International orthopaedics
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We followed prospectively 38 orthopaedic implants in 36 HIV-positive patients. X-rays and clinical examination were used to assess union, and observation was made for early and late wound sepsis for 12 months from the time of surgery. Two patients died of causes unrelated to the implantation, two patients had implants removed for reasons other than infection and eight cases were lost to follow-up. ⋯ It is still not certain whether or not such a risk also applies to HIV-positive patients who are not haemophiliacs and have undergone internal fixation of fractures or non-unions. This study increases the confidence that fixation in immune-compromised patients with intact skin is safe, at least for the time period that the implant is required. Further studies are required to know whether or not fixation implants should be removed.
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Randomized Controlled Trial Comparative Study Clinical Trial
The timing of tourniquet release and its influence on blood loss after total knee arthroplasty.
We performed a prospective, randomized study on 76 patients (82 knees) scheduled for total knee arthroplasty to determine the effect of tourniquet release and hemostasis on the peri- and postoperative blood loss. Patients were randomly divided in two groups. Posterior cruciate retaining tricompartmental total knee prostheses were used in all. ⋯ Mean blood drainage was 880.85 ml (320-1,315) in group 1 and 745.36 ml (220-1,175) in group 2 ( p=0.03). The mean number of blood transfusions given, hemoglobin and hematocrit values, operation time, and tourniquet time were similar in both groups. Intraoperative tourniquet release and hemostasis does not reduce total blood loss in total knee arthroplasty.
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Randomized Controlled Trial Clinical Trial
Tranexamic acid reduces blood loss after cementless total hip arthroplasty-prospective randomized study in 40 cases.
We investigated the effects of tranexamic acid in 40 patients who had received cementless total hip arthroplasty (THA) in a prospective, randomized study. In 20 patients, 1000 mg of whole-body tranexamic acid was administered intravenously 5 min before the operation started. The other 20 patients served as a control group and were operated on without tranexamic acid. ⋯ Regarding time-related changes of postoperative blood loss, significant reduction was observed during the first 2 h after surgery in the tranexamic acid group ( P<0.001). After the first 2 h, there was no significant difference between the tranexamic acid group and the control group. Preoperative administration of tranexamic acid decreased postoperative blood loss until 12 h and total bleeding in cementless THA by reduction of blood loss during the first 2 h after surgery.
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Whilst advances in cementing technique have led to improvement in the survival of cemented femoral stems in total hip arthroplasty (THA), cup failure due to aseptic loosening remains a major clinical problem. These observations have led to a move away from cemented cup designs, particularly in young patients, towards uncemented implants. The Plasmacup is a hemispherical, press-fit, cementless, titanium-shelled, acetabular component with a polyethylene liner. ⋯ Four cups had small radiographic areas of focal osteolysis and three had been revised (two for recurrent dislocation and one for deep sepsis; none were revised for aseptic loosening). The mean linear wear rate in this series was 0.14 mm/year. In conclusion, the Plasmacup shows satisfactory early stability, a wear rate similar to other uncemented cups, and favourable mid-term clinical function and survival rates.