[Homologous blood use and possibilities for autologous hemotherapy as exemplified in hip and knee endoprostheses].

In a retrospective study we documented the need for blood transfusion in total knee (TKR) and hip replacement (THR). The problems with homologous blood transfusion in orthopedic surgery and alternative techniques of autologous-blood transfusions are discussed. In this series patients with primary THR needed 1.69 (+/- 2.25) blood units, with primary TKR 1.58 (+/- 1.54) blood units, and secondary TKR 1.19 (+/- 1.47) blood units, Secondary THR required significantly more units (3.85 +/- 3.07). These procedures also asked for significantly more plasma (3.27 +/- 3.95) than all other procedures. For secondary THR 2.63 (+/- 2.45) blood units were intraoperatively used and only 1.23 (+/- 1.09) blood units postoperatively. All other procedures needed postoperatively significant more units than intraoperatively. In secondary THR the use of blood transfusions increased with age. 45% of the patients with primary THR and 15% with secondary THR were operated without additional blood transfusion. In secondary THR 36% of all patients needed more than 4 blood units and 27% more than 4 plasma units. In TKR 39% of the primary cases and 50% of the secondary cases were operated on without additional homologous blood. Based on these results we established a transfusion concept for our department. Economic, practical, as well as legal aspects were taken into account.