Blood transfusion requirement in shoulder surgery has been reported from 8.1% to up to 15%. Our observation was that blood transfusion rarely required after open shoulder surgery. We therefore decided to conduct a retrospective case notes study to look at the crossmatch-transfusion ratio for shoulder surgery.

A total of 211 patients were included in the study. Results were analysed using paired T-test from SPSS (15.0). There were 63 elective procedures and 148 trauma procedures during that period. Ten patients (4.8%) required intra-operative or post operative transfusion. Crossmatch-transfuison ratio was 21.

There should be a clear equation between crossmatch and its use, intra-operatively and post operatively. This study highlighted unnecessary cross-matching for shoulder operations which puts extra pressure on the laboratory staff, the blood bank and also has financial implications.

At present patients who require shoulder hemiarthroplasty in our unit routinely have two units of blood cross matched pre-operatively. Our observation was that blood transfusion rarely required after open shoulder surgery. We therefore decided to look at the crossmatch-transfusion ratio for the following procedures in our department; elective shoulder hemiarthroplasty, reverse total shoulder replacement, open rotator cuff repair, shoulder hemi-arthroplasty for trauma, open reduction and internal fixation of proximal humeral fractures.

We undertook a retrospective review of all such patients during the period of 2002 to 2005. All trauma and elective surgery included. Hospital notes were analysed to include age, sex, pre operative haemoglobin level, blood transfusion intra-operatively and post-operatively.

A total of 211 patients were included in the study. There were 63 elective procedures and 148 trauma procedures during that period. No patient required intra-operative or post operative transfusion. Three patients who required transfusions post operatively, due to other associated injury (liver laceration x1, spleen injuries x 2) were excluded from the study. Crossmatch-transfuison ratio was > 2.

There should be a clear equation between cross-match and its use, intra-operatively and post operatively. This study highlighted unnecessary cross-matching for shoulder operations in our unit which puts extra pressure on the laboratory staff, the blood bank and also has financial implications. We recommend, Standardised approach for pre-operative cross match practise, pre-operative group and screen to detect atypical antibodies and efficient hospital pathology services, to provide blood for transfusion within specified time, for atypical antibody negative blood, should it require.

Few studies suggest that the use of a cemented stem reduces proximal stresses and may result in proximal bone resorption. Aim of our study: Does bone cement affect peri prosthetic bone density? The study was approved by the local ethics committee.

Patient and methods: 30 patients were included in each group based on power analysis. All 60 patients had the same type of knee replacement (Rotaglide rotating platform). Both groups, cemented and uncemented respectively were matched for the variables like mean age (67.2 & 67.33 years), gender (13: 17 males: females), body mass index (30.95, 29.90), average time following surgery (4 and 3.25 years), activity level (UCLA scoring: 6 & 4) and mean T score (osteoporosis index: −0.51 & −0.62). Periprosthetic bone density was measured in five regions of interest in the distal femur and five regions of interest in the proximal tibia. This was performed with Prodigy scanner (Lunar) using ‘orthopedic’ software to eliminate metal related artifacts. The same area was measured on the opposite unoperated knee. The values thus obtained were compared between the cemented and uncemented groups.

Results: There was no statistically significant difference in bone density around proximal tibia, patella and bone density proximal to femoral flange. However, there was some difference between the groups for bone density behind the flange of the femoral component measured in the lateral view, although not strictly significant at the 5% level. In this region of interest, the bone density in the cemented group appears to be less than in the uncemented group (p=0.059).

Conclusion: Use of bone cement do not seem to alter the peri prosthetic bone density contrary to suggestions in a few other studies. While reduction in periprosthetic bone density is noted in both groups, use of bone cement did not affect the results significantly.