Total knee arthroplasty (TKA) is a common, effective operation but postoperative infection has devastating consequences. Several papers have associated perioperative autologous transfusion with reduced infection rates. Salvaged blood may augment the inflammatory response and central within it is polymorphonuclear leukocyte (PMN). Our hypothesis was that autologous transfusion enhances PMN activity by: increased PMN transmigration to potential infection site, enhanced phagocytosis, augmented respiratory burst activity. Our randomised controlled prospective study showed a significant increase in superoxide production by PMN of patients who received unwashed autologous transfusion supporting the clinical studies where infection rates following autologous transfusion were reduced

Objective: It has been observed in previous studies of autologous blood transfusion in total knee arthroplasty, that this technique is associated with a lower infection rate, though studies have not been sufficiently large to demonstrate a significant difference. We hypothesised that autologous salvage blood contained high levels of pro-inflammatory mediators which may prime or augment the patients’ inflammatory response, and, in particular, the function of the polymorphonuclear leukocyte (PMN). Methods: Patients were randomised after consent to those receiving autologous transfusion and those having conventional treatment which was homologous transfusion only if clinically indicated. PMN were then isolated from the patients pre-admission immediately after the operation and 24 hours post-total knee arthroplasty. Three different aspects of PMN activity were measured: 1) The respiratory burst activity; 2) the ability to phagocytose microbes using radiolabelled staphylococcus epidermis; 3) and the ability to migrate across a collagen coated porous inserts. Results: 80 patients were studied, of whom 43 were in the autologous transfusion group and 37 in the first group. Of these 37, 6 had homologous transfusion. The study showed no significant difference between the phagocytic ability of the PMN from both groups. The main stimulus to transmigration is surgery itself. There was a significant increase in the production of reactive oxygen species by the PMN of those patients who received an autologous transfusion post-operatively. Conclusions: Using molecular biology techniques to study the PMN directly, our study indicates that autologous transfusion alters the activity of PMN and this indicates a possible mechanism whereby the immune response to infection could be enhanced. This, in turn, would explain the observed differences in infection rate in previous studies

We prospectively randomised 104 consecutive patients undergoing primary cemented total knee arthroplasty to receive either a standard suction drain© (Redivac) or autologous transfusion drain® (Bellovac). There were fifty two patients in each group. Randomisation was performed using a software program (Minim) which set to stratify patients based on their age, sex and body mass index (BMI). All procedures were performed under pneumatic tourniquet. Drains were released in recovery room 20 minutes after surgery and were removed 24 hours following surgery. Blood collected in the standard suction drain was discarded but blood collected in the autologous transfusion drains was transfused unwashed to the patient within six hours of collection. 13 patients (25%) in the study group had two or more units of homologous blood transfused in addition to the blood collected postoperatively and re-transfused (Average= 438mls). 12 patients (23%) in the control group had two or more units of homologous blood transfused. No sepsis, transfusion reactions, or coagulopathies were associated with the autologous blood re-transfused in the study group. The use of autologous transfusion system (Bellovac) proved to be safe but failed to reduce the need for postoperative homologous blood transfusion following uncomplicated total knee arthroplasty

Introduction: The aims of this study were to determine whether patients were transfused appropriately, after a Unilateral Cemented Primary Total Knee Replacement (TKR), and whether it would be cost effective to use autologous transfusion drains compared with standard group & save and cross match protocols. Method: Retrospective study of the pre- and postoperative day 1 haemoglobin values of all patients who underwent unilateral primary cemented TKR between November 2004 – November 2005 at the Kent & Sussex Hospital, Tunbridge Wells. Haemoglobin data and length of stay was obtained from computerised records & transfusion data from the blood transfusion department. Results: 150 patients were assessed: 97 (65%) female and 53 (35%) male. 20 (14.6%) patients required blood transfusion. The mean preoperative haemoglobin for non-transfused and transfused patient’s was 13.7 and 12.5g/dl respectively (P = 0.0029). The mean postoperative haemoglobin for non-transfused and transfused patient’s was 11.1 and 9.27g/dl respectively (P< 0.001). The mean blood loss for non-transfused and transfused patient’s was 2.64 and 3.26g/dl respectively (P< 0.001). There was no significant correlation between length of stay and either preoperative haemoglobin or blood loss after surgery; Spearman’s correlation coefficient was 0.0222 and 0.0036 respectively. The cost of a standard group & save and cross match, plus the 56 required units of blood in this study was £15,443.60. The theoretical cost of using a CellTrans Autologous Transfusion System on these 150 patients would be £14,355.00, a saving of only £1,088.60. However, by only using the autologous drains on patients with a preoperative haemoglobin ≤ 12.5g/dl, this saving could be increased to £4,131.20 per annum. Conclusion: Using autologous transfusion drains on patients with a preoperative haemoglobin ≤ 12.5g/dl would save over £4,000 per annum at Maidstone & Tunbridge Wells Hospital Trust. There is no correlation between length of stay in hospital and either preoperative haemoglobin or blood loss after surgery. Patients transfused had significantly lower pre- and postoperative haemoglobins

Introduction: There is increasing awareness and concern among the medical profession, general public and media about the various complications of homologous blood transfusion. Primary arthroplasty of either the hip or knee has an estimated total bleeding of 1.51 (Lotke et al 1991), commonly resulting in transfusion. In knee arthroplasty, performed with the use of a tourniquet, almost all the bleeding occurs postoperatively. Several studies have shown that salvage of blood after the operation and reinfusion can reduce the need for homologous transfusion (Majkowski RS et al, Newman JH et al). We studied prospectively 100 consecutive patients for knee replacement to compare post-operative transfusion requirements in blood salvage and reinfusion group and a no drain technique. Methods: After written consent 100 consecutive patients for knee replacement surgery were randomly allocated by computer generated numbers to either the no drain group (n=50) or the reinfusion group (n=50). The patients were anaesthetised as deemed appropriate by their anaesthetist. All the patients were operated on using a tourniquet. At the end of surgery the wound was closed with or without a deep drain. The drain was attached to the Constavac CBC II closed suction system. Preoperative haemoglobin and haematocrit values were recorded. Homologous blood was transfused to the patients as per the standard protocol depending on the haematocrit and or haemoglobin at 4 & 8 hours post-operatively, as well as days 1,2 & 3. In the reinfusion group blood collected in the reservoir was transferred to the blood bag and reinfused at 5 hours or 500 mls depending which was earlier. At 8 hours the reservoir blood was collected and reinfused, no more blood was reinfused as per the manufacturer recommendations. Cardiovascular stability was assessed by hourly blood pressure and heart rate during the first 24 hours and twice daily thereafter. Blood loss was assesses by measuring the drain loss, assessing the wound ooze serial haematocrits and total transfusion requirements. Results: 50 patients were completed in each group. The mean preoperative haemoglobin in the drain group was 12.8 g/dl and in the no drain group it was 12.9 g/dl. No difference in predisposing factors for bleeding was recorded in the two groups. The mean volume of blood collected in the drain group was 1008mls and the mean volume of autologous transfused was 864 mls. 14% of patients in both groups had no requirement for homologous blood. There was no significant difference in the homologous blood transfusion in the two groups over the study period (up to day 3 post op), the no drain group requiring and average of 2.1 units of packed cells the reinfusion group requiring an average of 1.8 units of packed cells in total. The homologous blood requirements in the drain group was significantly reduced on day 2 in comparison to the no drain group, but as noted there was no overall reduction in homologous requirements. Cardiovascularly 16% of patients with a drain had at least one episode of hypotension (Bp < 90 systolic) compared with 20% of patients in the no drain group. The group without a drain had a significant increase in wound ooze (70% compared with 44%). Conclusion: Post-operative blood salvaging and autologous transfusion following primary knee replacement under tourniquet in this study did not significantly reduce the patient’s requirement for homologous blood transfusion in the first 3 days post operatively. There was a significant increase in wound ooze in the no drain group but as shown this has not result in an increase in cardiovascular instability or an increase in transfusion requirements

Introduction. The purpose of this study was to determine the efficacy of a multi-modal blood conservation protocol that involved pre–operative autologous blood donations (2 units) in conjunction with erythropoietin supplementation as well as intra-operative conservation modalities. Methods. A retrospective chart review of 90 patients with simultaneous bilateral total knee arthroplasty done between 2006–2009 by one of the 3 senior authors was performed. Patients donated two units of blood 4 weeks prior to surgery and also received erythropoietin injections (40,000 units: 3 weeks, 2 weeks and 1 week prior to surgery). Intra- operative blood management included use of pneumatic tourniquet, re-infusion drains, local epinephrine injections and fibrin spray. Post-operatively, autologous transfusions were provided based on symptoms. Pre-donation blood levels, peri-operative hemoglobin and hematocrit levels along with transfusion records were assessed. Results. The mean pre-donation hemoglobin was 13.1 g/dL. After 2 units of autologous blood donation and procrit injections, the mean preoperative hemoglobin was 13.0 g/dL. The mean hemoglobin dropped to 9.8 g/dL on postoperative day 3. The mean drop in hemoglobin from preadmission testing was 3.3 g/dl. Overall, 30% patients required autologous blood transfusion and no patients required allogenic transfusion. Conclusion. This multi-modal protocol was effective in not only avoiding allogeneic transfusions following bilateral TKA but also resulted in high blood levels at the time of discharge. This protocol was effective in eliminating allogenic transfusions and maintaining blood levels

Allogenic blood is becoming a scarce commodity, with many advocating autologous retransfusion systems to reduce the transfusion burden post primary arthroplasty. Many units have not embraced this, as the costs involved are perceived to be prohibitively expensive. The inpatient stays of 149 consecutive patients undergoing primary total knee arthroplasty, performed in a single unit by multiple surgeons, were reviewed. Length of post-operative stays and blood transfusion requirements were noted, and cost implications of allogenic and autologous transfusion determined. The total post-operative transfusion requirement was 28 units of allogenic blood in 12 patients (8%). The total transfusion cost per patient was £28.80. With the cheapest autologous re-infusion system costing £60.08 per patient, a marginal cost of £31.28 would need to be offset, to make such a system viable solely from an economic point of view. The average post operative stay was increased from 5.6 to7.7 days in those requiring blood transfusion. This extra bed occupancy was estimated to cost a minimum of £42.68 per patient. Autologous drainage systems not only lessen the risks associated with allogenic blood, but have been shown previously to shorten hospital stay and significantly reduce allogenic transfusion requirement. By doing so, they would easily offset the increased expenditure needed to institute such a system

Purpose: To study the judicious use of re-infusion drains in knee replacement on a target population with strict inclusion criteria and its impact on the transfusion rate and cost savings. Method: We devised an inclusion criterion after a preliminary study on 200 knee replacements and identified the target population likely to need transfusion after the index procedure. All bilateral total knee replacements, revision total knee replacements and primary total knee replacements were the pre-operative haemoglobin was less then 5 gm/l above the patient’s transfusion trigger were included. These criteria were further validated by retrospective application. 56 patients fulfilled the criteria and 50 patients were included in the study between September 2006 – May 2007. Male/female ratio was 18: 32. Mean age was 66.2 years. Procedure included 33 total knees, 13 bilateral and 4 revision knee replacements. Results: The overall transfusion rates dropped to 3% (bilateral, revisions 12%) during the period of this study. Mean volume re-infused was 600 ml (0–2600). Average drop in haemoglobin was 2.9 g/dl. No adverse incidents were reported. Prior to our study the expenditure on allogenic blood transfusion was £13,230. The estimated cost of using the re-infusion system was £6230. A saving of £ 7500 was achieved as a result of using the drain in the “at risk” patient. Conclusion: Post-operative autologous transfusion is a safe and efficient way to reduce patient’s exposure to donor blood. Use of re-infusion drains directed at a target population reduces need for allogenic blood and is cost effective

INTRODUCTION: Patients undergoing total knee arthroplasty may experience significant blood loss and are at risk of receiving blood transfusions. A bipolar sealing device designed to reduce intraoperative and postoperative blood loss, was compared to conventional electrocautery to determine its efficacy in maintaining hemoglobin levels and reducing transfusions in minimally invasive unilateral total knee arthroplasty. METHODS: A retrospective, matched control review of one hundred patients undergoing primary total knee arthroplasty by a single surgeon. Conventional electrocautery was used for hemostasis in 50 patients and bipolar sealing technology used in another 50 patients. RESULTS: Patients in the bipolar sealing group had a significantly lower mean decline in hemoglobin compared to the control group (3.3 ± 1.1 g/dL vs. 3.9 ± 1.2 g/dL; p = 0.0085). The prevalence of autologous transfusion was significantly lower for the bipolar sealing group (16%) compared to the controls (44%) (p < 0.001). The prevalence of allogeneic transfusion was also significantly lower for the bipolar sealing group (8%) compared to control group (22%) (p < 0.001). The prevalence of transfusion as a whole was significantly reduced by 64 percent (p < 0.001). While not statistically significant the break through allogeneic transfusion rate was reduced by 75 percent (4 controls compared to 1 treatment). DISCUSSION/CONCLUSION: The use of bipolar sealing technology in patients undergoing minimally invasive primary unilateral total knee arthroplasty is associated with a significant reduction in blood loss and transfusion rates compared to the use of conventional electrocautery. No funds were received in support of this study

Primary hip and knee replacements can be associated with significant blood loss. Tranexamic acid is a fibrinolytic inhibitor that has been shown to significantly reduce blood loss and transfusion requirement in hip and knee replacement, however the cost-benefit has not been widely investigated. Our study involved 100 patients, comprising a prospective cohort of 50 consecutive primary hip and knee replacements (treatment group) and a control group of the preceding 50 patients undergoing the same surgery. All knee replacements were computer navigated. The prospective cohort all had tranexamic acid 1g intravenously at the time of surgery, repeated at 8 and 16 hours. All patients had 28 days thromboprophylaxis with subcutaneous low-molecular-weight-heparin. The control group comprised 24 hip replacements and 26 knees versus 17 hips and 33 knees in the treatment group. Autologous transfusion drains were used in the control group knee replacements and the mean volume reinfused was 458ml. These drains were only used in the first 15 knee replacements in the treatment group as only one patient drained enough for reinfusion (100ml; p< 0.001). The mean fall in haemoglobin in the control group post surgery was 3.4g/dl versus 2.3g/dl in the treatment group (p< 0.001). Seven patients were transfused in the control group (14 units of red cells) versus two in the treatment group (5 units). The potential cost saving per patient averaged across all joints in the treatment group is £102.51. This is a function of savings in transfusion, cessation of drains for re-infusion in knee replacement and the cost of tranexamic acid. The only thromboembolic event was 1 deep vein thrombosis in the treatment group. Our data shows the cost savings associated with the use of tranexamic acid in primary hip and knee surgery are considerable and supports its use to significantly reduce blood loss and transfusion requirement

Introduction. Early rehabilitation and discharge following minimally-invasive total hip arthroplasty has potential risks including the possibility that patients may become progressively anemic at home. The current study assess the use of pre-emptive autologous blood transfusion on the length of stay, readmission, and allogenous transfusion. Methods. Patients treated by primary total hip arthroplasty using the superior capsulotomy technique were studied. Patients were divided into two groups. Group 1 were patients who did donate autologous blood and received an intra-operative pre-emptive transfusion. There were 283 patients in Group 1. Group 2 were patients who were medically capable of donating autologous blood but did not for non-medical reasons. There were 71 patients in Group 2. Patients who did not donate autologous blood for medical reasons (preoperative Hgb less than 11.5, age over 80) were excluded. All patients received general anesthesia. Length of stay, allogenous transfusion and readmission were compared. Results. The mean length of stay after surgery for the Group 1 patients who received autologous blood donation during primary THA was 1.56 days (SD 78 days, range 0–4). The mean length of stay for the Group 2 patients who did not donate or receive autologous blood during primary THA was 1.87 days (SD 84 days, range 1–4). Patients who received autologous blood donation had a significantly shorter post-surgical length of stay than patients who did not (p = .002, Mann-Whitney test). Patients who did not donate and preemptively receive autologous blood received significantly more allogenous blood (Mann-Whitney, p=.0004). Moreover 15% of those who auto-donated were given allogenic transfusions, while 37% of those who did not auto-donate were given allogeneic transfusions. One patient who did receive autologous transfusion and was discharged on day 2 sustained an NSAID induced GI-bleed 3 weeks postop and was admitted for transfusion and treatment. There were no other readmissions in either group. Conclusions. Patients who receive pre-emptive autologous blood transfusion intra-operatively when treated specifically by total hip arthroplasty using the superior capsulotomy technique under general anesthesia have shorter hospital stays and lower allogenous transfusion rates than a matched cohort of patients that did not donate and receive autogenous blood

Purpose of the study: The risk of homologous blood transfusion for primary total knee arthroplasty (TKA) varies between centres from 4 to 72%. Measurement of mean blood loss for patients undergoing primary total hip or knee arthroplasty led us to adopt a global blood-sparing protocol. Material and methods: This was a prospective observational study involving 90 TKA (TC-SB) implanted by one surgeon in 56 women and 33 men, mean age 74 years, ASA 3 for 29%, mean BMI=31. Programmed autologous transfusion and blood recovery were not applied. Alpha epoeitine (EPO was administered in the preoperative period in accordance with the predicted serum haemoglobin at discharge. Tranexamic acid (TA) was injected intravenously during the operation. Results: The mean operative time was 63 minutes, mean tourniquet time 51 minutes. During the perioperatively period, the mean 7-day blood loss was 566±254 ml red cells and 1560±643 total blood. Mean serum haemoglobin at discharge was 1.0 g/dl. Fourteen percent of patients had a postoperative serum haemoglobin less than 10 g/dl (lowest level 8.4 g/dl). One patient had a transfusion; this was a man in his nineties who was operated on without a tourniquet and without TA because of a poor arterial system. Nearly 86% of patients received TA with a significant (p< 0.05) decrease in bleeding compared with those who did not receive TA (365 ml total blood). EPO was delivered for 22% of patients (2.8 injections on average) to reached 14.2 g/dl the day before the operation. Discussion: This overall strategy for blood sparing enabled us to reduce the risk of transfusion and limit costs. In this series, the prescription of EPO was not targeted to reach a set level preoperatively but was based on the predicted serum haemoglobin level at discharge. Thus seven patients with a preoperative haematocrit below 39 did not receive EPO. None of these patients were transfused. Their discharge haemoglobin was between 10.7 and 12.4g/dl. Use of TA should be included in the calculation of the predicted discharge haemoglobin level in order to better determine candidates for EPO injections

Purpose: To develop a regression equation using preoperative variables to predict the likelihood of transfusion intra- or post- operatively for patients undergoing elective spinal fusion surgery. Methods: This study was a retrospective chart review of patients (n=774; 51% female; mean age=56 years; mean BMI=29) who underwent elective spinal fusion surgery between February 2001 and May 2005 at the QEII Health Sciences Centre in Halifax, Nova Scotia. The variables recorded were incidence of allogeneic and autologous transfusions (intra- and post-operatively), body mass index, age, gender, number of spinal levels fused, preoperative hemoglobin and hematocrit, ASA grade and pedicle screw and bone graft use. Results: Spinal fusion of 4 or more levels (n=24) resulted in a transfusion rate of 83%, therefore, the regression equation was calculated using only spinal fusions of 1 to 3 levels (n=750; transfusion rate=14%). The number of spinal levels fused and preoperative hemoglobin levels were found to be significantly related to the likelihood of receiving a transfusion. A predictive logistic regression equation was derived (Prediction = 3.615 + 1.018 x Levels fused–0.052 x Preop Hgb) where a probability cutoff of 0.160 gave a sensitivity of 63.5% and a specificity of 81.2%. Conclusions: The high sensitivity and specificity of the regression equation suggest that the results are clinically useful for determining whether alternatives to allogeneic transfusions should be investigated preoperatively for each patient undergoing elective spinal fusion surgery. The results could also have economic implications because implementing the use of a cell salvage device would be less costly than allogeneic units if the patient required a transfusion

Background: Perioperative red cell salvage may be of use in cases where significant blood loss is likely. The purpose of this investigation was to see if its use in revision hip surgery led to a reduction in homologous blood transfusion requirement. Methods: 48 patients were identified who had undergone revision hip surgery with the use of a Cell Saver device for perioperative autologous transfusion. Patients were individually matched to control patients who had undergone revision hip surgery without the Cell Saver. Patients were matched for age, sex and eight operative variables, which were chosen to indicate the type of revision surgery and possible level of blood loss, to ensure that the groups were comparable. Total homologous transfusion requirement in both groups was recorded as well as pre and post-operative haemoglobin levels. Results: The groups were well matched for age, sex and operative variables. The total homologous transfusion requirement was significantly lower in the Cell Saver group than the control group (mean 2.6 v 6.4 units of packed cells respectively, p 0.0006). There was no difference in pre-operative haemoglobin between the groups but it was lower in the Cell Saver group post-operatively (Cell Saver 10.1g/dl v Control 10.6g/dl, p 0.06). There was no difference in length of operation. Conclusions: Use of perioperative red cell salvage was associated with significantly lower homologous transfusion requirement. This is the first study looking at the use of perioperative red cell salvage in revision hip surgery with matching of patients on the basis of operative variables. A cost analysis shows that use of the Cell Saver has significant financial advantage in these patients

Background: Perioperative red cell salvage may be of use in cases where significant blood loss is likely. The purpose of this investigation was to see if its use in revision hip surgery led to a reduction in homologous blood transfusion requirement. Methods: 48 patients were identified who had undergone revision hip surgery with the use of a Cell Saver device for perioperative autologous transfusion. Patients were individually matched to control patients who had undergone revision hip surgery without the Cell Saver. Patients were matched for age, sex and eight operative variables ,which were chosen to indicate the type of revision surgery and possible level of blood loss, to ensure that the groups were comparable. Total homologous transfusion requirement in both groups was recorded as well as pre and post-operative haemoglobin levels. Results: The groups were well matched for age, sex and operative variables. The total homologous transfusion requirement was significantly lower in the Cell Saver group than the control group (mean 2.6 v 6.4 units of packed cells respectively, p 0.0006). There was no difference in pre-operative haemoglobin between the groups but it was lower in the Cell Saver group post-operatively (Cell Saver 10.1g/dl v Control 10.6g/dl, p 0.06). There was no difference in length of operation. Conclusions: Use of perioperative red cell salvage was associated with significantly lower homologous transfusion requirement. This is the first study looking at the use of perioperative red cell salvage in revision hip surgery with matching of patients on the basis of operative variables. A cost analysis shows that use of the Cell Saver has significant financial advantage in these patients

Introduction and Aims: Evaluate the efficacy of epsilon aminocaproic acid (Amicar) in decreasing peri-operative blood loss in patients with idiopathic scoliosis. Method: Thirty-six patients participated in this prospective, randomised, double blind, IRB-approved study. The patients who received Amicar were unknown until the completion of the study. All patients were 11–18 years of age, had idiopathic scoliosis, and underwent a posterior spinal fusion and segmental spinal instrumentation using standard hypotensive anesthesia. Factors analysed included age, gender, curve severity, number of vertebrae fused, operating time, hemoglobin and hematocrit pre-operatively and post-operatively, number of autologous units donated, pre-operative and post-operative fibrinogen levels, height, weight, estimated blood volume, estimated intra-operative blood loss, post-operative suction drainage, total peri-operative blood loss, and the autologous transfusion requirements. Results: Nineteen patients received Amicar and 17 patients were controls. There was no statistical difference between the two groups pre-operatively. Total peri-operative blood loss was statistically less in the Amicar group (p=.036). This was 1,391±212ml in the Amicar group compared to 1,716±513ml in the control group. The decrease was predominantly in the post-operative suction drainage – 605±253ml compared to 939±455ml. The hemoglobin and hematocrits were higher postoperatively in the Amicar group. Interestingly, the fibrinogen levels rose post-operatively in the Amicar group. Total autologous blood transfusions were less in the Amicar group at 1.0±0.8 units compared to 1.7±1.2 units (p=.061). No patient required homologous blood. There were no post-operative complications. Conclusions: Amicar is a safe, effective, and inexpensive pharmacologic agent that decreases peri-operative blood loss, particularly post-operative suction drainage, in patients with idiopathic scoliosis. This is probably due to increased fibrinogen levels. It results in a significantly decreased need for autologous blood donations pre-operatively and the associated costs

Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or post-operatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently specific indications for the use of the Cell Saver in Anterior Scoliosis have not been proven. Previous studies have commented on the beneficial aspects of recovered autologous transfusion for Orthopaedic patients in general, whilst others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. In order to assess the cost-effectiveness of the techniques used in Anterior Scoliosis Surgery we carried out a retrospective study of 180 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between July 2000 and September 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected. The median age of the study cohort was 11.2 years (range 7 – 64), and the male:female ratio was 1:8.4. The average preoperative haemoglobin in all patients was 12.7g/dl and the average postoperative haemoglobin was 9.8g/dl. In total the rate of homologous transfusion requirement was 1 unit per 9.1 patients. Results show that homologous transfusion was required in less than 11% of all patients. This is better than previously published rates of transfusion in similar procedures. The range of volume of intra-operatively salvaged cells was 200 to 770mls. There was no correlation between the number of levels fused (extent of scoliosis corrective surgery) and units transfused. Our experience shows that the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements

Introduction: Infection after hip or knee replacement occurs with low frequency but shares high morbidity. Aim of this study was an evaluation of incidence and risk factors related to post operative infection after joint lower limb joint replacement in an orthopaedics unit. Material and methods: This is a monocentric, retrospective, case control study over the years 2000 to 2002. All first intention Total Hip and Knee Replacement and revision cases for mechanical reasons that became infected were identified. Demographic, surgical and medical variables, potentially associated to prosthetic infection were compared for these patients to a control group of non ifected patients over the same time, matched for sex, age and surgery type. Results: Ten patients, all male, contracted post operative joint infection, out of 630 Total Hip or Knee Arthroplasties. This represented 1.2% after hip replacement and 3.1% after knee replacement. Bacteriological datas showed a majority of Staphylococal infection (5 aureus, 1 epidermidis), 2 among these being resistant to meticillin, but also evidence of ENT commensals (2 Streptococci milleri, 1 Actinomyces) and one epidermal commensal (Propionobacterium acnes). Univariate analysis: datas associated with increased risk of infection were diabetes melitus (OR 9.3; CI 95% 1.4–63), operating time exceeding 120 minutes (OR15.5 ; CI 95% 1,73–139,66), superficial wound infection (odds ratio 29; CI95% 2,77–303,32), coinfection outside the operation site (urinary tract , dental infection) (OR: 9,3 ; CI 95% 1,33–63,2). In our study an MNIS score higher than 1, autologous transfusion, locore-gional anaesthesia with or without the use of a catheter, antibioprophylaxis that did not comply with national recommendations could not be drawn as a risk factor. Discussion: Incidence of infection and risk factors related to infection in our study were found similar tothe results of published datas. The small number of events (10 cases) did not allow us to realize multivariate analysis and could explain that some known risk factors such as non recommended antibioprophylaxis, could not be elicitated. However these results suggested the need to reevaluate the system of prevention of infection in our centre such as protocolization of antibioprophylaxis and screening for and treatement of perioperative coinfection

Background: Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or postoperatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently, specific indications for the use of the Cell Saver in Anterior Scoliosis Surgery have not been proven. Previous studies have commented on the beneficial aspects of autologous transfusion for Orthopaedic patients in general; However, others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. The aim of our study was to assess and quantify the use of homologous blood, as well as the effects on haematological indices. Methods: We carried out a retrospective study of 144 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between April 2001 and October 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected. Results: The median age of the study cohort was 15.0 years (range 8 – 46), and there were 31 males and 113 females. The mean preoperative haemoglobin in patients was 13.5g/dl and the mean postoperative haemoglobin was 10.6g/dl. Haematocrit values followed a similar pattern, the mean pre-op value being 0.41, mean post-op value was 0.29. The range of volume of intra-operatively salvaged cells was 200 to 1100mls. 25 of 144 patients required transfusion. In these patients, the average number of units given was 2.3, although the total homologous transfusion rate was 0.4 units per patient. Results show that homologous transfusion was not required in 82.6% of patients. This is better than previously published rates of transfusion in this procedure. There was no correlation between the number of levels instrumented and the number of units transfused (Pearson Correlation Coefficient 0.19), and no correlation between the number of levels instrumented and postoperative haematocrit values (Pearson Correlation Coefficient 0.16). None of the patients required intra-operative homologous transfusion. Conclusion: Our experience shows that along with meticulous surgical haemostasis, and hypotensive anaesthesia the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements

Venous thromboembolism (VTE) is a frequent, life-threatening postoperative complication of orthopaedic surgery. Preoperative autologous blood donation has been advocated to reduce the risk of transfusion reactions and to limit potential infectious risk associated with donor blood. Experimental data suggest that autologous leukocytes might lead to immunomodulation similar to the effect attributed to allogenic leukocytes, but autologous whole blood (WB) is often still being used in Japan. We investigated the incidence rate of VTE and plasma D-dimer levels of the autologous WB transfusion and compared the findings with autologous red cell concentrates (RCC) and fresh frozen plasma (FFP) with regard to the cases of lower extremity arthroplasty. The subjects of this study were 138 patients with lower extremity arthroplasty who were scheduled to receive surgery. The operations included 72 total hip arthroplasties (THA) and 66 total knee arthroplasties (TKA). Postoperatively, plasma D-dimer levels were measured latex agglutination turbidimetric immunoassay. Ultrasonography and contrast-enhanced helical computed tomography was used for diagnosing VTE. There was no statistically significant difference in the post-surgery incidence rate of VTE between the autologous WB group (THA:20.0%, TKA: 27.9%) and autologous RCC/FFP group (THA: 11.9%, TKA: 30.4%). On the first post-surgery day, the plasma D-dimer levels were significantly higher in autologous WB group (THA: 8.1±9.5 μg/ml, TKA: 12.1±15.9 μg/ml) compared to the autologous RCC/FFP group (THA: 4.2±2.9 μg/ml, TKA:8.0±6.6 μg/ml). However, the plasma D-dimer levels were almost the same in both groups on the 14th day from the surgery. The results of this study suggest that donation and transfusion of autologous WB do not negatively influence the post operative VTE compared with autologous RCC/FFP. However, we must cautiously assess the plasma D-dimer levels of the autologous WB group on the first post-surgery day because of the high propensity of showing false positive rate compared to the RCC/FFP group