Acta Orthop Belg
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Randomized Controlled Trial Comparative Study
Delayed release of drain in total knee replacement reduces blood loss. A prospective randomised study.
Total knee arthroplasty is sometimes associated with major post-operative bleeding, often requiring transfusion. A prospective, randomised study was undertaken to assess the effect on post-operative bleeding of delaying release of the clamp on the suction drains. ⋯ Average drop in corrected haemoglobin and postoperative transfusion requirement were also less in the delayed group. The results show that delaying release of the drains by one hour reduces postoperative blood loss and transfusion requirement following total knee arthroplasty.
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Randomized Controlled Trial Comparative Study
Postoperative re-perfusion of drained blood in patients undergoing total knee arthroplasty: is it effective and cost-efficient?
The value of postoperative salvage and re-infusion of drained blood was assessed in 155 patients undergoing total knee arthroplasty for primary knee osteoarthritis. In group A (n = 77), standard vacuum drains were used. ⋯ Patients who received autologous blood had higher levels of haemoglobin at 8 hours (p < 0.05) and 24 hours postoperatively (p < 0.01) and needed less allogeneic blood transfusion (p < 0.01). Methylprednisolone administration was found to attenuate the postoperative febrile reaction (p = 0.01).
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Comparative Study
The uncemented isoelastic/isotitan total hip arthroplasty. A 10-15 years follow-up with bone mineral density evaluation.
The present study analyses the long-term outcome of isoelastic hip prostheses and their influence on the extent of periprosthetic bone remodeling. Ninety-two patients (102 hips) with Isoelastic/Isotitan uncemented total hip arthroplasty were evaluated after an average of 13.4 years. The average age of patients at surgery was 42.5 years. ⋯ Eight stems required revision whereas none of the cups showed any evidence of loosening. The change in the mean BMD values between the femora on the operated side and the contralateral femora averaged 15% for all zones Although the isoelastic stems are no longer used owing to their high loosening rate, it appears that this prosthesis preserved periprosthetic bone better than reported for cemented or uncemented metallic implants. Besides, the provision of a titanium coating on the isoelastic stem, comparable to that on the RM cup, would presumably have improved its long-term fixation by encouraging bony ongrowth.
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Comparative Study
A prospective audit of blood usage post primary total knee arthroplasty.
The use of allogeneic blood is associated with many complications. A baseline audit performed in our institution in 2000 showed that 11% of patients undergoing primary total knee arthroplasty (TKA) required post-operative transfusion. Following this audit, patients undergoing primary TKA were no longer routinely cross matched, a Haemovigilance Nurse was employed in compliance with the National Blood Users Group guidelines, and post-operative cell salvage was introduced for patients with a preoperative haemoglobin level of less than 12 g/dl. ⋯ Ten per cent required further transfusion with allogeneic blood. There was no statistically significant difference in either the percentage of patients transfused or the volume of blood given to each patient between the two periods of audit. We did not find post-operative cell salvage to be an effective method of reducing allogeneic blood use.
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The reported incidence of osteosarcoma of the foot is very low. Osteosarcoma of the talus is extremely rare and few cases have been reported in the literature. The clinical findings are not typical, and osteosarcoma of the talus can be easily misdiagnosed, resulting in a delay in proper treatment. We report the case of a patient with osteosarcoma of the talus, from a series of 120 osteosarcomas treated at our hospital between 1966 and 2002.