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Vrontis K, Tsinaslanidis G, Drosos GI, Tzatzairis T. Perioperative Blood Management Strategies for Patients Undergoing Total Hip Arthroplasty: Where Do We Currently Stand on This Matter? THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:646-655. [PMID: 33313343 DOI: 10.22038/abjs.2020.45651.2249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Total hip replacement (THR) has proved to be a reliable treatment for the end stage of hip osteoarthritis. It is a common orthopaedic procedure with excellent results, but is associated with significant blood loss and high rates of allogeneic blood transfusion (ABT). The potential complications and adverse events after ABT, combined with the ongoing research, have resulted in multimodel, multidisciplinary blood management strategies adoption, aiming to reduce the blood loss and transfusion rates. Many reviews and meta-analyses have tried to demonstrate the best blood management strategies. The purpose of this study is to review any evidence-based blood conserving technique, dividing them in three stages: preoperative, intraoperative and postoperative.
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Affiliation(s)
| | | | - Georgios I Drosos
- Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Dragana, Greece
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Henze K, Herten M, Haversath M, Busch A, Brandau S, Hackel A, Flohé SB, Jäger M. Surgical vacuum filter-derived stromal cells are superior in proliferation to human bone marrow aspirate. Stem Cell Res Ther 2019; 10:338. [PMID: 31753037 PMCID: PMC6868799 DOI: 10.1186/s13287-019-1461-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 01/11/2023] Open
Abstract
Background During joint replacement, surgical vacuum suction guarantees a sufficient overview on the situs. We assume high concentrations of mesenchymal stromal cells (MSCs) on surgical vacuum filters. We compared the in vitro proliferative and differentiation potency of cells from the following: (i) bone marrow (BM), (ii) cancellous bone (CB), (iii) vacuum filter (VF), and (iv) cell saver filtrate reservoir (SF) in 32 patients undergoing elective total hip replacement. Methods Mononuclear cells (MNC) were isolated, and cell proliferation and colony-forming units (CFU) were measured. Adherent cells were characterized by flow cytometry for MSC surface markers. Cells were incubated with osteogenic, adipogenic, and chondrogenic stimuli. Cells were cytochemically stained and osteoblastic expression (RUNX-2, ALP, and BMP-2) investigated via qPCR. Results Dependent on the source, initial MNC amount as well as CFU number was significantly different whereas generation time did not vary significantly. CFU numbers from VF were superior to those from SR, BM, and CB. The resulting amount of MSC from the respective source was highest in the vacuum filter followed by reservoir, aspirate, and cancellous bone. Cells from all groups could be differentiated into the three mesenchymal lines demonstrating their stemness nature. However, gene expression of osteoblastic markers did not differ significantly between the groups. Conclusion We conclude that surgical vacuum filters are able to concentrate tissue with relevant amounts of MSCs. A new potent source of autologous regeneration material with clinical significance is identified. Further clinical studies have to elucidate the regenerative potential of this material in an autologous setting.
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Affiliation(s)
- Katharina Henze
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Monika Herten
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Marcel Haversath
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - André Busch
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Sven Brandau
- Department of Otorhinolaryngology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Alexander Hackel
- Department of Otorhinolaryngology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Stefanie B Flohé
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany. .,Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Duisburg Essen & St. Marien Hospital Mülheim an der Ruhr / Contilia, Kaiserstrasse 50, 45468, Mülheim/Ruhr, Germany.
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Nunes NG, Oliveira JAA, Bezerra FMP, Nascimento VDD, Dumaresq DMH, Patrocinio MCA. Is Intraoperative Blood Cell Salvage Effective in Hip Surgery? Rev Bras Ortop 2019; 54:377-381. [PMID: 31435101 PMCID: PMC6702029 DOI: 10.1055/s-0039-1693054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022] Open
Abstract
Objective
The present study aims to evaluate the efficacy of blood cell salvage (CS) as a method of reducing allogeneic blood transfusion in patients submitted to transtrochanteric femoral and hip surgeries due to injury.
Methods
Prospective cohort of 38 patients from a school hospital submitted to hip or trochanteric surgeries and divided into two groups from August 2015 to February 2017. Patients with any malignancy or infectious condition were excluded from the study. Cell savage group (19 patients) received autologous blood using cell saver, whereas control group (19 patients) received just allogeneic blood, if needed. Red blood cell parameters, blood transfusion requirements, and clinical and surgical characteristics, such as age, gender, ASA scale and type of surgery, were compared both preoperatively and postoperatively. Data was processed in SPSS 20.0.
Results
There were no differences in the clinical parameters studied (age, gender and ASA scale). Red blood cell parameters on the first day postoperative were higher in the cell savage group (
p
< 0.05). No significant reduction of intraoperative and postoperative allogeneic blood transfusion requirements was found.
Conclusion
This study found that CS was not effective in reducing intraoperative and postoperative allogeneic blood transfusion requirements in patients submitted to transtrochanteric femoral and hip surgery.
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Affiliation(s)
- Nara Granja Nunes
- Serviço de Anestesiologia, Instituto Dr. José Frota, Fortaleza, CE, Brasil
| | - José Alberto Alves Oliveira
- Serviço de Ortopedia e Traumatologia, Hospital Infantil Albert Sabin, Hospital Geral de Fortaleza, Fortaleza, CE, Brasil
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Duramaz A, Bilgili MG, Bayram B, Ziroğlu N, Edipoğlu E, Öneş HN, Kural C, Avkan MC. The role of intraoperative cell salvage system on blood management in major orthopedic surgeries: a cost-benefit analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:991-997. [PMID: 29214459 DOI: 10.1007/s00590-017-2098-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/30/2017] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The aim of this study was to compare the efficiency and cost of cell salvage systems with allogeneic blood transfusions in patients who had major elective orthopedic surgeries. MATERIALS AND METHODS Consecutive 108 patients who had intraoperative cell saver (CS) performed routinely constitute the study group. In control group, consecutive 112 patients who were operated without intraoperative CS were investigated. Hemoglobin (Hb) level less than 8 mg/dL was regarded as the absolute transfusion indication. The patients were evaluated for age, gender, body mass index, operation period, mean intraoperative estimated blood loss (EBL), postoperative hemovac drainage volume; preoperative, postoperative first day and discharge Hb levels, allogeneic blood transfusion (ABT) volume, hospitalization and cost parameters. RESULTS The mean intraoperative EBL was 507 mL in the study group and 576 mL in control group. The mean ABT was 300 mL in the study group and 715 mL in control group. In the study group, intraoperative EBL, ABT usage and hospitalization period were significantly lower compared with the control group (p = 0.009, p = 0.000 and p = 0.000; p < 0.05, respectively). The mean cost was 771 Turkish liras (TL) in the study group and 224 TL in control group. In the study group, the cost was significantly higher than the control group (p = 0.000). The postoperative first day Hb level was significantly higher in the study group (p = 0.010). CONCLUSION Although CS usage was determined to increase the costs in this study, it significantly decreases intraoperative and postoperative ABT requirements. We believe that the increase in cost may be neglected when the complications and prolonged hospitalization due to ABT usage were regarded.
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Affiliation(s)
- Altuğ Duramaz
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey.
| | - Mustafa Gökhan Bilgili
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Berhan Bayram
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Nezih Ziroğlu
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Erdem Edipoğlu
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Halil Nadir Öneş
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Cemal Kural
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Mustafa Cevdet Avkan
- Department of Orthopedics and Traumatology, Avrasya Hospital, Hekimsuyu St. Number 26/34, Küçükköy, 34255, Gaziosmanpaşa, Istanbul, Turkey
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