Strategies to Reduce Blood Loss
in Lower Extremity
Total Joint Arthroplasty
Slif D. Ulrich, MD
Orthopaedic Resident
Department of Orthopaedic Surgery
Union Memorial Hospital
Baltimore, MD
Brad Kyle, BS
Medical Student
Department of Orthopaedic Surgery
Union Memorial Hospital
Baltimore, MD
Aaron J. Johnson, MD
Orthopaedic Fellow
Rubin Institute for Advanced Orthopedics
Sinai Hospital of Baltimore
Baltimore, MD
Mike G. Zywiel, MD
Orthopaedic Fellow
Rubin Institute for Advanced Orthopedics
Sinai Hospital of Baltimore
Baltimore, MD
Michael A. Mont, MD
Director
Center for Joint Preservation and Replacement,
Rubin Institute for Advanced Orthopedics
Sinai Hospital of Baltimore
Baltimore, MD
Concerns about blood loss and the safety of allogenic blood transfusion have led to the development of many transfusion options for lower extremity joint arthroplasty. Techniques for dealing with such blood loss include allogenic blood transfusion, autologous donation and transfusion, hemodilution, perioperative blood salvage, intraoperative cell savers, bipolar sealers, and pharmacological agents. A blood management strategy must consider both the patient and the surgical procedure, assess the transfusion risks, and formulate a plan to address them appropriately. This article is an overview of the blood management techniques for lower extremity joint arthroplasty. The purpose of this review is to report our opinion regarding the use of alternative blood management strategies and to discuss the possible advantages and disadvantages of each technique. The results of this review indicate that a patient-focused algorithm using one or more strategies such as preoperative administration of erythropoietin, preoperative autologous blood donation, use of a bipolar sealer, intraoperative blood collection and reinfusion, as well as postoperative reinfusion drains may reduce the need for allogenic blood transfusions in patients undergoing primary and revision lower-extremity joint arthroplasties. The authors believe that a patient-specific algorithm utilizing the aforementioned techniques can lead to a substantial decrease in morbidity and mortality and an overall cost saving for both patients and medical institutions.
