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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More than 700 total knee arthroplasties were performed in our Department between 1992-2000. 6 patients developed pain on the postero-medial aspect of the knee, within 1 year of surgery. The pain increased during walking and especially on rising from a chair. All patients were women with good knee motion and good alignment of the implanted prosthesis. ⋯ Injection of 1% Xylocaine relieved pain for a short time in all patients. They were all treated with excision of the reflected portion of the semimembranosus tendon which was not cut during the arthroplasty. Pain was completely relieved in 5 cases and improvement occurred in 1.
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Clinical Trial Controlled Clinical Trial
Effectiveness of the ROBODOC system in preventing intraoperative pulmonary embolism.
Intraoperative pulmonary embolism occurs not only during cemented but also during cementless total hip arthroplasty (THA). We determined whether the ROBODOC femoral milling system can reduce intraoperative pulmonary embolism, by using of transesophageal echocardiography and hemodynamic monitoring. ⋯ The incidence of severe embolic events was lower in group 1 than in group 2. Our findings suggest that the ROBODOC femoral milling system may reduce the risk of clinically significant pulmonary embolism during cementless THA.
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6 patients with symptomatic nonunion of midshaft clavicular fractures were treated by internal fixation with an intramedullary cancellous screw and autologous cancellous bone grafting. At follow-up after median 21 (12-72) months, all nonunions had healed. The Constant score was median 98 (57-100) points. 1 patient, with shortening of the clavicle, had poor function.