Introduction: The correction of anaemia prior to total hip arthroplasty reduces surgical risk, hospital stay and cost. This study considers the benefits of implementing a protocol of identifying and treating pre-operative anaemia whilst the patient is on the waiting list for surgery.

Methods: From a prospective series of 322 patients undergoing elective total hip arthroplasty (THA), patients identified as anaemic (Hb< 12 g/dl) when initially placed upon the waiting list were appropriately investigated and treated. Pre- and post-operative haemoglobin (Hb), need for transfusion, and length of hospital stay were collated for the entire patient cohort.

Result: 8.8% of patients were anaemic when initially placed upon the waiting list for THA and had a higher transfusion rate (23% to 3%, p< 0.05) and longer hospital stay (7.5 to 6.6 days, p< 0.05). Over 40% of these patients responded to investigation and treatment whilst on the waiting list, showing a significant improvement in Hb level (10.1 to 12.7 g /dl) and improved transfusion rate.

Discussion: Quantifying the haemoglobin level of patients when initially placed on the waiting list helps highlight those at risk of requiring a post-operative blood transfusion. Further, the early identification of anaemia allows for the utilization of the waiting list time to investigate and treat these patients. For patients who respond to treatment there is a significant reduction in the need for blood transfusion with its inherent hazards.

Adamantinoma is a rare low-grade malignant epithelial bone tumour.

We report a case of an expansile, osteolytic mid-diaphyseal tibial lesion found in a 12 year-old girl. An initial histological diagnosis of basaloid-type adamantinoma was made. Following excision, further histology demonstrated basaloid cells and acellular matrix focally surrounded by osteoclast giant cells with calcium deposits, features consistent with pilomatrixoma. Several histological variants of adamantinoma have been documented; this case details a previously unreported histological adamantinoma variant – pilomatrixoma-adaminatinoma.