Prevention of post-operative anaemia in hip and knee arthroplasty - a systematic review

INTRODUCTION: Patient blood management strategies for total hip and knee arthroplasty are controversial. They range from pre-operative haemoglobin optimisation to intra- and post-operative interventions. The aim of this study was to assess the various treatment modalities with respect to blood loss, haemoglobin levels and blood transfusions.

METHODS: The analysis was based on the principles of a systematic review. The literature was searched in PubMed for the period from 2004 to November 2014. The articles were reviewed with respect to blood loss, post-operative haemoglobin drop, blood transfusions and length of hospital stay. The papers were evidence-graded. Non-randomised clinical studies and papers not concerning total hip or knee arthroplasty were excluded as were studies lacking a control group. Subanalyses were performed for tran-examic acid, tourniquet and fibrin use.

RESULTS: A total of 49 studies were found eligible which is equivalent to a total of 4,752 patients. Tranexamic acid administered either orally, topically, intravenously or in combination decreased blood loss, increased the post-operative haemoglobin level, decreased the number of patients receiving blood transfusions and minimised the length of stay. A similar result was found for fibrin spray in total hip arthroplasty. However, for total knee arthroplasty, the outcome was blurred. Tourniquet use was uniformly not significant in the measured parameters.

CONCLUSIONS: Tranexamic acid is useful in managing anaemia and blood loss. Fibrin sealant also has this potential, but is not more potent than tranexamic acid. Tourniquet use is not advantageous.