Aims: We decided to investigate the efþcacy of postoperative Epoetin Alfa in decreasing allogenic transfusion exposure in patient who had an mediummajor orthopaedic intervention who could conduct in major loss of blood. Material-Method: Between July 2000-Mars 2002 in our department a trial was conducted comparing the safety and efþcacy of a weekly epoetin alfa dosing regimen (40000⋄4) with a daily regimen (10000⋄15) in patients with hemoglobin levels 9g/dl< Hb< 11g/dl in the 2nd postoperative day after a major orthopaedic procedure. The average age was 28–85y. Results: In the þrst group (24p) there was a increase of the Ht 6units and in the 2nd group 4units. In the þrst group we had a death in the 13een postoperative day from diffuse intravascular coagulation. In both groups the rehabilitation and discharge of the patients were quicker and there was no postoperative transfusion. In 9 cases of the þrst group and only in 2 of the second we observed a enormous augmentation of the platelets (600000–1000000) but without any signs of thrombosis. This point needs more investigation. Conclusion: These data showed the weekly Epoetin Alfa regimen to be at least as efþcacious and more convenient as the daily regimen in the treatmen of the postoperative anaemic patients. More investigation is needed for possible complications.

In modern surgery, one main goal is to reduce perioperative and postoperative transfusion need.

The haemostatic disorders, the patients’ gender and the type of the operation seems to predict the blood loss in orthopaedic surgery.

It has been reported recently, an association of the Factor V Leiden mutation and with a lower rate of intra-partum blood loss,

Purpose: The aim of our study was to evaluate if there is an association between blood loss and pro c global system in orthopaedic operations.

Pro C Global system is influenced by FRO C, PRO S, APC resistance (FV Leiden) and FV111.

Materials and methods: We studied 42 patients, 31 women and 11 men, between 22–86 years old, who were operated in our hospital.

19 with total knee arthroplasty, 11 with total hip arthroplasty, 11 with fractures and 1 patient with amputation of -the lower leg.

The blood loss for each patient was calculated according the Mercurialli formula: Total blood loss: total blood volume x (Ht preop-Ht day 5 postop)+ml of RBC transfused. The total blood loss was expressed in terms of percentage of total blood volume and defined as relative blood loss.

Patients were divided into two groups with high and low relative blood loss, according the median value of the relative blood loss.

Pro C global values was monitored in all patients pre-operatively on a BCT analyzer (Dade Behring). Values > 0.8 are considered normal.

Results: The median value of relative blood loss was 15,05%. 21 patients were below this level and considered to have low relative blood loss. 21 patients were above this level and considered to have high relative blood loss. 18 patients had pro C Global values < 0.8 and 24 patients had Pro C Global > 0.8. Patients with low relative blood loss tend to show lower Pro C Global values than patients with high relative blood loss. (0,87 versus 0.90, p= 0.7 NS) without statistical difference.

Conclusions: In this study the Pro C global system does not seems to predict perioperative blood loss in patients with orthopaedic surgery and so it is useless to be monitored preoperatively.

100 randomized primary cementless THRs in 80 patients were reviewed retrospectively regarding the HA cover of the stem which was Waldemar Link’s, ribbed type, made of Titanium, with a collar and mostly applied without the trochanteric screw. The femoral neck was always retained high as possible. Full weight bearing on the operated leg started the 3rd postoperative day, while years earlier the 6th postoperative week. Two more or less, equal groups were formed: (A) without, (B) with HA covered stems and two subgroups: patients of 60 to70 years and 70 to 80 years. Gender was matched as possible and mean follow-up time was 8 years (range 7 to IO years). The Harris Hip Score was used for clinical evaluation and the method of “pencil and ruler” in plain X- Rays for radiographical one. Patients who died after the 8th postoperative year of evaluation were included.

Results

1, The postoperative hip score was at average for group (A) 92.1 points and for gr. (B) 92,4p.

2. In gr. (A) we found* at a rate 70% 2mm of symptom less, adaptive, slow early migration, while in gr. (B) this corresponded to 1 mm of same migration at a rate 60%. In both groups migration stopped by the second postoperative year.

3. “Alarming” stem migration was found in two cases: one in each group. The cause was that the stems applied, were undersized and the patients were women on menopausal osteoporosis. Both sterns were revised. Two more “alarming” stem migrations were found, one in each group, in patients suffering from collagenosis with the relevant bone quality. This migration was related to bone retreat primarily and irrelevant to stem’s loosening, gender or age of patients. Both stems have not been revised yet.

4. Similar and minimal-2% for gr. (A) vs 4% for gr. (B)- was the rate of symptomless, limited, non-sclerotic of less than 2mm wide demarcations gradually resolving, 5. Similar and minimal-2% for gr. (A) vs 5% for gr (B)- was the rate of stress shielding phenomenon resolving in 2 years time.

6. No further mechanical or biological loosening were noticed at mid-term results

7. Similar- 20% for gr (A) vs 15% for gr (B) was the rate of mild symptomless ectopic ossifications.

Conclusions: No significant differences were found at mid-term results between the two groups, the one without (A) and the other (B) with HA covered sterns. In case a stem happens to be undersized not securing primary fixation or in case the bone’s quality is not promising mechanical and biological fixation of the stem, then the presence of HA cover will not prevent the stem from “alarming” migration. Though we are still using successfully the cementless stem for patients over 70 years of age, when ever dealing with such quality of bone as with collagenosis then it would be wise to consider the use of the cement and even so reservations must exist.

Introduction: Mitchell’s operation is a double step-cut osteotomy through the neck of first metatarsal (MT) which displaces laterally and plantar flexes the metatarsal head and minimally shortens the first MT. In coexisted further forefoot abnormalities this osteotomy can be combined by additional corrective osteotomies of the rest metatarsals and straightening of toes.

Material and Methods: A prospective study was carried out in our Department, on 42 patients (51feet) operated with this osteotomy alone or combined.

The mean follow-up time was 10 years (range, 3–15 years). The average age of patients was 58 years. The average angle of HV deformity was 38 degrees (in nine feet this angle was more than 40 degrees). Mean inter-metatarsal (IM) angulation was 15 degrees.

The procedure was always followed by Y or V capsuloplasty of first metatarsophallangeal (MTP) joint. Moderate arthritis of first MTP joint was not considered by us as a contraindication for this operation. The osteotomy was secured by two crossed K-wires.

In 20 feet (15 patients) with coexisted forefoot abnormalities oblique osteotomies of the rest metatarsals, arthrodeses of proximal interphalangeal (PIP) joints and elongation of extensor tendons were carried out.

Results: In examination, we checked the correction of the deformities; we assessed pain and comfortability in wearing shoes and the joints motion, hi early postoperative examination the mean correction in HV angle was 18 degrees and in IM angle was 5 degrees, but in last examination there was a loss of 5 degrees in the HV angle correction. One hallux was overcorrected. 90% of the results were satisfactory including all feet with osteoarmritis of first MTP joint. 10% of the results considered as poor including all feet with preoperative HV deformity of more than 40 degrees. Ten feet (eight patients) suffered from metatarsalgia established because of fall of MT arch. We feel that Mitchell’s osteotomy is not suitable for HV deformity exceeding the 40 degrees.