Evidence map›Paper›PMID 40343520›Full record

ArticleArchives of orthopaedic and trauma surgery2025

Blood loss in primary total hip arthroplasty occurs mainly postoperatively, but current formulas for calculating blood loss are inaccurate: a retrospective study of 208 cases.

Franziska Nehls, Michel Schläppi, Caveh Madjdpour, Christoph Meier, Peter Wahl

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Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Franziska NehlsDepartment of Anaesthesiology, Cantonal Hospital Winterthur, Brauerstrasse 15, PO Box 834, Winterthur, 8401, Switzerland. franziska.nehls@ksw.ch.
Michel SchläppiDivision of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
Caveh MadjdpourDepartment of Anaesthesiology, Cantonal Hospital Winterthur, Brauerstrasse 15, PO Box 834, Winterthur, 8401, Switzerland.
Christoph MeierDivision of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
Peter WahlDivision of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland.ORCID http://orcid.org/0000-0002-8895-8621

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionTotal hip arthroplasty (THA) is potentially associated with high blood loss, possibly requiring transfusion. To avoid well-known complications of allogenic transfusions, risk stratification and patient optimization are recommended. This study explores whether bone quality, as evaluated by the Singh Index (SI), impacts blood loss in primary THA, as recently identified in fracture surgery.

methodsRetrospective, single-center study conducted to examine intraoperative blood loss (IBL) and total blood loss (TBL) in primary THA performed in adults through an anterior approach between 10/2021 and 05/2022. TBL estimation utilized formulas of Gross, Camarasa, Frankfurt and OSTHEO.

resultsA total of 218 unilateral THA were included. TBL substantially exceeded IBL, primarily occurring within the first postoperative day. The formulas were largely consistent, TBL reaching approximately one-third of the estimated total blood volume, except for the Frankfurt formula, which provided much lower values. However, all four formulas failed when IBL exceeds 1'000 ml, a common threshold in THA. Operation time correlated with increased IBL but not TBL. The body mass index (BMI) appeared to be a risk factor for TBL. The SI had a significant but relatively small influence.

conclusionTBL after THA is relevant, accounting for approximately one-third of total blood volume, primarily occurring within the first 24 h. Blood counts are recommended on the first postoperative day and should be repeated on the second day in case of clinical suspicion. There is a correlation between bone quality, as evaluated by the SI, and TBL, but the effect is less than for BMI. Considering ease of use and consideration of RBC (re-)transfusion, the formula from Camarasa et al. appears to be the best available. However, the various formulas available for estimation of perioperative TBL fail at blood losses not uncommon in THA. Therefore, there is a need for new instruments to evaluate TBL.

Indexed as

Arthroplasty, Replacement, HipBlood Loss, SurgicalAdultAgedAged, 80 and overBlood TransfusionFemaleHumansMaleMiddle AgedRetrospective StudiesBlood lossCamarasa formulaGross' formulaHip arthroplastyOsteopeniaOsteoporosisRisk factorsSingh index

Identifiers

PMID40343520

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.