Arthroplasty entails considerable exposure to allogenic blood transfusion. Cell salvage with washing is a contemporary strategy that is not universally used despite considerable potential benefits. We searched Embase and Medline to determine if blood salvage with washing during primary and/or revision hip and knee arthroplasty results in lower rates of transfusion and postoperative complications. We included 10 studies in our analysis, which we rated according to Downs and Black criteria. With primary knee arthroplasty, there was a reduction in transfusion rate from 22% to 76% and a 48% reduction in transfusion volume (n = 887). With primary hip arthroplasty, there was a reduction from 69% to 73% in transfusion rate and a 31% reduction in transfusion volume (n = 239). There was a significant decrease in length of hospital stay (9.6 v. 13.6 d). Studies of revision arthroplasty reported a 31%-59% reduction in transfusion volume (n = 241). The available evidence demonstrates reduced exposure to allogenic blood with the use of salvage systems. Studies have been underpowered to detect differences in infection rates and other postoperative complications. Future cost analysis is warranted.
Obesity is an important comorbidity affecting outcomes after total joint arthroplasty. Consequently, surgeons may delay care of obese patients to first address obesity through different care pathways. The effect of obesity on patient wait times for total joint arthroplasty has not been explored. The purpose of this study was to evaluate the effect of obesity on access to total hip (THA) and knee (TKA) arthroplasty.
Methods
The study data set was constructed from the Nova Scotia Health Authority’s Horizon Patient Folder system and the Patient Access Registry Nova Scotia. Wait time was measured as days between the decision to treat and date of surgery. Body mass index (BMI) was calculated from a preoperative assessment, and patients were grouped into BMI categories. Multivariate log-linear regression was used to test for statistical differences, controlling for confounding factors.
Results
We observed longer wait times for TKA with increasing BMI weight class. Patients with BMIs greater than 50 had 34% longer waits than reference weight patients. However, THA recipients showed no statistical difference in wait times across weight categories. Furthermore, there was variability among surgeons in the wait times experienced by patients.
Conclusion
The finding of longer wait times for TKAs, but not THAs, among patients who were obese was unexpected. This shows the variable wait times for THA and TKA that patients who are obese can experience with different surgeons. It is important to understand the variability in wait times so that efforts to standardize the patient experience can be accomplished.
