Blood transfusion following primary hip arthroplasty: a review of transfusion practice

Aim

The objective of the study is to assess blood transfusion practices in an orthopaedic unit in order to address the issue of high consumption of banked blood. Areas of weakness in current practice were identified and guidelines were produced to help reduce the consumption of allogenic blood.

Materials and methods

A retrospective audit of case notes and haematological records of 100 patients who had undergone primary total hip replacement (THR) was carried out.

Results

Ninety-three patients’ case notes were available for review. Two groups of patients were identified: Transfusion group (N = 72) and Non-transfusion group (N = 21). A total of 170 units of blood were transfused postoperatively on the wards out of 277 cross-matched units, an utilisation rate of 61.3. 91.6% of units transfused were in pairs, with only 8.3% of units transfused given as single units.

Conclusions

Total hip arthroplasty can be safely performed without requiring blood transfusion in patients without co morbidity, or pre existing haematological disorder. Blood transfusion was higher in patients with a pre-operative Hb level of less than 13 g/dl. Cross-matched blood need to be made available to patients in this group and the required units based on our review can be reduced from 4 to 2 in patients undergoing primary THR. A group and save is judged to be an adequate measure for patients with a pre-operative haemoglobin level of 13 g/dl or more.     

Case Reports

Congenital limb deficiencies with severe shortening and/or deformity can be difficult to fit with a prosthesis. We report two patients in whom gradual lengthening and deformity correction with the Ilizarov/Taylor spatial frame™ was used to improve prosthesis fit, comfort, and gait. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.     

The skilled attendance index: proposal for a new measure of skilled attendance at delivery

Increasing the proportion of deliveries with skilled attendance is widely regarded as key to reducing maternal mortality and morbidity in developing countries. The percentage of deliveries with a health professional is commonly used to assess skilled attendance, but measures only the presence of an attendant, not the skills used or the enabling environment To supplement currently available information on the presence of an attendant at delivery, a method to measure the extent of skilled attendance at delivery through use of clinical records was devised. Data were collected from 416 delivery records in hospitals, government health centres and private non-hospital maternity facilities servicing Kintampo District, Ghana, using a case extraction form. Based on the defined criteria, summary measures of skilled attendance were calculated. Between 32.6% and 93.0% of the criteria for skilled attendance were met in the sample, with a mean of 65.5%. No delivery met all the criteria. A Skilled Attendance Index (SAI) was developed as a composite measure of delivery care. The SAI revealed that 26.9% of delivery records met at least three-quarters of the criteria for skilled attendance. Documentation of haemoglobin, current pregnancy complications, post-partum vital signs and completed partographs were amongst the criteria most poorly recorded. The purpose of applying these measures should be seen not as an end in itself but to advance improvements in delivery care.     

Autologous blood transfusion following total knee arthroplasty: is it always necessary?

A retrospective study of 85 patients undergoing primary total knee replacement (TKR), who also received autologous blood transfusion (ABT) to compensate for the perioperative blood loss. In our series 16.4% of the patients needed allogenic blood transfusion. Of the remaining 83.4% only 49.5% received autologous transfusion. Autologous transfusion was withheld in 34.1% of cases either because the blood volume was inadequate or because the collection time exceeded the recommended time limit. The mean haemoglobin (Hb) level with or without autologous transfusion was 10 g, raising the question of the necessity of using autologous transfusion in primary total TKR.     

Gradual Reduction of Chronic Fracture Dislocation of the Ankle Using Ilizarov/Taylor Spatial Frame

With the advances in trauma care, chronic fracture dislocation of the ankle is not a condition commonly seen in modern clinical practice. When encountered, it can be difficult to preserve the ankle joint. We present a case of a 65-year-old female, with a chronic fracture dislocation of the ankle. The ankle joint was subluxated with posterior translation of the talus, displacement of the posterior malleolus fragment, and a distal fibula fracture. A minimally traumatic approach was devised to treat this complex fracture dislocation which included gradual reduction of the ankle with a Taylor spatial frame, followed by stabilization with internal fixation and removal of the frame. Bony union and restoration of the ankle joint congruency was achieved.     

Incidence and risk factors of paediatric rotavirus diarrhoea in northern Ghana

We measured the type-specific incidence of paediatric rotavirus diarrhoea in an area of northern Ghana. Over 1 year, diarrhoea 1717 episodes were identified, of which 677 (39%) were positive for rotavirus. Risk factors for rotavirus infection included old age, wasting, high Vesikari score and the episode occurring in the dry season. Rotavirus-positive episodes tended to be more acute, causing vomiting and greater dehydration, and were more likely to require hospitalization. The incidence was 0.089 episodes per person-year for all diarrhoea, and 0.035 for rotavirus diarrhoea. The observed incidence decreased markedly with distance from the nearest health centre, suggesting a large unobserved burden. G2P[6], G3P[4] and G9P[8] made up more than half the genotypes detected, but the remainder were diverse. There is a large burden of rotavirus diarrhoea, but the effectiveness of future vaccines could be diluted by the high polymorphism of the virus, and the difficulty of reaching remote populations.     

Humeral lengthening and deformity correction in Ollier's disease: distraction osteogenesis with a multiaxial correction frame

A case of Ollier's disease with deformity and shortening of the humerus is presented. Lengthening of 9 cm and deformity correction of 50 degrees were accomplished with excellent functional and cosmetic results. Unique features of this case were the use of a multiaxial correction monolateral frame and the formation of normal bone within the region of diseased Ollier's bone.     

Comparison of meshes, gels and ceramic for cartilage tissue engineering in vitro

Full-thickness articular cartilage defects lack the capacity of healing because of lack of blood supply and lack of chondrocyte proliferation around the injury site. These factors contribute to the difficulty of getting good healing of cartilage defects. Autologous chondrocyte transplantation has been proposed as a method for treating cartilage defects using chondrocytes grown in vitro, which are then transplanted into the defects using a periosteal flap to retain the cells at the defect site. Studies that followed have attempted to refine this technique by using a cell matrix to support the chondrocytes. The reason for adding a resorbable cell matrix support that acts as a temporary scaffold until the chondrocytes are capable of producing extracellular matrix. Moreover, such a matrix may help in maintaining chondrocyte differentiation and phenotype. In this study, we have investigated the biocompatibility between human chondrocytes and biomaterials that could be used as matrix implants. It is a comparative study in vitro that involves assessing the proliferation and differentiation of human articular chondrocytes cultured on different resorbable biomaterials. Human chondrocytes were isolated from collagenase digest of articular cartilage provided by patients undergoing total knee replacements for osteoarthritis from the non-involved areas of the knee. The chondrocytes were then allowed to proliferate in vitro to increase the number of cells available for study. After adequate multiplication, the cells were seeded onto different biomaterials and allowed to from a cell biomaterial construct. The biomaterials used in this study were collagen I, calcium alginate, agarose, polyglycolic acid and Bioglass 45S5. The cell–biomaterial constructs were then collected at specific time points 3, 7, 14 and 21 days for histological and biochemical studies. The assessment includes studying proliferation, differentiation and extracellular matrix production. This was performed by immunostaining for collagen I and II production and histochemistry staining for glycosaminoglycans. Chondrocyte proliferation was more effective on 3D gels compared to ceramics and mesh. Cells on Bioglass expressed the same collagen type and at the same proportion as that expressed by freshly isolated cells. Moreover, Bioglass has induced cells to re-differentiate after they lost their differentiation in monolayer culture. Overall, however, there was no clear relationship between the cell morphology and type of collagen produced. Bioactive glass seems to behave as a suitable material for chondrocyte tissue engineering because it can maintain a chondrocyte phenotype.     

Simultaneous complete bilateral patellar tendon ruptures: two cases and literature review

Infra-patellar tendon is the least common site for the disruption of extensor mechanism of knee joint. Bilateral simultaneous patellar tendon ruptures are very rare and extremely uncommon in healthy individuals. We report two cases of simultaneous complete bilateral patellar tendon ruptures, one in a healthy adult male and the second in a patient suffering from chronic rheumatoid arthritis. To the best of our knowledge, this report represents the third reported case of bilateral simultaneous patellar tendon rupture in rheumatoid arthritis. Rarity of bilateral ruptures and symmetry of physical findings may make the diagnosis difficult. Early surgical repair gives excellent results. Relevant literature is reviewed.