Can cell saver be used in hip surgery with an infected hip?

Cell Salvage in Infected Hip Surgery

Cell salvage can be used in hip surgery with an infected hip, but infection is a relative contraindication that requires careful risk-benefit assessment on a case-by-case basis. 1

Key Guideline Position

The Association of Anaesthetists 2018 guidelines explicitly state that there are no absolute contraindications to cell salvage. 1 However, potential contamination of aspirated blood with infection should be regarded as a relative contraindication, depending on the likelihood and degree of contamination. 1

Risk-Benefit Assessment Framework

When considering cell salvage in infected hip surgery, you must weigh:

• Risk of allogeneic transfusion complications (blood-borne infections, hemolytic reactions, immunologic effects) 2, 3
• Severity of expected blood loss - revision hip surgery typically involves substantial bleeding (mean 1038 ml), with infection cases more likely to generate sufficient salvage volumes for reinfusion (OR 1.87) 4
• Patient's baseline anemia and transfusion risk - approximately 37% of revision hip patients require allogeneic transfusion within 72 hours 4
• Degree and type of infection - localized vs. systemic, organism virulence 1

Practical Implementation in Infected Cases

If you proceed with cell salvage in an infected hip:

• Use leukocyte depletion filters during processing to reduce bacterial load 1
• Ensure thorough washing cycles - the centrifugation and saline washing process removes most contaminants 1
• Administer appropriate systemic antibiotics before and during surgery 1
• Consider processing only blood collected after debridement and irrigation of infected tissue 5
• Document your risk-benefit decision clearly in the operative note 1

When Cell Salvage Is Most Justified in Infected Hip Surgery

Cell salvage becomes more defensible when:

• Expected blood loss exceeds 500 ml (the threshold for cost-effectiveness and clinical benefit) 1, 5, 4
• Patient has significant pre-existing anemia (Hb < 10 g/dL) 1
• Revision of both femoral and acetabular components is planned (higher blood loss) 4
• Patient refuses allogeneic transfusion (religious or personal objections) 1
• Limited allogeneic blood availability or patient has rare blood type 1

Critical Pitfalls to Avoid

• Do not use cell salvage during active purulent drainage - wait until after debridement and copious irrigation 1, 5
• Avoid salvaging blood contaminated with antibiotics, iodine, or topical clotting agents - use standard suction until the field is irrigated 5
• Do not assume infection is an absolute contraindication - this outdated thinking may expose patients to unnecessary allogeneic transfusion risks 1
• Never proceed without discussing risks and benefits with the patient preoperatively and documenting their informed consent 1

The Bottom Line

In infected hip surgery, the modern evidence supports using cell salvage when blood loss is expected to exceed 500 ml, provided you implement proper washing protocols and systemic antibiotic coverage. 1, 4 The theoretical risk of reinfusing bacteria is outweighed by the proven risks of allogeneic transfusion in most clinical scenarios, particularly given that the washing process removes most contaminants and patients receive systemic antibiotics regardless. 1, 2, 3