A common question for hip/knee joint replacement patients is whether they will need a blood transfusion during or after their operation. I have developed a blood management protocol which should allay your concerns. All patients having joint replacement are at risk for blood transfusion. However, I have found that by using a logical, evidenced –based approach to this problem, my patients rarely require blood products. If you have been diagnosed with a low red blood cell count (anemia) or if we discover that you have a low count when we take a simple pin prick test during your office consultation, there are several steps we can take to get you safely prepared for surgery. For those patients with known chronic anemia, a hematologist (anemia specialist) will meet with you regarding possible iron replacement, or possibly the use of an injectable drug (Epogen) to correct the low blood count. Those patients who were not aware of a low blood count will need diagnostic studies/tests to find the cause of anemia. All patients are asked to take a daily vitamin with folic acid and iron. Some patients will need more iron than what is commonly found in a good vitamin preparation (Silver Centrum).Vitamins and iron supplements are continued post-operatively for one month. There is no need to pre-donate blood prior to surgery. Pre-donation was once commonly used but over the last five years largely stopped because of safety concerns, wasting un-used blood, as well as inducing anemia pre-operatively.
At time of surgery, we employ several techniques to minimize blood loss. Regional (spinal) anesthesia with meticulous blood pressure control will keep you comfortable, pain-free, and decrease blood loss. For hip surgery, I use the Ortho Pat portable cell saver system during the surgery and 6 hours after surgery. A small smooth silicone drain gently removes blood from the hip area post-operatively and then after processing (washed red blood cells) your blood is given back to you via the intravenous catheter in your arm. The silicone drain is removed 8 hours after the operation. Most patients find that this to be practically painless. Anti-coagulation (to prevent blood clots, DVT) drugs are given 20-24 hours after surgery. The OrthoPat system is effective also for bilateral total knee patients. Patients having one knee replacement uncommonly need the cell saver system. Patients with higher red cell counts feel stronger and more fully participate in the post-op rehab program. This helps to facilitate early discharge home.