Blood Management for Hip Reconstruction Surgery

Introduction The article is a literature review focusing on reconstruction surgery for dislocated hips in children with cerebral palsy (CP). Material and methods Publications in Scopus, PubMed, RSCI indexed journals over the past 20 years were reviewed for hip dislocation in children with CP. Results and discussion The article discusses the prevalence of the orthopaedic complication of cerebral palsy, pathogenesis, diagnosis, indications to surgery, choice of surgical technique, early rehabilitation and long-term outcomes. A report made for the first educational meeting of the European Pediatric Orthopaedic Society held in Russia at the Ilizarov Center in 2021 was used for the contribution. Conclusion Surgical treatment is indicated for hip dislocation in children with CP using holistic approach and principles of single-event multilevel surgery that suggest hip reconstruction, addressing contractures and deformities of the subjacent segments and creating conditions for postoperative postural management. Standardized indications, patient selection and optimal time for intervention are to be carefully considered for the procedure with the use of customized orthopaedic implants and techniques.

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Foam splint versus spica cast - Early mobilization after hip reconstructive surgery in children - A prospective randomized clinical trial

10.21203/rs.2.19029/v1 ◽

2019 ◽

Author(s):

Lorenz Pisecky ◽

Gerhard Großbötzl ◽

Jakob Allerstorfer ◽

Thomas Bruckner ◽

Axel Horsch ◽

...

Keyword(s):

Clinical Trial ◽

Clinical Trials ◽

Children And Adolescents ◽

Hip Joint ◽

Reconstructive Surgery ◽

Spica Cast ◽

Hip Reconstruction ◽

Prospective Randomized Clinical Trial ◽

Reconstruction Surgery ◽

Pediatric Orthopaedics

Abstract Background Surgical hip joint reconstruction is the method of choice for children and adolescents with developmental dysplasia of the hip (DDH). After surgery, immobilization using a spica cast is considered to be the gold standard for preventing redislocation of the hip, dehiscence of the tightened hip joint capsule or secondary dislocation of the osteotomy. Neverthess, spica cast treatment may cause complications like hygiene problems, skin lesions, neurological deficits and rigidity of the adjacent joints. An alternative for postoperative immobilization is a foam splint. The purpose of this randomized controlled trial is to compare spica cast and foam splint immobilization after hip reconstruction in children and adolescents with DDH. The hypothesis of this study is, that foam splint immobilization leads to a higher satisfaction during postoperative aftercare in the patients and their caretakers. A further intent of the study is to analyse the complications occurring under the immobilization. Methods In a prospective randomized clinical trial children and adolescents (age: 4-14 years), who were diagnosed with DDH and received hip reconstruction surgery were included. Patient recruitment, group allocation, surgery and aftercare will be carried out at the Department for Department for Orthopedics and Traumatology, Kepler University Hospital, Linz, Austria. The approval of this study was granted by the local ethics committee (EK1183/2018) and a written informed consent will be obtained from each patient or his legal representative before start of the study. The study is funded by the Medical Society of Upper Austria and registered in the German Clinical Trials Register (DRKS-ID: DRKS00016861). A standardized questionnaire (SF-36, EQ-5D, CPCHILD) as well as a radiological assessment is gathered before, six and twelve weeks after surgery. Statistical methods are epidemiological calculations, analysis of covariance, t-test, chi-square test and graphical methods for visualisation. Power analysis showed a minimum optimum sample size of 15 individuals per group (t-test, two-sided, Cohen d 1.1, alpha=0.05, 1-beta=0.80). Discussion Recent retrospective studies suggest that foam splint immobilization after hip reconstruction surgery is a safe and feasible method, promising fewe complications rates compared to spica casting. Nevertheless, no prospective randomized clinical trials have been published to prove the promised and suspected benefits of foam splints compared to spica cast immobilization. Clinical trials on children, especially with physical and mental disorders, need to be planned with rigorous care for general ethics and legal rights. Advice from ethical review committees, self-help groups and legal advisers is mandatory. The presented clinical trial was planned under such strict standards and meets ethical and legal criteria. The results of this clinical trial will be published in national and international meetings for pediatric orthopaedics as well as in international journals for pediatric orthopaedics. The aim is to provide profound criteria for the usage of a foam splint instead of casting in immobilization after hip reconstructive surgery. Benefits for the patients may be fewer complications and no need for a second anaesthesia for recasting. Up to now, a comparable study does not exist.

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Controversies in the Clinical Practice of Patient Blood Management

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.11.020 ◽

2020 ◽

Author(s):

Daniel Bolliger ◽

Joachim M. Erb ◽

Andreas Buser

Keyword(s):

Clinical Practice ◽

Patient Blood Management ◽

Blood Management

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Patient Blood Management in der Orthopädie und Unfallchirurgie

Orthopädie und Unfallchirurgie up2date ◽

10.1055/a-0945-2550 ◽

2020 ◽

Vol 15 (03) ◽

pp. 239-255

Author(s):

Lea Valeska Blum ◽

Hendrik Kohlhof ◽

Dieter Wirtz ◽

Kai Zacharowski ◽

Patrick Meybohm

Keyword(s):

Patient Blood Management ◽

Blood Management ◽

Orthopädie Und Unfallchirurgie

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Blood Management in Total Knee Arthroplasty: A Nationwide Analysis from 2011 to 2018

The Journal of Knee Surgery ◽

10.1055/s-0040-1721414 ◽

2020 ◽

Author(s):

Jared A. Warren ◽

John P. McLaughlin ◽

Robert M. Molloy ◽

Carlos A. Higuera ◽

Jonathan L. Schaffer ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Platelet Count ◽

Knee Arthroplasty ◽

Categorical Variables ◽

Bleeding Disorders ◽

Blood Management ◽

Improvement Program ◽

Preoperative Anemia ◽

High Incidence ◽

Total Knee

AbstractBoth advances in perioperative blood management, anesthesia, and surgical technique have improved transfusion rates following primary total knee arthroplasty (TKA), and have driven substantial change in preoperative blood ordering protocols. Therefore, blood management in TKA has seen substantial changes with the implementation of preoperative screening, patient optimization, and intra- and postoperative advances. Thus, the purpose of this study was to examine changes in blood management in primary TKA, a nationwide sample, to assess gaps and opportunities. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify TKA (n = 337,160) cases from 2011 to 2018. The following variables examined, such as preoperative hematocrit (HCT), anemia (HCT <35.5% for females and <38.5% for males), platelet count, thrombocytopenia (platelet count < 150,000/µL), international normalized ration (INR), INR > 2.0, bleeding disorders, preoperative, and postoperative transfusions. Analysis of variances were used to examine changes in continuous variables, and Chi-squared tests were used for categorical variables. There was a substantial decrease in postoperative transfusions from high of 18.3% in 2011 to a low of 1.0% in 2018, (p < 0.001), as well as in preoperative anemia from a high of 13.3% in 2011 to a low of 9.5% in 2016 to 2017 (p < 0.001). There were statistically significant, but clinically irrelevant changes in the other variables examined. There was a HCT high of 41.2 in 2016 and a low of 40.4 in 2011 to 2012 (p < 0.001). There was platelet count high of 247,400 in 2018 and a low of 242,700 in 201 (p < 0.001). There was a high incidence of thrombocytopenia of 5.2% in 2017 and a low of low of 4.4% in 2018 (p < 0.001). There was a high INR of 1.037 in 2011 and a low of 1.021 in 2013 (p < 0.001). There was a high incidence of INR >2.0 of 1.0% in 2012 to 2015 and a low of 0.8% in 2016 to 2018 (p = 0.027). There was a high incidence of bleeding disorders of 2.9% in 2013 and a low of 1.8% in 2017 to 2018 (p < 0.001). There was a high incidence of preoperative transfusions of 0.1% in 2011 to 2014 and a low of <0.1% in 2015 to 2018 (p = 0.021). From 2011 to 2018, there has been substantial decreases in patients receiving postoperative transfusions after primary TKA. Similarly, although a decrease in patients with anemia was seen, there remains 1 out 10 patients with preoperative anemia, highlighting the opportunity to further improve and address this potentially modifiable risk factor before surgery. These findings may reflect changes during TKA patient selection, optimization, or management, and emphasizes the need to further advance multimodal approaches for perioperative blood management of TKA patients. This is a Level III study.

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