Hip and knee surgery is associated with a relatively large bleeding and a need for perioperative transfusion. Postoperative anaemia may delay recovery, but transfusion carries inherent risks. However, only few randomised controlled studies evaluating the effects of different transfusion triggers have been performed in orthopaedic surgery. The majority of these studies suffer from methodological weaknesses and have not been performed in a fast-track setting. Thus, large randomised studies evaluating a restrictive versus a liberal transfusion strategy in a procedure-specific setup are needed.