The merits of cell salvage in arthroplasty surgery: an overview

Chris J. Dusik; Carol Hutchison; David Langelier

doi:10.1503/cjs.026612

Article Figures & Tables

Tables

View popup

Table 1

Population and clinical characteristics of studies included in our review and meta-analysis

Study	Population/system	Design	Level of evidence/DB score	Findings
TKA
Thomas et al. (2001)14	Primary TKA Cell Saver	Single-centre RCT salvage with and without reinfusion (control) 231 patients	Level-1 evidence DB = 25/31	Transfusion rates Salvage: 7% Control: 28% (p < 0.001) Fewer readmits and GP visits
Sinclair et al. (2009)15	Primary TKA OrthoPAT	Retrospective cohort Salvage/PAD/control 229 patients	Level-3 evidence DB = 22/31	Transfusion rates Salvage: 25% PAD: 18% Control: 52% High-risk and low-risk sub-analysis
Blatsoukas et al. (2010)16	Primary TKA Dideco Compact Advanced	Prospective cohort Salvage (intraop and postop)/salvage (postop)/control 248 patients	Level-2 evidence DB = 23/31	Transfusion rates/mean units Salvage: (intra- and postop) 62%/0.81 Salvage: (postop) 59%/0.91 Control: 79%/1.74; (p < 0.001)
THA
del Trujillo et al. (2008)6	Primary THA OrthoPAT	Prospective cohort Salvage/control 108 patients	Level-2 evidence DB = 26/31	Transfusion rate/LOS Salvage: 15% / 9.6 days Control: 48% / 13.6 days (p < 0.001) Subanalysis: high/low preop Hgb Postop infection rates trended toward sign reduction (2% v. 10%; p = 0.09)
Revision
Bridgens et al. (2007)4	Revision THA Cell Saver	Prospective cohort Salvage/control 94 patients	Level-3 evidence DB = 22/31	Mean transfusion units Salvage: 2.6 Control: 6.4 (p < 0.001)
Garvin et al. (2005)17	Revision THA OrthoPAT and Cell Saver	Retrospective case series Salvage/no salvage 147 patients	Level-4 evidence DB = 19/31	Transfusion volume 31% incremental transfusion volume when salvage used No difference between salvage systems Inappropriate control group
TKA, THA and revision
Clark et al. (2006)9	Primary and revision TKA and THA OrthoPAT	Prospective cohort Salvage/control 310 patients	Level-2 evidence DB = 18/31	Transfusion rate THA 73% less likely to use allogenic blood TKA 76% less likely to have allogenic transfusion
Abstracts
Morgenschweis et al. (2011)18	Primary THA and TKA Dideco Electa	Prospective cohort Salvage/control 379 patients	Level-2 evidence DB = n/a	Transfusion rates THA salvage: 9.5 THA control: 4.3% (p = 0.16) TKA salvage: 13.3 TKA control: 14.0% (p = 0.89)
White et al. (2011)19	Primary THA and TKA OrthoPAT	Prospective cohort Salvage/control 268 patients	Level-2 evidence DB = n/a	Transfusion rates 48% reduction in allogenic transfusion rate with salvage
Paskova (2011)20	Primary and revision TKA and THA OrthoPAT and Cell Saver	Retrospective cohort study Salvage/control 443 patients	Level-3 evidence DB = n/a	Transfusion rates Salvage 23.1% Control 35.7%

DB = Downs and Black; GP = general practitioner; n/a = not available; LOS = length of stay in hospital; PAD = preoperative autogenic donation; THA = total hip arthroplasty; TKA = total knee arthroplasty; RCT = randomized controlled trial.