Quality of intraoperatively salvaged unwashed blood in hip arthroplasty.

BACKGROUND AND OBJECTIVES: Transfusion of autologous whole blood is one available method to reduce the need for allogenic blood transfusion. The aim of the present study was to investigate the quality of shed blood collected in a new intraoperative autotransfusion system. MATERIALS AND METHODS: In this prospective study fifteen consecutive patients who were scheduled for elective total hip arthroplasty were included. Shed blood was collected with a novel intraoperative autologous blood transfusion system (Sangvia®, AstraTech) from the surgical wound. Blood samples were taken from the transfusion bag. RESULTS: Mean blood loss during operation was 364ml (190-750ml) and mean transfused blood volume was 200ml (30-700ml). Mean haemoglobin concentration was 62g/l (17-91g/l) and mean plasma free haemoglobin concentration was 6.7g/l (1.9-12.7g/l) in transfusion blood. CONCLUSION: The basic laboratory characteristics of intraoperatively salvaged blood with the Sangvia® system are generally in the same range as reported in the studies on the postoperative transfusion of unwashed blood. From a blood quality point of view, our study indicates that transfusion of intraoperatively salvaged unwashed blood with the Sangvia® system in patients undergoing total hip arthroplasty is expected to be safe.

Interdisciplinary inter-observer agreement and accuracy of MR imaging of the shoulder with arthroscopic correlation.

INTRODUCTION: Differences between radiologists and orthopaedic surgeons in the interpretation of MR images of the shoulder joint are experienced in daily clinical practice. This study set out to evaluate the inter-observer agreement between radiologists and orthopaedic surgeons in assessing pathology on MR imaging of the shoulder joint. Also, we determined the accuracy of the observers with arthroscopy as the standard of reference. MATERIALS AND METHODS: Two radiologists and one orthopaedic surgeon reviewed 50 MR studies-25 conventional MR examinations and 25 MR arthrographies-of patients with shoulder complaints who had undergone MR imaging and subsequently arthroscopic surgery. The assessment was independent and blinded. All observers evaluated the MR examinations twice. Standard evaluation forms were used to score for pathology of rotator cuff, glenoid labrum, tendon of the long head of the biceps brachii and glenohumeral ligaments. The presence or absence of osteoarthritis, SLAP lesions, Bankart lesions, Hill-Sachs lesions or impingement was also noted. Intra- and inter-observer agreement, the sensitivity and specificity were calculated. Differences in percentages of correctly diagnosed lesions were tested for significance using McNemar's test. RESULTS: There was a poor inter-observer agreement between the orthopaedic surgeon and the radiologists in assessing Bankart lesions and ligamentous lesions. We found significant differences between the radiologists and the orthopaedic surgeon in the assessment of osteoarthritis, Hill-Sachs lesions and impingement. CONCLUSION: The orthopaedic surgeon and radiologists differed in their interpretation of what defines a Bankart lesion and what defines a ligamentous lesion. The orthopaedic surgeon was significantly more accurate in assessing impingement.

Assessment of the relationship between joint laxity and migration of the hip in children with Down syndrome.

PURPOSE: The aim of this cross-sectional cohort study is to describe the incidence of joint laxity and the correlation between joint laxity and radiological migration of the hip in children with Down syndrome. METHODS: Sixty-five children (2-19 years) with Down's syndrome were examined for joint laxity. For each subject, laxity scores for joints were carried out with the Bulbena method. Plane pelvic radiographs were used to determine the migration of the hip, according to Reimer's migration index. RESULTS: In this study, 26 out of 65 children with Down's syndrome (40 %) were diagnosed with general joint laxity. On the radiographs of the hips we found a mean Reimer's Migration Index of 5.2 % for all the subjects. Children with general joint laxity showed a lower Reimer's Migration Index (2.1 %). No significant correlation was found between general joint laxity and migration of the hip. CONCLUSIONS: This study showed no relationship between joint laxity and migration of the hip in children with Down's syndrome. This implicates that we were not able to prove that joint laxity is the major factor in developing hip migration in children with Down's syndrome.