Optimizing Anemia in Total Hip Arthroplasty: Experience With an Institutional Protocol

Area of Science:

• Orthopedic Surgery
• Hematology
• Anemia Management

Background:

• Preoperative anemia is a significant, modifiable risk factor in total hip arthroplasty (THA).
• Standardized protocols for anemia optimization in THA patients are lacking.
• Understanding anemia etiologies is crucial for effective management.

Purpose of the Study:

• To identify common causes of preoperative anemia in THA patients.
• To assess the effectiveness of an institutional anemia optimization protocol.
• To evaluate hemoglobin changes, optimization duration, and clinical outcomes.

Main Methods:

• Retrospective review of primary THA patients (2022-2024) in an anemia optimization protocol.
• Anemia defined as hemoglobin (Hb) <13 g/dL (men) or <12 g/dL (women).
• Etiology determined via laboratory tests; outcomes included Hb change, optimization duration, MCID achievement, and 1-year postoperative complications.

Main Results:

• 14.2% of 810 THA patients had preoperative anemia; 85 were included.
• Iron deficiency anemia (IDA) was the most frequent cause (73.7%), followed by anemia of chronic disease (ACD) (10.5%).
• Mean Hb increased by 1.3 g/dL; IDA and macrocytic anemia showed greatest improvement (1.5 g/dL). ACD patients had lower improvement (0.8 g/dL). 69% achieved MCID. Postoperative complications were rare.

Conclusions:

• The institutional protocol effectively improved hemoglobin in anemic THA patients, particularly those with IDA.
• Response to anemia optimization varied significantly by etiology.
• Balancing optimization benefits with potential delays in elective surgery is essential.