Nehls Franziska, Schläppi Michel, Madjdpour Caveh, Meier Christoph, Wahl Peter
Department of Anaesthesiology, Cantonal Hospital Winterthur, Brauerstrasse 15, PO Box 834, Winterthur, 8401, Switzerland.
Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.
Arch Orthop Trauma Surg. 2025 May 9;145(1):283. doi: 10.1007/s00402-025-05815-x.
Total hip arthroplasty (THA) is potentially associated with high blood loss, possibly requiring transfusion. To avoid well-known complications of allogenic transfusions, risk stratification and patient optimization are recommended. This study explores whether bone quality, as evaluated by the Singh Index (SI), impacts blood loss in primary THA, as recently identified in fracture surgery.
Retrospective, single-center study conducted to examine intraoperative blood loss (IBL) and total blood loss (TBL) in primary THA performed in adults through an anterior approach between 10/2021 and 05/2022. TBL estimation utilized formulas of Gross, Camarasa, Frankfurt and OSTHEO.
A total of 218 unilateral THA were included. TBL substantially exceeded IBL, primarily occurring within the first postoperative day. The formulas were largely consistent, TBL reaching approximately one-third of the estimated total blood volume, except for the Frankfurt formula, which provided much lower values. However, all four formulas failed when IBL exceeds 1'000 ml, a common threshold in THA. Operation time correlated with increased IBL but not TBL. The body mass index (BMI) appeared to be a risk factor for TBL. The SI had a significant but relatively small influence.
TBL after THA is relevant, accounting for approximately one-third of total blood volume, primarily occurring within the first 24 h. Blood counts are recommended on the first postoperative day and should be repeated on the second day in case of clinical suspicion. There is a correlation between bone quality, as evaluated by the SI, and TBL, but the effect is less than for BMI. Considering ease of use and consideration of RBC (re-)transfusion, the formula from Camarasa et al. appears to be the best available. However, the various formulas available for estimation of perioperative TBL fail at blood losses not uncommon in THA. Therefore, there is a need for new instruments to evaluate TBL.
全髋关节置换术（THA）可能会导致大量失血，可能需要输血。为避免同种异体输血的常见并发症，建议进行风险分层和患者优化。本研究探讨了如通过辛格指数（SI）评估的骨质量是否会影响初次全髋关节置换术中的失血量，这一情况最近在骨折手术中已被发现。
进行一项回顾性单中心研究，以检查2021年10月至2022年5月期间通过前路对成人进行的初次全髋关节置换术中的术中失血量（IBL）和总失血量（TBL）。总失血量的估算采用了格罗斯、卡马拉萨、法兰克福和OSTHEO公式。
共纳入218例单侧全髋关节置换术。总失血量大大超过术中失血量，主要发生在术后第一天内。这些公式在很大程度上是一致的，总失血量达到估计总血容量的约三分之一，但法兰克福公式得出的值要低得多。然而，当术中失血量超过1000毫升（全髋关节置换术中的一个常见阈值）时，所有四个公式都不适用。手术时间与术中失血量增加相关，但与总失血量无关。体重指数（BMI）似乎是总失血量的一个风险因素。辛格指数有显著但相对较小的影响。
全髋关节置换术后的总失血量值得关注，约占总血容量的三分之一，主要发生在术后24小时内。建议术后第一天进行血常规检查，如有临床怀疑，第二天应重复检查。通过辛格指数评估的骨质量与总失血量之间存在相关性，但效果小于体重指数。考虑到易用性和对红细胞（再）输血的考量，卡马拉萨等人的公式似乎是目前可用的最佳公式。然而，现有的用于估计围手术期总失血量的各种公式在全髋关节置换术中常见的失血量情况下均不适用。因此，需要新的工具来评估总失血量。
