International Orthopaedics

, Volume 43, Issue 3, pp 653–658 | Cite as

Differences in total blood loss and transfusion rate between different indications for shoulder arthroplasty

  • Dominik MalcherczykEmail author
  • Juliane Hack
  • Antonio Klasan
  • Asma Abdelmoula
  • Thomas J. Heyse
  • Brandon Greene
  • Bilal F. El-Zayat
Original Paper



In this study, the total blood loss, transfusion rate and number of transfused blood units in patients with different indications for shoulder arthroplasty: primary, fracture and secondary were compared. Risk factors for bleeding and transfusion were analysed.


Medical records and the database of the institution’s blood bank from 527 patients that received shoulder arthroplasty were analysed retrospectively. This study included 419 patients that were divided in three different groups: primary (n = 278), fracture (n = 110) and secondary (following prior osteosynthesis; n = 31) shoulder arthroplasty. The demographic and clinical data were collected. The total blood loss (TBL) was calculated and transfusions recorded.


The transfusion rate and mean amount of transfused blood units (BU) were higher in fracture (32.7% and 0.69BU, p < 0.01) and secondary arthroplasty (35.5% and 0.97BU, p < 0.01) than in primary arthroplasty (12.6% and 0.28BU). The overall transfusion rate was 19.6% at a mean TBL of 370 ml. However, patients with primary arthroplasty experienced significantly higher total blood loss than those after fracture arthroplasty (p < 0.01). Longer surgery time and male sex are significant risk factors for elevated blood loss. The pre-operative use of vitamin K antagonist, cemented arthroplasty, high BMI, coronary heart disease and ASA score > 2 are relevant risk factors for blood transfusion.


The most important susceptible factor that affects the TBL is the surgery time. Transfusion rates are higher in patients with fracture arthroplasty than after primary arthroplasty.


Primary arthroplasty Shoulder arthroplasty Shoulder endoprosthesis Bleeding Total blood loss Blood transfusion Primary Fracture Secondary 


Compliance with ethical standards

The study had the approval of the local ethic committee and was conducted in conformity with the principles of the revised version of the Declaration of Helsinki.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The study had approval of the local ethic committee (EK-MR-07_12_2016).

For this type of study, formal consent is not required.

Conflict of interest

DM; JH; AK; AA; BG: These authors have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

TJH: has been paid for presentations for Smith & Nephew, Zimmer Biomet and Implantcast. He has received research support from Smith & Nephew and Zimmer Biomet. He is a consultant to Smith & Nephew.

BFE: is Consultant to Smith & Nephew & CONMED; he received payments for lectures by Smith & Nephew & CONMED.

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Dominik Malcherczyk
    • 1
    Email author
  • Juliane Hack
    • 1
  • Antonio Klasan
    • 1
  • Asma Abdelmoula
    • 1
  • Thomas J. Heyse
    • 1
  • Brandon Greene
    • 2
  • Bilal F. El-Zayat
    • 1
  1. 1.Center for Orthopedics and Trauma SurgeryUniversity Hospital MarburgMarburgGermany
  2. 2.Institute of Medical Biometry and EpidemiologyUniversity MarburgMarburgGermany

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