Introduction: Elective joint replacement patients routinely require transfusion following surgery. Haemoglobin must remain within red blood cells in order to be functional. The process of surgery and collection in the reinfusion drain may disrupt cell membranes resulting in non functional haemoglobin. The filtration and collection process does not eliminate free haemoglobin. This results in intracellular and free haemoglobin being transfused into patients giving false functional haemoglobin levels.

Aim: To determine the proportion of intracellular haemoglobin in autologous blood transfusion drain following joint replacement.

Research Methodology: Research ethical approval was obtained prior to conducting this study. 20 consecutive patients undergoing elective total hip replacement (THR) and 20 consecutive patients undergoing elective knee replacement (TKR) from April 08–July 08 were consented to participate in this study. A standard full blood count sample of 3 mls was taken from the rein-fused blood. Each sample had the total haemoglobin (THb) concentration determined (i.e. free and intra-cellular) from the blood in the specimen tube. The sample was then centrifuged, and the THb of the supernatant was determined. This determined the concentation of ‘free’ haemoglobin. From these two respective values, the proportion of haemolysed haemoglobin was determined from each sample.

Results: There were a total of 35 participants of which 20 were TKR and 15 were THR. The average THb concentration for the THR and TKR were 7.7g/dl and 10.3g/dl respectively. The proportion of haemolysed Hb was 1.46% and 0% respectively. The THb and proportion of haemolysed Hb for all 35 patients were 8.76g/dl and 0.63%.

Conclusion: Autologous blood transfusion is not only safe and economical but remains an effective procedure with a negligible proportion of haemolysis

Background: With the foreseeable increase in demand for revision hip surgery, it is likely that orthopaedic surgeons working in district general orthopaedic units will undertake an increasing number of secondary procedures. This article set out to determine whether a single orthopaedic surgeon, working in a district general hospital, could achieve results comparable to those obtained by surgeons working in specialised tertiary referral centres.

Patients and methods: Complete records and serial radiographs of 72 patients (76 hips) having revision total hip arthroplasty by a single surgeon and follow-up of at least 1 year, were reviewed by an independent observer.

Results: The mean follow-up period was 4 years. Indications for revision were aseptic loosening (N=51), sepsis (N=16), fracture (N=3), dislocation (N=2), and other (N=4). Complete cement removal was achieved in 97% of acetabular components revised and 88% of femoral components revised. There were no documented complications in 68% of revised hip prostheses. The complications of the remaining cases comprised trochanteric bursitis (9%), dislocation (10%), thromboembolism (5%), periprosthetic fracture (1%) and infection of the revised prosthesis (1%). None of the cases studied died as a direct result of surgery. All radiographic parameters measured were improved by revision of the prostheses.

Conclusions: Orthopaedic surgeons working in district general hospitals performing 5 to 10 revision hip arthroplasties per year can achieve results comparable to those of surgeons working in specialised units.