Use of a Thrombin Fibrin Sealant in Reducing Blood Loss in Revision Hip Arthroplasty.

We present a retrospective evaluation assessing the use of a novel fibrin sealant, Quixil(®) (OMRIX Biopharmaceuticals S.A.) in reducing blood transfusions following revision total hip replacement surgery. Forty four patients underwent revision total hip replacement surgery using Quixil(®), while 45 patients underwent revision total hip replacement surgery without the use of Quixil(®). The duration of surgery and patient demographics were similar in both groups. Average blood loss was 1,010ml in the Quixil(®) group versus 1,021ml in the non-Quixil group. The use of cell saver and intra-operative blood transfusion were similar in both groups. The mean pre-operative Haemoglobin was 13.0 g/dl in the Quixil(®) group versus 12.4 g/dl in the non-Quixil group. The mean post-operative haemoglobin was 10.2 g/dl and 9.1 g/dl in the Quixil(®) and non-Quixil groups respectively. There was no difference in the blood transfused post-operatively between the two groups. Total units of blood transfused in Quixil(®) versus non-Quixil group were 60 verus 86. Total units of intra-operative blood transfused in Quixil(®) versus non-Quixil group were 16 versus 23. The use of fibrin tissue adhesive in revision total hip arthroplasty seems to be an effective and reliable means to reduce blood-transfusion requirements and prevent post-operative decreases in hemoglobin.

Outcomes of dual modular cementless femoral stems in revision hip arthroplasty.

With an increasing number of primary hip replacements being performed every year, the burden of revision hip arthroplasty, for septic and aseptic loosening, recurrent dislocation or periprosthetic fracture, is also increasing. In recent years, different approaches to revising the femoral prosthesis have emerged; including both cemented and cementless techniques. With a stable cement mantle and good bone quality, or through the use of impaction bone grafting when bone stock is lacking, it is possible to re-cement a femoral prosthesis. Alternatively, a cementless modular femoral prosthesis may be used, providing the surgeon with further options for restoring leg length, hip offset, anteversion and stability. Studies evaluating the use of modular cementless prostheses have so far been limited to midterm studies, with results comparable to primary hip arthroplasty. There are some concerns, however, regarding tribological complications such as stem fracture, corrosion, and failure, and long-term studies are required to further evaluate these concerns. This review outlines the current evidence for the use of both cemented and cementless modular femoral prostheses in the setting of revision hip arthroplasty. Results of prospective and retrospective studies will be outlined, along with results obtained from national joint registries.

Ilizarov fixator pin site care: the role of crusts in the prevention of infection.

Pin site infection is one of the most common local complications after procedures using the Ilizarov fine wire fixator. In this study, the rate of infection was investigated in two groups of patients, representing two consecutive case series, undergoing fracture stabilisation or lower limb reconstruction using an Ilizarov fine wire fixator. Both groups received identical Russian-style pin site care, except in the first Group A where the crusts of dried exudate were removed at the time of pin site cleaning; while in the subsequent Group B, the adherent crusts were retained during cleaning. Pin site infection was diagnosed if the site was painful and inflamed or discharging. The first infected pin site while the fixator remained in situ was considered the outcome of interest. Group A consisted of 59 patients and Group B of 33 patients. A lower proportion of patients in Group B (12/33 - 36%) developed a pin site infection compared to Group A (36/59 - 61%) (p=0.023). However, once infection had developed, a greater proportion of patients in Group B required more than one course of antibiotics to treat the infection when compared to patients in Group A (p=0.005). No patient required hospitalisation for intravenous antibiotics or wire change in Group B (0/33), whereas 3/59 patients required hospitalisation in Group A; but this did not reach statistical significance (Chi-squared test, p=0.18). Retention of adherent crusts during Ilizarov fixator pin site care significantly protects against the development of pin site infection, but renders subsequently infected pin sites more refractory to treatment. This study therefore suggests that crusts should be retained as long as a pin site remains uninfected. Retained crusts may act as a physical barrier to bacterial contamination ('biological dressing').

Spontaneous spinal cord infarction secondary to embolism from an aortic aneurysm mimicking as cauda equina due to disc prolapse: a case report.

Spinal "stroke" is an uncommon cause of paraplegia. Spinal cord infarction from unruptured aortic aneurysm is rare. When encountered it poses diagnostic challenge to the clinician due to its rarity, which may lead to incorrect or delayed diagnosis. We report a case of 62-year-old man presenting to casualty as caudaequina syndrome due to spinal cord infarction secondary to emboli from an infra renal abdominal aortic aneurysm. To the authors knowledge this is first case of its kind and has not been reported in literature. Patient had improvement in proximal motor function following repair of the aneurysm, although he remained doubly incontinent in six months follow up.

Hemoperitoneum secondary to rupture of cystic artery pseudoaneurysm.

BACKGROUND: Spontaneous hemoperitoneum of hepatobiliary origin is commonly due to hemorrhage from a liver tumor. It is rarely caused by spontaneous rupture of aneurysm in visceral arteries. METHODS: We report an unusual case of hemoperitoneum caused by rupture of cystic artery pseudoaneurysm, and also outline the approach to its management through surgical and radiological methods. RESULTS: In our patient, the pseudoanurysm was initially treated with percutaneous thrombin injection. However this method of treatment failed after initial success. The pseudoanurysm was finally obliterated successfully using microcoil embolization. CONCLUSIONS: The mainstay of treatment of cystic artery pseudoaneurysm is cholecystectomy and ligation of the aneurysm. Recent publications showed success in using microcoil embolisation. In this case we also outline the use of percutaneous thrombin injection as a definitive treatment method and discuss its success or failure as a new method of treatment.