Case Study: Transfusion-Free Orthopaedic Surgery

Transfusion-free surgery can be especially challenging in the field of orthopaedics. “Bones do not have true blood vessels,” explains Edward J. McPherson, M.D., associate professor of orthopaedic surgery. “Rather, there are sinuses and sinusoids where blood flows in bones. When bone is cut, it leaks and oozes blood and there is no effective way to actually ‘clamp down’ on these sinusoids. This represents an inherent problem in doing major reconstruction of bones without blood transfusions.”

At the USC Center for Arthritis and Joint Implant Surgery, McPherson has to deal with this challenge on a regular basis, as he treats patients with advanced degenerative osteoarthritis. In this condition, the cartilage that covers the surface of the hip and/or knee joint deteriorates, resulting in pain and loss of function. Through joint implant surgery, McPherson seeks to ease this pain and restore function to the affected joints.

Before performing transfusion-free joint replacement surgery, McPherson prescribes Procrit, a drug specially licensed for orthopaedics. Procrit boosts the levels of erythropoietin, stimulating the bone marrow to make more red blood cells.

During the surgery, McPherson uses acute normovolemic hemodilution, cell savers and hypotensive anesthesia to keep blood loss down. “The lower the blood pressure,” he says, “the faster the case gets done. When blood loss is decreased, the operative field is easier to visualize, allowing better exposure and more efficient surgery.” These techniques allow McPherson to perform total joint replacement surgeries–which are traditionally bloody-without the need for transfusion.

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