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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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.
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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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Comparative Study
Autologous blood transfusion after primary unilateral total knee replacement surgery.
A prospective study was undertaken to assess the efficacy and financial cost of the use of an autologous blood transfusion device in the reduction of allogeneic blood requirements of patients undergoing primary unilateral total knee arthroplasty. Forty-nine consecutive patients received either the CellTrans blood salvage device (group A of 32 patients) or the Redivac high vacuum drainage system (group B of 17 patients). The preoperative and postoperative haemoglobin levels were recorded at 72 or 96 hours. ⋯ There was an average saving of 1.1 unit of allogeneic blood per patient in group A (p<0.001). The total cost per patient was about Euro 111 less for the group A patients. Autologous re-infusion was found in this study to be an effective method of reducing allogeneic blood requirements and to afford significant cost savings in primary unilateral knee arthroplasty.