To date, there are no clear guidelines from the National Institute of Clinical Excellence or the British Orthopaedic Association regarding the use of Autologous Blood Transfusion (ABT) drains after elective primary Total Knee Replacement (TKR). There is little evidence to comparing specifically the use of ABT drains versus no drain. The majority of local practice is based on current evidence and personal surgical experience.

We aim to assess whether the use of ABT drains effects the haemoglobin level at day 1 post-operation and thus alter the requirement for allogenic blood transfusion. In addition we aim to establish whether ABT drains reduce post-operative infection risk and length of hospital stay.

Forty-two patients undergoing elective primary TKR in West London between September 2011 and December 2011 were evaluated pre- and post-operatively. Patient records were scrutinised. The patient population was divided into those who received no drain post-operatively and those with an ABT drain where fluid was suctioned out of the knee in a closed system, filtered in a separate compartment and re-transfused into the patient.

Twenty-six patients had ABT drains and 4 (15.4%) required an allogenic blood transfusion post-operatively. Sixteen patients received no drain and 5 (31.3%) required allogenic blood. There was no statistical difference between these two groups (p=0.22). There was no statistical difference (p=0.75) in the average day 1 haemoglobin drop between the ABT drain and no drain groups with haemoglobin drops of 2.80 and 2.91 respectively. There was no statistical difference in the length of hospital stay between the 2 groups (p=0.35). There was no statistical difference (p=0.26) in infection rates between the 2 groups (2 in ABT drains Vs. 0 in no drains). Of the 2 patients who experienced complications one had cellulitis and the other had an infected haematoma, which was subsequently washed out.

The results identify little benefit in using ABT drains to reduce the requirement for allogenic blood transfusion in the post-operative period following TKR. However, due to small patient numbers transfusion rates of 31.3% in the ABT drain group Vs. 15.4% in the no drain group cannot be ignored. Therefore further studies including larger patient numbers with power calculations are required before a true observation can be identified.

Introduction: Resurfacing arthroplasty of the hip joint has advantages of minimal bone resection, restoration of normal anatomy, and biomechanical circumstances. This study was undertaken to analyze the clinical and radiographic results of the resurfacing arthroplasty in patients with osteonecrosis of the femoral head (ONFH).

Materials and Methods: Between September 1998 and September 2001, 40 hips in 39 patients with ONFH had a resurfacing arthroplasty with the Birmingham Hip Resurfacing (BHR) system. The mean age at the time of operation was 38.3 years. The average follow-up period was 36.8 months after operation. The patients were clinically evaluated by hip pain, Harris hip scores, range of motion, and radiographically evaluated for wear, change of cup position, loosening, and osteolysis.

Results: The preoperative Harris hip score averaged 70.4 points and the degrees of flexion and internal rotation were 94° and 8°, respectively. The average Harris hip score at the last follow-up was 95.4 points. The degrees of flexion and internal rotation at last follow-up were 120°, and 20°, respectively. No patient complained of limb length discrepancy or pain in the hip or thigh. Rehabilitation programs and return to normal activities were earlier than that of conventional total hip arthroplasty (THA). There was no osteolysis, change of cup position, loosening, or detectable wear on the latest radiographic evaluation.

Conclusions: Our experience with resurfacing arthroplasty for ONFH indicates that the overall results are superior than conventional THA with respect to pain relief, range of hip motion, earlier rehabilitation, and early return to preoperative activity. This procedure with BHR could be an alternative between joint preserving procedure and conventional THA in ONFH especially in younger patients.