PURPOSE: To investigate the efficiency of preoperative autologous deposit and intra- and postoperative cell salvage (CS) to reduce homologous transfusion in hip arthroplasty and revision hip arthroplasty. METHODS: In a retrospective study, the data of 1402 patients scheduled for hip arthroplasty and for revision hip arthroplasty were analysed. RESULTS: 767 women and 635 men, age 62.9 +/- 9.8 years (x +/- s) were included in the study. 1270 were scheduled for hip arthroplasty, 132 for revision hip arthroplasty. Of the autologous donors, 51 patients predeposited four units, 1020 patients three, 204 patients two, 39 patients one unit. 88 patients who had not enrolled in the autologous donation program but received CS served as a control group. Blood loss in autologous donors amounted to 1620 (220-5620) ml in hip arthroplasty and 2830 (950-7910) ml in revision arthroplasty. CS was employed in part of the cases in arthroplasty and in all revision operations. 470 (0-2200) ml and 705 (0-2200) were retransfused. In hip arthroplasty 227 of 1182 patients (19.2%) received homologous blood. Homologous transfusion in patients with coxarthrosis due to acetabular protrusio, avascular necrosis of the femoral head and hip dysplasia showed a trend to higher values. Patients who had donated 3 units and received CS required homologous transfusion in 12.4% of the cases. CS reduced the homolgous transfusion rate significantly if the preoperative hemoglobin concentration was < or = 12 g/dl. A group of autologous donors receiving CS was matched with patients receiving CS only. 12 of 76 (15.8%) vs. 45 of 76 (59.2%) required homologous transfusion. In revision hip arthroplasty 58 of 132 patients (43.9%) required homologous blood. CONCLUSIONS: Preoperative deposit reduces homologous transfusion requirements considerably in hip surgery. Under the conditions studied CS should be employed in hip arthroplasty in addition to preoperative deposit if the preoperative hemoglobin concentration falls below 12 g/dl. In revision arthroplasty, 4 or more autologous units should be predeposited and CS should be used regularly.

Aged↗

PubMedDate not supplied

[Osseontegration of trial implants of carbon fiber reinforced plastics].

PROBLEM: To what extent are carbon fibre-reinforced plastics (CFRP) suitable as an osseous integration surface for implants? METHOD: CFRP test implants having a plexus-structured, rhombus-structured, and plexus-structured, hydroxyapatite surface were implanted in the femura of mini-plgs. Exposure time lasted 12 weeks. The implants were subjected to a macroradiological, a histological-histomorphometrical, and a fluorescence-microscopical evaluation. RESULTS: One half of the uncoated, plexus-structured implants were not osteointegrated, the other half displayed an osteointegration rate of 11.8% in the spongy area and 29.8% in the cortex layer. The HA-coated test implants showed an osteointegration of 29.5% in the spongiosa and 56.8% in the cortex layer. The rhombus-structured test implants had an osteointegration of 29.2% (spongiosa) and 46.2% (cortex layer). CONCLUSION: Compared to the osteointegration of metallic, especially titanium surfaces the CFRP surfaces tested by us fared worse, especially the uncoated, plexus-structured surfaces. For this reason we view very critically the use of carbon-fibre reinforced plastics together with the surfaces tested by us as osteointegrating surfaces.

Animals↗

PubMedDate not supplied

[Femoral head epiphyseolysis].

Slipped capital femoral epiphysis could be regarded as exceeding of a physiological process in puberty in which overweight of the patients seems to be the essential factor. Early clinical and radiological diagnosis are important to perform simple surgical procedures stopping further lysis and avoiding later osteoarthritis. Fixation of the femoral epiphysis with K.-wires are emphasized worldwide because of the lower complication rate. In case of severe slip osteotomies for realignment are more problematic. Long term follow-up studies have shown poor results mostly because of chondrolysis and femoral head necrosis in a high percentage. The demand on renunciation of realignment procedures in s.c.f.e. however, can't be supported. In our own patients, recently followed up, realignment osteotomies were without greater problems with no complications like chondrolysis or head necrosis. Stabile fixation of osteotomies allowed early mobilisation just after operation and may be one reason that chondrolysis didn't exist in our patient group. Considering our knowledge today therapeutic procedure of slipped capital femoral epiphysis is described.

Adolescent↗