Higher hemoglobin thresholds were required for aseptic cases compared to septic cases to prevent transfusion.

Conclusions:

• This study is the first to define preoperative hemoglobin thresholds for rTJA to reduce perioperative transfusion or adverse events.
• Established thresholds can guide optimization efforts for patients undergoing rTJA.
• Further research is needed to refine these preoperative hemoglobin thresholds for improved patient management.