The aim of this study is to present the early results of our department’s experience, about cementless fixation of femoral component in total knee replacement.

During the period 1997–2002 from the patients who treated surgically for knee osteoarthratis, 285 were followed up p.o. from 6 months up to 5 years (mean 30 months). They were 246 women and 39 men (mean age 69,4 years), to whom we used unconstrained total knee arthroplasty. For all of them, we didn’t use orthopaedic cement to fix the femoral component and there were no case of patella replacement. All the patients were examined clinically and with x-rays (Knee Society Roentgenographic Evaluation and Scoring System).

The answer to the question about the use or not of orthopaedic cement for femoral component fixation is not clear in the international literature. There is the attitude of using cement every time or depending the use of cement on patient’s age and bone quality. On the other hand, many orthopaedic surgeons, like us, never use cement (except for the very osteoporotic bone). There were no cases of femoral component’s loosening in our data.

In conclusion, we believe that the cementless fixation of femoral component in total knee replacement offers satisfactory stabilization of the component, the same as the cemented fixation offers, according to the international literature.

The purpose of this paper is to present the results of the comparative study about the use of autologous transfusion system for drainage of surgical trauma after total knee arthroplasty, aiming to decrease the p.o. homologous blood transfusion need.

During the period between Nov 2001 and Apr 2003 we studied 110 patients (80 women and 15 men, mean age 70,5 years) who underwent TKR. We used autologous transfusion system in 55 patients (group A) and for the rest 55 (group B) a plain negative pressure drainage system.

From the group B patients, 35 (63,63%) were transfused with 2–4 blood units, while only 17 (30,9%) patients from group A had the need for homologous blood transfusion (2–5 units). But, we should mark that in 8 patients autologous transfusion system failed and 7 of them were transfused (2 units each). This means that from group A patients to whom autologous transfusion system was used successfully (47) only for 10 (21,27%) there was need for homologous blood transfusion. The autologous transfusion system gave 200–1650cc (mean 619cc) of blood. None of group A patients and 2 of group B had allergic reaction.

In conclusion, the autologous transfusion system contributes to decreasing the homologous blood transfusion after TKR and in addition it decreases the transfusion’s complications.

Last decade intramedullary nailing is the choice method for the treatment of lower extremity’s long bone fractures. This method matches much better the biomechanics of bones and therefore it leads to faster and better fracture porosis. The aim of our study is to record our experience of using intramedullary nailing and other methods of osteosynthesis for femur and tibia fractures and pseudarthrosis.

During the last 6 years we treated 264 with long bone fractures. One hundred ninety two of them are available at least for 2 years postoperatively. Patients with major health problems or tumors were excluded. From this group of patients 116 were men and 76 women with mean age 42 years (16 up to 75). They had 107 tibial fractures, 81 femoral fractures, 12 tibial pseudarthrosis and 3 femoral pseudarthrosis. We used reamed or undreamed intramedullary nails for 64 tibial and 52 femoral fractures and we used other methods (internal fixation with plates, external fixation) for 43 tibial and 29 femoral fractures. All the cases of pseudarthrosis were after surgical treatment and they were treated only with intramedullary nails. All the nails were dynamized depending on fracture type and the healing procedure. The follow up of our patients included clinical examination (pain, length, torsion etc) and x-rays at 1st, 3rd and 6th month postoperatively and after that every year.

Our data (clinical examination and x-rays) were enriched with objective estimation of patients physical condition at specific time intervals from the operation. We recorded also their one opinion about their health standard.

The analysis of our results shows that intramedullary nailing, and especially after reaming, provides more rigid and secure stabilization. It also leads to faster porosis. This method allows immediate mobilization of nearby joints and better rehabilitation. It has fewer complications and we found completely valuable for the pseudrathrosis cases. Regarding only patients general health condition and return in preinjury functional level and professional activities, intramedullary nailing becomes a statistically more useful method for treatment of long bone fractures of lower extremity.