Krawczyk A

Methods of reducing allogeneic blood demand in orthopedic surgery.

Despite advances in this field, allogeneic blood transfusion still carries a lot of risk; the availability of heterologous blood is also constantly decreasing. We describe the most popular methods for reducing the allogeneic blood requirement. Basic information is presented about the physiological mechanisms of compensation for intraoperative blood loss, which can be compromised by respiratory and cardiovascular disease or infections. Preoperative anemia (manifested by low hemoglobin levels) is statistically the most significant factor that increases the need for allogeneic blood transfusion. This paper evaluates the importance of oral and intravenous iron supplementation in the perioperative period, and the use of erythropoietin to boost Hb levels. Minimizing intraoperative blood loss also decreases the need for transfusion, and may be accomplished via meticulous hemostasis, an appropriate surgical approach, atraumatic surgical technique, reduced surgery time, and rational tourniquet use. Controlled intraoperative hypotension is a method of proven efficacy. Synthetic antifibrinolytic agents are also used to reduce perioperative blood loss; however, few clinical trials have focused on the use of such drugs in orthopedics. The use of postoperative drainage is still debatable. The allogeneic blood requirement can also be reduced by autologous blood transfusion. Autologous transfusion can be accomplished by preoperative autotransfusion, preoperative hemodilution, and intra- or postoperative blood salvage. It is currently the safest method of compensating for perioperative blood loss, avoiding all the described risks of heterologous blood transfusion.

Sport and physical activity after ankle arthrodesiswith Ilizarov fixation and internal fixation

BACKGROUNDnSevere osteoarthritis (OA) of the ankle joint constitutes an important social problem.nnnOBJECTIVESnWe used (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA (University of California Los Angeles) activity scale, (4) the VAS (visual analogue scale) ACTIVITY scale, and (5) the FAAM (foot and ankle ability measure) SPORT scale to verify whether the type of ankle joint arthrodesis stabilization affected sports and physical activity levels.nnnMATERIAL AND METHODSnWe carried out a prospective clinical study of 47 patients who had undergone ankle arthrodesis with Ilizarov external fixator stabilization (Group 1, n = 21) or internal stabilization with screws (Group 2, n = 26) at Orthopaedic Clinic at the Wroclaw Medical University, Poland, from 2007 to 2015. Sports and physical activity levels were measured by (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA activity scale, (4) the VAS ACTIVITY scale, and (5) the FAAM SPORT scale.nnnRESULTSnA comparison between the average results of Group 1 and Group 2 on the LOWER LIMB Activity scale and the GRIMBY scale before and after surgery revealed no significant differences. In Group 1, the mean scores on the VAS ACTIVITY scale and the UCLA activity scale after treatment were higher than in Group 2. In Group 1, the mean outcome in the SPORT FAAM scale after treatment was 40; in Group 2 it was 30.06.nnnCONCLUSIONSnIlizarov fixation of ankle arthrodesis is associated with better scores on the FAAM SPORT, UCLA activity and VAS ACTIVITY scales after treatment than internal fixation. The scores on the GRIMBY scale and the UCLA activity scale were significantly higher after treatment than before treatment in both groups. In this study, ankle fusion with Ilizarov fixation and internal fixation was found to be effective in the treatment of ankle arthritis. The levels of sport and physical activity were satisfactory in both groups, but the outcomes after fixation with the Ilizarov apparatus were better than after internal stabilization.