Optimising the use of cell salvage in revision hip arthroplasty.

BACKGROUND: Intraoperative cell salvage is an established method to reduce the requirement for and the volume of allogenic blood transfusion but adds to the financial cost of performing surgery. AIMS: The primary aim of this study was to determine which patients and what type of revision hip surgery benefit most from intraoperative cell salvage. METHODS: This observational study included patients who underwent revision hip surgery performed by the senior author at a single orthopaedic unit. The cohort was divided into single and two-component revision groups; then, the transfusion requirement combined with analysis of patient factors was used to create a decision-making protocol. FINDINGS: The two-component group had a significantly higher number of cases using cell salvage and a higher total transfusion volume. Patients who required postoperative allogenic blood transfusions had a higher mean age, were less likely to have received tranexamic acid and had a lower preoperative haemoglobin level. CONCLUSION: Based on these results, a decision-making protocol was developed for when to use cell salvage in revision hip surgery.

Compaction bone grafting in tibial plateau fracture fixation.

BACKGROUND: Displaced tibial plateau fractures are traditionally treated with internal fixation using autologous bone grafting to provide structural support. In comminuted and osteoporotic fractures, there can be insufficient autograft available for this. Fresh-frozen bone allograft is readily available in sufficient quantity to fill all voids, is relatively inexpensive, and avoids donor site morbidity. METHODS: We describe our technique and the early clinical and radiologic results of compaction morselized bone grafting (CMBG) for displaced tibial plateau fractures using fresh-frozen allograft. RESULTS: This technique has been performed since July 2006 on eight patients. One patient died of an unrelated cause 3 months after surgery and one patient failed to attend follow-up clinic. Clinical and radiologic follow-up was performed on the remaining six patients at an average 15 months (range, 12-19) after surgery. One patient underwent a manipulation under anesthesia at 3 months for knee stiffness. One patient developed a painless valgus deformity and underwent a corrective osteotomy at 15 months. The height of the tibial plateau on radiographs has been maintained to an excellent grade (less than 2 mm depression) in all but one patient. CONCLUSION: CMBG using fresh-frozen allograft in depressed tibial plateau fractures provides structural support sufficient to maintain the height of the tibial plateau, is associated with few complications in complex patients with large bone loss, and has theoretical advantages of graft incorporation and remodeling.

Accuracy and precision of peripheral quantitative computed tomography measurements at the tibial metaphysis.

The ability of 29 peripheral quantitative computed tomography (pQCT) software analysis modes at defining cortical from trabecular bone at three tibial metaphyseal regions was evaluated using five cadaveric tibiae. The accuracy of pQCT was determined by comparing the bone mineral content (BMC) with the ash weight. The precision of the pQCT scanner was calculated using repeated measurements. All the analysis modes had a good accuracy when measuring total bone area and a poor accuracy when measuring cortical bone area at the proximal 5% and distal 4% regions. For trabecular bone measured at all three regions and cortical bone area measured at the proximal 10% region, the Stratec peel mode 5 was the most accurate analysis mode. Highly significant correlations (r = 0.71-0.98) and a moderate accuracy error (coefficient of variation [CV] = 5-22%) was found between ash weight and BMC when using this mode. The precision of bone mineral density (BMD) measurements was good (total, CV = 2-5%; trabecular, CV = 2-5%; cortical, CV = 4-6%). pQCT is a moderately accurate, precise method of measuring trabecular and total BMD at the tibial metaphysis. The authors recommend caution when interpreting results for cortical BMD, as cortical area measurements at the metaphyseal region are less accurate and less precise.