Does patient positioning influence blood loss and transfusion rate in hip replacement for femoral neck fractures? A single-centre, retrospective chart review

Background We compared blood loss and transfusion frequency between the lateral decubitus and the supine position in patients undergoing hip replacement surgery due to femoral neck fractures. Methods We retrospectively included femoral neck fracture patients treated with either hemi (HA) or total hip arthroplasty (THA). We included a total of 626 patients, of which 313 patients underwent surgery in the lateral decubitus position and 313 patients in the supine position. Preoperative and day 1 postoperative blood measures including hemoglobin (Hb), hematocrit (Hct), and red blood cell count (RBC) were evaluated, as well as transfusion records analyzed. Results The following decrease of laboratory parameters between pre- and 1st day postoperative measures was noted: RBC: -0.77 G/L ([+ or -] 0.5 G/L, median = -0.80 G/L; range: -0.50 - -1.10 G/L); Hct: -7.08 % ([+ or -] 4.7 %, range: -4.70 - -9.90 G/L); Hb: -2.36 g/dL ([+ or -] 1.6 g/dL, range: -1.50. - -3.40 g/dL). We did not observe significant differences in transfusion frequency between the two study cohorts (p = 0.735 for THA, p = 0.273 for HA). No influence of patient positioning on Hb-decrease, Hct-decrease, or RBC-decrease was noted in our two-way ANOVA models with consideration of implant type and fixation technique (F(3,618) = 1.838, p = 0.139; F(3,618) = 2.606, p = 0.051; F(3,618) = 1.407, p = 0.240). Conclusions We did not observe significant differences in perioperative blood values and transfusion rates in association with patient positioning in patients undergoing hip replacement surgery for femoral neck fractures. Level of evidence Level III, retrospective cohort study. Keywords: Femoral neck fracture, Hip arthroplasty, Hip replacement, Blood loss, Patient positioning