Aims

Osteoarthritis (OA) affecting the thumb carpometacarpal joint (CMCJ) is a common painful condition. In this study, we aimed to explore clinicians’ approach to management with a particular focus on the role of specific interventions that will inform the design of future clinical trials.

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.