Is Total Hip Arthroplasty Feasible in Patients with Severe Preoperative Thrombocytopenia Managed by a Structured Perioperative Protocol? A Propensity Score-Matched Cohort Study

Background/Objectives: Total hip arthroplasty (THA) routinely produces perioperative blood loss of 800–1200 mL, which raises concern that patients with thrombocytopenia may be at substantially higher surgical risk. Evidence on THA safety in this population, however, remains scarce. We compared perioperative and functional outcomes of THA between patients with preoperative platelet counts below 80 × 109 cells/L and propensity score-matched controls with normal counts. Methods: In this retrospective matched cohort study, we reviewed 972 consecutive primary THAs. From this cohort, 30 patients with baseline platelet counts below 80 × 109 cells/L were identified and matched 1:2 with 60 control patients who had normal platelet counts (≥150 × 109 cells/L) using 1:2 nearest-neighbor matching. For all patients in the thrombocytopenic group, platelet counts were corrected to above 80 × 109 cells/L prior to surgery; thus, the study evaluates outcomes after preoperative hematologic optimization rather than surgery performed at uncorrected thrombocytopenic levels. All patients were closely monitored for at least one week postoperatively to evaluate complications and clinical outcomes. Results: Operative time (78.2 vs. 78.8 min, p = 0.898), estimated blood loss (492 vs. 505 mL, p = 0.821), hematoma rate (6.7% vs. 1.7%, p = 0.257), surgical site infection (6.7% vs. 1.7%, p = 0.257), and Harris Hip Scores (86.1 vs. 85.7, p = 0.615) did not differ significantly between groups, although the absolute wound-complication rates were numerically about four-fold higher in the thrombocytopenic group and the small sample limited statistical power. The study group did require more packed red blood cell transfusions (7.43 vs. 1.4 units, p < 0.001) and had longer hospital stays (9.8 vs. 6.0 days, p = 0.017). Conclusions: When severe preoperative thrombocytopenia is corrected to above 80 × 109 cells/L and managed with a structured perioperative protocol—meticulous intraoperative hemostasis and close postoperative surveillance for re-bleeding—THA can be performed with acceptable wound complication rates and functional outcomes and without catastrophic hemorrhage. Transfusion requirements and hospital stay remain higher, and the small sample size precludes concluding that the risk of infrequent complications is equivalent to that of patients with normal platelet counts. THA is therefore feasible, rather than unequivocally safe, under careful hematologic optimization.