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Ligature of the deep medial femoral circumflex artery decreases the incidence of transfusion in primary total hip arthroplasty

Rodríguez, Hugo A., MDa; Fiorillo, Alvaro A., MDa; Monsalvo, Daniel J., MDb; Segura, Omar, MDc

doi: 10.1097/BCO.0000000000000709
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Background: Primary total hip arthroplasty (THA) is associated with substantial blood loss during the surgical approach and the postoperative period. This causes a decrease in hemoglobin levels up to 5 g/dL, and blood transfusion rates that vary between 30% and 73%. The purpose of this study was to compare the rate of blood transfusions in patients with or without ligature of the deep branch of the medial femoral circumflex artery (MFCA) during THA.

Methods: A randomized controlled trial of patients who underwent primary THA between January and October 2011 was conducted. Patients were randomly allocated to either ligature or no ligature of the deep branch of the MFCA. The number of units of red blood cells transfused and surgical time were defined as main outcomes. Differences between groups were assessed using Student’s t-test.

Results: A total of 146 patients were analyzed. Artery ligation reduced the need for blood transfusion in 74% (P<0.001) of patients and was identified as a protective factor in 76% of the sample. A mean decrease in bleeding of 200 cc (P<0.001) and mean increase of 2 minutes (P=0.61) in surgical time were found in the ligature group. This difference in the total surgical time between the two groups was not significant.

Discussion: Ligature of the deep branch of the MFCA decreases the need for blood transfusion without increasing the surgical time or the difficulty of the procedure. We recommend that surgeons include this step during a THA surgical approach.

aDepartment of Orthopedics and Traumatology, Hospital Infantil Universitario de San José, School of Medicine, Fundación Universitaria de Ciencias de la Salud

bDepartment of Orthopedics and Traumatology, Hospital Infantil Universitario de San José

cDepartment of Research, School of Medicine, Fundación Universitaria de Ciencias de la Salud

Financial Disclosure: The authors report no conflicts of interest.

Correspondence to Hugo A. Rodríguez, MD, Department of Orthopedics and Traumatology, Hospital Infantil, Universitario de San José 110221172 Tel: +57(1) 2960105; fax: +57(1) 2960596; e-mail: harodriguez1@fucsalud.edu.co.

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