Minimizing bleeding and transfusion in single-stage bilateral hip and knee arthroplasty: A systematic review of current interventions.

OBJECTIVES

To evaluate perioperative strategies for minimizing bleeding and transfusion needs in single-stage bilateral hip and knee arthroplasty. This systematic review identifies effective interventions and provides evidence-based recommendations and highlight areas for future research in optimizing bleeding management.

METHODS

A systematic review of literature from January 2010 to October 2024 was conducted, focusing on randomized controlled trials, meta-analyses, and guidelines. Databases searched included PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science. Interventions assessed included tranexamic acid (TXA), surgical techniques, regional anesthesia, controlled hypotension, preoperative anemia correction, tourniquet use, bone wax, and restrictive transfusion strategies. Study selection, data extraction, and quality assessment followed PRISMA and Newcastle-Ottawa Scale guidelines.

RESULTS

From 325 included studies, TXA consistently demonstrated the most significant impact, reducing transfusion rates by 40-60%. Anterior total hip arthroplasty was associated with reduced blood loss. Regional anesthesia and controlled hypotension further minimized intraoperative bleeding. Preoperative anemia correction and restrictive transfusion thresholds also showed benefits. Tourniquet evidence was inconclusive. Limited evidence supported bone wax. GRADE assessment suggested high evidence quality for TXA and regional anesthesia, moderate for minimally invasive surgery, anemia correction, and restrictive transfusion, and low for bone wax.

CONCLUSIONS

Multimodal approach integrating TXA, regional anesthesia, minimally invasive surgery, anemia correction, and restrictive transfusion protocols effectively reduces bleeding and transfusion needs in bilateral arthroplasty. Incorporation into enhance recovery after surgery protocols is recommended. Future research should refine TXA dosing, clarify tourniquet use, and assess cost-effectiveness.