Is homologous blood transfusion a risk factor for infection after hip replacement?

OBJECTIVES: To assess the risk of postoperative infection associated with blood transfusion in patients who undergo primary total hip arthroplasty. DESIGN: A retrospective cohort study. SETTING: Victoria General Hospital, Halifax, (a tertiary-care centre). PATIENTS: All patients who underwent primary total hip replacement between 1990 and 1995 (N = 1206). INTERVENTIONS: Hip replacement with or without perioperative blood transfusion. OUTCOME MEASURES: The rate of postoperative infection, the number of blood transfusions, patient age and sex, duration of surgery and the surgeon who performed the procedure. Victoria General Hospital medical records, the transfusion services record and the Dalhousie University Hip Study databases were integrated and analyzed using a standard statistical package. RESULTS: The incidence of infection postoperative was 9.9% overall, 8.4% in patients receiving no transfusion, and 14% in those receiving homologous transfusion (p = 0.035). There were no infections in the 11 patients who received an autologous blood transfusion. Significant predictors of postoperative infection were sex, age and duration surgery; these were not confounding variables multivariate analysis). Neither the operating surgeon nor the blood product transfused affected the infection rate. CONCLUSIONS: These findings suggest an increased risk of postoperative infection in patients who undergo primary hip replacement and receive homologous blood transfusions perioperatively.

Late displacement of a fracture dislocation at the lumbosacral junction. A case study.

STUDY DESIGN: This is a retrospective single-patient case report with a literature review. OBJECTIVE: To report on an uncommon injury: traumatic fracture-dislocation of the lumbosacral junction with delayed displacement. SUMMARY OF BACKGROUND DATA: Only 31 cases of traumatic fracture-dislocation of the lumbosacral junction were found in the English literature. Only three previous reports refer to this injury occurring with a posterior displacement. This is the first report of this type of injury displacing in a delayed manner. METHODS: Chart review. RESULTS: Open reduction, Arbeitsgemeinschaft fur Osteosynthesefargen instrumentation, and interbody fusion resulted in a satisfactory clinical result with no neurologic impairment. CONCLUSIONS: The present study reports a very rare injury consisting of traumatic dislocation of the lumbosacral joint, presenting with displacement 2 months after injury. The patient was treated successfully with surgery even though the injury displaced in a delayed fashion.