USF-LVHN SELECT
Bloodless Total Hip Arthroplasty in Jehovah's Witness Patients: Contemporary Strategies and Outcomes.
Publication/Presentation Date
9-26-2024
Abstract
BACKGROUND: Reported blood transfusion rates in total hip arthroplasty (THA) range between 3 and 22%. Jehovah's Witnesses (JW) do not accept blood transfusions and make conscience decisions to accept blood derivatives. This study reports on strategies and outcomes for bloodless THA.
METHODS: All JW patients undergoing primary THA at our institution between 2011 and 2022 were included in this study (94 of 110 THA). The indications for THA were osteoarthritis (92%), femoral neck fracture (6%), rheumatoid arthritis (1%), and failed open reduction and internal fixation (1%). Strategies used to optimize outcomes included erythropoietin, tranexamic acid (TXA), cell savers, intra-iliac artery tourniquets, and minimizing phlebotomy.
RESULTS: The mean estimated blood loss was 201.2 ± 122.2 ml. Preoperative hemoglobin (Hgb) levels were 13.4 ± 1.4 g/dl, which decreased to 11.0 ± 1.3 g/dl on postoperative day 1 (POD1, P < 0.001), 10.3 ± 1.5 g/dl on POD2 (P = 0.001), and 9.8 ± 1.1 g/dl on POD3 (P = 0.171). The use of TXA significantly decreased Hgb on POD1 (P = 0.04). Subgroup analysis showed that preoperatively anemic patients (Hgb < 12 g/dl) had significantly less Hgb drop postoperatively (P = 0.003). No patients met the recommended transfusion threshold (Hgb < 7 g/dl). There were two 90-day readmissions due to falls. There was zero 90-day mortality.
CONCLUSION: A THA can be safely performed on JW patients. Preoperatively anemic patients had a decreased Hgb drop postoperatively. JW patients make a conscious decision to accept blood derivatives, which may be present in medications including erythropoietin. Cell savers can be utilized when anticipating intraoperative blood loss greater than 500 mL. We recommend maintaining a Hgb above 11 g/dl prior to surgery, as a Hgb drop of 3.1 g/dl can be expected. These findings highlight the efficacy of a multimodal approach to optimizing bloodless primary THAs.
ISSN
1532-8406
Published In/Presented At
Shen, V., Salomon, K., Ohanisian, L., Simon, P., Miranda, M., & Bernasek, T. (2024). Bloodless Total Hip Arthroplasty in Jehovah's Witness Patients: Contemporary Strategies and Outcomes. The Journal of arthroplasty, S0883-5403(24)00994-X. Advance online publication. https://doi.org/10.1016/j.arth.2024.09.035
Disciplines
Medical Education | Medicine and Health Sciences
PubMedID
39341580
Department(s)
USF-LVHN SELECT Program, USF-LVHN SELECT Program Students
Document Type
Article