Orthopedic surgery is one of the most blood-consuming surgeries. Currently there has been a radical change in transfusion policies, developing a series of therapeutic measures essentially created to minimize the use of allogeneic blood.

On the one hand, the safety of our patients must be even more our main objective. On the other hand, our economic resources are more restricted and therefore we must evaluate our surgical techniques and proceedings in order to be safer and more cost-effective.

The aim of this study is to report our results of the blood lost, the percentage of blood loss, the necessity of transfussions and how many blood pakages are needed.

From a sample of 2400 total knee arthroplasties proceedings, we analyze some surgical proceedings such as lligament balance, patelar traking, artrotomy, ischemia, femoro-tibial axis and type of arthroplasty.

We also examine the total blood lost and the percentage of total blood loss after 4 hours, after 24hours and after 48 hour of the total knee arthoplasty surgery.

We made a statistical analysis with t-test or anova test when it was necesassary.

The outcome of our investigation show that the blood loss when the ischemia is less than 50 minutes is 1470 cc and 1603 cc when is more than 50 minuntes (p<0.05). If we use the medial arthrotomy, the total bleeding is 1563cc, but with subvastus arthrotomy is 1294cc (p<0.05). If we use a primary rotational total knee arthroplasty the bleeding is 953cc, but if we use a PS or PCR the bleeding is 874cc (p<0.05).

As a conclusion we should know that our patients have more blood loss when the ischemia is more than fifty minutes, the bleeding is higher when we make a medial arthrotomy and when we use a rotational knee primary arthroplasty.

Exchange of infected implant using antibiotic-impregnated cement is the treatment of choice in prosthetic joint infection (PJI). We presented our experience using one or two-stage exchange with uncemented implants.

From January 2000 to June 2006 patients with a PJI that were treated with one or two-stage exchange with uncemented implants, were prospectively followed up. The treatment protocol consisted of radical excision of devitalized tissue and of maintaining a high serum antibiotic concentration during surgery followed by systemic antibiotic administration according to the microbiology results. Only patients with ≥6 months of follow-up were included. Good evolution was considered when symptoms and signs of infection disappeared and the C-Reactive Protein was normal.

Forty-two patients were included in the study, of whom 25 were male. The mean age was 70 years. The most common symptom was pain (100%) and radiological signs of prosthesis loosening were present in 36 cases (85.7%). Histology was positive in 32 patients (76.2%). Coagulase-negative staphylococci was the most common microorganism (23 cases) followed by S. aureus (5 cases). One-stage exchange was performed in 18 patients, and the long stem component was always uncemented. In one case an acute infection after the arthroplasty obligated to perform an open debridément without implant removal. After a mean follow-up of 31 months (range: 6–84) all patients had a good evolution. In 24 cases a 2-stage exchange with a joint spacer with gentamycin (Spacer-G) was performed. In all cases the definitive arthroplasty was performed using an uncemented long stem. Good evolution was documented in all but one case with persistent infection due to S. aureus after a mean follow-up of 19 months (range: 12–48).

Our results suggest that uncemented arthroplasty following a protocol based on radical debridément and systemic antibiotic therapy during and after surgery is a useful approach in PJI.

Introduction and purpose: The purpose of this study was to obtain environmental scanning electron microscope images of the joint surface of fresh osteochondral grafts cryopreserved in RPMI and modified Krebs-Henseleit medium (K-H) and evaluate and compare them using a validated classification system.

Materials and methods: We extracted the femoral condyles from 6-month-old female New Zealand rabbits weighing 3.5 kg and cryopreserved them using two methods (RPMI and K-H). After thawing the samples we took 20 photographs of each one (total of 100 images per group, 3 study groups) using an environmental scanning electron microscope.

Results: We assessed and compared each of the study parameters using the Chi-Square test:

- smooth surface, protuberances and peaks

Conclusions: On the basis of morphological studies, we can conclude that the K-H method provides a higher degree of chondrocyte viability than other cryopreservation methods in use up to the present.

Introduction: A hip replacement is an usually procedure in patients with chronic renal failure (CRF) affected of osteoarthritis, avascular necrosis of the femoral head or femoral neck fracture. The infection of the prosthesis is the most severe and important complication related to hip arthroplasty (HA). Patients with CRF have a immunosupression status, that increases the infection risk. The aim of the study was to evaluate the results of HA in patients on renal replacement therapy (RRT) through haemodialysis (HD) or renal transplantation (RT) .

Material and methods: Between 1990 and 2002, 23 HA have been performed in 18 patients on RRT (9 patients on HD and 9 RT). There were 9 women and 9 men, with an average age of 56 years old (range 30–83). In 5 patients the procedure was bilateral. The average time on RRT was 13.1 years (range 4–28). Preoperative diagnostic was: avascular necrosis of the femoral head (15 hips), femoral neck fracture (6 hips) and hip dysplasia (2 hips).

Results: The average follow-up was 59 months (range 3–140). All patients received antibiotic prophylaxis. Bleeding was the most frequent complication (74%, n=17). Infectious complications occurred in 33% of HA (n=6) in the early postoperative period and in 9% of HA (n=2) during the long-term follow-up. Early infections were: urinary tract infection (n=2 – Pseudomona species) and deep wound infection [n=4 – Pseudomona aeruginosa (n=1), Candida parapsilosis (n=1), Entero-coccus faecalis (n=1) and unknown aetiology (n=1), that required surgical debridement. Two patients had later infection of the prostheses (9%), and a two-stage revision in one case and resection arthroplasty in the other was performed. In-hospital mortality was 5.5% (n=1) and long-term mortality was 16.6% (n=3).

Conclusions: Infectious morbidity associated with HA in patients with chronic renal failure is important. The priority in this patients is individualize the surgical indication. An intensive medical control is needed.

Aims: The study we present compares quantitatively the bone regeneration in experimental animals obtained with autologus and homologus grafts against a calcium phosphate cement. Methods: We performed cavitary defects o 6 mm of diameter in the metaphiseal region of the distal femur of 48 rabbits of albine race. They were divided in 4 groups, and received respectively autologous grafts, homologous freezed graft, calcium phosphate cement or the absence of any implant (control group). Results: The results are valued by radiological, histological and histomorphometrical studies (with digitalysed images). Histological study shows a correct integration of the calcium phosphate cement, without þbrous interphase, and a bone regeneration which is progressive and centripetal. Statistical analysis of the histomorphometrical data shows that bone regeneration obtained with the calcium phosphate cement its similar to the one obtained with the grafts. Conclusions: Calcium phosphate cement is a biocompatible material, biodegradable and conductor.

Introduction and Objectives: The disadvantages attributed to unreamed intramedullary nails in fractures of the femoral diaphysis include delayed fracture consolidation and fatigue of the material. The aim of our study is to describe the low incidence of these complications.

Materials and Methods: We present a series of 25 patients treated by means of 26 unreamed femoral nails (Synthes) and static locking in all cases and follow up until the time of bone healing (6 months). Mean age of the patients was 43 years (range 18–86 years). The most common cause of injury was automobile accident. All treated fractures were located in the diaphysis (32-A in 9 cases, 32-B in 15 cases, and 32-C in 2 cases) and were closed fractures, except in 4 cases (2 Gustillo type II and 2 of type IIIa). In only 6 patients was the femoral fracture the sole lesion. In the rest of the patients, it was accompanied by other skeletal (multiple fractures) or visceral (polytraumatic) lesions.

Results: We were able to achieve fracture consolidation within a period ranging from 2 to 6 months (mean 4.2 months). We did not experience any problems with material fatigue in any of the cases. In one case it was necessary to remove the static lock to allow for bone healing due to diastasis of the fracture site.

Discussion and Conclusions: Unreamed intramedullary nails allow for consolidation of fractures of the femoral diaphysis in a period of time of about 4 months, which we consider to be accurate. Furthermore, the absence of reaming is associated with a less severe local reaction, which we consider to be preferable.

Introduction: The hypothesis of this work is to demonstrate that the Flexible Flat Foot (FFF) in children is not affected for any kind of treatment. The objective is: 1.-Rate the evolution of FFF during growing. 2.- Evaluate the accuracy of diagnosis criterion. 3.-Appoint the optimal age to diagnose and treat the FFF. 4.- Evaluate the different kinds of treatment.

Material and methods: 242 children of both sex, aged between 3 and 5 years old, diagnosed of flexible flat foot. We compare three groups of treatment during three years. One group were treated with orthopaedic shoes and internal wedges, other with inserts, and the third were a control group. We evaluated: Clinical findings: age, sex, flat foot family antecedents, weight, degree of flat foot, valgus of ankle, age of begin to walk, ligament hiperlaxity, vicious direction of leg axis and erosion of shoes. Radiological measurements: An astragalus-1°metatarsian, Moreau and Costa-Bartani, and astragalus-calcaneus divergence angles, valgus of ankle according Viladot system. We perform a walking test with an electronic baropodometer “PEL 38” with 20 children of every group.

Results: An 85 % child of our series has been normalized with growing. The overweight and ligament hiper-laxity are the most predisponent family antecedents. The Jack Test is not a prognostic factor of FFF. The vicious direction of leg is not related with the FFF. The valgus of ankle is physiologic. X-ray are not reliable to diagnose a FFF in children, while the walking test give us dates about the dynamic behaviour of FFF.

Conclusions

– The flexible flat foot in children is normally corrected with growing and is a normal step of foot evolution.