Bloodless Total Hip Replacement Surgery
Fall 2004
Severe blood loss can be an issue with any major
surgery, including total hip replacement surgery.
An
average of one to two pints of blood can be lost
during
this surgery. However, bloodless surgery, or
surgery
performed without the use of whole blood or blood
products, may be an option for patients who object
to
blood transfusions for religious or personal
reasons.
Key to the success of bloodless hip replacement
surgery is the use of state-of-the-art equipment,
as well
as the implementation of procedures to minimize
blood
loss. Prior to the surgery, the patient’s
medications can
be adjusted and the patient can also receive
a supply of
vitamins and iron to increase their ability to
make more
hemoglobin. During the operation, the surgeon
works
with the anesthesiologist to achieve minimal
blood loss.
The anesthesiologist uses surgical monitoring
to
determine the amount of blood lost and to prevent
fluctuations in blood pressure. By using hypotensive
anesthesia, a constant low blood pressure can
be
maintained, decreasing total blood loss.
Another
new advancement in bloodless hip replacement
surgery is the use of a genetically engineered
growth factor called epoetin alfa, more
commonly known as PROCRIT®. This substance
is
naturally produced by the kidneys to increase
red blood
cells, so that more oxygen can be carried to
the tissues.
In addition to other uses, PROCRIT® is administered
to
surgical patients, prior to surgery, to reduce
the need for
a blood transfusion during surgery.
Acute normovolemic
hemodilution (ANH) is a method also used prior
to surgery, which allows a patient to use
his or her own blood just before surgery. The
patient’s
blood is diluted with a volume expander, such
as
crystalloids or colloids, which are solutions
used to
increase the volume of fluid in the circulating
blood. By
doing this, if a patient loses fluid during surgery,
the
solution would be lost rather than the red blood
cells.
During this process, the blood is kept in a continuous
loop, or closed circuit.
By using ANH, surgery
can take
place without using blood from an outside source.
A decision to have total hip replacement surgery
without the use of blood or blood products
is a matter of
personal choice, and should be discussed with
a primary
care physician and an orthopaedic surgeon.
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