Blood conservation in primary total hip arthroplasty.

Abstract

Total hip arthroplasty is characterized by significant blood loss. The principal aim of blood management in joint replacement surgery is to minimize both the risks associated with surgical blood loss and the risks associated with allogenic blood transfusion. In the 1980s, the AIDS epidemic triggered the development of a variety of innovative approaches to conserving blood and reducing the need for allogenic transfusion to replace surgical blood loss. Subsequently, the safety of the blood supply was dramatically improved, changes in surgical technique led to decreased surgical blood loss, and changes in transfusion thresholds made the need for transfusion less common. The review re-examines the options available for the management of blood loss in total joint replacement and defines parameters that can be used preoperatively to predict which patients are likely to benefit from these interventions, given the clinical realities of the 21st century.