Blood loss and transfusion rate in noncemented and cemented/hybrid total hip arthroplasty. Is there a difference? A comparison of 25 matched pairs

A common assumption among orthopedic surgeons is that cemented/hybrid total hip arthroplasty (THA) results in lower transfusion requirements than nonc emented THA. The hypothesized mechanism to account for transfusion differen ces is that cement application, after polymerization, decreases perioperati ve blood loss. To evaluate this theory, a retrospective matched-pair study was performed to quantify perioperative, intraoperative, postoperative bloo d loss, and transfusion requirements among patients undergoing cemented/hyb rid and noncemented THA. Twenty-five THA procedures were either cemented or hybrid and 25 were noncemented. Patients were matched with respect to age, gender, weight, and diagnosis. Six patients in the noncemented group and 10 in the cemented/hybrid group r eceived autologous blood in the Post Anesthesia Care Unit. Among this subgr oup, those in the cemented/hybrid group received a significantly greater vo lume of transfused blood (519.20 mL, versus 291.67 mL in the noncemented gr oup, P < .017). After stratifying patients by gender, additional analysis revealed a greate r total blood loss in the male population than in females (1848 mL versus 1 464 mL, P < .004). Males also had a greater drain volume (548 mL versus 414 mL, P < .02). The female population utilizing hormone replacement therapy (HRT) was found to have a lesser blood loss (810 mL versus 1209 mL, P < .01 07) and received a smaller amount of transfused blood (1164 mL versus 1377 mL) than those who were not on HRT. Other significant findings included a s horter length of stay in the cemented/hybrid group (6.85 versus 7.56 days, P < .012). Based on this matched-pair retrospective analysis of blood requirements, th ere is no indication that cemented/hybrid and noncemented THA procedures re sult in different blood requirements. However, differences were found in se veral areas when the population was stratified by gender. The information o btained from this study is important in its ability to solidify a foundatio n from which blood management decisions can be made.