Last reviewed: September 29, 2026

Probably not. Transfusion after a first hip replacement has become uncommon.

In 2011, about 1 in 5 people in the US received blood after a first hip replacement. By 2019, it was about 1 in 40. Some people are more likely to need blood. They include older people, women, and people with several medical conditions. Longer operations also raise the chance. The biggest factor is a low blood count before surgery.

The main reason for the drop is a medicine called tranexamic acid. It slows bleeding during and after surgery. A large review of trials found it the most effective drug for reducing blood loss in hip and knee replacement. As a pill, it may work as well as through a vein. The trials found little or no increase in blood clots. One study looked at more than 70,000 people who had had a blood clot in the past. In them, tranexamic acid was not linked to more lung clots, strokes or heart attacks. Those who got it needed fewer transfusions.

A low blood count before surgery is called anemia. It is measured with a blood test called hemoglobin. Normal hemoglobin is about 12 or higher in women and 13 or higher in men.

In one hospital, everyone got tranexamic acid. With a hemoglobin above 12 before surgery, transfusion was rare. With a hemoglobin between 11 and 12, about 1 in 7 needed blood. With a hemoglobin below 11, more than 1 in 4 did.

Anemia is also linked to more infections and other complications. The lower the hemoglobin, the higher the risk. But there is no single hemoglobin level below which surgery is unsafe. An international expert panel recommends checking everyone for anemia before surgery and treating the cause. Whether treating it lowers complications after hip replacement has not been proven.

People who do not accept blood, including Jehovah’s Witnesses, can have a hip replacement safely with planning. Their blood count is raised before surgery. They are given tranexamic acid, and the surgery is done with extra care to limit bleeding. One study compared Jehovah’s Witnesses with similar patients. They were no more likely to reach a dangerously low hemoglobin, and their hips lasted as well. Some medicines that raise the blood count contain small amounts of blood products. Each person decides whether to accept them.

In general:

  • Ask for a blood count well before surgery, so there is time to treat anemia.
  • Ask your surgeon what is done to reduce the need for a blood transfusion.
  • If you do not accept blood, tell your surgeon early so there is time to plan.
  • Tiredness, shortness of breath or a racing heart after surgery is worth reporting.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

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