Intraoperative autotransfusion in reconstructive hip joint surgery of patients with rheumatoid arthritis and ankylosing spondylitis

Intraoperative cell salvage in revision hip arthroplasty

Aims

The aim of this study was to perform a systematic review of the evidence for the use of intraoperative cell salvage in patients undergoing revision hip arthroplasty, and specifically to analyze the available data in order to quantify any associated reduction in the use of allogenic blood transfusion, and the volume which is used.

Methods

An electronic search of MEDLINE (PubMed), Embase, Scopus, and the Cochrane Library was completed from the date of their inception to 24 February 2022, using a search strategy and protocol created in conjunction with the PRISMA statement. Inclusion criteria were patients aged > 18 years who underwent revision hip arthroplasty when cell salvage was used. Studies in which pre-donated red blood cells were used were excluded. A meta-analysis was also performed using a random effects model with significance set at p = 0.05.

Results

Of the 283 studies which were identified, 11 were included in the systematic review, and nine in the meta-analysis. There was a significant difference (p < 0.001) in the proportion of patients requiring allogenic transfusion between groups, with an odds ratio of 0.331 (95% confidence interval (CI) 0.165 to 0.663) associated with the use of cell salvage. For a total of 561 patients undergoing revision hip arthroplasty who were treated with cell salvage, 247 (44.0%) required allogenic transfusion compared with 418 of 643 patients (65.0%) who were treated without cell salvage. For those treated with cell salvage, the mean volume of allogenic blood which was required was 1.95 units (390 ml) per patient (0.7 to 4.5 units), compared with 3.25 units (650 ml) per patient (1.2 to 7.0 units) in those treated without cell salvage. The mean difference of -1.91 units (95% CI -4.0 to 0.2) in the meta-analysis was also significant (p = 0.003).

Conclusion

We found a a significant reduction in the need for allogenic blood transfusion when cell salvage was used in patients undergoing revision hip arthroplasty, supporting its routine use in these patients. Further research is required to determine whether this effect is associated with types of revision arthroplasty of differing complexity.

Calprotectin (the L1 protein) during surgery in patients with rheumatoid arthritis

Calprotectin (L1) is a major leukocyte protein which is released during activation or death of neutrophil granulocytes and monocytes. Previous studies have shown that L1 may be a useful marker of disease activity in patients with adult or juvenile rheumatoid arthritis (RA). In the present study, the plasma concentrations of L1 were analysed during shoulder-joint surgery in 16 patients with adult or juvenile RA. Decreased L1 concentrations were found 48 h postoperatively. Thereafter, the L1 concentrations were increased at 72 h, with a following decrease until day 14 postoperatively. In contrast, increased serum concentrations of both C-reactive protein (CRP) and orosomucoid (i.e. alpha 1-acid glycoprotein) were found at 48 h after surgery. Plasma samples obtained before and after surgery were analysed by gel filtration. Approximately 3/4 of the plasma L1 was found in fractions corresponding to the native molecule, while the rest was detected in higher molecular mass fractions. The distribution of L1 antigen in low and high molecular mass regions did not differ between the pre- and postoperative plasma samples. The L1 protein consists of light and heavy chains. Increased serum levels of the cystic fibrosis antigen, which is identical to L1 light chain, have been described in patients with cystic fibrosis. The existence of circulating free L1 chains was presently investigated in plasma obtained before and after surgery. After gel filtration of plasma samples, no free L1 chains were detected by use of enzyme immunoassay and dot blot.