Allogeneic blood transfusion is associated with many complications and significant cost. The RD&E has looked at the use of autologous drains after our study of 100 cases showed an improved post-operative haemoglobin and reduced length of stay. There is a need to identify those patients of increased need for an autologous drain, in order to decrease the frequency of allogeneic transfusion. In 2007 a protocol was drawn up using information from our study of 191 cases which showed an average haemoglobin drop post-operatively of 3.05g/dl and average intra-operative blood loss of 285 ml. This protocol gives the surgeon triggers for autologous drain use; preoperative haemoglobin of <13g/dl, intra-operative blood loss of >400ml, tourniquet use, patient weight <50kg and patients refusing donated blood.

In 2007-08, 65% of a further 275 cases analysed met the triggers for use of an autologous system. The remaining patients received low vacuum drains. Of the 275 patients, only 2 (<1%) of those who did not fulfil the criteria for an autologous drain required allogeneic blood, compared with 43 patients (24%) of those deemed high risk of transfusion, and assigned autologous drains. The protocol was therefore deemed to be successful in identifying those patients who required additional support and expenditure to minimise allogeneic blood transfusion.

Analysis of this data led to recommended changes to the protocol in order to maximise the efficiency of the autologous drain use. In 2010 a further patient cohort studied showed a reduction in allogeneic blood transfusion to <10% of those receiving autologous drains, and an increase to 5% of those with low vacuum drains.

Due to the increased cost of autologous drains (£68) compared with the low vacuum systems (£32), and the cost of allogeneic units at £141, the expenditure per patient was calculated and shown to fall from £92 in 2007 to £78 in the 2010.

In conclusion, this protocol allows the clinician to appropriately target the use of the more expensive autologous drains to those of increased risk of transfusion. This protocol helps to minimise unnecessary allogeneic blood transfusion risks, and this has been shown to be more cost effective.

Aim: To report the intermediate clinical and radiological results of a consecutive series of knee arthroplasies using PFC Sigma endoprosthesis.

Methods: 525 total knee replacements (469 patients) were performed from Aug 97 to Jun 01 using the PFC Sigma components. Cruciate retaining femoral component was used in 219 knees. All patients were prospectively followed up at 6 weeks, 3 months and yearly. Pre operative HSS knee scores and Oxford knee scores were compared with annual scores. Quality of life was assessed using SF12 questionnaire. Knee Society scores were used to assess the radiographs. The average follow up was 61 months (36–84). 11 patients lost to follow up.

Results: Of the 469 patients, 64% were females. Mean age was 74.2 yrs (59–90). Pre operative valgus deformity of at least 10 deg was present in 87 (16.5%). Patella resurfacing was performed in 80.5%. A lateral release was performed in 20 patients. Post operative mobilisation was standardised in all patients. 34 patients developed radiologically proven DVT. 24 patients died from unrelated causes. 16 (3%) patients developed superficial and 6 developed deep infection. 4 patients underwent revision surgery (3 for infection, 1- catastrophic failure). The HSS scores improved from 29(16–65) to 86(59–97) at final follow up (p=0.004). Pre operative Oxford knee scores improved from 10(6–31) to 43(37–48) at last follow up (p=0.008). Radiological knee society score for the femur were less than 5 in 477/478 patients and 7 in 1 patient. The scores for the tibia were less than 5 in 475/478 patients and 6 in 3 patients. Average femoral flexion was 1–9.2 deg (3.9), knee valgus angle 0.5–7.4 (3.5) degrees and the tibial slope was 3.1 deg (0–7.1). SF 12 health scores revealed a good functional outcome of both the physical and mental components. With failure defined as repeat revision because of aseptic loosening, the rate of survival at 5 years months was 99.1% and overall survival at 5 years with removal or repeat revision of any component for any reason as the end point was 97.5%.

Conclusion: Our prospective study of patients with primary knee arthroplasties supports the use of PFC sigma total knee endoproshesis. Our results show excellent clinical outcome comparable with other prosthesis. A longer follow up is needed to establish the durability and longevity of this prosthesis given its excellent intermediate term results

Aim: To report the intermediate clinical and radiological results of a consecutive series of knee arthroplasies using PFC Sigma endoprosthesis.

Methods: 525 total knee replacements (469 patients) were performed from Aug 97 to Jun 01 using the PFC Sigma components. Cruciate retaining femoral component was used in 219 knees. All patients were prospectively followed up at 6 weeks, 3 months and yearly. Pre operative HSS knee scores and Oxford knee scores were compared with annual scores. Quality of life was assessed using SF12 questionnaire. Knee Society scores were used to assess the radiographs. The average follow up was 61 months (36–84). 11 patients lost to follow up.

Results: Of the 469 patients, 64% were females. Mean age was 74.2 yrs(59–90). Valgus deformity of at least 10 deg was present in 87 (16.5%). Patella resurfacing was performed in 80.5%. A lateral release was performed in 20 patients. Post operative mobilisation was standardised in all patients. 34 patients developed radiologically proven DVT. 24 patients died to unrelated causes. 21 were lost to follow up. 16 (3%) patients developed superficial and 6 developed deep infection. 4 patients underwent revision surgery (3 – infection,1- catastrophic failure). The HSS scores improved from 29(16–65) to 86(59–97) at final follow up (p=0.004). Pre operative Oxford knee scores improved from 10(6–31) to 43(37–48) at last follow up (p=0.008). Radiological knee society score for the femur were less than 5 in 477/478 patients and 7 in 1 patient. The scores for the tibia were less than 5 in 475/478 patients and 6 in 3 patients. Average femoral flexion was 1– 9.2 deg (3.9), knee valgus angle 0.5 – 7.4 (3.5) degrees and the tibial slope was 3.1 deg(0–7.1). SF 12 health scores revealed a good functional outcome of both the physical and mental components. With failure defined as repeat revision because of aseptic loosening, the rate of survival at 5 years months was 99.1% and overall survival at 5 years with removal or repeat revision of any component for any reason as the end point was 97.5%.

Conclusion: Our prospective study of patients with primary knee arthroplasties supports the use of the PFC Sigma total knee proshesis. Our results show excellent clinical outcome comparable with other prostheses. A longer follow-up is needed to establish the durability and longevity of this prosthesis given its excellent intermediate term results