Introduction: During the postoperative follow up of patients who underwent primary total hip replacement, it was observed that the haemoglobin concentration had dropped more than expected when compared to the intra and postoperative (drain) loss. This study was carried out to ascertain whether this drop in haemoglobin reflects a real blood loss or is due to hemodilution secondary to intravenous fluids, or both. Also to establish the average amount of blood loss responsible for the drop of one gm of haemoglobin concentration, in order to confirm or alter the old belief that every 500ml of blood loss is responsible for 1 gm drop in Hb concentration.

Method: A prospective study was carried out to include 20 patients undergoing primary total hip replacement due to osteoarthritis in the period, March to November 2006. 2 drains were used, one was deep and the other was superficial. 7 samples of haemoglobin were taken in every case. The first sample preoperatively, the second postoperatively in the recovery room, the third and forth samples taken 6 hours postoperatively from the patient and the deep drain. The fifth and sixth samples from the patient and the deep drain 24 hours postoperatively. And the last sample from the patient 5 days postoperatively. Also the IV Fluids given were recorded in the first 24 hours.

Results:

The Hb concentration in the deep drain was gradually decreasing over the first 24 hours after the operation when compared to the patient’s Hb which means that the total volume of the drain loss doesn’t mean an equal volume of blood loss.

During a 3-year period in which 348 hallux valgus correction were performed, 10 patients with symptomatic hallux valgus deformity underwent triple osteotomies. All the 10 patients had intermetatarsal 1–2 angle of over 20 degrees and DMAA angle of over −10 degrees and no degenerative changes at MTP joint. They were studied retrospectively at an average follow-up of 9.7 months.

The surgical technique comprised a proximal open medial based wedge first metatarsl osteotomy and a distal closing medial based wedge first metatarsal osteotomy and a closing medial basal wedge phalangeal osteotomy. The average age of the patients at the time of surgery was 53.4 years.

At final follow-up, the average hallux valgus correction measured 22 degrees and the average intermetatarsal 1–2 angle correction was 9 degrees postoperatively. The DMAA averaged −4 degrees postoperatively the average length of the 1st metatarsal was shorter 2.43 mm postoperatively.

The average of the (VAS FA) score was improved from 55 preoperatively to 83.9 postoperatively.

8 patients were very satisfied, one patient was satisfied and one patient was unsatisfied. A hallux valgus deformity with an increased 1–2 intermetatasal angle over 20 degrees can be successfully treated with triple first ray osteotomies that maintain articular congruity of the the first metatarsophalangeal joint.