Orthopedic surgery is one of the most blood-consuming surgeries. Currently there has been a radical change in transfusion policies, developing a series of therapeutic measures essentially created to minimize the use of allogeneic blood.

On the one hand, the safety of our patients must be even more our main objective. On the other hand, our economic resources are more restricted and therefore we must evaluate our surgical techniques and proceedings in order to be safer and more cost-effective.

The aim of this study is to report our results of the blood lost, the percentage of blood loss, the necessity of transfussions and how many blood pakages are needed.

From a sample of 2400 total knee arthroplasties proceedings, we analyze some surgical proceedings such as lligament balance, patelar traking, artrotomy, ischemia, femoro-tibial axis and type of arthroplasty.

We also examine the total blood lost and the percentage of total blood loss after 4 hours, after 24hours and after 48 hour of the total knee arthoplasty surgery.

We made a statistical analysis with t-test or anova test when it was necesassary.

The outcome of our investigation show that the blood loss when the ischemia is less than 50 minutes is 1470 cc and 1603 cc when is more than 50 minuntes (p<0.05). If we use the medial arthrotomy, the total bleeding is 1563cc, but with subvastus arthrotomy is 1294cc (p<0.05). If we use a primary rotational total knee arthroplasty the bleeding is 953cc, but if we use a PS or PCR the bleeding is 874cc (p<0.05).

As a conclusion we should know that our patients have more blood loss when the ischemia is more than fifty minutes, the bleeding is higher when we make a medial arthrotomy and when we use a rotational knee primary arthroplasty.

Purpose:

To describe the health status of patients after total knee replacement (TKR) and compare it with the state of health of a comparative Spanish population

Materials and methods: This is an observational analytical study The following variables were assessed: sociodemographic, clinical and HRQofL. Health status was determined by means of generic and specific questionnaires (SF-36 and WOMAC). The age (65–74 years of age) and sex (VPR) values of the comparative population were used. Statistical analysis: mean values and standard deviation were calculated for continuous variables; percentages were determined for categorical variables and Spearman’s correlation analysis was used to determine the correlation of quality of life variables.

Results: There were 82 patients of 72.5 years of age (SD 7.5), 78% were women. There were significant differences between the preoperative and the postoperative WOMAC in pain, stiffness and function (p< 0.001, p=0.035, p< 0.001, respectively). Seventy-nine percent of the patients reported improvement after surgery, and an improvement in general health was also seen (SF-36). However, these values did not reach those of the comparison population in terms of physical function and pain (51.5 vs 61.3 and 50.7 vs 59.0, respectively for women and 60.5 vs 68.9 and 65.0 vs 76.7 for men). The rest of the figures were comparable to those of the comparison population. The correlation between WOMAC function and SF-36 physical function was 87% and that between WOMAC pain and SF-36 body pain, 77%; both were statistically significant (p< 0.001).

Conclusions: Patients reported improvement after TKR both in terms of function and pain and also in their general health status although they did not achieve the values of the comparative population as regards physical function and pain. The correlation between both questionnaires was extremely high, therefore, it is possible to leave aside the specific questionnaire and use the SF-36 since it provides multidimensional information on patients’ HRQofL.

Introduction and purpose: The purpose of this study was to obtain environmental scanning electron microscope images of the joint surface of fresh osteochondral grafts cryopreserved in RPMI and modified Krebs-Henseleit medium (K-H) and evaluate and compare them using a validated classification system.

Materials and methods: We extracted the femoral condyles from 6-month-old female New Zealand rabbits weighing 3.5 kg and cryopreserved them using two methods (RPMI and K-H). After thawing the samples we took 20 photographs of each one (total of 100 images per group, 3 study groups) using an environmental scanning electron microscope.

Results: We assessed and compared each of the study parameters using the Chi-Square test:

- smooth surface, protuberances and peaks

Conclusions: On the basis of morphological studies, we can conclude that the K-H method provides a higher degree of chondrocyte viability than other cryopreservation methods in use up to the present.

Introduction and Objectives: Periprosthetic fractures present some difficult problems: the inability to use intramedullary implants, difficulty in inserting screws (since the cavity is occupied), bone fragility, great mechanical demands, elderly patients, and associated conditions. We have used two osteosynthesis reinforcement techniques in these cases: massive intramedullary cementation and implantation of bone allograph counterplates. Both techniques give a simple solution for complex peri-prosthetic fractures.

Materials and Methods: We used this technique to treat 9 periprosthetic fractures of the femur between 1999 and 2003. In 3 cases, massive intramedullary cementation was used (Johansson type III, distal to the prosthetic stem) and in 6 cases a bone allograft counterplate (Johansson type II, around the prosthesis), associated with the stem replacement in 2 cases. Allografts came from the Tissue Bank of the Institut Clinic de l’Aparell Locomotor (ICAL). There were 7 females and 2 males, with an average age of 76 years (range: 66–83). Average follow-up time was 14 months (range: 6 months to 3.5 years).

Results: In 8 of 9 cases (89%), fracture consolidation was achieved in 3.5 months, with patients regaining the same ability to walk as before the injury. In one case with intramedullary cementation, non-union developed with breakage of the plate at 10 months post-intervention. This case was treated with compression osteosynthesis with a new plate and bone allograft counterplate, and final outcome was satisfactory (consolidation at 4 months) with the patient walking with full weight bearing without crutches.

Discussion and Conclusions: We believe both techniques are useful in the resolution of periprosthetic fractures of the femur over porous bone. However, a very precise surgical technique is necessary, as well as respect for the classical principles of osteosynthesis: fracture fixation with anatomic reduction, interfragmentary compression, and maximum care afforded soft tissue.