Aim

The aim of this prospective comparative study was to evaluate the serum levels of different cytokines in patients underwent total knee replacement (TKR) and received allogeneic blood transfusion, post-operative auto-transfusion or not transfused.

Rivaroxiban is a factor Xa inhibitor and is a newer oral alternative for thromboprophylaxis after joint replacements. Its major advantage is its oral administration and hence better patient compliance. However there are some doubts about its efficacy compared to dalteparin/heparin. We have recently changed over from using dalteparin injections to rivaroxiban tablets for thromboprophylaxis after hip replacements. We assessed our results to find efficacy and specificity of its action in patients undergoing THR.

504 patients underwent hip replacement in last 2 years. 316 were treated with dalteparin injections (fragmin) for thromboprophylaxis while 189 patients were treated with oral rivaroxiban for 35 days after their hip replacement.

Average haemoglobin drop at 24 hours postop was 2.79 in Rivaroxiban group compared to 3. 10 in dalteparin group. 19 patients (of 189 i.e. 10.05%) required postop blood transfusion in rivaroxiban group as against 60 (of 315 i.e. 19.04%) in Dalteparin group. This difference was statistically significant. Incidence of DVT was no different in either groups, but the number of patients was too small to compare this.

Rivaroxiban appears to be more specific in its action and our results suggest a significant reduction in postop blood transfusion following hip replacements without any increase in rate of Deep Vein Thrombosis. We would like to present our findings and discuss role of oral thromboprophylaxis after joint replacements.

Introduction

There is no established evidence to support the use of drains after total knee replacement; however 94% of orthopaedic surgeons in UK routinely use closed suction drains. Haematomas can form with or without using drains, presence of which in addition may provide portal for infection and may increase blood loss. Blood group and save is routinely performed for every patient undergoing total knee replacement, however actual cross match and transfusion is needed for a small percentage of patients.

Aims. The aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients. Methods. A retrospective cohort study was undertaken using linked data from the Scottish Hip Fracture Audit and the Scottish National Blood Transfusion Service between May 2016 and December 2020. All patients aged ≥ 50 years admitted to a Scottish hospital with a hip fracture were included. Assessment of the factors independently associated with red blood cell transfusion (RBCT) during admission was performed, alongside determination of the association between RBCT and hip fracture outcomes. Results. A total of 23,266 individual patient records from 18 hospitals were included. The overall rate of blood transfusion during admission was 28.7% (n = 6,685). There was inter-hospital variation in transfusion rate, ranging from 16.6% to 37.4%. Independent perioperative factors significantly associated with RBCT included older age (90 to 94 years, odds ratio (OR) 3.04 (95% confidence interval (CI) 2.28 to 4.04); p < 0.001), intramedullary fixation (OR 7.15 (95% CI 6.50 to 7.86); p < 0.001), and sliding hip screw constructs (OR 2.34 (95% CI 2.19 to 2.50); p < 0.001). Blood transfusion during admission was significantly associated with higher rates of 30-day mortality (OR 1.35 (95% CI 1.19 to 1.53); p < 0.001) and 60-day mortality (OR 1.54 (95% CI 1.43 to 1.67); p < 0.001), as well as delays to postoperative mobilization, higher likelihood of not returning to their home, and longer length of stay. Conclusion. Blood transfusion after hip fracture was common, although practice varied nationally. RBCT is associated with adverse outcomes, which is most likely a reflection of perioperative anaemia, rather than any causal effect. Use of RBCT does not appear to reverse this effect, highlighting the importance of perioperative blood loss reduction. Cite this article: Bone Joint J 2022;104-B(11):1266–1272