Aim

A two-stage exchange of an infected prosthetic joint (PJI) is considered the most effective surgical treatment of chronic PJIs, particularly in North America. However, reinfection rates are unacceptably high (10–20%). This could be the consequence of a persistent infection or a new infection introduced during the first or second stage of the exchange arthroplasty. We aimed to determine: i) the prevalence of positive cultures at reimplantation, ii) whether there is an association between positive cultures at reimplantation and reinfection during follow-up, and iii) if there is a microbiological correlation between primary infections, reimplantations and reinfections.

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.

Introduction: Although the influence of preoperative nutritional status on short term outcome in arthroplasty is well known, its relationship with early prosthetic joint infection (EPJI) in total knee replacement remains unclear.

Aim: Our aim was to assess the effect of preoperative nutritional status on patients who went on to present with EPJI following total knee replacement surgery. This assessment was based on preoperative blood tests and anthropometric measurements.

Methods: A total of 213 patients undergoing total knee replacement between December 2007 and May 2008 were included in the study. Patients with rheumatoid arthritis were excluded. For each patient we pre-operatively checked haemoglobin level, CRP, ESR, total lymphocyte and protein count, albumin and pre-albumin concentration and triglicerids, cholesterol and creatinine levels. Triceps skindfold and arm/muscle circumference were measured the day before surgery. The body mass index was calculated based on the information contained in the anaesthetic chart. We also collected information about co-morbidities such as Diabetes, High blood pressure, ASA grading, age and gender. Information about early infections, both superficial and deep, was collected. A descriptive statistical analysis and logistic regression models approach for independent risk factors were performed.

Results: The mean age was 71.5 years. There were 162 female and 51 male. Eleven patients (5.16%) had early wound infection: 5 deep EPJI and 6 superficial. Neither co-morbidities nor preoperatively laboratory test except CRP (OR 1.44, p=0.03) were associated with a high early infection risk. However, there was an inversely proportional relationship between EPJI and anthropometric measurements: triceps skindfold (OR 0.9 p=0.011) and fat area (FA) (OR 0.94, p=0.01).

Conclusion: A low triceps skindfold and FA were associated with an increment of risk of EPJI after a knee replacement. Although the relationship between some laboratory test as pre-albumin and lymphocyte account and wound healing and postoperatively complications is well known, we didn’t find it with EPJI in our group except for CRP levels.