The journal of knee surgery
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The purpose of this study was to evaluate the blood levels of patients preparing for total knee arthroplasty (TKA) who were enrolled in a preoperative autologous donation program. The charts and hospital records of 70 consecutive patients who underwent primary unilateral TKA between 2000 and 2002 were retrospectively reviewed. Study participants were instructed to donate one unit of blood approximately 4 weeks prior to surgery. ⋯ Postoperatively, the mean hemoglobin concentration in the recovery room was 11.6 g/dL and dropped to a nadir of 10.8 g/dL on postoperative day 3. Overall, 91% of patients required autologous blood transfusion following TKA but no patients required allogeneic blood transfusions. Preoperative autologous donation was associated with a decrease in preoperative hemoglobin levels and with a high rate of autologous transfusion based on clinical symptoms of postoperative anemia.
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High tibial osteotomy has become an accepted treatment for patients with varus degenerative arthritis of the knee. We sought to determine factors associated with patient satisfaction and functional outcome following medial opening wedge high tibial osteotomy for the degenerative varus knee. Sixty-one patients (14 women and 47 men) undergoing medial opening wedge osteotomy and chondral resurfacing procedure (microfracture) for medial knee pain, with minimum 2-year follow-up, were identified through our clinical database. ⋯ A positive correlation was observed between satisfaction and postoperative Lysholm score (P < .001). The independent multivariate predictor of patient satisfaction was the postoperative Lysholm score. Medial opening wedge high tibial osteotomy is an efficacious surgical option for the treatment of the degenerative varus knee, as demonstrated by both patient satisfaction and functional outcome scores.
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The management of fractures with traditional plating techniques has undergone a paradigm shift over the past 20 years. For many fractures, anatomic reduction using a dynamic compression plate has been the gold standard. However, minimally invasive approaches combined with biologically friendly internal fixation have become accepted methods of complex fracture treatment. ⋯ The literature demonstrates low rates of nonunion and overall complication rates with locking plates in difficult metaphyseal and diaphyseal fractures. Anatomic reduction of the articular surface remains paramount. Hybrid techniques that combine the benefits of compression plate fixation with the biological and biomechanical advantages of locking plates are the most likely end result of current locking plate applications.
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Comparative Study
Prolonged storage of osteochondral allografts: does the addition of fetal bovine serum improve chondrocyte viability?
Osteochondral plugs were harvested from eight fresh human femoral condyles within 96 hours of donor death. The plugs were either stored in a serum-free media containing glucose, salts, and amino acids or 10% fetal bovine serum at 4 degrees C. After 28 days of storage, the osteochondral plugs were analyzed for chondrocyte viability and viable cell density using confocal microscopy, proteoglycan synthesis by (35)SO4 incorporation, and glycosaminoglycan content. ⋯ No significant difference was detected between the glycosaminoglycan content in any of the specimens. These data suggest that the quality of osteochondral allografts as measured by chondrocyte viability, viable cell density, and proteoglycan synthesis is superior after storage in fetal bovine serum versus serum-free media. These results must be taken cautiously, however, as the clinical ramifications of storage in fetal bovine serum, including potential infectious disease transmission risks and immunogenic factors, have yet to be studied.
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Comparative Study
Blood loss management in high-risk patients undergoing total knee arthroplasty: a comparison of two techniques.
Although it is well known that patients with preoperative hemoglobin levels <13.0 g/dL are at a higher risk for requiring postoperative transfusions, the ideal blood management strategy for this group of patients remains unclear. This study compared preoperative autologous donation with preoperative administration of epoetin alfa as a method to maximize perioperative hemoglobin levels and minimize blood transfusions in these high-risk patients undergoing total knee arthroplasty (TKA). Results show that both preoperative autologous donation and epoetin alfa were successful in decreasing the need for allogeneic blood transfusions following TKA in high-risk patients. Epoetin alfa was more effective in maximizing perioperative hemoglobin levels.