Introduction: The use of H A coated implants for Total Hip Replacement is now well established. We are entering an era where some of these implants are requiring revision. This presentation reviews our experience of revising H A coated THR, considers the failure pattern and attempts to produce a rational method of treatment.

Methods: This is a retrospective study of all HAC coated implants revised by a single surgeon (senior author) covering last five years. It includes 20patients (21 Hips) eleven male and 9 female. The mean age at revision was 62 years (26–82 yrs). The mode of failure suggested three failure patterns hence we have divided them in three groups.

Results:

Early Failure 0– 2 years : Six hips

Medium Term Failure 2–10 years : Two hips

Long Term Failure 10 years or more: Thirteen hips

Early Failure: The cause for early revision in most cases was technical problems with the primary procedure with improper seating of liner, cup or femoral stem. Correcting the primary problem led to satisfactory results in this group.

Medium term failure: Medium term failure were found to be due to either liner failure or infection. Replacing the liner and two staged revision for infection gave good results.

Long term failure: All cases in this group were due to plastic failure, which led to aseptic loosening of acetabular shell in five cases and aseptic loosening of cup and femoral stem in further two cases.

Only loose components were replaced.

Analysing this series we conclude that in absence of infection only loose components should be replaced. Well held components should be left alone and only the failing component need to be revised.

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 .