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Comparison of the Risk of Perioperative Blood Loss in Hemophilic Arthritis and Initial Total Hip Arthroplasty for Femoral Head Necrosis under Multimodal Blood Management Measures: A Retrospective Cohort Study
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摘要:
目的 对比在多模式血液管理措施下，血友病关节炎（hemophilia arthritisHA）与股骨头坏死（osteonecrosis of the femoral head,ONFH）行单侧全髋关节置换（Total hip arthroplasty THA）围手术期失血量及异体输血风险。 方法 回顾性纳入2010年1月1日至2022年6月15日接受单侧THA并符合标准的26例HA患者，平均年龄（30.46±6.78）岁，BMI（23.90±4.53） kg/m2；按照1:3匹配76例接受单侧THA的ONFH患者。两组均为男性，平均年龄（34.41±7.398）岁，BMI（24.61±4.11） kg/m2；比较两组人口学资料，中位手术时间、中位住院时间，术前及术后第1、3天血红蛋白及红细胞压积、术后血红蛋白及红细胞压积下降值、总失血量、输血比例及并发症情况。 结果： HA-THA组术后总失血量[（1927.08±956.60） mL比（1475.88±924.43） mL,P=0.036]及隐性失血量[（1526.70±835.82） mL比（1147.94±930.10） mL,P=0.069]均多于对照;大出血率高于对照组（38.46%比15.38%,P=0.002）；输血率高于对照组（15.38%比9.89%，P=0,012）；中位手术时间长于对照组（98min比77min，P=0.015）；中位住院时间明显长于对照组（20天比12天，P=0.000）。 结论 单侧HA-THA的围手术期失血及异体输血风险相比ONFH-THA患者仍高，需进一步研究预防性和有效的方法来降低HA-THA失血风险。
Abstract:Objective We aim to compare the perioperative blood loss and risk of allogeneic transfusion between hemophilia arthritis (HA)patients and osteonecrosis of the femoral head (ONFH) patients underwent unilateral total hip arthroplasty （ THA） under multimodal blood management measures. Methods: 26 patients with HA who underwent unilateral THA from January 1, 2010, to June 15, 2022, and met the criteria, with a mean age of (30.46±6.78) years and BMI of (23.90±4.53) kg/m2, were retrospectively included; 76 patients with ONFH who underwent unilateral THA were matched according to 1:3. All were male, mean age (34.41±7.398) years, BMI (24.61±4.11) kg/m2; demographic data, median operative time, median hospital stay, preoperative and postoperative day 1 and 3 hemoglobin and hematocrit, postoperative hemoglobin and hematocrit decline values, total blood loss, transfusion ratio, and complications were compared between the two groups. Results: There was significantly more total blood loss ((1927.08±956.60) mL vs. (1475.88±924.43) mL, P=0.036) and hidden blood loss (1526.70±835.82 mL vs. (1147.94±930.10) mL, P=0.069), higher rate of major bleeding (38.46% vs. 15.38%, P=0.002); higher transfusion risk (15.38% vs. 9.89%, P=0.012); longer median operative time (98min vs. 77min, P=0.015); and longer median hospital stay (20 days vs. 12 days, P=0.000) in HA-THA group than in ONFH-THA group. Conclusion: The risk of perioperative blood loss and allogeneic transfusion is still high in unilateral HA-THA compared to ONFH-THA patients. Further research is needed on prophylactic and effective methods to reduce the risk of blood loss in HA-THA.
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Key words:
- hip replacement /
- arthroplasty /
- hemophilia /
- factor replacement /
- blood loss
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[1] Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet Lond Engl 2018;392:1662–71. https://doi.org/10/gfmkb7. [2] Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br 2004;86:561–5. [3] Park JH, Rasouli MR, Mortazavi SMJ, Tokarski AT, Maltenfort MG, Parvizi J. Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am 2013;95:1777–83. https://doi.org/10/gq57kb. [4] Carling MS, Jeppsson A, Eriksson BI, Brisby H. Transfusions and blood loss in total hip and knee arthroplasty: a prospective observational study. J Orthop Surg 2015;10:48. https://doi.org/10/f3mwh8. [5] Parsa A, Azizbaig Mohajer M, Mirzaie M. Hip arthroplasty in haemophilia: a systematic review. HIP Int 2018;28:459–67. https://doi.org/10/gfcdvq. [6] Berntorp E, Fischer K, Hart DP, Mancuso ME, Stephensen D, Shapiro AD, et al. Haemophilia. Nat Rev Dis Primer 2021;7:45. https://doi.org/10/gmg2nj. [7] Strauss AC, Rommelspacher Y, Nouri B, Bornemann R, Wimmer MD, Oldenburg J, et al. Long-term outcome of total hip arthroplasty in patients with haemophilia. Haemophilia 2017;23:129–34. https://doi.org/10/f9k62b. [8] Wu G, Zhai J, Feng B, Bian Y, Xu C, Weng X. Total Hip Arthroplasty in Hemophilia Patients: A Mid-term to Long-term Follow-up. Orthop Surg 2017;9:359–64. https://doi.org/10/gcmfx2. [9] 翟吉良, 翁习生, 彭慧明, 边焱焱, 孙天闻, 周磊. 血友病性关节炎及骨关节炎患者膝关节置换术后出血量的比较. 中国医学科学院学报2012;34. [10] Nelson IW, Sivamurugan S, Latham PD, Matthews J, Bulstrode CJ. Total hip arthroplasty for hemophilic arthropathy. Clin Orthop 1992:210–3. [11] Zy H, Q H, Hj Z, J M, B S, Zk Z, et al. Tranexamic acid may benefit patients undergoing total hip/knee arthroplasty because of haemophilia. BMC Musculoskelet Disord 2019;20. https://doi.org/10/gqcprr. [12] Peng H, Wang L, Zhai J, Jiang C, Weng X, Feng B, et al. Incidence of Symptomatic Venous Thromboembolism in Patients with Hemophilia Undergoing Hip and Knee Joint Replacement without Chemoprophylaxis: A Retrospective Study. Orthop Surg 2019;11:236–40. https://doi.org/10.1111/os.12444. [13] Swystun LL, James PD. Genetic diagnosis in hemophilia and von Willebrand disease. Blood Rev 2017;31:47–56. https://doi.org/10/f9wcm4. [14] Liu X, Zhang X, Chen Y, Wang Q, Jiang Y, Zeng B. Hidden blood loss after total hip arthroplasty. J Arthroplasty 2011;26:1100-1105.e1. https://doi.org/10/fdsdxm. [15] Colgan G, Baker JF, Donlon N, Hogan N, McCarthy T. Total hip arthroplasty in patients with haemophilia - What are the risks of bleeding in the immediate perioperative period? J Orthop 2016;13:389–93. https://doi.org/10/gq5668. [16] Bellingham A, Fletcher D, Kirwan EO, Prankerd TA, Cleghorn T. Hip arthroplasty in a haemophiliac and subsequent prophylactic therapy with cryoprecipitate. Br Med J 1967;4:531–2. https://doi.org/10/dmb36c. [17] Shen SN, Wu DX, Lv SJ, Tong PJ. Hidden blood loss of total knee arthroplasty in hemophilia arthritis: an analysis of influencing factors. BMC Musculoskelet Disord 2022;23:587. https://doi.org/10/gq57jq. [18] Kleiboer B, Layer MA, Cafuir LA, Cuker A, Escobar M, Eyster ME, et al. Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study. J Thromb Haemost JTH 2022;20:857–65. https://doi.org/10/gpz5q2. [19] Zhai J, Weng X, Lin J, Qian W, Guo S. Efficacy of a modified coagulation factor substitution for total hip arthroplasty in patients with end-stage haemophilic arthropathy. Blood Coagul Fibrinolysis 2017;28:24–7. https://doi.org/10.1097/MBC.0000000000000527. [20] Kapadia BH, Boylan MR, Elmallah RK, Krebs VE, Paulino CB, Mont MA. Does Hemophilia Increase the Risk of Postoperative Blood Transfusion After Lower Extremity Total Joint Arthroplasty? J Arthroplasty 2016;31:1578–82. https://doi.org/10/f8sksz. [21] Wang S-H, Chung C-H, Chen Y-C, Cooper AM, Chien W-C, Pan R-Y. Does Hemophilia Increase Risk of Adverse Outcomes Following Total Hip and Knee Arthroplasty? A Propensity Score-Matched Analysis of a Nationwide, PopulationBased Study. J Arthroplasty 2019;34:2329-2336.e1. https://doi.org/10/gn9j74. [22] Gillinov SM, Burroughs PJ, Moore HG, Rubin LE, Frumberg DB, Grauer JN. Total Hip Arthroplasty in Patients With Classic Hemophilia: A Matched Comparison of 90-Day Outcomes and 5-Year Implant Survival. J Arthroplasty 2022;37:1333–7. https://doi.org/10/gqcpnc. [23] Kaseb MH, Shafiee SH, Shamabadi A, Aminjavaheri SA, Mortazavi SMJ. Cementless total hip arthroplasty in haemophilia patients through direct anterior approach n.d.:6. https://doi.org/10/gqcsgp. [24] Almeida RP, Mokete L, Sikhauli N, et al. The draining surgical wound post total hip and knee arthroplasty: what are my options? A narrative review. EFORT Open Rev 2021;6:872–80. https://doi.org/10/grkzdz. -
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