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Hidden blood loss following hip and knee arthroplasty

CORRECT MANAGEMENT OF BLOOD LOSS SHOULD TAKE HIDDEN LOSS INTO ACCOUNT

Department of Orthopaedics, Derbyshire Royal Infirmary, London Road, Derby DE1 2QY, UK.

R. L. Evans, RGN Dip, Research Audit Sister; and J. H. Newman, FRCS, Consultant Orthopaedic Surgeon

Avon Orthopaedics Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.

Correspondence should be sent to Mr K. R. Sehat at 19 Covent Gardens, Radcliffe-on-Trent, Nottingham NG12 2NF, UK.

Following total hip arthroplasty (THA) and total knee arthroplasty (TKR) only the ‘visible’ measured blood loss is usually known. This underestimates the ‘true’ total loss, as some loss is ‘hidden’. Correct management of blood loss should take hidden loss into account.

We studied 101 THAs and 101 TKAs (with re-infusion of drained blood). Following THA, the mean total loss was 1510 ml and the hidden loss 471 ml (26%). Following TKA, the mean total loss was 1498 ml. The hidden loss was 765 ml (49%). Obesity made no difference with either operation.

THA involves a small hidden loss, the total loss being 1.3 times that measured. However, following TKA, there may be substantial hidden blood loss due to bleeding into the tissues and residual blood in the joint. The true total loss can be determined by doubling the measured loss.

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