Park Yong-Beom, Kim Kang-Il, Lee Han-Jun, Yoo Je-Hyun, Kim Jun-Ho
Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Kyung-Hee University Hospital at Gangdong, Kyung-Hee University College of Medicine, Seoul, South Korea.
J Arthroplasty. 2025 Jul;40(7):1910-1920. doi: 10.1016/j.arth.2024.11.058. Epub 2024 Dec 2.
Intravenous (IV) iron supplementation is a potential strategy to address anemia and reduce the need for blood transfusion following total knee or hip arthroplasty (TKA or THA). We aimed to investigate the effect and safety of IV iron supplementation as optimal blood management in patients after TKA or THA.
The MEDLINE, Embase, Cochrane Library, CINAHL, and Scopus databases were systematically searched for studies comparing patients undergoing total knee arthroplasty or total hip arthroplasty with and without IV iron supplementation. Blood transfusion rate and postoperative hemoglobin drop were assessed for effectiveness, while adverse events and surgical site infection were evaluated for the safety of IV iron supplementation. Additionally, subgroup analyses were performed to investigate the effect of IV iron supplementation based on the iron dose or patient's indication. There were 14 studies included.
The use of IV iron supplementation significantly decreased the blood transfusion rate compared to no supplementation after TKA or THA (odds ratio [OR] 0.43; 95% confidence interval [CI], 0.27 to 0.68; P < 0.001) as clinical manifestations were considered for the transfusion, although no significant difference was found between postoperative days one and seven. Furthermore, IV iron supplementation significantly reduced postoperative Hb drop compared to no supplementation at postoperative two to six weeks (postoperative weeks two to three: mean difference [MD], -0.61; 95% CI, -1.01 to -0.20; P = 0.003 and postoperative weeks four to six: MD, -0.50; 95% CI, -0.70 to -0.31; P < 0.001). The safety profile did not significantly differ between the two groups. Adverse events occurred in 0.5% of the treatment group. Subgroup analysis showed that high-dose iron in high-risk patients led to a faster recovery of Hb drop than low-dose iron in routine patients following TKA or THA.
Perioperative IV iron supplementation was effective and safe in blood management for reducing blood transfusion and Hb drop in patients following TKA or THA. High-dose iron supplementation provided faster recovery of Hb than low-dose iron, which was more effective in high-risk patients.
Meta-analysis of level 3 studies.
静脉补充铁剂是一种潜在的策略，可用于解决全膝关节或全髋关节置换术（TKA或THA）后贫血问题并减少输血需求。我们旨在研究静脉补充铁剂作为TKA或THA患者最佳血液管理方法的效果和安全性。
系统检索MEDLINE、Embase、Cochrane图书馆、CINAHL和Scopus数据库，以查找比较接受全膝关节置换术或全髋关节置换术且补充或未补充静脉铁剂患者的研究。评估输血率和术后血红蛋白下降情况以确定有效性，同时评估不良事件和手术部位感染以确定静脉补充铁剂的安全性。此外，进行亚组分析以研究基于铁剂剂量或患者指征的静脉补充铁剂的效果。共纳入14项研究。
与TKA或THA后未补充铁剂相比，补充静脉铁剂显著降低了输血率（优势比[OR]0.43；95%置信区间[CI]，0.27至0.68；P<0.001），尽管术后第1天和第7天之间未发现显著差异，但输血是基于临床表现考虑的。此外，与术后2至6周未补充铁剂相比，补充静脉铁剂显著降低了术后血红蛋白下降幅度（术后第2至3周：平均差[MD]，-0.61；95%CI，-1.01至-0.20；P=0.003；术后第4至6周：MD，-0.50；95%CI，-0.70至-0.31；P<0.001）。两组的安全性概况无显著差异。治疗组中0.5%发生了不良事件。亚组分析表明，TKA或THA后，高危患者使用高剂量铁剂比常规患者使用低剂量铁剂导致血红蛋白下降恢复更快。
围手术期静脉补充铁剂在血液管理中对减少TKA或THA患者的输血和血红蛋白下降有效且安全。高剂量铁剂补充比低剂量铁剂使血红蛋白恢复更快，在高危患者中更有效。
3级研究的荟萃分析。
