Intracapsular and para-articular osteochondromas are a rare subtype of soft tissue chondroma occurring in and around joints. We report a giant 5.5cm × 5.5cm × 3.0cm mass occurring in the knee of a 45 years old lady and examine previous cases to update our understanding of para-articular soft tissue osteochondromas.

Clinicopathological data were obtained from medical records for the case report whilst a multi-database literature search was conduction for the literature review. 27 articles containing 39 cases were identified in the English literature under our strict inclusion criteria. Along with our data, 40 cases were collated and analysed to provide a set of reference characteristics. These included: age, male-female ratio, spatial location, time of onset, tumour size, clinical symptoms, mechanism of injury, investigations used, treatment received, histopathology features, follow-up and recurrence characteristics. Statistical analysis was performed on data to elicit any discernable pattern of tumour formation.

Median age of patients was 50 years old with a male to female ratio of 1:1.11. Most commonly occurs in the 40s, 50s and 60s accounting for two-thirds of all cases. Majority of tumours were located within or adjacent to a fat pad structure. 33 were located in the infra-patellar region, 3 in the suprapatella/pre-femoral region and 4 in other para-articular locations. Average time of onset to diagnosis was 5.81 yrs with a mean volume of 87.5 cubic centimetres. No discernable correlation between time of onset to diagnosis and tumour size was found (spearman correlation co-efficient 0.534, p=0.007). The main symptom reported was pain in 29 cases, whilst 5 were pain free, 6 cases were unspecified. X-Rays, CT and MRI have become the core imaging modalities in investigation. En bloc excision is the choice of treatment, whilst arthroscopic techniques have also been used with similar success. Histologically, 35 cases had a typical description of a cartilage capped lesion with central trabecular bone and areas of endochondral ossification. 3 cases had a histological appearance of predominantly bone whilst 2 cases had predominantly cartilage. All tumours analysed were benign. No recurrences were reported with an average follow up period of 1.91 years.

We have provided the latest set of data for the characterisation of para-articular and intracapsular soft tissue osteochondromas. These tumours are benign entity with an invariably good outcome following simple excision. Recognition of this entity is important to prevent over investigation and the performance unnecessarily invasive and radical procedures.

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.