Yoeri Bemelmans

Chapter 3 40 In uncemented procedures more blood transfusions were given. In contrast to our results, Trice et al. [26] found no differences between a small cohort of uncemented and cemented/hybrid THA patients. Possible explanation for our results could be the opening of the intra-medullar canal, which is directly covered after cementation of the prosthesis in cemented THA. In the current cohort, uncemented THAwas the preferred operation technique, even for patients with a higher age and thus relatively higher comorbidity status, which could have biased the results. To our knowledge, no clear evidence exists on the underlying mechanism. No difference in anaesthesia method was found between BT and non-BT patients. In contrast to previous results, which have shown that spinal anaesthesia protects against allogenic blood transfusions [13,23]. Spinal anaesthesia decreases blood loss based on a reduction in sympathetic tone and blood flow to the operative extremity [23]. But these results were found in studies before implementation of TXA which makes it less comparable to the presented study. In most of the high-quality TXA studies, no data is provided. There is of course a relation between duration of surgery and amount of blood loss with a self-evident increased transfusion risk [12]. Duration of surgery was previously described by Song et al. [25] as an independent risk factor for blood transfusion in THA patients. These results were obtained from arthroplasty surgeries with duration longer than 2 hours and only in THA patients [25]. For TKA patients, no significant difference was found. This is in line with our results. Although we found a significant longer duration of surgery in blood transfused THA patients, mean time between both groups was merely three minutes. The clinical relevance of three minutes is doubtful in our opinion. Carling et al. [6] found low BMI to be associated with an increased risk of excessive blood loss and thereby increased risk for blood transfusion. In line with these results, our study found that BMI was significant lower in the BT group. Contrarily, other studies reported no difference or even significant more blood loss in obese patients [5]. The current evidence is divided on the role of BMI in blood transfusion risk after arthroplasty surgery. In this study we can’t give more clarification on this topic and further studies are thus needed. There are some potential limitations. Due to the retrospective nature of the study, presented perioperative complications (in particular vascular/hematologic) could possibly be underestimated. Data in this study depends on the registration of complications in our hospital system. On the other hand, similar (low) rates of thrombo-