Blood transfusion in hip and knee arthroplasties: the end of the pre-operative group and save?

Total hip and knee replacements (THR and TKR) are a common procedure. Transfusion rates have fallen in the literature over the past decade, and this study aimed to quantify the transfusion rates and identify the clinical transfusion threshold in our centre, which uses a multimodal enhanced recovery after surgery (ERAS) programme. A retrospective review of case notes from a 12-month period identified 997 patients undergoing primary THR or TKR. 4.1 % of the patients undergoing THR and 1.4 % of patients undergoing TKR required blood transfusion. 61 % of patients receiving blood transfusions had pre-transfusion haemoglobin levels >80 gl(-1). One patient required blood on the day of surgery. With the ERAS programme, transfusion rates are low and very rarely blood is required on the day of surgery. We would suggest that routine pre-operative group and save or cross-match testing may no longer be essential, as long as there is a stock of O- blood for the rare emergency issues.