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Optimizing Anemia in Total Hip Arthroplasty: Experience With an Institutional Protocol
Anirudh Buddhiraju1, Sanjana Agarwal1, James Ro1
1Department of Orthopaedic Surgery, The John Hopkins University, Baltimore, Maryland.
Background:
Preoperative anemia is a modifiable risk factor in total hip arthroplasty (THA), yet standardized anemia optimization strategies remain poorly defined. This study aimed to characterize typical anemia etiologies presenting in THA patients and evaluate the performance of an institutional anemia optimization protocol.
Methods:
A retrospective review was conducted of primary THA patients enrolled in an institutional preoperative anemia optimization protocol between 2022 and 2024. Anemia was defined as hemoglobin (Hb) less than 13 g/dL in men and less than 12 g/dL in women. Etiology was determined using laboratory investigations. The primary outcomes included change in hemoglobin, duration of optimization, achievement of minimal clinically important difference, and postoperative complications at one year.
Results:
Among 810 primary THAs, 115 patients (14.2%) who had preoperative anemia were identified, of whom 85 had complete optimization records and were included. Iron deficiency anemia (IDA) was the most common etiology (73.7%), followed by anemia of chronic disease (ACD) (10.5%). The mean baseline hemoglobin was 11.3 g/dL (range, 10.3 to 12.4). Overall, optimization was associated with a mean hemoglobin increase of 1.3 g/dL (range, 0.2 to 2.4). Patients who had IDA and macrocytic anemia demonstrated the greatest mean improvement (1.5 g/dL [range 0.3 to 2.7] and 1.5 g/dL[range 1.1 to 1.9], respectively), whereas patients who had ACD had comparatively lower mean improvement (0.8 g/dL [range -0.3 to 1.9]) despite similar duration of optimization (IDA: 91 days [range, 24 to 159]; ACD: 83 days [range, 28 to 138]). There were 69% of the patients who achieved minimal clinically important difference overall. Postoperative complications were infrequent, with one revision noted (0.8%). There were no transfusions, periprosthetic joint infections, or readmissions found at one year postoperatively.
Conclusions:
This study found that the institutional anemia optimization protocol was associated with clinically meaningful hemoglobin improvement in anemic THA patients, particularly in those who had IDA. The response to optimization varied by etiology, underscoring the importance of balancing the purported benefits of optimization with the potential for delay in elective arthroplasty care.
Level Of Evidence:
III, retrospective.