Review of the influence of anaemia on the effect of total hip arthroplasty, and the prognosis of patients: recent advances and future directions.

Preoperative anaemia is a significant predictor of negative outcomes in total hip arthroplasty, but its management as a modifiable risk factor requires further high-quality evidence.

Summary and findings

This review examines the impact of preoperative anaemia on outcomes following total hip arthroplasty (THA) and the importance of managing it. The review highlights that preoperative anaemia is linked to negative outcomes, but lacks high-quality data demonstrating that correction improves clinical outcomes. The authors emphasize the need for systematic identification of anaemia before surgery.

Abstract

<h4>Background</h4>This review examines the impact of preoperative anaemia on outcomes following total hip arthroplasty (THA) and the importance of managing it, given rising surgical volumes and the need to optimize patient care and prevent complications.<h4>Discussion</h4>Preoperative anaemia in THA patients is consistently linked to negative outcomes, such as increased blood loss, higher transfusion rates, longer hospital stays, and a higher risk of complications, according to key results. A holistic approach that includes identifying the underlying cause, making any necessary corrections, and using blood-conservation strategies is necessary for effective management. Nonetheless, there is a crucial conflict in the literature: while anaemia is often characterized as a modifiable risk factor, there remains a lack of high-quality data demonstrating that preoperative correction improves key clinical outcomes, such as functional recovery, implant survival, or mortality. It is uncertain whether anaemia is a direct cause or primarily a marker of underlying patient fragility and comorbidity, as most available data are observational.<h4>Conclusion</h4>For patients receiving THA, preoperative anaemia is a reliable and substantial predictor of unfavourable outcomes. For patient optimization and risk stratification, systematic identification before surgery is crucial. However, unless significant randomized controlled trials demonstrate that correction results in better patient-centred outcomes, the classification of anaemia as a modifiable risk factor should be approached with caution. To improve treatment for this group, it is essential to address existing evidence gaps and implementation issues.

Key findings

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Limitations

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