Introduction and Aims: Reinfusion drains have been used to decrease the need for blood transfusion following total knee replacement. The aim of this study was to evaluate the degree of activation of platelets and leucocytes in both the blood that has been salvaged after total knee arthroplasty and the patients’ blood following reinfusion. Method: A prospective series of 24 consecutive patients undergoing a primary total knee replacement in a case-control study were investigated. Post-operatively 12 patients received salvaged blood reinfusion and as a control, 12 patients underwent TKA with a standard drain. The reinfusion was initiated four hours after the operation. Blood samples were taken from all patients at three and five and a half to six hours post-operatively. A third sample was acquired in the treatment group from salvaged blood after reinfusion. Platelet, platelet-leucocyte and leucocyte activation markers were studied in both the drainage blood and the patients’ blood following reinfusion. Results: Comparison between platelet, platelet-leucocyte and leucocyte activation markers in patients’ circulation prior to reinfusion compared to salvaged blood showed that almost all markers were significantly increased in salvaged blood. For example the platelet activation markers P-selectin (p< 0.01), Factor V (p< 0.01), CD40L (p< 0.01) and platelet derived microparticles (p< 0.01) were all significantly increased in the drainage blood. All studied platelet-leukocyte and leucocyte activation particles were also significantly increased. Following re-infusion of autologous salvaged blood there was no statistically measurable effect on activation markers of patients’ circulating platelets and leucocytes, but there was a slight drop in platelet count in the reinfused group compared to the control group. Levels of prothrombin fragment F 1+2 increased in the reinfused group compared to control indicating either activation of coagulation or simply the effect of addition of the high levels present in the salvage blood. Conclusion: Blood from reinfusion drains showed a significant increase in activation of platelets and leukocytes indicating activation of coagulation. The reinfused blood did not lead to a difference in platelet and leukocyte activation but a decrease in platelets and an increase in fragment F1+2 suggests the possibility of activation of coagulation

Background: Autologous blood from reinfusion drains are commonly used after major joint arthroplasties with a view to decrease the heterologous blood transfusion requirement. The aim of this study is to find the effect of reinfusion drains on the difference in haemoglobin (Hb) level before and after total knee arthroplasties. Material and Methods: Between January 2001 and October 2003, 158 patients had total knee arthroplasty on one side. The type of thromboprophylaxis used was the same in all the patients. 74 patients had autologous blood transfusion through reinfusion drains (Group I) while 84 patients had no autologous blood transfusion and ordinary suction drains were used to drain the wound in the immediate postoperative period (Group II). The mean age was 72.1 +/− 8.5 in group I and 69.3 +/− 9.1 in group II. In each patient the preoperative Hb level, the amount of autologous blood transfusion, the postoperative Hb level and the amount of heterologous bleed transfusion requirement were noted. Results: The mean preoperative Hb level was 13.6 +/− 1.4 g/dL (10.4–18.1) in group I and 13.7 +/− 1.3 g/dL (7.9–16.5) in group II. The mean postoperative Hb level was 10.7 +/− 1.5 g/dL (10.4–18.1) in group I and 10.7 + 1.6 g/dL (5.4 +/− 13.6) in group II. The difference in Hb level between the two groups was analysed using t-test and found to be not significant (p = 0.76), with the mean difference between the groups being 0.05 and the 95% CI to the mean difference includes zero (range −0.3 to +0.4). The difference in Hb level before and after surgery was plotted against the amount of autologous blood transfused and it was observed that there was no significant improvement with increased amount of autologous blood transfusion. The cost of reinfusion drain is 36.43 (~ 53.37 Euros) more than the suction drain. Conclusion: Autologous blood from reinfusion drains did not significantly improve the postoperative Hb level. Further usage of reinfusion drain is not cost-beneficial

Primary total knee arthroplasty is associated with considerable blood loss, and allergenic blood transfusions are frequently necessary. Because of the cost and risks of allogenic blood transfusions, the autologous drainage blood reinfusion technique has been developed as an alternative. A number of studies have compared reinfusion techniques with standard suction drainage, but few reports compared with no drain use. We analyzed early results after primary total knee arthroplasty using autologous drainage blood reinfusion and no drain. We selected 30 patients who underwent primary total knee arthroplasty using no drain between November 2005 and March 2006 and matched for age and gender with 30 patients who underwent primary total knee arthroplasty using autologous drainage blood reinfusion technique between January 2003 and October 2005. All operations were done under pneumatic tourniquet and meticulous hemostasis was performed after deflation of the tourniquet. We have retrospectively reviewed the preoperative data (age, gender, body mass index, diagnosis, history of the knee surgery, infection and anticoagulant therapy, and medical cormorbidities) and the postoperative data (hemoglobin, hematocrit and platelet during hospitalization, the amount of allogenic blood transfusion and narcotics, complications, rehabilitation process, and clinical scores). All preoperative and postoperative variables except the postoperative second and seventh days hemoglobin and 2nd day hematocrit showed no significant differences between two groups. The hemoglobin and hematocrit also showed no significant differences at the postoperative fourteenth day. The autologous drainage blood reinfusion method in primary total knee arthroplasty does not have significant clinical benefit over no-drain method with regards to allogenic blood transfusions, narcotics uses, the incidence of complications and rehabilitation processes

Purpose: To determine the effectiveness of a postoperative autologous blood reinfusion system, as an alternative to homologous, banked blood transfusions in total hip arthroplasty. Material and Methods: We have carried out a prospective randomized, controlled study on 60 patients having unilateral total hip replacement. In all these patients the same surgical team applied the same surgical technique (hybrid THA) and they follow the same rehabilitation program. All the patients received intraoperatively one or two units of homologous banked blood transfusion (average 1.7 units/patient) according to the volume of blood collected in the suction device and to the anaesthesiologist’s estimation. In 30 of these patients (group A) a reinfusion system of unwashed blood salvaged was applied and they supplemented postoperatively with banked blood transfusions when required. A control group of 30 patients (group B), in whom standard suction drains were used, received also additional blood transfusions when required. The admission of banked blood transfusions determined by haemoglobin value (< 9mg/dL) and/or clinical signs (blood pressure, pulses, etc). The value of haemoglobin, haematocrite and platelets recorded preoperatively and the 1st, 5th and 15th day after operation. Results: 13 patients of group A required postoperatively 13 units of homologous blood (0.43 units/patient) (total amount for group A 64 banked blood units or 2.14 units/patient). 21 patients of group B required additional 28 banked blood units postoperatively (totally 79 units for group B or 2.63 units/patient). In the study group the total homologous blood requirements reduced by 20%, while the postoperative blood requirements reduced by 54% and the number of patients required additional blood transfusion reduced by 38%. There was no significant difference in the postoperative haematocrite and haemoglobin values between the two groups. None of the patients developed any adverse reactions after reinfusion. Conclusions: The use of an autologous blood reinfusion system reduces effectively the postoperative demands of homologous banked blood transfusion in total hip arthroplasty

Study Purpose: To investigate whether the use of reinfusion drains and post-operative autogenous blood transfusion reduces the rate of allogeneic blood transfusion after primary total knee replacement in our unit. Methods: A prospective audit was carried out over a 14-week period. Patients received either a reinfusion drain, a suction drain or no drain according to surgeon preference. Post-operative allogeneic blood transfusion criteria were based on clinical indication rather than an absolute haemoglobin level. Results:127 consecutive patients underwent total knee replacement during the study period. Patients were matched between the three groups for age, medical co-morbidity, DVT prophylaxis, and implant used. Conclusion: The use of reinfusion drains did not significantly reduce the requirement for post-operative allogeneic blood transfusion. This directly contrasts much of the published literature

Blood loss during the perioperative period of total joint arthroplasty has been well described in the literature. Despite numerous advances, allogeneic transfusion rates are still reported as high as 50%. Often the literature focuses on one area or mechanism of blood loss prevention but this article focuses on a multimodal approach to blood loss prevention including preoperative optimization, intraoperative technique, and postoperative management. Hemoglobin drop and transfusion rates were retrospectively reviewed for 134 control patients undergoing total knee arthroplasty (TKA) in three groups. Group 1 included low risk patients (Hb >14 g/dl), Group 2 included intermediate risk patients (Hb 13-14 g/dl) utilizing reinfusion drain and preoperative autologous blood donation, and Group 3 included high risk (Hgb <13) patients treated with preoperative erythropoietin (EPO). These controls were then compared to two groups of patients undergoing minimally invasive total knee arthroplasty (MIS TKA). Group 4 included 20 consecutive patients undergoing MIS TKA with intraoperative injection of lidocaine and epinephrine along the arthrotomy site. Group 5 included 22 consecutive patients treated with similar technique plus the additional intraoperative use of a bipolar sealer device. The combined utilization of MIS TKA, epinephrine, and bipolar sealer minimized hemoglobin drop (2.74 (Std Dev 0.77) vs 3.29 (SD 1.05) g/dl, p= 0.01) and total blood transfusions (0.05 (SD 0.21) vs 0.86 (SD 0.63) units, p< 0.01) compared with the traditional TKA approach for high risk patients using reinfusion drain and preoperative autologous donation (Group 2). This series demonstrates how a busy knee practice minimizes hemoglobin drop and transfusion requirements with preoperative optimization of high risk patients utilizing EPO, minimally invasive technique, intraoperative hemostasis obtained with epinephering injection, use of a bipolar sealer, and postoperative management with a reinfusion drain

Introduction Blood loss and requirement for blood transfusion is a recognized and common complication of major joint replacement arthroplasty. In 2001, the authors began using an autologous blood transfusion (ABT) drainage system for total hip and knee arthroplasty. This paper illustrates changes in post-arthroplasty transfusion practice in a rural orthopaedic hospital. Methods Retrospective review of all 289 patients undergoing 132 primary hip and 157 knee replacement arthroplasties in 2001 to 2002 was performed. ABT drainage was used in 187 patients (64%). Wound fluid collected during the first six post-operative hours was filtered by the ABT device and reinfused to the patient intravenously. The observational database was explored by general linear modeling to investigate whether using the reinfusion drain resulted in higher post-operative haemoglobin concentrations. Various multifactor models were explored, re-fitted and regressions diagnostics examined. A final model directed further prospective analysis. Results Independent of all variables, post-operative haemoglobin was on average 0.3g/dl higher (p=0.0308) when ABT was used. Levels were significantly higher for knee compared with hip replacement (p=0.0083) and significantly higher by 0.55g/dl for uncemented compared to cemented/hybrid knee arthroplasty (p=0.0271). ABT reduced blood transfusion requirements from 46.5% to 22% following hip replacement and from 23.6% to 16.3% following knee replacement. Conclusions Introduction of the ABT system resulted in significantly higher post-operative haemoglobin levels and decreased blood transfusion rates following hip and knee replacement arthroplasty. Uncemented component fixation further increased post-operative haemoglobin levels. The authors advise routine use of this system for joint replacement. In relation to the conduct of this study, one or more of the authors is in receipt of a research grant from a non-commercial source

Introduction: There is an increasing trend for autologous blood transfusion in hip and knee replacement and we therefore felt the need to properties of the fluid reinfused. Objectives of the study: The study objective was to determine the volume and Haemoglobin content of the reinfused blood. Methods: We prospectively studied 108 patients with primary Hip and knee arthroplasty. The drained blood was reinfused within 6 hours as recommended by the manufacturer. The volume of the drained and reinfused fluid was measured in millilitres.. The Haemoglobin (Hb.) of the patient was measured preoperatively and postoperatively in recovery. The Hb. of the drained blood and reinfused blood were also measured. Results: The mean volume of the drained blood in the hip replacement group was 180.6 ml. while that of the reinfused blood was 132.7 ml. The mean volume of the drained blood in the knee group was 372.78 ml. while that of the reinfused blood was 362.76 ml. The mean Haemoglobin of the reinfused blood in the hip group was 6.9 gm/dl significantly lower (p< 0.05) than the drained blood Hb. of 10.9. Similarly the Haemoglobin of the blood reinfused in knee replacements was significantly lower at 6.8 gm/dl. (p< 0.001). This was less than half of the average Hb. content of homologous blood transfusion. Discussion: The Haemoglobin content of the reinfused blood in Hip and knee replacement was quite low to be considered as a replacement for homologous blood transfusion and further studies may be required to confirm the efficacy of reinfusion drainage compared to homologous blood transfusion

Introduction: The benefits of postoperative wound drainage in patients with total knee arthroplasty (TKA) with regards to mobilisation and wound healing were studied. We wanted to determine the efficacy of an autologous blood retransfusion system.

Materials and Methods: 150 patients with TKA were divided into three groups of 50 patients:

A) Three wound drainages with an autotransfusion system and suction;

Haemoglobin values, blood transfusion requirements, blood loss, postoperative range of motion, knee society score and rate of complications were observed and recorded. All patients were operated without tourniques for lower blood loss during total knee replacement.

Results: In the group of patients with wound drainage and a retransfusion system the requirement of postoperative additional blood transfusion was not significantly less than in the group without wound drainage. Group A had the most blood loss of all. The group without wound drainage had more haematoma and wound healing complications. Best results were observed within the group with one intraarticular drainage without suction. The rate of complications was not increased and the blood transfusion requirements were the lowest.

Conclusion: This study shows that total knee replacement involving one intraarticular wound drainage without suction attains the best results. During the last four years we used this wound drainage technique in 787 TKAs and can confirm all findings of this study.

Introduction: Reinfusion drains are used to minimise the need for allogenic blood transfusion, and its potential complications. Tranexamic acid {TA} is an antifibrinolytic agent that is used to decrease blood loss in total knee arthroplasty surgery. The effect of TA on reinfusion volume of drained blood has received little attention. The aim of our study is to measure the effect of TA on reinfusion volumes in primary total knee replacement {TKR}. Methods: A cohort of consecutive patients undergoing primary total knee replacement between November 2006 and January 2008 were studied. Each patient was operated upon by the same surgeon, and had the same pros-thesis inserted. Patients operated upon before June 2007 did not receive TA but had reinfusion drains, while those who underwent surgery after June 2007 received TA along with the reinfusion drain. We measured pre and post operative haemoglobin {Hb}, drainage volume and reinfusion volume. The need for allogenic blood transfusion was recorded. TA and non TA groups were compared. Results: Seventy patients were included in the study. There was no significant difference between the TA and non TA groups in pre operative Hb {13.2, 13.1g/dl} or post operative Hb {10.95, 10.9}. There was a significantly lower drainage volume {250 v 600ml} and subsequent reinfusion volume {100 v 465ml} in the TA group versus non TA groups respectively. There were no cases of thromboembolism or allogenic blood transfusion in either group. Conclusion: Tranexamic acid significantly decreased post operative blood loss and subsequent reinfusion volumes in TKR. TA and reinfusion drains greatly decrease the demand for allogenic blood transfusion. Drainage volume is so low when TA is used in routine primary TKR, that the need for reinfusion drains is questionable. TA is cost-effective compared to reinfusion drains in TKR

The reinfusion of perioperative cell salvage is one method employed to reduce exposure to donor blood. Data on the safety of this process, however, are scant. Notably, the effect of intraoperative, washed cell salvage reinfusion on prothrombotic markers has not been demonstrated. The risk of postoperative venous thromboembolism following major orthopaedic operations is not insignificant. The study objective was to assess the effect of cell salvage reinfusion on coagulation and platelet activation. Twenty-one patients undergoing elective primary hip operations were recruited. Nine patients received washed cell salvage intraoperatively, and were compared with 12 patients undergoing similar surgery that did not. Two patients in the cell salvage group also received postoperative, unwashed cell salvage. Blood samples were collected pre-operatively, immediately post-operatively, and one day post-operatively for assays of platelet activation markers, P-selectin expression and fibrinogen binding by flow cytometry in diluted whole blood; coagulation activation marker, thrombin-antithrombin complex (TAT); D-dimer by ELISA, thrombin generation by chromogenic assay, and full blood count. Samples of cell salvage material were also analysed for prothrombotic markers. There were no significant differences between the groups preoperatively. Postoperatively haemoglobin levels did not differ significantly between the cell salvage group and controls. Postoperative TAT and D-dimer were significantly higher in the cell salvage group compared with controls (p<0.05). One day postoperatively, there were significantly higher platelet P-selectin expression (p=0.006) and platelet fibrinogen binding (p=0.004) in the cell salvage group compared with controls. The white cell count (WCC) was also significantly higher (p=0.04). In the intraoperative washed cell salvage material, and in postoperative cell salvage, the platelet count was low, but significant proportions of platelets were activated, and levels of D-dimer were elevated compared with venous blood. The postoperative salvage material also contained high levels of TAT. The results from this pilot study show the induction of a prothrombotic state following reinfusion of intraoperative, washed cell salvage in recipients undergoing primary elective hip operations. An inflammatory response to reinfusion is also indicated by the raised WCC. Further investigation into the safety of cell salvage is indicated

Purpose. To evaluate the long term results of the use of a postoperative autologous blood reinfusion system in total knee arthroplasty. Material and method. In a prospective study, 176 patients who underwent unilateral total knee replacement, during the period 2004–2008, were evaluated (study group or group A). In all these patients a reinfusion system of unwashed blood salvaged was applied, while supplementary homologous blood transfusion was performed when required. The admission of banked blood transfusion determined by haemoglobin value (<9mg/dL) and/or clinical signs (blood pressure, pulses, etc). The value of haemoglobin, haematocrite and platelets recorded preoperatively and the 1st, 5th and 15th day after operation. Results were compared with the material of our previous prospective randomized controlled study (control groups B and C), where in 60 patients, between the years 2002–2004, the effectiveness of postoperative autologous blood reinfusion had been proved. Results. 19 patients of group A required postoperatively 23 units of homologous blood (total study group requirements23 blood units or 0.13 units per patient) while in group B required 1.5 units/patient and in group C 0.3 units/patient. In the study group the total homologous blood requirements reduced by 91% compared with group B (patients without autotransfusion system applied) and by 47% compared with group C (patients with autotransfusion system applied). There was no statistically significant difference in the postoperative values of Hb and Ht between the groups. None of the patients developed any adverse reactions after reinfusion. The cost of blood management was reduced in study group by 76%. Conclusions. The use of an autotransfusion system postoperatively minimizes practically the demands for homologous banked blood transfusion in total knee arthroplasty

Introduction: Primary total hip replacement remains one of the commonest orthopaedic procedures performed. It is yet to be clearly demonstrated whether use of a postoperative drain is of benefit in these procedures. Methods: We carried out a prospective randomised study comparing the use of autologous reinfusion drains, closed suction drains or no drain to determine their influence on allogenic blood transfusion requirements, length of hospital stay and infection rates. Stratification was carried out for confounding factors. Results: 153 patients were recruited into the study and randomised to one of the three closely matched groups. There was no significant difference between the mean intra-operative blood loss or post-operative haemaglo-bin levels between the 3 groups. 42% of the suction drain group required post-operative transfusion as compared to 17% of the reinfusion drain group and 12% of the group with no drains. This difference was highly significant (P=0.02) Mean time for the wound to become dry was 3 days, 3.9 days and 4 days in the no drain, re-transfusion drain and suction drain groups respectively. This difference was statistically significant (P=0.03). There was no statistically significant difference in the mean length of inpatient stay. Discussion: This study demonstrates a significantly higher transfusion rate with closed suction drains compared to reinfusion drains or no drains. With the drive to reduce hospital stay our study supports the considered use of no drain or a reinfusion drain

Purpose. The traditional use of pneumatic tourniquets and reinfusion drains in total knee replacement (TKR) has recently been challenged and the aim of our study was to compare the outcomes of three different blood management techniques in primary TKR. Methods. We prospectively conducted a study of 87 patients with mean age of 71 (44-91) years old. They were randomised into three groups: Group A: 29 patients without the use of tourniquet and reinfusion drain, Group B: 27 patients without the use of tourniquet and reinfusion drain but application of intraoperative cell salvage system and Group C: 31 patients with the use of tourniquet and reinfusion drain. All groups were well matched and all patients were reassessed at the 2. nd. postoperative day. Results. There was no difference between the postoperative haemoglobin drop (Group A: 3.6 g/dl; Group B: 3.3 g/dl; Group C: 3.2 g/dl) and allogenic blood transfusion rate (Group A: 6.8%; Group B: 7.4%; Group C: 6.4%). In Group B an average of 525 ml of blood was collected and an average of 148 ml of concentrated blood was reinfused. In Group C an average of 432 ml of blood was collected by the drain and an average of 324 ml of blood was reinfused. The 2. nd. postoperative day range of knee movements showed no significant difference. Only 2 Group C patients (6.4%) had postoperative thrombembolic events (one DVT, one TIA). Readmission rate due to knee stiffness and superficial wound problems did not revealed any significant difference. The average operative time (83 minutes) and hospital stay (5.3 days) were the same in all groups and there was no wound haematoma or deep infection in any groups. Conclusion. There was no statistical difference between the groups for any outcome measure

Introduction: There is increasing awareness and concern among the medical profession, general public and media about the various complications of homologous blood transfusion. Primary arthroplasty of either the hip or knee has an estimated total bleeding of 1.51 (Lotke et al 1991), commonly resulting in transfusion. In knee arthroplasty, performed with the use of a tourniquet, almost all the bleeding occurs postoperatively. Several studies have shown that salvage of blood after the operation and reinfusion can reduce the need for homologous transfusion (Majkowski RS et al, Newman JH et al). We studied prospectively 100 consecutive patients for knee replacement to compare post-operative transfusion requirements in blood salvage and reinfusion group and a no drain technique. Methods: After written consent 100 consecutive patients for knee replacement surgery were randomly allocated by computer generated numbers to either the no drain group (n=50) or the reinfusion group (n=50). The patients were anaesthetised as deemed appropriate by their anaesthetist. All the patients were operated on using a tourniquet. At the end of surgery the wound was closed with or without a deep drain. The drain was attached to the Constavac CBC II closed suction system. Preoperative haemoglobin and haematocrit values were recorded. Homologous blood was transfused to the patients as per the standard protocol depending on the haematocrit and or haemoglobin at 4 & 8 hours post-operatively, as well as days 1,2 & 3. In the reinfusion group blood collected in the reservoir was transferred to the blood bag and reinfused at 5 hours or 500 mls depending which was earlier. At 8 hours the reservoir blood was collected and reinfused, no more blood was reinfused as per the manufacturer recommendations. Cardiovascular stability was assessed by hourly blood pressure and heart rate during the first 24 hours and twice daily thereafter. Blood loss was assesses by measuring the drain loss, assessing the wound ooze serial haematocrits and total transfusion requirements. Results: 50 patients were completed in each group. The mean preoperative haemoglobin in the drain group was 12.8 g/dl and in the no drain group it was 12.9 g/dl. No difference in predisposing factors for bleeding was recorded in the two groups. The mean volume of blood collected in the drain group was 1008mls and the mean volume of autologous transfused was 864 mls. 14% of patients in both groups had no requirement for homologous blood. There was no significant difference in the homologous blood transfusion in the two groups over the study period (up to day 3 post op), the no drain group requiring and average of 2.1 units of packed cells the reinfusion group requiring an average of 1.8 units of packed cells in total. The homologous blood requirements in the drain group was significantly reduced on day 2 in comparison to the no drain group, but as noted there was no overall reduction in homologous requirements. Cardiovascularly 16% of patients with a drain had at least one episode of hypotension (Bp < 90 systolic) compared with 20% of patients in the no drain group. The group without a drain had a significant increase in wound ooze (70% compared with 44%). Conclusion: Post-operative blood salvaging and autologous transfusion following primary knee replacement under tourniquet in this study did not significantly reduce the patient’s requirement for homologous blood transfusion in the first 3 days post operatively. There was a significant increase in wound ooze in the no drain group but as shown this has not result in an increase in cardiovascular instability or an increase in transfusion requirements

Introduction: Total Knee Replacement is a commonly done planned operative procedure frequently requiring blood transfusion. Fear of adverse reactions, transmission of viral illnesses like AIDS, Hepatitis B, C and Non A Non B has led to interest in alternatives to allogenic blood transfusion. Predonation of autologous blood, administration of erythropoeitin alpha, postoperative blood recovery using cell saver or suction devices for reinfusion of whole blood have all been suggested to overcome this problem. Aim: Our study was aimed to assess the efficacy of reinfusion of autologous blood transfusion from the blood collected after completion of the surgical procedure using Constavac reinfusion drain system. Method: A prospective analysis of 54 patients undergoing primary total knee replacement was done. All patients with preoperative Hb of 12.5gm/dl or more were included. Postoperative drop in Hb below 9 gm/dl was an indication of supplemental transfusion. Probability of sepsis or malignancy were criterion for exclusion. Results: In all patients undergoing Total knee replacement , average amount of blood reinfused was 480 mls. 50 of the 54 (92.6%) patients did not need any homologous blood transfusion. Average drop in Hb was 2.3 gm/dl. In nine patients (16.7%) there was drop in Hb of more than 3 gm% but only three of them needed blood transfusion. Patients with valgus deformity and needing lateral release were more at risk of needing homologous blood transfusion. No complications or adverse effects were noticed. Discussion: Our study shows that reinfusion alone may be sufficient in most cases needing Total knee replacement. It is a reliable, safe, simple and cost effective way to overcome the need of allogenic blood transfusion in patients undergoing Total Knee Replacement. This may reduce the load on blood banks for cross matching all patients undergoing knee replacement except in valgus knees

In Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA) the total blood loss is composed of ‘visible’ blood loss from the surgical field and wound drainage, and blood loss into the tissues which is ‘hidden’. Blood management should be aimed at addressing the total blood loss. 56 TKAs and 46 THAs were prospectively studied. TKAs were performed with tourniquet. After tourniquet release, all drained blood was salvaged and significant volumes reinfused. No reinfusion was used for THAs. The true total blood loss was calculated in the following way:. Patient Blood Volume (PBV) is: [1]. PBV = k1 x height3 + k2 x weight + k3. Therefore patient total Red Blood Cell volume (RBCv) is:. RBCv = PBV x Hct. (where Hct is Haematocrit). Total RBCv loss = PBV x (Hct preop – Hct postop) + ml RBC transfused. The result is reconverted to Whole Blood volume. Hidden Loss = Total Loss – Visible Loss. In TKA, the mean total true blood loss was 1474ml. The mean hidden loss was 735ml. Therefore hidden loss is 50% of the total loss and the total true loss following TKA is twice the visible volume. In THA, the mean total true blood loss was 1629ml. The mean hidden loss was 343ml. Thus hidden loss in THA is much smaller. (21%) Total loss is 1.3 times the visible loss. In the TKA group, comparing patients with large losses receiving reinfusion and those with small losses not receiving reinfusion, the proportion of total true loss which was hidden was the same, at 50%. Patients with Body Mass Index (BMI) > 30 were compared with those with a BMI < 30 and no correlation was found between BMI and Hidden Loss. Joint Replacement Surgery involves a ‘hidden’ blood loss which is not revealed and cannot be measured or reinfused in practice, but which should be taken into account when planning blood loss management. In TKA it is substantial. In THA it is much smaller and probably not of as much clinical concern. Hidden loss is no greater in the Obese patient

The management of autologous blood aims at reducing the need for allogenic transfusion. Blood requirement (autologous and/or allogenic) will depend on the pre-operative red blood cell stock and on the perioperative blood loss. The red cell stock is related to body weight and preoperative haemoglobin (haematocrit) level; it can be calculated accurately, whereas the perioperative blood loss (external and occult) is variable and unpredictable. Preoperative donation of autologous blood, as well as intraoperative and/or postoperative recuperation and reinfusion of shed blood decrease the risk for allogenic transfusion in total hip replacement (THR) and total knee replacement (TKR) surgery. However, their efficiency and cost effectiveness are not optimal when applied to unselected patients. Up to 50% of the predonated units of autologous blood are wasted after THR and THK surgery if patients have not been specifically selected to predonate blood. In hip surgery the volume reinfused after intraoperative blood recuperation obviously depends on intraoperative bleeding; it averages 500 ml in a hip revision operation. In TKR (with a tourniquet) the volume reinfused after postoperative recuperation depends on the amount of blood drained in the immediate postoperative period, which reflects both the amount of bleeding and the efficiency of the drainage. On average, 500 ml of shed blood with a haematocrit of 35% is reinfused, which increases the haemoglobin level by 1.0 gr/dl on average. The efficiency of this technique is unpredictable, with a wide dispersion of individual values (standard deviation: 208 ml) for the volumes reinfused. However, in patients with a body weight of 70 kg or less, the increase in haemoglobin level was more predictable and averaged 1.23 gr/dl. In order to improve the efficiency of these two techniques (preoperative autologous blood donation and recuperation/reinfusion of shed blood), patients need to be targeted, taking into account:. - the calculated preoperative (day before surgery) red blood cell stock and the number of units of predonated blood,. - the lowest postoperative haemoglobin and haematocrit level clinically tolerable for that specific patient,. - the expected perioperative blood loss, which depends on such factors as duration of surgery, anticoagulant administration, use of a tourniquet,etc). As a general rule, a haemoglobin level < 13 gr/dl, age > 65 years and weight < 70 kg all increase the risk to require autologous or allogenic blood transfusion, and would justify planning predonation of blood and/or recuperation/reinfusion of shed blood

Objective: Bone marrow stromal cells (BMSC) represent an interesting target for novel strategies in the gene and cell therapy of skeletal pathologies, involving BMSC in vitro expansion/transfection and reinfusion. Materials and Methods: Stromal cells were obtained from healthy donors. For the first 2 weeks, culture medium was supplemented only with human recombinant fibroblast growth factor 2 (FGF-2) to promote cell proliferation and maintain cells in a more immature state. Confluent cultures were detached with trypsin-EDTA. Cells were replated for the in vitro differentiation experiments and for determination of BMSC growth kinetics. Cultures were stimulated with appropriate inductive media and the chondro-/osteo-/adipo-diferentiations were tested by staining with alizarin red, alcian blue, Sudan black and by immunostaining for osteocalcina or collagen II. Results: After the first passage, BMSC had a markedly diminish proliferation rate and gradually lost their multiple differentiation potential. Their bone-forming efficiency in vivo was reduced by about 36 times at first confluence as compared to fresh bone marrow. Conclusion: Culture expansion causes BMSC gradually to lose their early progenitor properties. Both the duration and the conditions of culture could be crucial to successful clinical use of these cells and must be considered when designing novel therapeutic strategies involving stromal mesenchymal progenitor manipulation and reinfusion. There are numerous potential applications of this novel strategy, for example: reconstruction of extensive long-bone defects, osteochondral defect repair, treatment of bone cyst, bioactivable scaffolds, etc

Purpose : The evaluation of the results of the comparison, between homologous blood transfusion and reinfusion of wound drainage blood, to patients with primary total knee replacement. Materials and methods: A study on 44 consequent patients,who underwent to primary total knee replacement. Study group comprised 29 patients, employing a post operative autologous collection system and the control group 15 patients, using a standard drainage system. The patiens of the control group transfused with homologous blood when it was needed. The amount of drainage blood autotransfused in the study group was 633,15cm3 per patient, approximately. The preoperative haematocrit of this group was 39,24% average. In the study group, 10/29 patients required two extra units of homologous blood per patient,where the preoperative haematocrit was 36,01% average. The control group, required 2,66 units of homologous blood per patient, wherees the preoperative haematocrit was 39,23% average. Results : The haematocrit in the 3rd post operative days, to the group of autotransfusion, was 32,70% average, while to the group of homologous blood transfusion was 31,91%. The temperature was approximately at the same levels to both groups of patients, post operatively, with a mean rate of 38,350C and it’s duration was two days post operatively, average. There were no complications to both groups after the operation. Conclusions: The system of reinfusion of unwashed shed whole blood is effective and safe as far as it concerns the decrease of the dangers from the homologous blood transfusion. Moreover, the cost is cheaper comparing to the homologous transfusion, whereas it is the solution of choice, to the people who refuse the blood transfusion, due to religion reasons