***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Purpose . To compare the use of a blood salvage and reinfusion system with st and ard allogeneic blood transfusion  after total knee arthroplasty — a procedure associated with significant postoperative blood loss . Methods . Between June 2002 and May 2004 , 60 patients undergoing total knee arthroplasty were r and omly allocated into a reinfusion group ( n=26 ) or a control group ( n=34 ) . Patients in the reinfusion group had their blood reinfused from drains within 6 hours of surgery . Both groups received allogeneic blood transfusions according to specified transfusion criteria if the haemoglobin level fell below 90 g/l , or in the presence of severe anaemic symptoms . Haemoglobin levels and drain output were recorded daily for 3 consecutive days after surgery . Results . There was no significant difference between the 2 groups in demographic data , drain output , total blood loss , and mean postoperative haemoglobin levels . Significantly more allogeneic blood was required by the control group than by the reinfusion group ( p=0.022 ) . Conclusion . Postoperative reinfusion of drained blood reduced the need for blood transfusion after total knee arthroplasty , while having an effect on postoperative haemoglobin level equivalent to st and ard allogeneic blood transfusion Background : A phase-III trial that included fifty-three patients undergoing unilateral primary total knee arthroplasty with cement was conducted to investigate the hemostatic efficacy of fibrin sealant . Methods : Following cementing of the joint , 10 mL of fibrin sealant was sprayed onto the wound before tourniquet deflation and wound closure . No placebo was used in the control group . All patients received drains . Results : Within twelve hours after the surgery , the amount of bloody drainage was 184.5 ± 28.9 mL ( mean and st and ard error ) in the fibrin-sealant group ( information available for twenty-three patients ) and 408.3 ± 54.6 mL in the control group ( information available for twenty-three patients ) ( p = 0.002 , after adjustment for variance in the time that the drainage was measured ) . On the first postoperative day , the hemoglobin level had decreased by 20.1 ± 2.1 g/L in the fibrin-sealant group ( information available for twenty-two patients ) and by 27.3 ± 2.1 g/L in the control group ( information available for twenty-four patients ) . After adjustment for baseline values , the decrease in the hemoglobin level was 28.9 % less in the fibrin-sealant group than in the control group ( p = 0.005 , 95 % confidence limits = 10.2 , 43.7 ) . There were no seroconversions in the fibrin-sealant group . Conclusion : These results suggest that fibrin sealant can safely reduce bloody drainage following total knee arthroplasty while maintaining higher hemoglobin levels A series of 40 patients undergoing primary unilateral total knee arthroplasty were entered into a r and omised controlled trial to assess the safety and efficacy of postoperative autologous blood salvage and reinfusion . The mean volume of autologous blood reinfused was 520 ml per patient ( 51 % of the mean total drainage ) .  Homologous blood transfusion  was required in only 35 % of patients in the study group compared with 95 % of patients in the control group ( P less than 0.001 ) . The mean volume of homologous blood transfused was 0.9 units per patient in the study group compared with 2.5 units in the control group ( P less than 0.001 ) , a saving of 64 % OBJECTIVES We aim ed to evaluate the effectiveness of postoperative autotransfusion method on prevention of the need of allogeneic blood transfusion  in hip and knee arthroplasty . METHODS Seventy-four patients who underwent 77 hip and knee arthroplasty operations were r and omized into control and study groups , and evaluated prospect ively . In the knee group ( 39 patients ; 30 females , 9 males ; mean age 66.6 years ) , cemented , cruciate retaining , and bicompartmental arthroplasty was performed under tourniquet control ; whereas in the hip group ( 35 patients ; 24 females , 11 males ; mean age 59.3 years )  cementless arthroplasty with posterolateral approach was performed . None of the patients received preoperative and intraoperative allogeneic blood transfusion . The collected blood in the surgical area was transfused with autotransfusion system to the patients in the study groups at the end of the fourth hour postoperatively . The mean amounts of autotransfused blood in hip and knee groups were 413 mL and 480 mL , respectively . Allogeneic blood transfusion was applied to the patients with hemoglobin level below 8 g/dL , hematocrit level below 25 % , and clinical symptoms of anemia . RESULTS Preoperative and postoperative hemoglobin-hematocrit levels did not differ significantly between study and control groups .  Allogeneic blood transfusion  was applied to one patient ( 5 % ) in study and 8 patients ( 38 % ) in control groups during knee arthroplasty ( p=0.01 ) ; whereas 9 patients ( 53 % ) in study and 15 patients ( 79 % ) in control groups received  allogeneic blood transfusion  during hip arthroplasty ( p=0.044 ) . The amount of allogeneic blood transfusion in study groups was significantly lower than that in control groups ( p=0.008 for knee arthroplasty , p=0.048 for hip arthroplasty ) . CONCLUSION The need and amount of allogeneic transfusion were reduced with postoperative autotransfusion in both knee and hip arthroplasty groups with greater extent in knee arthroplasty Objective To evaluate the efficacy of platelet-rich plasma regarding healing , pain and hemostasis after total knee arthroplasty , by means of a blinded r and omized controlled and blinded clinical study . Methods Forty patients who were going to undergo implantation of a total knee prosthesis were selected and r and omized . In 20 of these patients , platelet-rich plasma was applied before the joint capsule was closed . The hemoglobin ( mg/dL ) and hematocrit ( % ) levels were assayed before the operation and 24 and 48 h afterwards . The Womac question naire and a verbal pain scale were applied and knee range of motion measurements were made up to the second postoperative month . The statistical analysis compared the results with the aim of determining whether there were any differences between the groups at each of the evaluation times . Results The hemoglobin ( mg/dL ) and hematocrit ( % ) measurements made before the operation and 24 and 48 h afterwards did not show any significant differences between the groups ( p > 0.05 ) . The Womac question naire and the range of motion measured before the operation and up to the first two months also did not show any statistical differences between the groups ( p > 0.05 ) . The pain evaluation using the verbal scale showed that there was an advantage for the group that received platelet-rich plasma , 24 h , 48 h , one week , three weeks and two months after the operation ( p < 0.05 ) . Conclusions In the manner in which the platelet-rich plasma was used , it was not shown to be effective for reducing bleeding or improving knee function after arthroplasty , in comparison with the controls . There was an advantage on the postoperative verbal pain scale BACKGROUND / AIM Total knee replacement ( TKR ) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery , accompanied with some serious complications . Perioperative blood loss is one of the most serious losses , so it is vital to recognize and treat such losses properly . Autologous blood transfusion is the only true alternative for the allogeneic blood . The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery , as well as to examine possible effect of autologous blood transfusion on postoperative complications , recovery and hospital stay of patients after total knee replacement surgery . METHODS During the controlled , prospect i ve , r and omised study we compared two groups of patients ( n = 112 ) with total prosthesis implanted in their knee . The group I consisted of the patients who received the transfusion of other people 's ( allogeneic ) blood ( n = 57 ) and the group II of the patients  whose blood was collected postoperatively and then given them [ their own ( autologous ) blood ] ( n = 55 ) . The transfusion trigger for both groups was hemoglobin level of 85 g/L. RESULTS In the group of patients whose blood was collected perioperatively only 9 ( 0.9 % ) of the patients received  transfusion of allogeneic blood , as opposed to the control group in which 98.24 % of the patients received the transfusion of allogeneic blood ( p < or = 0.01 ) . The patients whose blood was collected stayed in hospital for 6.18 days , while the patients of the control group stayed 7.67 days ( p < 0.01 ) . CONCLUSION Autologous blood transfusion is a very effective method for reducing consumption of allogenic blood and thus , indirectly for reducing all complications related to allogenic blood transfusion . There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay , and indirectly on the reduction of hospital costs In recent years , the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis . We design ed a prospect i ve r and omized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant ( 5 and 10 ml ) in patients undergoing total knee arthroplasty , as compared with the untreated control group . A total of 90 patients entered the study , r and omly assigned to one of the three groups : treatment with 5 ml fibrin sealant ( 30 patients ) , with 10 ml fibrin sealant ( 30 patients ) or no treatment ( 30 patients ) . A statistically significant difference in the mean reduction of hemoglobin concentrations was found on the first postoperative day in the treated groups as compared with the controls : 5 ml fibrin sealant ( 2.6 mg/dl ) and 10 ml fibrin sealant ( 2.5 mg/dl ) vs. controls ( 3.7 mg/dl ) ( P = 0.024 ) . The mean number of blood transfusions was significantly lower in the treated groups : 5 ml ( 0.5 ) and 10 ml ( 0.3 ) of fibrin sealant vs. controls ( 1 ) ( P = 0.0019 ) . Functional recovery was also better in the treated groups : on the seventh day , the joint ROM ( range of motion ) was statistically superior in the 5 ml group ( 96.5 ° ) and 10 ml group ( 98.8 ° ) as compared with the controls ( 75.5 ° ) ( P < 0.0001 ) . This study supports the efficacy of administering fibrin sealant in the perioperative management of bleeding after total knee arthroplasty and shows that a 5 ml dosage yields a comparable outcome to the 10 ml dosage previously reported in the literature Background Total knee arthroplasty is associated with a significant postoperative blood loss even without any form of perioperative anticoagulation . Methods The potential role of QUIXIL ® , a fibrin sealant used in orthopaedic surgery to control blood loss and avoid blood transfusions in patients undergoing total knee arthroplasty was evaluated in a prospect i ve r and omized trial with twenty-four patients diagnosed with primary osteoarthritis of the knee . Results Results showed that application of 2 ml QUIXIL ®  adds costs to treatment without reducing the number of transfused red blood cell counts and postoperative haemoglobin loss . However , significant lower levels of postoperative fluid loss ( P = 0.026 ) was detected in QUIXIL ® treated patients . Conclusion Regarding cost effectiveness and benefit no indication for the use of 2 ml QUIXIL ® fibrin sealant in st and ard knee arthroplasty could be proofed statistically Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Elbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments . When these measures fail , however , patients are interested in an alternative to surgical intervention . Hypothesis Treatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem . Study Design Cohort study ; Level of evidence , 2 . Methods One hundred forty patients with elbow epicondylar pain were evaluated in this study . All these patients were initially given a st and ardized physical therapy protocol and a variety of other nonoperative treatments .  Twenty of these patients had significant persistent pain for a mean of 15 months ( mean , 82 of 100 ; range , 60 - 100 of 100 on a visual analog pain scale ) , despite these interventions . All patients were considering surgery . This cohort of patients who had failed nonoperative treatment was then given either 
    Output:
    
The available evidence in this meta- analysis suggests that postoperative flexion position , fibrin sealant , and cell salvage can substantially decrease the rate of ABT in TKA .