Blood management strategies in lower limb arthroplasty

Rates of post-operative allogenic blood transfusion in primary hip and knee arthroplasty can be as high as 50%. Risks of allogenic blood transfusion include increased risk of orthopaedic and non-orthopaedic infection in addition to the general risks of transfusion. Measures have been developed to minimise the requirements for post-operative allogenic blood transfusion in lower limb arthroplasty. These include pre-operative screening of patients, risk stratification, raising pre-operative haemoglobin pharmacologically, pre-operative autologous donation, minimising intra- and post-operative blood loss and suitable post-operative transfusion practices. Pharmacological, haematological and surgical methods of blood management in lower limb arthroplasty are discussed.