The increase in knee arthroscopy performed on an out-patient basis, along with the need for cost reduction and a safe and rapid patient discharge, has underlined the importance of adequate anaesthesia techniques. We designed this study to compare efficacy, efficiency and surgeon’s satisfaction of total intravenous anaesthesia with propofol and remifentanil with those of spinal or peripheral nerve blocks for outpatient knee arthroscopy.

A total of 120 patients undergoing elective outpatient knee arthroscopy were randomly allocated to receive total intravenous anaesthesia with propofol and remifent-anil (n=40), combined sciatic-femoral nerve block (n=40) or spinal anaesthesia (n=40). Preparation times, surgeon’s satisfaction, discharge times and anaesthesia-related costs with the three anaesthesia techniques were analysed.

Preparation time was shorter with general anaesthesia (13 min) than with spinal anaesthesia or sciatic-femoral block (15 min; p=0.006). Surgeon’s satisfaction was similar in the three groups. Furthermore, 17 patients receiving peripheral nerve block (42%) and 12 receiving spinal anaesthesia (30%) by-passed the post-anaesthesia care unit after surgery as compared with only two general anaesthesia patients (5%; p=0.01). Discharge from the post-anaesthesia care unit was more rapid after peripheral block; however, stay in the Day Surgery Unit was shorter after general anaesthesia than peripheral or spinal blocks (p=0.026). Urinary retention was reported in three spinal anaesthesia patients only (8%; p=0.03).

Regional anaesthesia techniques reduce the rate of admission and the duration of stay in the post-anaesthesia care unit as compared with general anaesthesia. Peripheral rather than spinal nerve blocks should be preferred to minimise the risk of urinary retention.

Aims: To identify the incidence of neurological deþcit and functional outcome following displaced acetabular fractures. Methods: We carried out a prospective study of 136 patients who underwent skeletal stabilization of displaced acetabular fractures. Patients with sciatic nerve injuries were identiþed, assessed and followed up clinically. Routine EMG and nerve conduction studies were performed post-operatively on all cases with clinical proven neurological lesions to correlate the level, severity of the lesion and monitor progress of recovery. Results: 27 patients (19.8%) have neurological deþcit identiþed preoperatively. In 12 patients where the femoral heads were dislocated posteriorly. 20 were male and 7 were female. The mean age was 33.8 years (range 16–66). 15 patients had associated injuries but none of the patients had injury to the spinal cord. The mean ISS was 12.6 (range 9–34). The mean follow up was 3.4 years (range 1.5–6 years). 13 patients with complete drop foot at presentation. 9 patients had EMG proven double crush lesion. 3 patients had ipsilateral knee injury. 2 patients had intraopearative iatrogenic injury. All 9 patients with double crush syndrome have no improvement in function. Conclusions: Acetabular fractures associated with sciatic nerve injuries are devastating injuries with signiþcant long term morbidity. 50% patients showed improvement with time. Identiþcation of double crush lesion is vital as it is associated with poorer functional recovery as compared to single lesion.

Introduction and Objectives: This is a retrospective study on the treatment of lumbar degenerative disk disease (LDDD) using intervertebral arthroplasty. The lack of uniformity in the treatment of LDDD, persistence of pain even with solid fusion, and the possibility of changes over the fusion site have encouraged us to seek other solutions for this condition. Total intervertebral arthroplasty has been proposed as a possible alternative for selected cases of LDDD.

Materials and Methods: Between November 1999 and July 2002, 16 patients with LDDD were treated surgically using third-generation total intervertebral arthroplasty (Link SB Charité III) with a chromium-cobalt alloy and ultra-high molecular weight (UHMW) poly-ethylene. Average follow-up time was 14 months (6-36 months), and average age was 42 years (35–52). There were 11 females and 5 males. All patients underwent radi-olographic studies, CT scan, MRI, and discography (minimum 2 levels). Indications included LDDD of one to three segments, absence of root tension signs, absence of complete disc collapse, and iconography including concordant discography. LDDD was primary in 11 cases and post-discectomy in 5 cases. Surgery was indicated when at least 6 months of conservative treatment failed to yield results. Blood loss and length of hospital stay were compared to a similar group that underwent posterolateral arthrodesis. Pain, function, and degree of disability were evaluated before and after surgery using GEER (1999) instruments for the evaluation of degenerative lumbar pathology. Increase in height of the posterior intervertebral space and segmentary lordosis were also measured.

Results: Preoperative VAS: 7.8; postoperative VAS: 2.3. Disability index (Oswestry) was 41.3% preoperative and 10.8% postoperative. Average increase in height of posterior intervertebral space was 2.4mm, and mean segmental lordosis was 19.5°, which remained constant through the end of the follow-up period. Average hospital stay was 4.8 days (3–15) compared with 7.5 (5–18) for a group of patients who underwent suspended arthrodesis of L4–L5 with a much smaller quantity of blood loss. No infections were found. Complications: One patient developed an epidural haematoma, which was treated conservatively. Another developed a postoperative retroperitoneal haematoma, which was also treated conservatively. In neither case was there an adverse effect on the outcome of the procedure. One patient showed malpositioning of the prosthetic components on follow-up radiographs, with poor clinical progression at one year postoperative. The patient was treated with posterolateral fusion and right L5 foraminotomy. No infections were seen.

Discussion and Conclusions: Treatment of LDDD with intervertrebral arthroplasty was shown to be effective in the short term, if strict guidelines are followed. Aggressive surgical management is highly inferior to conventional arthrodesis. A longer follow-up period is needed to confirm the validity of this treatment. Technical error in malpositioning of the components in one case caused a poor result.