Liberal blood transfusion strategies and associated infection in orthopedic patients: A meta-analysis
OBJECTIVE It remains unclear whether transfusion strategies during orthopedic surgery and infection are related. The purpose of this study is to evaluate whether liberal blood transfusion strategies contribute to infection risk in orthopedic patients by analyzing randomized controlled trials (RCTs). METHODS RCTs with liberal versus restrictive red blood cell (RBC) transfusion strategies were identified by searching PubMed, Embase, the Cochrane Central Register of Controlled Trials from their inception to July 2019. Ten studies with infections as outcomes were included in the final analysis. According to the Jadad scale, all studies were considered to be of high quality. RESULTS Ten trials involving 3938 participants were included in this study. The pooled risk ratio (RR) for the association between liberal transfusion strategy and infection was 1.34 (95% confidence intervals [CI], 0.94-1.90; P = .106). The sensitivity analysis indicated unstable results, and no significant publication bias was observed. CONCLUSION This pooled analysis of RCTs demonstrates that liberal transfusion strategies in orthopedic patients result in a nonsignificant increase in infections compared with more restrictive strategies. The conclusions are mainly based on retrospective studies and should not be considered as recommendation before they are supported by larger scale and well-designed RCTs.
Total hip arthroplasty in sickle cell disease: a systematic review
EFORT Open Rev. 2020;5(3):180-188
Total hip arthroplasty (THA) in sickle cell disease (SCD) patients can be a challenging procedure.This systematic review evaluated the revision rate, functional outcomes and complications of THA in sicklers.A systematic search was conducted according to the PRISMA guidelines, using four search engines from inception to May 2019.Fifteen studies with 971 THAs were included. There were 437 cemented and 520 uncemented THAs.There were 164 revision THAs (16.8%); 52 uncemented and 105 cemented THAs.Forty-two infections were recorded; 16 infections for cemented and 23 for uncemented THAs.Fifty-seven cups, 26 stems, eight cup/stem with aseptic loosening that were more frequently cemented were reported. The 28 unspecified aseptic loosening cases were more frequently uncemented THAs.All studies demonstrated the functional improvement of patients.There were 109 medical complications (14.3%). Sickle cell crises (SCC) and transfusion reactions were most usually recorded.Forty-six intraoperative complications (4.7%) were reported; 18 femoral fractures, four acetabular and 18 femoral perforations. Seventeen femoral fractures occurred during uncemented THA.THA in SCD is still related to a high risk of complications. The outcomes in properly selected sicklers have been improved. Perioperative adequate hydration, warming, oxygen supply and transfusion protocols are mandated to prevent SCC and transfusion reactions. The surgeon must be prepared to deal with a high rate of intraoperative fractures and have different implant options readily available. No definite conclusion can be made regarding the best fixation mode. Cemented implants demonstrated a higher revision rate and uncemented implants a higher risk for intraoperative complications. Cite this article: EFORT Open Rev 2020;5:180-188. DOI: 10.1302/2058-5241.5.190038.