Mehmet Can KENGİL, Alperen YÜKSEK, Sinan VAROL, Ceyhun ÇAĞLAR, Mahmut UĞURLU, Mehmet İsmail Safa KAPICIOĞLU, Metin DOĞAN
Journal of Comprehensive Surgery - 2026;4(2):36-40
Aims: The influence of previous COVID-19 infection on perioperative blood loss in total joint arthroplasty remains uncertain. Although COVID-19-related inflammatory and vascular alterations have been described, their impact on early postoperative hemoglobin and hematocrit changes after total knee arthroplasty (TKA) and total hip arthroplasty (THA) has not been well established. Methods: This retrospective comparative study included patients who underwent primary TKA or THA between April 2022 and April 2025. Demographic characteristics, comorbidities, vaccination status, and perioperative laboratory values were recorded. Patients were categorized based on prior COVID-19 infection history. Changes in hemoglobin and hematocrit from the preoperative period to postoperative day 1 were calculated. Intergroup comparisons were performed, and multivariable linear regression analysis was used to identify independent predictors of postoperative hemoglobin decline. Results: A total of 381 patients were included (244 TKA, 137 THA; mean age 63.4+/-10.1 years). Overall mean decreases were -2.53+/-1.32 g/dl for hemoglobin and -7.85+/-5.34% for hematocrit. Patients with a history of COVID-19 infection demonstrated smaller reductions in hemoglobin (-2.22+/-1.37 vs -2.65+/-1.25 g/dl, p=0.003) and hematocrit (-7.02+/-4.33 vs -8.18+/-5.76%, p=0.031) compared with COVID-negative patients. Multivariable analysis identified prior COVID-19 infection, BNT162b2 vaccination, and undergoing TKA (vs THA) as independent factors associated with reduced postoperative hemoglobin decline. Despite statistical significance, the absolute differences were small. Conclusion: Prior COVID-19 infection and vaccination status were associated with statistically lower early postoperative hemoglobin and hematocrit decreases following TKA and THA; however, these differences were not clinically meaningful. A history of COVID-19 does not appear to significantly alter perioperative bleeding profiles in arthroplasty patients.
