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.

Comparison of patellar resurfacing versus nonresurfacing in total knee arthroplasty.

OBJECTIVES: To determine whether resurfacing the patellar component during total knee replacement (TKR) influences the clinical outcome. DESIGN: A retrospective study of data gathered prospectively during the recovery course of patients who underwent TKR with or without patellar resurfacing. SETTING: Victoria General Hospital, Halifax, NS. PATIENTS: One hundred and eighty-five patients operated on between 1992 and 1995. The inclusion criteria were (a) osteoarthritis, (b) replacement carried out by 2 independent surgeons, (c) no comorbid illness such as rheumatoid arthritis, cancer or infection, (d) pre- and postoperative attendance at the assessment clinics. INTERVENTION: TKR with (45) or without (140) patellar replacement. MAIN OUTCOME MEASURES: Range of motion (ROM), pain assessment, Hospital Severity Score (HSS) and complications. RESULTS: There was no statistical difference between the 2 groups with respect to ROM, pain, HSS and complications postoperatively. CONCLUSIONS: Resurfacing the patella during TKR does not seem to influence the clinical outcome with respect to ROM, pain and overall complications. The decision should be based on individual criteria, depending on the preoperative and intraoperative findings. Randomized clinical trials assessing ROM, pain, complications and cost-effectiveness with long-term follow-up are necessary to further investigate this controversial issue.

Presidential address 1998. In search of daylight.

Practising medicine in Canada has become increasingly bureaucratic, confrontational and stressful. The Canadian Orthopaedic Association must take a far more proactive role in the development of orthopedic surgeons as professionals and in the political environment in which they practise. Living in a "knowledge-rich workplace" orthopedic surgeons must support continuous professional development and provide leadership and incentive to maintain competence in their profession. The "baby boomers" are coming. Their numbers will have a profound effect on the practice of orthopedic surgery, not 20 or 30 years from now but within the next 10 years. Therefore it is imperative that orthopedic surgeons assess and accept the impact that the "boomers" will have on surgeons, hospital beds and operating-room time. Orthopedic surgeons and the Canadian Orthopaedic Association are challenged by a new role as vendors of information in a new "information age" economy, whose fundamental sources of wealth are knowledge and communication.

Flexion-distraction injuries of the lumbar spine and associated abdominal trauma.

Recent experience with flexion-distraction injuries of the lumbar spine associated with blunt abdominal trauma and the use of a lap belt alone has caused us to review our experience over the last 7 years. Eighteen patients were identified, with an average age of 22 years, and an average followup of 34 months. Fifteen were involved in motor vehicle accidents, with 11 being single-vehicle accidents. Of note, 12 of the 15 were rear seat passengers with lap belts only. Twelve patients suffered abdominal injury, seven requiring operative intervention, mainly for hollow viscus injury. In three patients, a delay of 24 hours or more occurred before recognition of intra-abdominal pathology requiring surgical therapy. One patient had an unrecognized spinal fracture for 2 weeks after abdominal surgery for a perforated viscus. The spinal injury was carefully assessed and analyzed for prognostic factors. Six were graded excellent, five good, four fair, and one poor. One case of paraplegia associated with avulsion of the spinal cord from distraction is reported. Prognostic factors included the amount of facet joint involvement and the degree of initial kyphosis. Those having greater than 17 degrees of kyphosis had a poor prognosis. Early recognition of the constellation of injuries involving the spine and abdomen associated with the use of the lap belt is recommended with surgery to the spinal fracture as outlined.