Summary
Two hundred and twelve total hip replacements performed in one clinic over 1 year were reviewed. The mean operative time was 89 min and mean total blood loss 1090 ml. Homologous blood was administered to 74% of the patients. Blood loss was dependent on sex, body weight and height, but these correlations were eliminated when blood loss was related to estimated blood volume. There was no correlation to age. There was a positive correlation between operative time and intraoperative blood loss, but not between any of these factors and postoperative blood loss. Operative time varied significantly between surgeons, but there was no correlation between surgeon's experience and operative time or blood loss. Despite a mean of only 12 total hip replacements per surgeon, both operative time and blood loss were small compared to what was found in other studies. The use of a posterior approach is believed to contribute to a shorter operative time as well as to moderate blood loss. Intraoperative blood loss was less under epidural than under general anaesthesia, but in contrast to others we found higher postoperative blood loss after epidural anaesthesia.
Similar content being viewed by others
References
Amrein PC, Ellman L, Harris WH (1981) Aspirin-induced prolongation of bleeding time and perioperative blood loss. JAMA 245:1825–1828
Armitage P, Berry G (1987) Statistical methods in medical research, 2nd edn. Blackwell Scientific, Oxford
Barbier-Böhm G, Desmonts JM, Couderc E, Moulin D, Prokocimer P, Olivier H (1980) Comparative effects of induced hypotension and normovolaemic haemodilution on blood loss in total hip arthroplasty. Br J Anaesth 52:1039–1042
Bergqvist D (1983) Postoperative thromboembolism. Springer, Berlin, Heidelberg, New York
Bredbacka S, Andréen M, Blombäck M, Wykman A (1987) Activation of cascade systems by hip arthroplasty. No difference between fixation with and without cement. Acta Orthop Scand 58:231–235
Carlin G, Karlström G, Modig J, Saldeen T (1980) Effect of dextran on fibrinolysis inhibition activity in the blood after major surgery. Acta Anaesthesiol Scand 24:375–378
Chin S, Abou-Madi MN, Eurin B, Witvoet J, Montagne J (1982) Blood loss in total hip replacement: extradural v. phenoperidine analgesia. Br J Anaesth 54:491–495
Davis FM, McDermott E, Hickton C, Wells E, Heaton DC, Laurenson VG, Gillespie WJ, Foate J (1987) Influence of spinal and general anaesthesia on haemostasis during total hip arthroplasty. Br J Anaesth 59:561–571
Eriksson BI, Zachrisson BE, Teger-Nilsson A-C, Risberg B (1988) Thrombosis prophylaxis with low molecular weight heparin in total hip replacement. Br J Surg 75:1053–1057
Fredin H, Gustafsson C, Rosberg B (1984) Hypotensive anaesthesia, thromboprophylaxis and posteroperative thromboembolism in total hip arthroplasty. Acta Anaesthesiol Scand 28:503–507
Grillner L (1988) Transfusion transmitted human T-lymphotropic virus infections. Acta Anaesthesiol Scand 32 [Suppl 89]:16–19
Itami Y, Akamatsu N, Tomita Y, Nagai N, Nakajima I (1983) A clinical study of the results of cementless total hip replacement. Arch Orthop Trauma Surg 102:1–10
Iwarson S (1988) Transfusion transmitted non-A, non-B hepatitis. Acta Anaesthesiol Scand 32 [Suppl 89]:13–15
Johnson RA, Wichern DW (1982) Applied multivariate statistical analysis. Prentice-Hall, Englewood Cliffs
assen MR, Borris LC, Christiansen HM, Møller-Larsen F, Knudsen VE, Boris P, Nehen A-M, de Carvalho A, Jurik AG, Nielsen BW, Lucht U (1988) Heparin/dihydroergotamine for venous thrombosis prophylaxis: comparison of low-dose heparin and low molecular weight heparin in hip surgery. Br J Surg 75:686–689
Leikola J (1988) Transfusion transmitted infectious agents, excluding hepatitis and human immunodeficiency viruses. Acta Anaesthesiol Scand 32 [Suppl 89]:20–25
Modig J, Karlström G (1987) Intra- and post-operative blood loss and haemodynamics in total hip replacement when performed under lumbar epidural versus general anaesthesia. Eur J Anaesthesiol 4:345–355
Modig J, Karlström G Malmberg P, (1980) Effect of epidural versus general anaesthesia on calf blood flow. Acta Anaesthesiol Scand 24:305–309
Modig J, Borg T, Karlström G Sahlstedt B, Rikner L (1981) Effects of tocainide, an oral analogue of lidocaine, on thromboembolism after total hip replacement. Ups J Med Sci 86:269–278
Modig J, Borg T, Bagge L, Saldeen T (1983) Role of extradural and of general anaesthesia in fibrinolysis and coagulation after total hip replacement. Br J Anaesth 55:625–629
Modig J, Borg T, Karlström G, Maripuu E, Sahlstedt B (1983) Thromboembolism after total hip replacement: role of epidural and general anesthesia. Anesth Analg 62:174–180
Modig J, Maripuu E, Sahlstedt B (1986) Thromboembolism following total hip replacement. A prospective investigation of 94 patients with emphasis on the efficacy of lumbar epidural anesthesia in prophylaxis. Regional Anesthesia 11:72–79
Nadler SB, Hidalgo JU, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51:224–232
Roberts JM, Fu FH, McClain EJ, Ferguson AB (1984) A comparison of the posterolateral and anterolateral approaches to total hip arthroplasty. Clin Orthop 187:205–210
osberg B, Fredin H, Gustafsson C (1982) Anesthetic techniques and surgical blood loss in total hip arthroplasty. Acta Anaesthesiol Scand 26:189–193
Salo M (1988) Immunosuppressive effects of blood transfusion in anaesthesia and surgery. Acta Anaesthesiol Scand 32 [Suppl 89]:26–34
Schött U, Sjöstrand U, Thorén T, Berséus O (1985) Three per cent dextran-60 as a plasma substitute in blood component therapy. I. An alternative in surgical blood loss replacement. Acta Anaesthesiol Scand 29:767–774
Schött U, Berséus U, Järemo P (1987) Blood substitution and complement activation. Acta Anaesthesiol Scand 31:559–566
Sikorski JM, Hampson WG, Staddon GE (1981) The natural history and aetiology of deep vein thrombosis after total hip replacement. J Bone Joint Surg [Br] 63:171–177
Snedecor GW, Cochran WG (1982) Statistical methods, 7th edn. Iowa State University Press, Ames
Thompson GE, Miller RD, Stevens WC, Murray WR (1978) Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver and kidney) Anesthesiology 48:91–96
Thorburn J, Louden JR, Vallance R (1980) Spinal and general anaesthesia in total hip replacement: frequency of deep vein thrombosis. Br J Anaesth 52:1117–1121
Thoren L, Wiklund L (1983) Intraoperative fluid therapy. World J Surg 7:581–589
Welin-Berger T, Bygdeman S, Mebius C (1982) Deep vein thrombosis following hip surgery. Relation to activated factor X inhibitor: effect of heparin and dextran. Acta Orthop Scand 53:937–945
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Flordal, P.A., Neander, G. Blood loss in total hip replacement. Arch Orthop Trauma Surg 111, 34–38 (1991). https://doi.org/10.1007/BF00390191
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00390191