Komnos George A, Manrique Jorge, Foltz Carol, Klement Mitchell R, Restrepo Camilo, Parvizi Javad
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Cleveland Clinic Florida, Weston, FL, USA.
Arch Bone Jt Surg. 2021 Nov;9(6):659-664. doi: 10.22038/ABJS.2021.50237.2497.
Blood conservation and reduction in the need for allogeneic blood transfusion (ABT) has been a subject of importance in total hip arthroplasty. There are a number of well-recognized parameters that influence blood loss during total hip arthroplasty (THA). The role of surgical approach on blood loss and the rate of ABT during THA is not well studied. The hypothesis of this study was that blood loss and the need for ABT is lower with direct anterior (DA) approach.
In a case-control retrospective cohort study, we analyzed 1,524 primary THAs performed at a single institution by seven fellowship-trained surgeons between January 2015 to March 2017. All patients received THA using either the modified direct lateral (DL) or direct anterior (DA) approach using a standard operating table. The overall ABT rate was 10.2% (155/1,524) in the cohort. Demographic, surgical, and postoperative data were extracted and analyzed. Logistic regression was used to identify independent risk factors for transfusion.
Higher preoperative hemoglobin (p<0.001), use of DA approach (p<0.016) and administration of tranexamic acid TXA, (p=0.024) were identified as independent factors which reduced the odds of ABT. Operative time (p<0.001) was associated with an increased odd of ABT, while age, BMI and type of anesthesia were not statistically significant.
Based on the findings of this study, direct anterior approach for THA appears to be protective against blood loss and reduced ABT rate, when controlling for confounding variables.
在全髋关节置换术中，血液保护及减少异体输血（ABT）需求一直是重要课题。全髋关节置换术（THA）期间有许多公认的影响失血的参数。手术入路对THA期间失血及ABT率的作用尚未得到充分研究。本研究的假设是直接前路（DA）入路的失血量及ABT需求较低。
在一项病例对照回顾性队列研究中，我们分析了2015年1月至2017年3月间由七位接受过 fellowship 培训的外科医生在单一机构进行的1524例初次THA。所有患者均使用标准手术台，采用改良直接外侧（DL）或直接前路（DA）入路进行THA。该队列的总体ABT率为10.2%（155/1524）。提取并分析了人口统计学、手术及术后数据。采用逻辑回归确定输血的独立危险因素。
术前血红蛋白水平较高（p<0.001）、采用DA入路（p<0.016）及使用氨甲环酸（TXA）（p=0.024）被确定为降低ABT几率的独立因素。手术时间（p<0.001）与ABT几率增加相关，而年龄、BMI及麻醉类型无统计学意义。
基于本研究结果，在控制混杂变量时，THA的直接前路入路似乎对失血有保护作用，并降低了ABT率。
