G. Gasparini

Clinical Factors Associated with an Increased Risk of Perioperative Blood Transfusion in Nonanemic Patients Undergoing Total Hip Arthroplasty

BACKGROUND The aim of this study was to identify clinical factors associated with an increased need for perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. METHODS We evaluated eighty-five consecutive nonanemic patients who underwent elective, unilateral, cementless, primary total hip arthroplasty and met our inclusion criteria. We attempted to determine whether clinical parameters influencing perioperative blood loss, such as age, gender, hypertension, and body mass index, were also associated with the need for perioperative blood transfusion. RESULTS Perioperative blood transfusion was required in twenty-four (28%) of the eighty-five nonanemic patients. When considered alone, age, gender, hypertension, and body mass index were not significantly associated with an increased risk of perioperative blood transfusion, on the basis of the numbers available. In contrast, there was a significantly increased risk of blood transfusion when two or more of these clinical parameters were present (p = 0.02). CONCLUSIONS Our findings indicate that clinical variables such as age, gender, hypertension, and body mass index may have a synergistic effect on the risk of transfusion in patients undergoing elective total hip arthroplasty. The simultaneous analysis of these parameters might help to stratify patients with different risks for transfusion and may increase the efficiency and reduce the cost of blood-ordering practices associated with total hip arthroplasty. LEVEL OF EVIDENCE Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty

Blood loss after total knee arthroplasty (TKA) is often associated with cardiovascular complications and a high transfusion rate of allogenic blood. In our study we focused our attention on developing a new intra-surgical procedure that appears safe, easy to perform and effective in the reduction of bleeding in TKA. We evaluated 84 patients who underwent TKA and met our inclusion criteria; they were assigned to two groups: 55 controls in which a saline solution was used to wash the surgical field before tourniquet release, and a second group of 29 patients, in which a saline solution containing a low dose of norepinephrine was locally applied before tourniquet release. The local administration of a low dose of norepinephrine has induced a significant reduction of perioperative blood loss and blood transfusion requirements; in addition, this method was characterised by the absence of complications or adverse effects. In conclusion, our data suggest that intraoperative local administration of a low dose of norepinephrine could represent an effective and safe method of reducing blood loss and preventing blood transfusions in patients with TKA.RésuméLes pertes sanguines après prothèse totale du genou sont souvent associées avec des complications cardio-vasculaires et nécessitent un pourcentage important de transfusions sanguines. Nous avons développé pour notre étude une technique chirurgicale destinée à réduire les saignements dans les prothèses totales du genou. Nous avons inclus 84 patients qui ont bénéficié d’une prothèse totale du genou. Nous les avons divisés en deux groupes: un groupe contrôle de 55 patients pour lesquels une solution saline a été utilisée pour laver le champ opératoire avant le lever du garrot et un second groupe de 29 patients pour lequel une solution saline contenant une faible dose de norépinéphrine a été localement appliquée avant l’ablation du garrot. L’administration locale d’une petite dose de norépinéphrine a entraîné une reduction significative du saignement péri-opératoire et de la nécessité de transfusion sanguine. Cette méthode n’a entraîné aucune complication. Conclusion, ces données nous incitent à suggérer que l’administration locale de deux petites doses de norépinéphrine représente une méthode de réduction du saignement et de prévention de la transfusion sanguine dans la mise en place d’une prothèse totale du genou.

Radiation therapy to prevent heterotopic ossification after cementless total hip arthroplasty

Clinical and roentgenographic observations on a postoperative low-dose radiation of 1000 cGy for prevention of heterotopic ossification in high-risk patients after 48 noncemented total hip arthroplasties demonstrated no overall statistical difference in the Harris hip scores between the treated group (92.2) and the control group (91.0). There was no difference in the incidence of radiolucent lines about the components, and there were no revisions for aseptic loosening in the treated group. The incidence of clinically significant (Brooker Grades III and IV) heterotopic bone formation was lower in the treated group (7%) than in the control group (32%). This difference in the incidence of heterotopic bone formation was statistically significant. Radiation therapy was effective in preventing postoperative heterotopic bone formation in biologically fixed total hip implants.

Total Knee Arthroplasty Using Cementless Porous Tantalum Monoblock Tibial Component: A Minimum 10-Year Follow-Up

BACKGROUND Cementless fixation in total knee arthroplasty (TKA) was introduced to improve the longevity of implants but has yet to be widely adopted because of reports of higher failure rates in some series. The cementless tantalum monoblock tibial component, in contrast, has shown successful short-term results, but long-term survivorship with this design is still lacking. The purpose of this study was to investigate the minimum 10-year clinical and radiographic results of the cementless tantalum monoblock tibial component in primary TKA. METHODS From March 2002 to March 2005, 33 patients (33 knees) underwent primary TKA with a cementless tantalum monoblock tibial component. All patients were followed clinically and radiographically for a minimum of 10 years (mean 11.5 years, range 10-13 years). No patients were lost to follow-up. The underlying diagnosis that led to the primary TKA was primary osteoarthritis in 31 knees and post-traumatic osteoarthritis in 2 knees. RESULTS None of the components was revised. At a minimum 10-year follow-up, the survivorship with reoperation for any reason as end point was 96.9%. With tibial component revision for aseptic loosening or osteolysis as the end point survivorship was 100%. There was no radiographic evidence of tibial component loosening, subsidence, osteolysis, or migration at the time of the latest follow-up. The mean Knee Society knee scores improved from 56 points preoperatively to 93 points at the last clinical visit. CONCLUSION The porous tantalum tibial monoblock component demonstrated excellent clinical and radiographic outcomes with no component revisions for aseptic loosening at a minimum follow-up of 10 years.

The Synergy cementless femoral stem in primary total hip arthroplasty at a minimum follow-up of 15 years

Aims We report on the outcome of the Synergy cementless femoral stem with a minimum followup of 15 years (15 to 17). Patients and Methods A retrospective review was undertaken of a consecutive series of 112 routine primary cementless total hip arthroplasties (THAs) in 102 patients (112 hips). There were 60 female and 42 male patients with a mean age of 61 years (18 to 82) at the time of surgery. A total of 78 hips in the 69 patients remain in situ; nine hips in eight patients died before 15 years, and 16 hips in 16 patients were revised. Clinical outcome scores and radiographs were available for 94 hips in 85 patients. Results In all, four stems were revised. One stem was revised for aseptic loosening; two stems because of deep infection; and one because of periprosthetic femoral fracture. There was a significant improvement in all components of the Western Ontario and McMaster Universities Osteoarthritis Index score at the final follow‐up (total: p < 0.001, pain: p < 0.001, stiffness: p < 0.001, function: p < 0.001). The mean Harris Hip Scores improved from 47 points (27 to 59) pre‐operatively to 89 points (65 to 100) at the latest follow‐up (p < 0.001). Kaplan‐Meier survivorship, with stem revision for aseptic loosening as the endpoint, was 98.9% at 15 years (95% confidence interval (CI) 96.9 to 100, number at risk at 15 years: 90) and with stem revision for any reason was 95.7% (95% CI 91.7 to 99.8, number at risk at 15 years: 90). Conclusion The Synergy cementless femoral stem demonstrates excellent survivorship and functional outcomes at 15 years.