Assessment of Total Blood Loss in the Management of Periprosthetic Hip Fractures

Introduction: With the ageing population and the increase in total hip arthroplasties, the incidence of periprosthetic hip fractures (PPHF) is constantly on the rise. Treatment of this fracture often leads to blood loss and anaemia. The aim of this study was to evaluate total blood loss induced by PPHF, to analyse the influence the type of fracture has over blood loss, the influence of treatment on the bleeding and, finally, the blood transfusion rate. Methods: A prospective study was performed within our department, over a 6-year period from January 1, 2010, to December 31, 2015, including 88 patients. All fractures were treated surgically in accordance with Vancouver guidelines. We evaluated the blood loss volume with formulas based on haemoglobin and haematocrit. Subgroup, stratified according Vancouver Classification, were comparable. Results: The mean estimated Red Blood Cell loss was 582.19 ml. The mean Blood Volume Loss was 1149.31 ml or 1199.35 ml, depending on the formula used. The greatest blood loss was found in Vancouver B3 fractures, followed by Vancouver B2, C and B1 fractures. The volume of blood loss was statistically different between each type of fracture (P<0.05). The postoperative transfusion rate was 87.5 % with a mean of 3.18 Units of blood concentrates. The blood loss and transfusion rates were different between each type of fracture (P<0.05). Discussion: Anaemia is a pejorative factor for mortality and morbidity in PPHF population in previous studies. Recently, many studies have tried to evaluate different pre-operative blood management programs to reduce postoperative anaemia. Conclusion: Periprosthetic hip fractures and their treatments are associated with significant blood loss requiring transfusion of several units of blood.