Examination of intra-operative blood loss on the first side to perform simultaneous bilateral total hip arthroplasty without allogeneic blood transfusion

Purpose

Simultaneous bilateral total hip arthroplasty (THA) offers benefits such as early rehabilitation and reduced medical costs but carries a risk of peri-operative bleeding necessitating post-operative blood transfusion. This study aimed to investigate factors associated with post-operative anemia in simultaneous bilateral THA using the direct anterior approach (DAA) and to identify criteria for limiting the surgery to one side.

Methods

Patients who underwent simultaneous bilateral THA without allogeneic blood transfusion during surgery at Funabashi Orthopaedic Hospital (Chiba, Japan) between January 2022 and December 2022 were included. Multiple regression analysis was performed to identify factors associated with post-operative anemia. Receiver operating characteristic (ROC) analysis was performed using the results in multiple regression analysis to calculate cutoff values.

Results

In total, 161 patients (28 men and 133 women) were included, with a mean age of 61 years. Pre-operative hemoglobin levels and intra-operative blood loss on the first side were identified as factors associated with post-operative anemia. ROC analysis showed that the cutoff value of intra-operative blood loss on the first side was 9.2% of the patient blood volume (PBV) when the pre-operative hemoglobin level was <12 ​g/dL and 16.9% of the PBV when it was ≥12 ​g/dL.

Conclusion

This study identified factors associated with post-operative anemia in simultaneous bilateral THA using DAA as well as the criteria for limiting surgery to the first side to prevent post-operative blood transfusion.