Postoperative Intravenous Ferric Carboxymaltose Reduces Transfusion Amounts after Orthopedic Hip Surgery.

BACKGROUND: This retrospective study was performed to determine whether postoperative intravenous ferric carboxymaltose reduces transfusion amounts without influencing clinical outcomes in patients that have undergone hip surgery. METHODS: Between May 2014 and April 2016, the authors adopted a new perioperative blood management protocol involving the administration of intravenous ferric carboxymaltose after hip surgeries. One-to-one matching between the 150 patients treated during this period with 150 patients treated before initiation of the new protocol was performed by propensity scoring for age, sex, diagnosis, and type of hip surgery. Hematologic results and clinical outcomes in these two groups were compared. RESULTS: Average amounts of perioperative blood loss were not different in the two groups. Ninety-two patients (61%) were transfused in the control group and 70 patients (47%) were transfused in the intravenous ferric carboxymaltose group. The average number of transfused blood units was significantly lower in the intravenous ferric carboxymaltose group (1.7 ± 2.7 units vs. 1.0 ± 1.2 units, p = 0.002). At 6 weeks after surgery, the average hemoglobin concentration recovered to baseline in both groups, but the amount of recovered hemoglobin concentration at 6 weeks was significantly greater in the intravenous ferric carboxymaltose group than in the control group. Clinical outcomes including incidences of postsurgical complications were similar between the two groups. CONCLUSIONS: This study suggests that postoperative intravenous ferric carboxymaltose injection is associated with reduced transfusion amounts and that intravenous ferric carboxymaltose does not influence clinical outcomes after hip surgery.

Meniscal extrusion and spontaneous osteonecrosis with root tear of medial meniscus: comparison with horizontal tear.

PURPOSE: The incidence of root tears in patients with spontaneous osteonecrosis of the knee has been studied, but the incidence of spontaneous osteonecrosis of the knee in patients with medial meniscus root tears has not. We assessed the latter incidence and evaluated the characteristics of medial meniscus root tears by comparing clinical status, the degree of osteonecrosis, and meniscal extrusion in patients with horizontal tears. METHODS: Sixty-three patients who were diagnosed with medial meniscus posterior horn tear and treated by arthroscopic surgery between March 2005 and March 2009 were evaluated retrospectively. Patients were divided into 2 groups, the root tear group (R group) and the horizontal tear group (H group). Functional scores and radiography, simple radiography, and magnetic resonance imaging were investigated. RESULTS: No significant differences in age, body mass index, and symptom duration were observed between the 2 groups. The incidence of osteonecrosis was 12 of 36 knees (33.3%) in the R group and 4 of 27 (14.8%) in the H group. The mean absolute extrusion was 4.1 ± 0.7 mm and 3.5 ± 1.4 mm in the R and H groups, respectively (P = not significant). The mean relative percentage of extrusion in the R group (46.1% ± 9.0%) was greater than that in the H group (35.3% ± 13.2%) (P = .01). The degree of osteonecrosis (ellipsoidal volume) was also greater in the R group (423.1 ± 236.7 mm(3)) than that in the H group (175.8 ± 43.6 mm(3)) (P = .03). Though not significant, the visual analog pain score had a tendency to be more severe and knee scores had a tendency to be lower in the R group than in the H group. CONCLUSIONS: Medial meniscus root tears had a greater degree of meniscal extrusion and wider osteonecrosis than horizontal tears of the posterior horn related to loss of the main function of the meniscus. LEVEL OF EVIDENCE: Level III, retrospective comparative study.