Comparison of the Risk of Perioperative Blood Loss in Hemophilic Arthritis and Initial Total Hip Arthroplasty for Femoral Head Necrosis under Multimodal Blood Management Measures: A Retrospective Cohort Study

To compare the perioperative blood loss and risk of allogeneic transfusion between hemophilia arthritis (HA) patients and osteonecrosis of the femoral head (ONFH) patients undergoing unilateral total hip arthroplasty (THA) under multimodal blood management measures.

Clinical data of HA patients treated with unilateral THA from January 2010 to June 2022 and ONFH patients matched 1:3 by gender were retrospectively collected at Peking Union Medical College Hospital, and the differences in indicators related to perioperative blood loss and complication rates were compared between the two groups.

A total of 26 patients with HA and 76 patients with ONFH who met the inclusion and exclusion criteria were enrolled.Compared with ONFH patients, the total blood loss[(1927.08±956.59) mL vs.(1475.88±924.43) mL, P=0.036], major bleeding rate (38.46%vs. 14.47%, P=0.009), allogeneic transfusion rate (15.38%vs. 3.95%, P=0.046), and complication rate (34.62%vs. 7.89%, P=0.000) in HA patients were higher, and postoperative day 3 hemoglobin[(112.94±12.26) g/L vs.(117.40±11.17) g/L, P=0.000]and hematocrit[(29.44±7.96)%vs.(32.80±5.52)%, P=0.019]were lower.

The risk of perioperative blood loss and allogeneic transfusion is higher in HA patients treated with unilateral THA than in ONFH-THA patients, and further optimization of blood management strategies is needed.