The Journal of arthroplasty
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Postoperative blood salvage reduces the risk of allogenic transfusion in patients undergoing elective total joint arthroplasty. We measured the concentrations of coagulation parameters after autotransfusion of unwashed shed blood in 22 patients having elective joint arthroplasty and compared them with patients without retransfusion. ⋯ Levels of D-dimer and fibrinogen increased significantly over time after retransfusion (P < .0001). Comparison of the autotransfused group with the 25 patients without reinfused shed blood showed no significant difference in fibrinogen concentration between the 2 groups in the postoperative course but a significant difference with increased D-dimer concentrations in the autotransfused group (P < .001).
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Randomized Controlled Trial Comparative Study
Blood rheology in PCA and PCEA after total knee arthroplasty.
The rheological events in 2 groups of patients undergoing total knee arthroplasty were compared--15 patients were given general anesthesia and controlled their postoperative pain applying intravenous patient-controlled analgesia; 17 individuals received combined spinal-epidural anesthesia and controlled their postoperative pain by patient-controlled epidural analgesia (PCEA). Twenty-four and 48 hours after surgery, the patient-controlled analgesia group showed a significant increase in whole-blood viscosity at the 3 shear rates (P < .01), as well as in relative viscosity at both periods (P < .001 and .01, respectively). ⋯ These values were less expressed in the PCEA group, particularly 48 hours after surgery (P < .01), and the patients showed lower scores on the visual analog pain scale. The better results observed in the PCEA group favor the application of epidural anesthesia and PCEA analgesia in patients undergoing total knee arthroplasty.
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We assessed the OrthoPAT Orthopedic Perioperative Autotransfusion System (Zimmer Inc, Warsaw, Ind) in reducing the need for allogeneic blood in hip or knee arthroplasty. Patients (N = 398) were divided into 5 cohorts: unilateral primary hip (n = 131), unilateral revision hip (n = 38), unilateral primary knee (n = 179), unilateral revision knee (n = 26), and bilateral primary knee (n = 24). Primary or revision hip arthroplasties with no preoperative autologous blood donation, knee arthroplasties with no preoperative autologous blood donation, and unilateral primary hip arthroplasties were 2.7, 2.3, and 2 times less likely (P < .05), respectively, to use allogeneic blood with OrthoPAT. We conclude that OrthoPAT use significantly reduced the risk of receiving allogeneic blood transfusions in defined patient subsets.
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The Internet is a popular source of information regarding health care especially when seeking advice on new and less invasive surgical techniques. We evaluated 150 Web sites (3 search engines) for authorship and quality of information regarding minimally invasive hip arthroplasty. The results revealed that 45% were authored by a hospital/university, 26% were news stories, 25% were private medical groups, and 6% were orthopedic industry Web sites. ⋯ Thirteen percent described the risks, whereas 9% made reference to peer-reviewed publications. More than 91% made specific claims regarding the advantages of minimally invasive surgery. Our study suggests the information on the Internet regarding minimally invasive total hip arthroplasty is misleading and of poor quality.