Introduction

Sling immobilization of the upper limb may affect balance. Computerized dynamic posturography (CDP) provides a validated, objective assessment of balance control and postural stability under dynamic test conditions. We tested the balance of individuals with a shoulder stabilization sling (SSS) using an Equitest Machine to objectively assess imbalance wearing a sling.

Aims

Falls are a common occurrence among hospital inpatients and can lead to injury, prolonged hospitalisation and delayed rehabilitation. There is major economic burden associated with this. Post operative orthopaedic patients have certain risk factors that predispose them to falls including decreased mobility, use of opioids and, in some cases, history of previous falls.

Background

Post operative analgesia is an important part of Total Knee Arthroplasty (TKA) to facilitate early mobilisation and patient satisfaction. We investigated the effect of periarticular infiltration of the joint with chirocaine local anaesthetic (LA) on the requirement of analgesic in the first 24 hrs period post op.

Introduction: There is a general conception in the orthopaedic community that blood loss/transfusion rate in hip resurfacing procedures is greater than that conventional Total Hip Arthroplasty (THA). The theoretical basis is that uncemented procedures leave large bleeding bone surfaces and that resurfacing arthroplasty needs larger incisions, greater exposure and more extensive soft tissue releases. Although this theory has gained informal

Acceptance in orthopaedic practice, there is little evidence in the literature to support this.

Background The purpose of this study was to determine the actual blood loss and transfusion rate (including hidden blood loss) in a consecutive cohort of patients undergoing hip re-surfacing by a single surgeon using the Articular Surface Replacement (ASR – DePuy).

Materials and Methods: The cohort consisted of 58 patients who were followed prospectively. All patients underwent a standardized surgical procedure performed by one senior surgeon. Hypotensive anaesthesia was used in all cases and surgery was via a standard posterior approach. Drains were not routinely placed, but if used, were removed within 24 hours. Low Molecular Weight Heparin was given 24 hours post procedure until discharge. Surgical blood loss was calculated in a standard fashion (suction volume plus swab weight). Drain volume (if used) was added after removal at 24 hours. Unseen loss of blood in soft tissues, joint space, as well as loss due to haemolysis, is calculated by the modified formula of Kallos¹:

\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \[MABL=\ EBV\ x\ (\underline{Hct\ pt\ -\ Hct\ min})\] \end{document}

Hct pt, Where is

MABL = Maximum allowable blood loss

EBV =Estimated blood volume, 70 ml/kg

Hct pt= Pre operative haematocrit of patient

Hct min=Minimum allowable haematocrit

This was modified to

\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(ABL=\ EBV\ {\times}\ \frac{(Hct\ pre\ op\ {-}\ Hct\ post\ opD2)}{Hct\ pre\ op}\) \end{document} where is

ABL= Actual blood loss, Unseen loss = ABL – Visible loss (Loss in OT + Drain)

Results: 58 Patients undergoing ASR, the aeitology was Osteoarthritis in 50 Patients, Dysplasia in 3, Inflammatory Arthritis in 1 and in 1 patient the aetiology was arthrosis secondary to trauma. The average blood loss during the procedure was 221 mls. After 24 hours this had risen to 377 ml, Mean Unseen blood loss was 787.6 ml, Mean Total actual blood loss was 1385.6 ml. There was a mean drop in haemoglobin of 3.6 g/dl and mean drop of Hematocrit was 10.33%. Only 3 patients required blood transfusion.

Conclusion: The mean blood loss in this study was 598 ml and actual blood loss was 1385.60. This is considerably lower than expected for resurfacing arthroplasty and results in a low transfusion rate of only 5% patients undergoing the procedure. Meticulous haemostasis combined with hypotensive anaesthesia reduced the perioperative blood loss and transfusion rate