Background: Patients undergoing revision total hip arthroplasty
frequently require perioperative blood transfusion, increasing the risk for
blood-borne disease and anaphylactic and hemolytic reactions. The purpose of
this retrospective study was to evaluate the effect of intraoperative blood
collection and reinfusion on net blood loss in patients undergoing revision
Methods: The medical records of 126 patients who had had a revision
total hip arthroplasty with intraoperative blood salvage, with use of a
collection and reinfusion device, during a twenty-eight-month period were
reviewed. For comparison, the medical records of ninety-six patients who had
undergone revision hip arthroplasty without intraoperative blood salvage were
reviewed. Each of the 222 patients was categorized into a group on the basis
of the type of revision.
Results: Patients who had a revision of the femoral and acetabular
components (Group C) had significantly higher mean intraoperative and total
blood loss than did those who had a revision of the femoral component only
(Group A [p = 0.009 and p = 0.02, respectively]) or a revision of the
acetabular component only (Group B [p = 0.0001 for both]). Total blood loss
was not significantly different between Groups A and B. The mean amount of
blood reinfused intraoperatively was 356 mL for the patients in Group A, 374
mL for the patients in Group B, and 519 mL for the patients in Group C.
Regression analysis showed a significant decrease in net blood loss with
intraoperative collection and reinfusion in Groups B (p = 0.002) and C (p =
0.0001) but not in Group A.
Conclusions: Intraoperative collection and reinfusion substantially
decreased net perioperative blood loss in patients who had a revision of both
components (Group C) and in those who had a revision of the acetabular
component (Group B). The use of intraoperative blood collection and reinfusion
appears to be a valuable method of preserving blood volume in the
Level of Evidence: Therapeutic study, Level III-2
(retrospective cohort study). See Instructions to Authors for a complete
description of levels of evidence.