We compared blood transfusion for three groups of patients undergoing total knee arthroplasty (TKA). Patients were randomized to receive either their post operative wound drainage as an autotransfusion We used an autotransfusion system with anticoagulant in one group (n=28) and an other one without anticoagulant in the other group (n=28). Allogeneic blood was transfused in patients of either group whose haemoglobin fell bellow 9 gr/dl. Only 2% of patients in two autotransfusion groups required an allogeneic transfusion compared with 82% in the control group (n=28 without any autotransfusionsystem). We compared Ht, Hgb, WBC, SGOT, SGPT, Bilirubin and D-dimers test before, one, three and seven days post-operative. We also compared the patients temperature before and after auto or allogeneic transfusion. There was no hospital mortality and the patients costs were lesser in the autotransfusion group. We conclude that in TKA postoperative autotransfusion is a safe, effective economic method and the most of all reduces allogeneic blood use.

Aims: To explore the clinical value of foot extensor digi-torum brevis (EDB) muscle in patients with unilateral lumbosacral radiculopathy. Methods: This is a prospective study of 153 patients with low back pain (LBP) and unilateral lumbosacral radiculopathy. The average duration of symptoms was 94 (1–279) days and the average age of patients was 62 (18–75) years. Twenty þve patients had disc herniation with the involvement of L4 nerve root; 32 patients with the L5, and 36 with the S1. There were 31 patients with LBP only. Patients with a history of trauma of the lower legs, repetitive mechanical irritation, or systemic diseases were excluded. In all patients full clinical and neurological examination of the spine was performed. Clinical evaluation of the EDB with resisted dorsal ßexion of the toes was also made. The size and consistency of the EDB muscle was documented and compared with that of the opposite foot. Results: Seventeen patients with L5 and S1 nerve root involvement had isolated atrophy of the EDB muscle as this was compared to the EDB of the opposite side. Conclusions: Clinical evaluation of EDB muscle in patients with unilateral lumbosacral radiculopathy may aid the examiner in understanding the nature and level of the spinal nerve root pathology.

Introduction: Modern navigation technology appears to be acquiring an established place in the fields of total knee arthroplasty. This technology helps the surgeon to apply his manual skills with greater precision and thus more effectively, and its positive impact on the quality of surgical treatment has already been demonstrated. The Surgetics navigation system described in this paper shows that the Technology can be adapted to the requirements of daily surgical practice, without compromising its utility to the surgeon.

The Surgetics navigation system: The Surgetics navigation system represents a multifunctional tool, that can be used in a lot of fields in orthopedic surgery. For every special use as prosthesis, osteotomies ore ACL-replacement, the hard- and software is adapted thus not any compromise should be accepted for the surgical procedure. In total knee prostheses navigation no ct- scan is needed preoperatively, the patented bone morphing procedure is entering all the anatomic datas to the computer for an absolutely correct positioning of the implant. Consequently the pre- and intraoperative inputs are reduced to a minimum.

Material: To evaluate the advantage of the Surgetics navigation system in total knee prosthesis, the technical datas of a non constrained knee prostheses with rotational platform (ESKA) had been entered in the system. The patient datas, concerning size of the knee joint, leg axes, center of rotation of the hip joint and ligament balance are transmitted by rigid bodies and a pointer with 6 reflecting markers each and a stereo infrared camera. The rigid bodies are fixed by two thin Steinmann-nails each in the tibial and femoral bone. On a monitor each step of the bone morphing and the surgical procedure is shown. Thus the bonecutting guides are placed in an absolutely correct position. The extension – and the flexion gap is presented as well for a precise ligament balancing. The additional time for using this system is not extending 15 minutes.

Methods: 50 ESKA total knee prosthesis with rotational platform have been implanted with standard instrumentation and another 50 with the use of the Surgetics navigation system. In both groups the reason fore surgery has been nearly identic. In 92% the patients suffered from arthritis. More varus than valgus deformities have been seen. The range of deformity went up to 25 degrees.In 8% posttraumatic deformities with consecutive arthritis leaded to surgery. Preoperative X rays of the whole leg in a standing position have been taken, the shifting of the bearing axes in comparison to the center of the knee joint has been determined. The maximum of this shifting was 6.3 cm. The HSS score has been used to describe the clinical findings pre- and postoperativly. In 38 cases of the S- group and in 39 of the N- group the joint was inserted cementless. 2 in the s-group and 1 in the n-group in a hybrid technic, the rest cemented.

Results: The follow up time in both groups ranged from 6 month to one year.Because it has not been the purpose of this paper to report on long time clinical results or survivership, this short follow up time seems to be acceptable for the evidence upon the value of a navigation system.The postoperative x- rays showed a correction of the bearing axes of the leg in relation to the center of the knee joint in a 4 degree corridor in 94,6% for the N – group and in 69,9% in the S- group. Two failures in the N-group came from a change of position of the rigid bodies during surgery due to pushing them by lack of caution.

Conclusion: The surgetics navigation system is a technical help for the orthopedic surgeon, improving the radiological and clinical results in knee arthroplasty. The correction of the bearing axes in the 4 degree corridor is significantly higher in the N-group then in S-group. This has as well an important influence on the clinical outcome. The HSS score by first impression differs by 6 points. The use of the system is economically reasonable,because preoperative ct- scan is not needed and the time of surgery is not extended more than 15 minutes.The Surgetics navigation system with its sophisticated software is leading the surgeon visually through the bone morphing procedure, the bone cutting process and the ligament balancing step by step.