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ABSTRACT: The results of cheilectomy, performed on 67 consecutive patients with hallux rigidus resulting in primary extraarticular symptoms are presented. Four patients who underwent subsequent fusion were rated as failures. Follow-up evaluation, averaging 65 months (28-117) on 53 additional patients available for follow-up, revealed an average AOFAS score of 80. with 91% of the patients stating that they were currently better than before surgery. There was a statistically significant higher mean score (89) in patients over 60 years of age at the time of surgery. There were no differences between other age groups, preoperative grade, duration of symptoms, or length of follow-up. Cheilectomy should be the treatment of choice for hallux rigidus with predominantly extra-articular symptoms, especially in patients over 60 years of age.
The Foot and Ankle Online Journal 04/2001; 22(3):192-7. · 1.22 Impact Factor
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ABSTRACT: The clinical importance of iron-restricted erythropoiesis in erythropoietin (EPO)-stimulated patients is controversial.
We therefore reviewed 70 patients randomized into clinical trials of aggressive autologous donation and oral iron supplementation, with or without recombinant human EPO therapy.
Nineteen (27%) iron-depleted patients produced 5.4+/-2.8 ml RBC/kg compared to 4.8+/-2.3 ml RBC/kg (nonsignificant) in iron-replete patients due to endogenous EPO (placebo group) stimulation. EPO-treated iron-depleted patients produced 20% less RBC than iron-replete patients (8.23+/-3.3 vs. 10. 2+/-4.0, p = 0.066). RBC volume expansion correlated with initial storage iron only in iron-replete patients who received EPO therapy.
Initial storage iron status is a marginally important limitation to EPO-mediated erythropoiesis in the setting of oral iron supplementation. Strategies to maintain plasma transferrin saturation with intravenous iron therapy may be desirable to improve the erythropoietic response to EPO in this setting.
Vox Sanguinis 02/1998; 75(2):128-33. · 2.86 Impact Factor
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ABSTRACT: We studied whether orthopedic surgical patients with rheumatoid arthritis (RA) can generate an erythropoietic response to either endogenous erythropoietin or to recombinant human erythropoietin (EPO) therapy to the same extent as patients without rheumatoid arthritis (non-RA). Seventy patients (10 RA, 60 non-RA) were entered into clinical trials of aggressive autologous blood donation before elective orthopedic surgery at one institution, randomized to receive EPO (600 U/kg, iv, 6 times over 3 weeks) or placebo. RA patients given EPO had red blood cell (RBC) production that was enhanced by 624 +/- 137 ml (mean +/- SD) as compared with 271 +/- 174 ml (p = 0.02) for RA patients given placebo treatment. Preoperative RBC volume expansion in 10 RA patients was 5.9 +/- 3.7 ml/kg as compared with 7.4 +/- 3.9 ml/kg for 60 non-RA patients (p = 0.13). RA patients can benefit to the same extent as non-RA patients from aggressive blood conservation programs that incorporate erythropoietin-modulated erythropoiesis.
Journal of Laboratory and Clinical Medicine 11/1997; 130(4):381-6. · 2.62 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the treatment of fractures of the proximal fifth metatarsal at the junction of the metaphysis and diaphysis (i.e., Jones fracture) in diabetics. Open reduction and internal fixation with bone grafting resulted in clinical and radiographic union 8 weeks after surgery in patients treated with either immediate or delayed open reduction and internal fixation. Open reduction and internal fixation with autologous bone grafting is an effective treatment regimen in the diabetic patient with a Jones fracture. An initial trial of casting can be attempted without any apparent deleterious effects on secondary open reduction and internal fixation.
The Foot and Ankle Online Journal 10/1996; 17(9):559-62. · 1.22 Impact Factor
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ABSTRACT: An arthroscopic method for the treatment of osteochondritis dissecans lesions in the knee is described. The technique involves using autogenous bone pegs for arthroscopic transfixion of femoral osteochondritis dissecans (OCD) lesions. The method represents a simple biological alternative for arthroscopic fixation of OCD lesions.
Arthroscopy The Journal of Arthroscopic and Related Surgery 09/1996; 12(4):506-9. · 3.02 Impact Factor
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ABSTRACT: Avascular necrosis (AVN) of the femoral head after a traumatic posterior hip dislocation (Thompson and Epstein type I) has been hypothesized to occur due to changes in blood flow. However, to the best of our knowledge of the English literature, a human cadaveric angiographic study has never been performed to delineate these vascular changes. Six fresh frozen human cadavers were used to examine the effects of posterior hip dislocation on the extraosseous and intraosseous blood supply to the femoral head and neck. After a forceful posterior hip dislocation was performed on the cadavers, the proximal vessels were injected with a radioopaque colored latex liquid polymer (Microfil) and examined under cinefluoroscopy. The contra lateral hips were used as controls and were examined in a similar manner. Both hips of the cadavers were harvested, and a macroscopic and microscopic examination was performed. The cine-fluoroscopic examination delineated the dynamic effects of posterior dislocation on the surrounding vasculature. Filling defects were most notable at the junction of the external iliac and common femoral arteries. Filling defects were also present in the circumflex vessels. Compared to controls, the common femoral and circumflex vessel filling defects were statistically significant (p < 0.004). These defects were secondary to an apparent stretching and twisting of the artery caused by the pull and rotation of the dislocated hip. A number of collateral vessels from the gluteal arteries were also demonstrated on fluoroscopic examination. The macro and microscopic examination did not show a qualitative or a quantitative difference in the amount of latex present in the dislocated and control groups. Based on the results of this study, changes in the extraosseous blood flow to the dislocated hip do occur. The vessels that appear to be most affected by the dislocation are the common femoral and circumflex vessels. However, these extraosseous changes do not consistently result in changes in the intraosseous blood flow possibly due to collateral circulation. Relocating the femoral head in a traumatic posterior hip dislocation may provide earlier blood flow to the femoral head by relieving tension across the femoral and circumflex vessels. Delayed relocation could contribute to the development of AVN in the femoral head by not only inducing immediate ischemia at the time of injury but by also producing a progressive and delayed form of arterial damage in the femoral and circumflex vessels. AVN may not be an absolute outcome of posterior hip dislocations due to preexisting collateral circulation and/or the preservation of the femoral circumflex vessels.
Journal of Orthopaedic Trauma 02/1996; 10(7):447-54. · 2.13 Impact Factor
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ABSTRACT: The relationship between patient hematocrit level, red blood cell volume lost, and blood units transfused is important in determining conservation strategies in patients undergoing total knee replacement surgery. In a series of 30 such patients, 3 (10%) received allogeneic blood, despite preoperative autologous blood donation in 28 patients. There was no evidence that the degree of anemia affected rate or volume of postoperative wound blood drainage. The wound drainage volume that could have been salvaged and reinfused in bilateral procedures was substantial. A combination of one or more conservation techniques along with conservative transfusion practice is necessary to achieve minimal allogeneic blood exposure.
The American journal of knee surgery 02/1995; 8(3):83-7.
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ABSTRACT: As the result of the institution of coordinated programs involving regional blood centers, hospital blood banks, information services, and physicians, preoperative autologous blood donation, a previously underutilized practice, has become a standard of care in a number of elective surgical procedures. In addition, the administration of recombinant human erythropoietin has been shown to facilitate the collection of autologous blood from patients scheduled for elective orthopaedic surgery. An analysis of the findings in a study of 263 orthopaedic surgical patients in which the relationship between autologous blood ordering, collection and storage, and subsequent blood transfusion was studied indicates that both blood ordering and blood procurement practices are significant factors with regard to allogeneic blood exposure.
Contemporary orthopaedics 01/1995; 29(6):430-4.
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ABSTRACT: Recombinant human erythropoietin (EPO) therapy has been known to enhance erythropoiesis and facilitate autologous blood donation before elective orthopedic operations. However, the optimal EPO dose in this setting remains undefined. To help determine this, we have examined the effect of patient weight and EPO dose on red blood cell (RBC) volume expansion.
Forty-six nonanemic autologous blood donors enrolled at our institution in two previously reported multicenter clinical trials were analyzed. Patients received either placebo or EPO (150, 300, or 600 units [U] per kg) given intravenously at each of six AB blood type donation visits.
Total preoperative RBC volume expansion over a 22 day period was 465 +/- 135 mL (mean +/- SD) in patients receiving a placebo and 588 +/- 201 mL, 735 +/- 144 mL, and 881 +/- 292 mL in patients receiving graded concentrations of EPO. When RBC volume increase was corrected for patient weight and EPO dose, patients receiving placebo or EPO (150, 300, and 600 U per kg) expanded RBC volume by 5.9 mL per kg in patients receiving placebo and 7.9, 9.1, and 10.9 mL per kg in patients receiving EPO, respectively (p < 0.02 for each EPO group compared with placebo group). A direct relationship between EPO dose and RBC volume increase (response) over 22 days was determined by the linear regression equation: RBC volume (mL per kg) = 6.34 + 0.0013X, r = 0.98, where X equals total units EPO administered (per kg body weight).
We conclude that EPO dose can be based on anticipated blood losses and transfusion needs in autologous blood donors before orthopedic operation.
Journal of the American College of Surgeons 08/1994; 179(2):171-6. · 4.55 Impact Factor
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ABSTRACT: Autologous blood predeposit is a widely used transfusion practice that has become a standard of care for elective orthopedic operation. Despite the support for this practice, there are limitations in the use and efficacy of autologous blood programs. This study is a prospective analysis of 385 orthopedic patients in whom a type and crossmatch were requested in which 249 patients predonated autologous blood and 136 patients did not. Preoperative anemia, blood lost and the "transfusion trigger" were evaluated for each of these patients. We conclude that the prevalence of anemia (25 percent) and rate of homologous blood exposure (25 percent) in autologous blood donors indicate a need for innovative blood conservation strategies to minimize homologous blood transfusion in this patient subgroup; the high prevalence of anemia (39 percent) and the homologous blood exposure (49 percent) in patients who did not donate autologous blood demonstrate a need for early recognition and treatment to procure autologous blood and reduce homologous blood exposure in these patients. The procurement of three to eight autologous blood units, along with the regeneration of a erythrocyte volume of 8 to 12 milliliters per kilogram, would avoid homologous blood transfusion in 95 percent of the patients in this setting.
Surgery, gynecology & obstetrics 04/1993; 176(3):235-8.
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ABSTRACT: To address the potential role of innovative blood conservation interventions in nonelective surgery, we reviewed blood transfusions and blood losses during hospitalization of patients undergoing open reduction internal fixation of an intratrochanteric hip fracture. Sixty-four orthopaedic patients consecutively admitted over a 3-year interval were analyzed for transfusion needs by calculating red blood cell (RBC) volume lost during hospitalization. Overall, 39 (61%) patients received blood. We found that the "transfusion-trigger" was higher for females compared to males. Fifteen (23%) of 64 patients were identified to have been transfused with RBC volumes in excess of RBC volumes lost. The remaining 49 patients determined to be untransfused or to be transfused appropriately received 1.4 +/- 2.1 blood units (M +/- SD). Of these, 30 (60%) received < or = 1 U. We found no evidence that patients who received blood transfusions in excess of blood losses benefited compared to those whose blood replacement was less than blood lost. We conclude that innovative blood conservation interventions such as recombinant human erythropoietin (EPO) therapy can be incorporated into this nonelective surgical setting and may permit a significant percentage of hip fracture patients to avoid homologous blood transfusion. An algorithm for physician education programs that can address blood transfusion practices is provided so that patients can benefit from new blood conservation approaches.
Journal of Orthopaedic Trauma 01/1993; 7(1):47-51. · 2.13 Impact Factor
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ABSTRACT: Autologous blood predeposit before elective surgery is a rapidly expanding transfusion practice. A 3-year analysis of an autologous blood predeposit program was conducted to assess its impact on orthopaedic spine surgery. It was concluded that, first, autologous blood donation has resulted in a reduction of homologous blood transfusions in patients undergoing elective spine procedures from 26% to 13% (P = .02). Second, autologous blood preoperative donation in elective spine surgery has increased significantly, so that autologous blood as an alternative to homologous blood transfusion now represents a standard of practice for elective spine surgery at the institution included in the study. Third, limitations of preoperative autologous blood procurement suggest that application of additional blood conservation interventions as alternatives to homologous blood would be important contributors to achieving "bloodless" surgery in this setting.
Spine 03/1992; 17(2):172-5. · 2.08 Impact Factor
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ABSTRACT: Autologous blood predeposit before elective surgery is a rapidly expanding transfusion practice. The authors have conducted a 3-year analysis of an autologous blood predeposit program to assess its impact on orthopaedic joint surgery. The authors conclude: autologous blood donation has resulted in a reduction of homologous blood transfusions in patients undergoing elective hip and knee procedures from 73% to 18% and from 71% to 12%, respectively. In addition, autologous blood preoperative donation in elective orthopaedic joint surgery has increased dramatically, so that while previously this practice was considered underutilized, autologous blood as an alternative to homologous blood transfusion now represents a standard of practice for elective orthopaedic joint arthroplasty at University Hospitals of Cleveland.
The Journal of Arthroplasty 02/1990; 5 Suppl:S89-94. · 2.38 Impact Factor
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ABSTRACT: We have conducted a retrospective 3-year analysis of our autologous blood donation program to assess its impact on orthopaedic surgery. We conclude: (1) utilization has increased from less than 5% of eligible patients in the first audit interval to nearly 50% in the last audit interval; (2) in the last audit interval, autologous blood donation resulted in a reduction of homologous blood transfusion from 41% in nonautologous blood patients to 14% in autologous blood donors; (3) increasingly conservative transfusion practice is seen for all patients undergoing elective orthopaedic surgery; (4) regional blood centers are responding to increasing requests for autologous blood with programs that are effective in attracting autologous blood donors; (5) on the basis of utilization and efficacy, preoperative autologous blood donation as an alternative to homologous blood transfusion now represents a standard of practice for elective orthopaedic surgery.
Vox Sanguinis 02/1990; 59(2):65-9. · 2.86 Impact Factor
