Venous thromboembolism (VTE) is a frequent, life-threatening postoperative complication of orthopaedic surgery. Preoperative autologous blood donation has been advocated to reduce the risk of transfusion reactions and to limit potential infectious risk associated with donor blood. Experimental data suggest that autologous leukocytes might lead to immunomodulation similar to the effect attributed to allogenic leukocytes, but autologous whole blood (WB) is often still being used in Japan. We investigated the incidence rate of VTE and plasma D-dimer levels of the autologous WB transfusion and compared the findings with autologous red cell concentrates (RCC) and fresh frozen plasma (FFP) with regard to the cases of lower extremity arthroplasty.

The subjects of this study were 138 patients with lower extremity arthroplasty who were scheduled to receive surgery. The operations included 72 total hip arthroplasties (THA) and 66 total knee arthroplasties (TKA). Postoperatively, plasma D-dimer levels were measured latex agglutination turbidimetric immunoassay. Ultrasonography and contrast-enhanced helical computed tomography was used for diagnosing VTE.

There was no statistically significant difference in the post-surgery incidence rate of VTE between the autologous WB group (THA:20.0%, TKA: 27.9%) and autologous RCC/FFP group (THA: 11.9%, TKA: 30.4%). On the first post-surgery day, the plasma D-dimer levels were significantly higher in autologous WB group (THA: 8.1±9.5 μg/ml, TKA: 12.1±15.9 μg/ml) compared to the autologous RCC/FFP group (THA: 4.2±2.9 μg/ml, TKA:8.0±6.6 μg/ml). However, the plasma D-dimer levels were almost the same in both groups on the 14th day from the surgery. The results of this study suggest that donation and transfusion of autologous WB do not negatively influence the post operative VTE compared with autologous RCC/FFP. However, we must cautiously assess the plasma D-dimer levels of the autologous WB group on the first post-surgery day because of the high propensity of showing false positive rate compared to the RCC/FFP group.

We carried out three total knee replacements with proximal realignment in two patients with severe osteoarthritis of the knee and congenital dislocation of the patella. During the operation, the femur and the tibia were cut according to the recommendations of the manufacturer of the implant. The femoral component was placed in external rotation and the centre of the tibial component aligned in relation to the tibial tuberosity with regard to rotation and translation. After making the bone cuts, the iliotibial tract was detached from Gerdy’s tubercle, the popliteus tendon divided, and the biceps femoris tendon elongated by Z-plasty. After the trial implants were positioned, a proximal re-alignment procedure was performed. One knee had deep infection. There was one dislocated patella which was repositioned, and walking ability was improved in all knees. We believe that the rotational alignment of a prosthesis is as important as the soft-tissue surgery.