Predicting Blood Loss in Total Knee and Hip Arthroplasty

Marked blood loss during lower extremity total joint arthroplasties may lead to higher rates of transfusion, which may negatively affect surgical outcomes and yield greater complication rates. It is therefore ideal to identify factors that may increase the likelihood of blood loss, so they can be modified. From this review, it can be concluded that preoperative anemia, older age, multiple comorbidities, increased operative time, and use of postoperative anticoagulation may lead to higher blood loss and transfusion rates, although the influence of other factors remains controversial.

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The use of blood loss strategies, such as tranexamic acid, may reduce the role these factors play in bleeding and transfusion risk.

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The use of blood loss strategies, such as tranexamic acid, may reduce the role these factors play in bleeding and transfusion risk.

It seems that TXA has beneficial effects on blood loss and transfusion rates ( Table 14 ). If TXA becomes widely incorporated in THA and TKA, this may change many of the prior conclusions and minimize the role of various perioperative factors in blood loss.

Table 14

Studies describing the use of tranexamic acid and the associated risk of transfusion

Author, Year	Number of Arthroplasties	Risk Factor	Relative Risk for Transfusion	P Value	LOE
Alshryda et al, 2013	161	TXA	NR	.004	I
Sabatini et al, 2014	45	TXA	NR	<.05	IV
Samujh et al, 2014	113	TXA	0.25	.03	III
Sukeik et al, 2011	370	TXA	NR	<.001	II

Abbreviations: LOE, level of evidence; NR, not reported.

Data from Refs.

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