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Aim: The rejection rate of autologous blood donation before joint replacement is high. The influence of the haemoglobin value and the age of patient before autologous blood donation was examined according to the necessity for blood transfusion., Method: In a retrospective study, the data of 233 patients who had donated autologous blood before hip (THR) or knee arthroplasty (TKR) were analysed., Results: 72 patients (30.9 %) received an autologous blood transfusion during surgery or in the further course until the first day after surgery. A multivariate analysis showed no significant influence of age on the need for transfusions (p = 0.093), but a higher haemoglobin value before blood donation reduced the risk significantly to 0.712 per unit (1 g/dl). Therefore the age of the patient was less predictive compared to the haemoglobin value as to whether or not a blood transfusion had been necessary., Conclusion: The high security of homologous blood reached in the last years and the knowledge that autologous blood donation reduces the haemoglobin value before surgery has led to the procedure in our hospital only to perform autologous blood donation at the explicit request of the patient.

Aim: Preoperative autologous blood donation before joint replacement has become standard practice. However, this procedure is discussed controversially regarding medical benefit and cost-effectiveness., Method: In a retrospective study the data of 994 patients scheduled for hip (THR) or knee arthroplasty (TKR) between 1/2000 and 9/2002 were analysed., Results: Altogether 612 patients donated autologous blood (61.6 %). 50.2 % of the patients got blood transfusions during surgery or in the course of their hospitalisation. Donors received blood units more often than non-donors (55.2 vs. 41.9 %). On average 1.4 +/- 1.7 blood units were given during or after THR and 0.8 +/- 1.1 units during or after TKR. Clear predispositions for an increased use of blood transfusions were cemented endoprosthesis, old age (> 70 years) as well as exclusive general anaesthesia. Since 57.8 % of the blood units were wasted, the additional expenses (only laboratory and material costs were calculated) for each retransfused autologous blood unit were calculated to be 28.76., Conclusion: Besides saving homologous blood, autologous blood donation causes mainly an increased probability of giving transfusions and higher costs. Therefore autologous blood donation should be indicated more critically, especially in younger patients and knee replacements.

Aim: The type and frequency of side effects due to treatment of vertebral pain syndromes with local injections were examined. Risks and complications were evaluated and precautions are presented in order to avoid these problems., Methods: The medical records of 453 patients who had undergone injection therapy in hospital for spinal pain syndromes were investigated retrospectively., Results: Paravertebral injections with cervical and lumbar spinal nerve analgesia, facet joint injections, lumbar epidural-perineural injections, epidural-dorsal and epidural-sacral injections, and injections next to the ileosacral joint were administered, amounting to a total of 7 963 injections. In 25 cases (0.3 %) unfavourable side effects were observed. Epidural-perineural injections led to headache in 10 cases and paravertebral lumbar nerve analgesia in 3 cases. Five times after epidural-perineural injections circulatory dysregulation with vertigo, nausea and decreased blood pressure was observed. One patient fell after an epidural-perineural injection, and one patient developed a sensory block up to the thoracic segment 6. Five patients showed local allergic reactions at the injection site after Mepivacain. All complications could be treated with simple symptomatic measures and had no severe effects., Conclusion: Compared to other studies, only few side effects were observed. The injections described above may thus be regarded as low-risk therapy.

Objective: This retrospective study was designed to evaluate mid-term results of patients after surgical treatment of rotator-cuff-tears by means of clinical and ultrasonographical examination with special regard to factors influencing the prognosis., Method: 126 patients were examined clinically and ultrasonographically at a mean postoperative period of 37 months after surgery for rotator cuff lesions. A conservative therapy failed to be successful for at least 3 months before. All patients received an open decompression of the subacromial space, 68.6% of the patients received an additional reconstruction of the rotator cuff. The results were evaluated by use of the Constant-Score. The ultrasonographical examination was performed according to the technique described by Hedtmann., Results: 69% of the patients showed good and excellent results. The mean Constant-Score was 81.4% of the age- and sex-related normal values. Patients with lesions extending more than 3 cm did significantly worse than those with smaller ruptures (Constant-Score: 74.2% vs. 90.6%). An involvement of the subscapularis-tendon was related with bad results. A rerupture was seen ultrasonographically in 17.3% of the patients., Conclusion: Regarding strict criteria of evaluation almost 70% of our patients not responding to conservative treatment achieved good and excellent results after surgery. Smaller lesions and tears solely involving the supraspinatus-tendon were associated with a better prognosis. Ultrasonography allows a reliable examination of the rotator-cuff-anatomy postoperatively performed, too.

Synovial tissue from 37 patients suffering from osteoarthritis, chondrocalcinosis, active and inactive rheumatoid arthritis was investigated. The tissue was obtained during knee surgery and immediately incubated in tyrode solution. PGE2, 6-keto-PGF1 alpha, LTB4 and LTC4 were measured by radioimmunoassay. Calcium ionophore A 23187 stimulated the eicosanoid release significantly. This effect was more pronounced with LT than with PG. In the four different joint diseases there was no significant difference in the PG release. The LTC4 release was significantly lower in inactive rheumatoid arthritis as compared to the other joint diseases. For LTB4 this effect was significant only when compared to osteoarthritis. Indomethacin 10(-5) and 10(-7)mol/l inhibited the PG release from synovial tissue in all joint diseases significantly (p less than 0.05), there was no significant effect on the LT release. LT as well as PG are pro-inflammatory mediators. Non-steroidal anti-inflammatory drugs inhibit only the PG release. The remaining LT synthesis might thus be partially responsible for the lack of efficacy of these drugs in some patients.