Acta orthopaedica Scandinavica
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In a previous prospective study, we confirmed that transfusion-related immunosuppression predisposes to postoperative infections, impairs the postoperative healing of wound and thereby prolongs hospitalization. This increases the well-known risks, such as transmission of infection or transfusion reactions, and has obliged us to revise our transfusion guidelines. We used a relational database containing information about 28,861 orthopedic surgery patients was used to determine when and how to improve these guidelines for transfusions. ⋯ Although these steps can not be regarded as a new approach, we show that by following a strict rules with appropriate steps and in a concerted fashion, the use of allogenic red blood cells was reduced by 80%. Moreover, the amount of blood saved had other effects--e.g., the incidence of deep wound infections was reduced by 40%. The outcome is described in an algorithm summarizing the steps in a comprehensive perioperative diagram for giving blood.
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Recent studies have reported that bisphosphonates reduce the resorption of grafted bone and inhibit bone resorption at a bone-implant interface. However, it is not known whether bisphosphonates affect bone ingrowth into porous biomaterial or spine fusion interbody devices with an autograft. In this study, 18 pigs (9 in each group) underwent anterior intervertebral lumbar arthrodeses at L2-3, L4-5 and L6-7. ⋯ On histomorphometric analysis, the bone volume fraction, both inside the central hole of porous tantalum ring and in the porous tantalum, was larger in the pigs given alendronate than in the controls, but the fraction inside and around the central hole of the carbon fiber cage was not affected by this treatment. Short-term alendronate treatment, in a relatively low dose, does not impair the formation of new bone, but increases bone ingrowth into the central hole of the porous tantalum ring and the pores of the porous tantalum in this porcine model. This may be an effective way to enhance early biologic fixation of porous intervertebral implants.