Joint arthroplasties may be associated with a blood loss, which necessitates transfusion. Especially, hip arthroplasties are highly associate with transfusion to compensate perioperative bleeding. Orthopaedic surgeons and patients have increasing concerns regarding complications of blood transfusions. Although various methods to reduce transfusions have been attempted in TJA, a high percentage of patients require a transfusion during and after the procedures. The purposes of this study were to evaluate the trends of the transfusion(transfusion rates, transfusion amounts, economic burden) in hip arthroplasties, using nationwide data from the National Health Insurance Service (NHIS). We used data from nationwide claims database of Health Insurance Review Assessment Service (HIRA). The data managed by the NHIS were used to identify the 161,934 hip arthroplasties by 3 categories including bipolar hemiarthroplasty(BH), total hip arthroplasty(THA), and revision arthroplasty(RA) from 2007 to 2015. These 3 categories were classified using the operation code recorded in the requisition data of NHIS. The transfusion rates, transfusion amounts, proportion of transfusion, cost of each type of operation was investigated and stratified by age, gender, hospital type, and area in hip arthroplasties. The proportion of transfusion about whole blood, red blood cell, fresh frozen plasma, platelet, was also evaluated in hip arthroplasties.Aims
Patients and methods
Venous thromboembolism (VTE), including pulmonary embolism (PE) resulting from deep vein thrombosis (DVT), remains a well-known serious complication after femoral fractures. The low molecular heparin is widely used to prevent VTE. This study compared the effectiveness of VTE prevention between dalteparin and enoxaparin. From 2013 to 2014, we retrospectively recruited 712 patients who had femoral fractures with operative treatment. All patients receiving VTE chemoprophylaxis with perioperative period using dalateparin in Group 1(N=395) and enoxaparin in Group 2(N=317). The prophylactic dosing was determined using individual product labeling and identified as enoxaparin 40 mg every 12 hours and dalteparin 2500 international unit (IU) once daily, based on clinical practice guidelines. The prophylaxis was started at admission, and maintained during average 8.43.5 days after operation. The outcome including the incidence of clinically significant deep vein thrombosis, pulmonary embolism, perioperative bleeding and cost of drugs were evaluated between two groups.Introduction
Materials and Methods
Arthroplasties of hip and knee are associated with blood loss, which may lead to adverse patient outcome. Jehovah's Witnesses do not accept blood transfusion. Performing arthroplasties in Witness patients without transfusion has been a matter of concern. We developed a protocol, which avoids transfusion in arthroplasties of Witness patients, and evaluated the feasibility and safety of the protocol. Our protocol consisted of subcutaneous administration of 4000 U recombinant erythropoietin and 100 mg of intravenous iron supplements when patient's hemoglobin level was less than 10 g/dL in preoperative evaluation. During the operation, cell saver, and plasma expander were used. Postoperatively, recombinant erythropoietin was administered three times a week and iron supplements were administered daily until the hemoglobin level reached 10 g/dL. We evaluated the feasibility of our protocol, perioperative complications and hematologic changes.Introduction
Materials and Methods
In comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty(BH), compression hip screw(CHS) and proximal femur nail antirotatory(PFNA) in treating comminuted intertrochanteric fractures(AO type, A2(21, 22, 23)) We retrospectively evaluated total 150 patients(BH:50, CHS:50, PFNA: 50) who were operated due to intertrochanteric fractures from March 2010 to Dec 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris hip score, ability of ambulation(Koval stage), visual analogue scale and radiologic limb length discrepancy(shortening). Landmark and radiologic length was checked.
–A: postoperative length –A’: POD 1year –B: immediate posteopative contralateral length(from hip center to distal tip of lesser trochanter) –B’: POD 1year contralateral length(from hip center to distal tip of lesser trochanter) –
Limb length(shortening) was adjusted considering difference of magnification = {A × (B’/B)}− A’Introduction
Materials and Methods
