輸血不能のエホバの証人に対する人工股関節置換術の経験

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  • Total Hip Arthroplasty Without Blood Transfusion in a Jehovah's Witness : A Case Report

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Jehovah's Witnesses refuse blood transfusions on the basis of their religious belief. We report our experience with total hip arthroplasty without blood transfusion in a Jehovah's Witness.<br>The patient was a 70-year-old woman who had been receiving treatment for rheumatoid arthritis for 34 year and had been taking anti-platelet agents for atrial fibrillation and hypertension. Plain radiographs revealed severe erosions (Larsen Grade 4) in the right hip. We used a cemented femoral component and reamed the acetabulum gently to minimize any bleeding, while performing intraoperative blood-salvaging autotransfusion.<br>We carried out hybrid total hip arthroplasty with a cementless acetabular component and a cemented femoral component. The operation time was 62 minutes, intraoperative blood loss was 50ml, and postoperative blood loss was 90ml. The preoperative hemoglobin level was 9.9g/dl, and the lowest hemoglobin level was 6.8g/dl after surgery. At the final follow-up, the patient was able to walk with a T-shaped walking stick, and her Japanese Orthopaedics Association score (right/left) was 80 points/81 points on.<br>We considered that the use of a cemented femoral component and gentle reaming of the acetabulum were factors that reduced bleeding during total hip arthroplasty.

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