We conducted a retrospective study to compare the blood loss following Primary Total Knee Replacement (TKR) to see effectiveness of Tranexamic acid (TXA).v/s Cell Salvage.

This was a retrospective study conducted from Aug 2008 to Dec 2009. We compared two groups. Group A was given TXA IV (two doses – first dose before tourniquet release and second dose six hours post-operative) and in group B post op cell salvage was used. 84 knees were included in this study with 42 patients in each group. The surgical technique, implants used and post-operative Thromboprophylaxis care were same in both groups.

The corrected mean Hob drop in Group A was 1.76g/dl (Range-0.7 to 4.3) while that in Group B was 2.32g/dl (Range-0.7 to 5.3). Use of TXA lead to a 24.13% decrease in mean Hob drop and 3.7% fall in mean drain output following TKR in our study. Two thromboembolic events in the form of deep vein thrombosis (DVT) confirmed by Duplex US scan, were noted in each group. There was no difference in complication rate i.e. drain site infection and wound leaking in either group. Costs - The cost of two doses of TXA is £3.81 per patient and cost of bellovac drain was £85 per patient.

We found TXA was more effective and cheaper than autolougus blood transfusion and there was no increase in thromboembolic complications

The 2007 National Institute for health and Clinical Excellence (NICE) thromboprophylaxis guidelines concerning hip arthroplasty remain contentious. A survey among British Hip Society members was performed to investigate the impact of these guidelines. Information on thromboprophylactic measures before and after guideline publication was gathered in the three categories of Total Hip Replacement (THR), hip fracture and high-risk patients as defined by NICE. The response rate was 185/250 (74%). All responders used thromboprophylaxis, but only 44%, 22% and 7% indicated they were currently acting in accordance with guidance for THR, high risk and hip fracture groups respectively. 19%, 14% and 14% had changed their practice since publication of the guidance in THR, high risk and hip fracture groups respectively. The effects of the NICE guidance in influencing the responders’ thromboprophylactic protocols have been very limited. These results do not appear to endorse the authority of NICE in decisions made in this area.

After total hip and knee replacement arthoplasty, patients may become anaemic and may be prescribed oral iron. There is, however, no published evidence that this is of benefit when used postoperatively. We treated 72 patients who were anaemic after primary total hip and knee arthroplasty by randomly allocating them to receive six weeks of either oral ferrous sulphate (35 patients) or a placebo (37 patients). Both groups of patients were similar in all aspects except for the treatment given. There was no statistically significant difference in the change of haemoglobin levels between the two groups. We therefore believe that the prescription of iron to all anaemic patients postoperatively should be avoided. The level of serum ferritin should be monitored at preoperative assessment.

Routine metalwork removal, in asymptomatic patients, remains a controversial issue in our daily practice. Current literature emphasized the potential hazards of implant removal and the financial implications encountered from these procedures. However, there is little literature guidance and no published research on current practice.

To estimate the current state of practice of orthopaedic surgeons in the United Kingdom regarding implant removal for limb trauma in asymptomatic patients, an analysis of the postal questionnaire replies of 36% (500 out of 1390) of randomly selected UK orthopaedic consultants was performed by two independent observers.

47.4% replies were received. A total of 205 (41%) were found to be suitable for analysis. The most significant results of our study I: 92% of orthopaedic surgeons stated that they do not routinely remove metalwork in asymptomatic skeletally mature patients. II: 60% of trauma surgeons stated that they do routinely remove metalwork in patients aged 16 years and under, while only 12% of trauma surgeons do routinely remove metalwork in the age group between 16–35 years. III: 87% of the practising surgeons indicated that they believe it is reasonable to leave metalwork in for 10 years or more. IV: Only 7% of practising trauma surgeons replied to this questionnaire have departmental or unit policy.

No policy is needed for metalwork removal, as most of the orthopaedic surgeons were complying with literature guidance supporting the potential risks associated with implant removal, in spite of the limited number of departmental or units’ policies on implant removal and the paucity of the literature documenting the current practice. However, there is a discrepancy among trauma surgeons in relation to metalwork removal between patient age groups. This indicates guidelines would be helpful to guide the surgeon for the best practice. This is important from a medico-legal standpoint because surgeons are being criticised for not achieving satisfactory results in negligence cases.

Aim: To estimate the prevalence of iron deficiency in patients undergoing primary total hip (THR) or knee (TKR) replacement surgery and to test the clinical effectiveness of routinely prescribing iron supplements to all anæmic patients after THR and TKR.

Method: This was designed as a randomised, doubleblind, placebo-controlled trial. Serum ferritin was measured in 230 consecutive patients admitted for primary THR or TKR. Seventy-two patients were entered into the randomised arm of the trial, 35 were randomised to the treatment group, and 37 to the placebo group. Patients meeting the inclusion criteria after primary THR or TKR were randomised to receive six week’s treatment with either ferrous sulphate (200mg) or an identical gelatin placebo, three times daily. The serum ferritin level and the change in hæmoglobin were measured between five and seven days post-operatively and each patient attended for an out-patient review at six weeks after the surgery.

Results: The study achieved a statistical power of 80%. Serum ferritin was abnormally low in 15 of 230 patients (6.5%). Hæmoglobin in the group of patients receiving ferrous sulphate increased by a mean of 0.31 g/dL more than the group receiving the placebo (95% confidence interval −0.17 −0.79 g/dL). This difference was not statistically significant (p=0.18).

Conclusions: We found that iron deficiency was uncommon in patients who had undergone primary THR or TKR. The routine prescription of oral iron salts to all anæmic patients after these procedures had no clinical benefit.