Perioperative Transfusion in Total Hip Arthroplasty: Predictive Factors and Outcomes

Keywords:

Total hip arthroplasty, transfusion, anemia, infection, tranexamic acid.


Published online: Aug 06 2026

https://doi.org/10.52628/92.2.13561

VAN DEN WYNGAERT T.1, MANON J.1,2, POILVACHE H.1,2, POPESCU D.1, JACQUEMART N.1, EL CHOUHEIRI J.1, DRUEZ V.5, POSTELTHWAITE D.1, DUBUC J.-E.1, LAVAND’HOMME P.3, YOMBI J.-C.1,4, CORNU O.1,2

1Department of Orthopaedic and Trauma Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200 Brussels, Belgium
2Experimental and Clinical Research Institute (IREC), Neuro-Musculo-Skeletal Pole (NMSK), Université Catholique de Louvain, Avenue Mounier 52 , 1200 Brussels, Belgium
3Department of Anesthesia, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), avenue Hippocrate 10, 1200 Brussels, Belgium
4Department of Internal Medecine, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), avenue Hippocrate 10, 1200 Brussels, Belgium
5Department of Orthopaedic and Trauma Surgery, Clinique Générale Saint-Jean, boulevard du Jardin Botanique 32, Brussels, Belgium

Abstract

Background: Total hip arthroplasty is a common orthopedic procedure with significant hemorrhagic risks, often necessitating postoperative transfusions to treat anemia. Transfusions carry considerable costs and complications, including infection, necessitating judicious use. Identifying factors influencing transfusion rates in hip arthroplasty can improve perioperative management. Patients and

methods: Records of 3,865 patients who underwent primary total hip arthroplasty at a university center from 2002 to 2020 were retrospectively reviewed. Factors analyzed included age, sex, BMI, ASA physical status classification, surgical indication, operation duration, surgical approach, additional procedures, hospital stay duration, intraoperative complications, postoperative infections, anticoagulation, tranexamic acid use, anti- inflammatory use, and pre- and postoperative hemoglobin levels. Data were analyzed using descriptive, univariate, and multivariate analyses.

Results: The overall transfusion rate was 9.4%. Transfusion rates decreased from 28.5% (2002-2003) to 11.3% (2004-2012) and 4.3% (2013-2020). Multiple logistic regression showed that female sex, surgical indication, surgical approach, longer operative time, higher ASA scores, and greater postoperative hemoglobin drop significantly increased transfusion risk. Conversely, tranexamic acid and anti-inflammatory use, and higher body weight significantly decreased transfusion risk. Infection rates were higher among transfused patients (3%) compared to non-transfused patients (0.83%).

Conclusion: Reducing transfusion use is essential due to the scarcity of blood, associated costs, and complications, necessitating a standardized transfusion policy and perioperative care protocols. Optimizing preoperative hemoglobin, using controlled hypotension anesthesia, minimally invasive surgical approaches, consistent surgical techniques, perioperative tranexamic acid, and postoperative anti-inflammatory use are crucial to reducing

ActaOrthopBelg-92-1-cover

About this issue

Volume 92, issue 2.

Summer 2026.

Open access journal

This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.