Perioperative Blood Loss During Total Hip Arthroplasty Among Patients With Ankylosing Spondylitis

Predisposing factors for allogeneic blood transfusion in patients with ankylosing spondylitis undergoing primary unilateral total hip arthroplasty: a retrospective study

BACKGROUND

The transfusion rate is relatively high in patients with ankylosing spondylitis (AS) undergoing total hip arthroplasty (THA). However, relevant studies focusing on the predisposing factors for transfusion with a large sample size are lacking. This study aimed to investigate the incidence of and risk factors for allogeneic blood transfusion in patients with AS undergoing primary unilateral THA.

METHODS

This retrospective study included 331 patients with AS who underwent primary unilateral THA between 2011 and 2021. Relevant parameters were collected through a chart review. Multivariate logistic regression analysis was conducted to identify possible factors associated with perioperative allogeneic blood transfusion.

RESULTS

A total of 113 (34.1%) patients received perioperative allogeneic blood transfusions. Factors related to receiving an allogeneic blood transfusion included prolonged operative duration (odds ratio [OR] per 10 min = 1.139, P = 0.047), increased estimated intraoperative blood loss (OR per 100 mL = 1.348, P < 0.001), and increased postoperative drainage volume (OR per 100 mL = 1.235, P = 0.024). A higher body mass index (BMI) (OR = 0.914, P = 0.012), perioperative tranexamic acid (TXA) use (OR = 0.166, P < 0.001), and a higher preoperative hemoglobin level (OR per 1 g/dL = 0.744, P = 0.004) decreased the risk of transfusion.

CONCLUSIONS

In patients with AS undergoing THA, prolonged operative duration, increased estimated intraoperative blood loss, and increased postoperative drainage volume were found to be risk factors for transfusion, whereas a higher BMI, perioperative TXA use, and a higher preoperative hemoglobin level were protective factors. These results may aid in developing a better perioperative management strategy, ultimately reducing the need for transfusion.

The correlation between volumetric bone mineral density and morphological parameters of the proximal femur and clinical outcomes in ankylosing spondylitis patients with hip involvement

Background

To measure volumetric bone mineral density (vBMD) with quantitative computed tomography (QCT) in the proximal femur of ankylosing spondylitis (AS) patients with hip involvement and analyze their correlations with radiographic and clinical parameters.

Methods

Sixty-five AS inpatients were enrolled in this study. The bone mineral density was measured by QCT and dual-energy x-ray absorptiometry (DXA), respectively. The morphological parameters of the proximal femur were measured on digital anteroposterior (AP) radiographs of the pelvis. The correlations between them were analyzed by SPSS software.

Results

The average trabecular vBMD measured at the femoral neck was 136.38 ± 25.58 mg/cm³. According to the BASRI-Hip score, group A consisted of 39 hips (0–2 score) and group B consisted of 26 hips (3–4 score). There were significant differences regarding trabecular CTXA equivalent T-score between group A and B at the femoral neck (p = 0.004); intertrochanteric region (p < 0.001) and greater trochanter (p = 0.001). The trabecular CTXA equivalent T-score at femoral neck had a negative correlation with disease duration (r = − 0.311, p = 0.012) and with CBR (r = − 0.319, p = 0.010).

Conclusions

The low trabecular bone density at the site of the hip was associated with the duration of disease progression and degree of hip involvement. Meanwhile, it had a correlation with hip function status although we failed to confirm a significant relationship between hip vBMD and disease activity.

Two-Stage Treatment for Ankylosing Spondylitis With Severe Hip Contracture

Ankylosing spondylitis is a progressive inflammatory disease that often involves the hip, causing deformities and dysfunction. Total hip arthroplasty (THA) may be used, but contracture of the hip joint in ankylosing spondylitis makes THA technically difficult and leads to poor efficacy. This retrospective study describes a novel 2-stage surgical treatment for ankylosing spondylitis of the hip and evaluates its efficacy relative to THA alone. Patients with ankylosing spondylitis and severe hip flexion contracture treated between 2011 and 2017 were assigned to either an experimental group or an age-matched control group (n=12 each) based on receiving, respectively, soft tissue release of the hip joint, femoral osteotomy, and supracondylar bone traction (stage I) and THA (stage II) or THA only. Clinical and radiological data included preoperative, postoperative, and follow-up Harris Hip Score and visual analog scale score, hip range of motion, femoral nerve injury, and heterotopic ossification. Both groups had significant corrections after surgery. At the final follow-up, the experimental group had significantly higher Harris Hip Scores and range of motion in extension compared with the control group, significantly more reduction in visual analog scale score, and no femoral nerve injury. The novel 2-stage surgery for patients with ankylosing spondylitis and severe hip flexion contracture is effective for restoring hip function and improving patients' quality of life, having fewer complications than traditional THA alone. [Orthopedics. 2019; 42(6):e502-e506.].