Aims

The purpose of this study was to assess the reliability and responsiveness to hip surgery of a four-point modified Care and Comfort Hypertonicity Questionnaire (mCCHQ) scoring tool in children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V.

The reinfusion of perioperative cell salvage is one method employed to reduce exposure to donor blood. Data on the safety of this process, however, are scant. Notably, the effect of intraoperative, washed cell salvage reinfusion on prothrombotic markers has not been demonstrated. The risk of postoperative venous thromboembolism following major orthopaedic operations is not insignificant. The study objective was to assess the effect of cell salvage reinfusion on coagulation and platelet activation.

Twenty-one patients undergoing elective primary hip operations were recruited. Nine patients received washed cell salvage intraoperatively, and were compared with 12 patients undergoing similar surgery that did not. Two patients in the cell salvage group also received postoperative, unwashed cell salvage. Blood samples were collected pre-operatively, immediately post-operatively, and one day post-operatively for assays of platelet activation markers, P-selectin expression and fibrinogen binding by flow cytometry in diluted whole blood; coagulation activation marker, thrombin-antithrombin complex (TAT); D-dimer by ELISA, thrombin generation by chromogenic assay, and full blood count. Samples of cell salvage material were also analysed for prothrombotic markers.

There were no significant differences between the groups preoperatively. Postoperatively haemoglobin levels did not differ significantly between the cell salvage group and controls. Postoperative TAT and D-dimer were significantly higher in the cell salvage group compared with controls (p<0.05). One day postoperatively, there were significantly higher platelet P-selectin expression (p=0.006) and platelet fibrinogen binding (p=0.004) in the cell salvage group compared with controls. The white cell count (WCC) was also significantly higher (p=0.04). In the intraoperative washed cell salvage material, and in postoperative cell salvage, the platelet count was low, but significant proportions of platelets were activated, and levels of D-dimer were elevated compared with venous blood. The postoperative salvage material also contained high levels of TAT.

The results from this pilot study show the induction of a prothrombotic state following reinfusion of intraoperative, washed cell salvage in recipients undergoing primary elective hip operations. An inflammatory response to reinfusion is also indicated by the raised WCC. Further investigation into the safety of cell salvage is indicated.

Purpose: Purpose: Prognostic factors for a satisfactory result for repaired tears have been postulated to include patient age and size of tear. The purpose of this study was to examine the impact of rotator cuff tear size on pre-operative and 2 year post-operative perceived functional level of patients undergoing repair of the full-thickness tear.

Methods: Methods: Data of 88 consecutive patients were included in data analysis. Patients were categorized into two groups: small or moderate tear (SMT) group, and large or massive tear (LMT) group. Two self-report measures - the Western Ontario Rotator Cuff Index (WORC), and the American Shoulder and Elbow Surgeons (ASES) evaluation form - were used to examine disability at baseline, and two years after surgery for repair of the rotator cuff. The Constant Murley (CM), which evaluates range of motion, strength and self-report function, was also used at the two time periods. A two-way, repeated measures analysis of co-variance (ANCOVA) compared the two groups across the two times. Covariates were age and gender.

Results: Results: Fifty-two patients (mean age = 56.6±10.4) had small or moderate and 36 (mean age = 66.7±11.3) had large or massive full-thickness tears. The results of all measures at both time periods demonstrated poorer function for the LMT group (pre WORC 31.4, post WORC 59.0; pre ASES 37.0, post ASES 65.0; pre CM 49.3, post CM 69.6) compared to the SMT group (pre WORC 38.2, post WORC 67.2; pre ASES 43.4, post ASES 73.8; pre CM 55.3, post CM 80.7). Both groups had improved function at 2 years post-operatively, but the rate of change was similar in the two groups.

Conclusions: Conclusion: The results of this study indicate that the size of a full-thickness tear of the rotator cuff has an effect on shoulder function both pre and postoperatively, but not on the pattern of recovery.