In modern surgery, one main goal is to reduce perioperative and postoperative transfusion need. The haemostatic disorders, the patients’ gender and the type of the operation seems to predict the blood loss in orthopaedic surgery. It has been reported recently, an association of the Factor V Leiden mutation and with a lower rate of intra-partum blood loss,
Pro C Global system is influenced by FRO C, PRO S, APC resistance (FV Leiden) and FV111.
19 with total knee arthroplasty, 11 with total hip arthroplasty, 11 with fractures and 1 patient with amputation of -the lower leg. The blood loss for each patient was calculated according the Mercurialli formula: Total blood loss: total blood volume x (Ht preop-Ht day 5 postop)+ml of RBC transfused. The total blood loss was expressed in terms of percentage of total blood volume and defined as relative blood loss. Patients were divided into two groups with high and low relative blood loss, according the median value of the relative blood loss. Pro C global values was monitored in all patients pre-operatively on a BCT analyzer (Dade Behring). Values >
0.8 are considered normal.
It is known that patients who are undergoing major orthopaedic operations of the lower legs (fractures, total hip and knee arthroplasty) belong to a high-risk group, for the development of thromboembolic events. 20–40% of the patients develop deep vein thrombosis (DVT) of the calf and 2–4% fatal pulmonary embolism. These patients may have remarkable activation of the coagulation system, which is important for the development of deep vein thrombosis of the lower legs.
The exact estimation of these factors is necessary, so that these patients receive the suitable prophylactic antithrombotic therapy,
All patients had normal renal function, and the platelets, count, the PT and aPTT were in a normal range. The patients were hospitalized for 7 days and then they were observed as outpatients for the possibility of developing deep vein thrombosis and for a 4 weeks period. All patients received a combination of LMWH and graduated compression elastic stockings as a prophylaxis against DVT. Plasma concentration of Di-dimers and Thrombin -Antithrombin complex (TAT) were measured preoperatively and the second, the fourth and the sixth day postoperatively. Di-dimers plasma concentration were measured by automated analyzer (VidasBiomerieux) and TAT plasma concentration were measured by an enzyme-linked microimmunoabsorbent assay (microelisa Dade-Berhing)
In patients with total hip and knee arthroplasty TAT plasma concentration increased significantly the 12nd postoperative, day, decreased the 4th postoperative day and then increased again (p<
0.01). Di-dimers plasma concentration increased significantly the 2nd postoperative day and then decreased (p<
0,03). Until the 6th postoperative day Di-dimcrs concentration remained above normal range. Patients with fractures had higher TAT levels preoperatively than patients with total hip and knee arthroplasty. (p<
0.027)
100 randomized primary cementless THRs in 80 patients were reviewed retrospectively regarding the HA cover of the stem which was Waldemar Link’s, ribbed type, made of Titanium, with a collar and mostly applied without the trochanteric screw. The femoral neck was always retained high as possible. Full weight bearing on the operated leg started the 3rd postoperative day, while years earlier the 6th postoperative week. Two more or less, equal groups were formed: (A) without, (B) with HA covered stems and two subgroups: patients of 60 to70 years and 70 to 80 years. Gender was matched as possible and mean follow-up time was 8 years (range 7 to IO years). The Harris Hip Score was used for clinical evaluation and the method of “pencil and ruler” in plain X- Rays for radiographical one. Patients who died after the 8th postoperative year of evaluation were included. Results 1, The postoperative hip score was at average for group (A) 92.1 points and for gr. (B) 92,4p. 2. In gr. (A) we found* at a rate 70% 2mm of symptom less, adaptive, slow early migration, while in gr. (B) this corresponded to 1 mm of same migration at a rate 60%. In both groups migration stopped by the second postoperative year. 3. “Alarming” stem migration was found in two cases: one in each group. The cause was that the stems applied, were undersized and the patients were women on menopausal osteoporosis. Both sterns were revised. Two more “alarming” stem migrations were found, one in each group, in patients suffering from collagenosis with the relevant bone quality. This migration was related to bone retreat primarily and irrelevant to stem’s loosening, gender or age of patients. Both stems have not been revised yet. 4. Similar and minimal-2% for gr. (A) vs 4% for gr. (B)- was the rate of symptomless, limited, non-sclerotic of less than 2mm wide demarcations gradually resolving, 5. Similar and minimal-2% for gr. (A) vs 5% for gr (B)- was the rate of stress shielding phenomenon resolving in 2 years time. 6. No further mechanical or biological loosening were noticed at mid-term results 7. Similar- 20% for gr (A) vs 15% for gr (B) was the rate of mild symptomless ectopic ossifications.
The mean follow-up time was 10 years (range, 3–15 years). The average age of patients was 58 years. The average angle of HV deformity was 38 degrees (in nine feet this angle was more than 40 degrees). Mean inter-metatarsal (IM) angulation was 15 degrees. The procedure was always followed by Y or V capsuloplasty of first metatarsophallangeal (MTP) joint. Moderate arthritis of first MTP joint was not considered by us as a contraindication for this operation. The osteotomy was secured by two crossed K-wires. In 20 feet (15 patients) with coexisted forefoot abnormalities oblique osteotomies of the rest metatarsals, arthrodeses of proximal interphalangeal (PIP) joints and elongation of extensor tendons were carried out.
Patients were divided in two groups, hi the first group (18 patients) were provided 2 X 10000 units Epoetin Alpha daily for 15 days, hi the second group (after August 2001) we provided 40000 units X 4 every three days, hi all cases we provided Fe per os. One patient (in the second group) sustained diffuse intravascular coagulation (DIG) on the 13th postoperative day and finally she died. In the first group we noticed an increase of Ht by 4 units (mean rate) and in the second group by 6 units. Two cases in the first group presented a slight raise of the Ht (one unit), while the patient who presented DIG belonged to the second group. No patient was transfused postoperatively. Mobilization of patients especially the elderly was earlier than usual. An interesting notice was the raise of platelets (>
600000) in nine cases of the second group and in only two cases of first group, without complications. This raise was attributed to the stimulation of bone marrow due to the fast blood loss during the operation.