The Mannheim concept for preoperative autologous blood deposit and perioperative cell salvage in hip arthroplasty.

Purpose: To investigate the efficiency of preoperative autologous deposit a nd intra- and postoperative cell salvage (CS) to reduce homologous transfus ion in hip arthroplasty and revision hip arthroplasty. Methods: In a retros pective study, the data of 1402 patients scheduled for hip arthroplasty and for revision hip arthroplasty were analysed. Results: 767 women and 635 me n, age 62.9+/-9.8 years (x+/-s) were included in the study. 1270 were sched uled for hip arthroplasty, 132 for revision hip arthroplasty. Of the autolo gous donors, 51 patients predeposited four units, 1020 patients three, 204 patients two, 39 patients one unit. 88 patients who had not enrolled in the autologous donation program but received CS served as a control group. Blo od loss in autologous donors amounted to 1620 (220- 5620) mi in hip arthrop lasty and 2830 (950-7910) mi in revision arthroplasty. CS was employed in p art of the cases in arthroplasty and in all revision operations. 470 (0-220 0) mi and 705 (0-2200) were retransfused. In hip arthroplasty 227 of 1182 p atients (19.2%) received homologous blood. Homologous transfusion in patien ts with coxarthrosis due to acetabular protrusio, avascular necrosis of the femoral head and hip dysplasia showed a trend to higher values. Patients w ho had donated 3 units and received CS required homologous transfusion in 1 2.4% of the cases. CS reduced the homolgous transfusion rate significantly if the preoperative hemoglobin concentration was less than or equal to 12 g /dl. A group of autologous donors receiving CS was matched with patients re ceiving CS only. 12 of 76 (15.8%) vs. 45 of 76 (59,2%) required homologous transfusion. In revision hip arthroplasty 58 of 132 patients (43,9%) requir ed homologous blood. Conclusions: Preoperative deposit reduces homologous t ransfusion requirements considerably in hip surgery. Under the conditions s tudied CS should be employed in hip arthroplasty in addition to preoperativ e deposit if the preoperative hemoglobin concentration falls below 12 g/dl. In revision arthroplasty, 4 or more autologous units should be predeposite d and CS should be used regularly.