Paediatric bone sarcomas are a dual challenge for orthopaedic surgeons in terms of tumour resection and reconstruction, as it is important to minimize functional and growth problems without compromising survival rates. Cañadell’s technique consists of a Type I epiphysiolysis performed using continuous distraction by an external fixator prior to resection. It was designed to achieve a safe margin due to the ability of the physeal cartilage to be a barrier to tumour spread in some situations, avoiding the need for articular reconstruction, and preserving the growth capacity most of the times. Despite initial doubts raised in the scientific community, this technique is now widely used in many countries for the treatment of metaphyseal paediatric bone sarcomas. This annotation highlights the importance of Cañadell’s work and reviews the experience of applying it to bone sarcoma patients over the last 40 years.

Cite this article: Bone Joint J 2023;105-B(1):11–16.

Introduction: Early recovery after TKR is currently one of the main challenges faced by orthopedic surgeons. The decrease in pain during the postoperative period improves functional outcome, shortens hospital stay and brings down the complications rate. We compared 3 methods of analgesia for post TKR surgery.

Materials and methods: We carried out a prospective randomized study using three types of postoperative analgesia: group 1: epidural catheter, group 2: intradural analgesia plus femoral block and group 3: periarticular infiltration with an analgesic cocktail before incision closure. We included 90 consecutive TKRs performed between May and December 2006, which were randomized into one of the 3 groups. The following variables were measured at 6, 24, 48, 72 hours and on discharge: VAS (visual analgesic scale), blood pressure, heart rate, need for rescue analgesia, functional recovery of the patient, hospital stay and rate of complications.

Results: Patients in group 1 had higher VAS values and a greater need of rescue analgesia. The best results were seen in group 3 (local infiltration) followed by group 2. The differences as regards locomotion and mean hospital stay were correlated with VAS values but were not statistically significant.

Conclusions: We believe that periarticular infiltration with an analgesic cocktail before incision closure is a good treatment option for postoperative pain in TKR.

Introduction and purpose: There has been a great increase in prosthetic surgery. The demand for homologous blood is higher than the supply in blood banks. We must bear in mind the adverse effects of homologous blood transfusion: incompatibility reactions, metabolic disorders, risk of disease transmission. There are alternatives to homologous blood: autotransfusion methods.

Materials and methods: Knee prostheses were implanted in 60 patients between 2002 and 2003 using the CBCII Constavac Blood Conservation System and reinfusion of the harvested blood. We analysed epidemiological data, ASA, harvested blood volume, haematology values, need for homologous blood transfusion and complications.

Results: 60 prostheses. Mean duration of surgery 121 minutes, mean hospital stay 8 days. 83.3% women, mean age 66.2 years. Harvested volume 677.5 ml (±221.3). Homologous transfusion was required in 9 cases. Haematocrit and haemoglobin tests were performed prior to surgery and at 24, 48 and 72 hours with the following results, respectively: 40.87, 13.4; 31.39, 10.4; 30.06, 10.05; 30.75, 10.2. Complications: fever (7), nausea (3).

Conclusions: Autotransfusion reduces the need for homologous blood. Harvested blood is an excellent source of erythrocytes and platelets. There are few adverse effects if reinfusion takes place within 6 hours and the volume is not over 1,000 ml. The association of different autotransfusion techniques and other more recent ones such as EPO and intravenous iron could make transfusion of homologous blood unnecessary in over 90% of patients.