The purpose of the study was to assess the use of the Internet for medical information, both in the Orthopaedic Outpatient population, and in practicing Orthopaedic Surgeons in New Zealand.

To identify any potential sites that may be of use to the patient in gaining reliable information on their orthopaedic problem. 300 questionnaires were distributed to Orthopaedic Outpatient Clinics (Public Trauma, Public Elective, and Private) in Christchurch. Each clinic had 100 questionnaires. A second questionnaire was sent out to all Orthopaedic Surgeons currently practising in New Zealand. A literature search was also performed.

Overall 18% of patients use the Internet to look up medical problems. Internet use was highest amongst the younger population. 68% of patients had a computer at home. 52% of patients thought recommended Internet sites would be useful. 91 % of patients stated they used their Doctor as their most common source of healthcare information, with only 5% stating the Internet. 76% of Orthopaedic Surgeons used the Internet for work purposes. 54% thought that the Internet misinformed patients. Only 50% of surgeons had accessed the NZOA web site.

The Internet is becoming an increasingly common source of healthcare information for patients and doctors. The NZOA site has huge potential for both surgeons and the public with regard to useful links. At present this site is largely under-utilised.

The purpose of this study was to establish whether retransfusion of blood collected in drains following total joint replacement was a safe and effective procedure. All patients undergoing a total joint arthroplasty, with no history of infection, between March and October 2001, were entered into the study. A single surgeon operated on all patients and no patient was excluded from the study. Informed consent was obtained and all blood drained into a recollection system within 6 hours of surgery was retransfused .A prospective protocol was filled out in all cases documenting the pre and postoperative haemoglobin, amount transfused and any extra transfusion requirements. A special note was made of any complications encountered during retransfusion. The results were then compared to previously known transfusion rates within the same hospitals.

There were 141 Total Joint Arthroplasties performed within the study period -12 were bilateral and 12 were revisions procedures. The average drainage was 655ml (60–3280ml) and the average amount of retransfused blood from the drains was 225ml (100–1822ml). There were a total of 9 (6.3%) subsequent blood transfusions. Four (3.8%) in primary and 5 (20.8%) in bilateral or revision procedures.

Transfusing patients with salvaged blood from the drains in total joint arthroplasty is a safe, reliable and cost effective practice, which significantly reduces the requirement for a subsequent blood transfusion. As a result of this study the Christchurch Orthopaedic Group has adopted a routine practise of retransfusing drained blood in all total joint arthroplasties.

Despite a variety of reports to the contrary it was felt by the Christchurch Orthopaedic group that the “wait” on the orthopaedic waiting list has been escalating rapidly to the point that a routine operation is now in the order of approximately 3 years from the time of GP referral.

A review of the time taken for GP referrals to be assessed by an Orthopaedic Surgeon was undertaken. The waiting lists from October 98 to May 02 were analysed, in addition to the operation outputs from the Burwood Hospital elective theatre records over the same period. Time taken from referral to be seen, time taken from been placed on the waiting list to receive an operation and volume of elective procedures were evaluated. A breakdown was made of those removed from the list vs those operated on. A major reduction in the waiting list over the last three years was secondary to 1/3 of the people on the list (1177) been “culled”. This was initiated in January 1999 and completed by January 2001. Since January 1999, 2538 patients had received their operations. The waiting list had dropped from 3303 to a low of 1164. It has since climbed to 2036. That waiting longer than 12 months for surgery, initially 64%, had dropped to 29% and has climbed back up to 40%. The figures have climbed dramatically since the waiting list initiative for arthroplasty was discontinued. The culling of the list has been responsible for removal of 1/3 of people off the original list without having an operation and has given a false sense of success in reducing the waiting list to various political interests. The criteria set for culling people assessed as requiring an operation has been set arbitrarily There is twice the number of patients waiting to see an orthopaedic surgeon than 2 years ago of which a proportion are requiring reassessment to be deemed eligible for an operation that they have already been assessed as requiring.

The waiting list initiative was effective as an addition to the regular DHB lists in maintaining the lists at a manageable level. Even if all those culled represented a group that no longer required their operation the current list cannot be considered to have such a group as they have all been recently reviewed and are in genuine need. There is an apparent lack of concern and denial over the current escalation in the numbers on the waiting list, and no plan instituted to address it.

Hypotheses:

A subject’s response to commonly used knee assessment scores is variable, even in the presence of a normal knee.

Methods: A group of 150 New Zealand subjects with normal knees were given three commonly used knee assessment questionnaires. There were three age groups with 50 subjects in each group: 20 to 40, 40 to 60 and above 60 years of age. All were examined to determine that each knee was objectively normal. This group was then compared with a similar group of Canadian subjects and the results were analysed.

Results: The results showed significant differences in expectation between the age groups, with the older age group less happy to score maximum points for their ‘normal’ knee. The Hospital for Special Surgery Knee Score scored the lowest followed by the Knee Society Knee Score. In the over 60 years group there was a significant difference between the New Zealand and Canadian subjects with the Canadians tending to score higher in all scores.

Conclusions: These results have implications when trying to compare results of total knee arthroplasty between different countries and age groups. This study has been expanded to include other countries in an attempt to find a mathematical formula to make future comparisons more relevant.

Aim: In 1990 the Christchurch Hospital Sarcoma Clinic established management guidelines for patients with suspected sarcomas, recommending referral prior to investigation, biopsy and excision. The aim of this study was to determine whether these guidelines are being followed.

Method: A review of the case notes of all sarcomas referred to the Sarcoma Clinic between 1990 and 1999 was performed.

Results: There were 53 referrals, 34 (22%) from orthopaedic surgeons, 56 (37%) from general surgeons, 16 (10%) from general practice and 47 (31%) from other specialties. Only 83 (54%) of the referrals had followed the guidelines. Twenty-five (74%) of the orthopaedic referrals, 19 (34%) of the general surgical, 10 (63%) of the general practice and 29 (62%) of the other specialties had followed the guidelines. Seventy (46%) of the referrals had failed to follow the guidelines. Thirty-four (49%) of these had undergone excision inadequate for sarcoma prior to referral, of which eight had been re-excised. Twenty-four patients had not been staged prior to excision despite having a positive fine needle aspiration (FNA) in four cases. Eighteen patients (26%) had FNA or biopsy prior to imaging or referral.

Conclusion: Forty-six percent of sarcoma patients had not been treated according to the recommended guidelines. Forty-nine percent of these had inadequate primary sarcoma excision and this may have compromised their outcome. Orthopaedic surgeons had the best record for following the guidelines at 74% of referrals but this could be further improved. Doctors and especially surgeons need to be more aware of the principle of early referral of patients with suspected sarcomas.

Aim: To compare the function in two groups of high demand patients with a total knee arthroplasty (TKA) – one group using a posterior cruciate sacrificing (PCS) prosthesis and the other a posterior cruciate retaining (PCR) prosthesis of similar design.

Method: Patients were eligible for the study if they were greater than two years from surgery, less than 65 years of age and without other co-existing morbidity to significantly decrease their physical activities. Group A underwent surgery by one surgeon who routinely retained the posterior cruciate ligament whereas Group B underwent surgery by one surgeon who routinely sacrificed the PCL. A mobile bearing TKA of similar design was used in each group. All patients were selected and assessed by an independent assessor using a questionnaire developed specifically to assess higher levels of activity not usually assessed by other knee scores.

Results: Group A (28 TKA in 20 patients) were matched with Group B (25 TKA in 19 patients) for age, length of follow-up and range of motion. The gross activity score was 3.36 in Group A compared with 3.12 in Group B. The combined walking, running and stair climbing score was significantly better in Group A (7.68 compared to 6.64 in Group B). Group B perceived their TKA was closer to a normal knee (2.00 compared to 2.32) with decreased anterior knee pain.

Conclusions: Retaining the PCL in TKA results in better function without significant complications.

A patient’s response to knee assessment questionnaires is often subjective and linked to age and cultural expectations.

In New Zealand 150 people, split into three groups of ages 20 to 40 years, 40 to 60 years and over 60 years, were given three commonly used knee assessment questionnaires. All were examined objectively to determine that their knees were normal. Scores in these groups were compared to similar groups of Canadian subjects and the results analysed.

The results show significant differences in expectations between the age groups. Older people were reluctant to score maximum points for their normal knees. The Hospital for Special Surgery’s knee score gave the lowest results, followed by the Knee Society score. In the over-60-year group there was a significant difference between scores in New Zealand and Canada, with Canadians tending to score higher in all scores.

These findings have implications when it comes to comparing results of total knee arthroplasty in different countries and age groups. This study has been expanded to include other countries in an attempt to find a mathematical formula that will make future comparisons more relevant.

Since its introduction in Christchurch in 1989, the mobile bearing LCS prosthesis has been used in over 3 500 total knee arthroplasty (TKA) procedures. The prosthesis is unique in that it has a mobile articulation not only at the tibiofemoral joint but also at the patellofemoral joint. The tibiofemoral articulation may be posterior cruciate retaining (meniscal bearings - MB) or sacrificing (rotating platform - RP).

Clinical and radiological assessment of 569 patients over three to nine years shows no significant difference between MB and RP groups with respect to Knee Society and New Jersey knees or the WOMAC functional score. In 93% of patients results were good or excellent. There were more early complications among MB patients, with five MB dislocations. However, four of these dislocations occurred in the early years this prosthesis and may reflect surgical inexperience. Clinical evidence of posterior cruciate laxity was present in 15% of the MB group, but there was no significant difference between knee scores of this group, the rest of the MB group, or the RP group.

When resurfaced patellae were compared to knees that were not resurfaced, there was no significant difference. Patellae with more than 4 mm of lateral subluxation were identified, but their knee scores were not significantly different.

The early to medium-term results of our continuing study of the LCS mobile bearing prosthesis are at least comparable to those of studies of fixed bearing prostheses. We continue to use this implant with confidence, but await long-term results.

We compared function in two groups of high demand patients who had undergone total knee arthroplasty (TKA), one group using a posterior cruciate sacrificing (PCS) prosthesis and the other a posterior cruciate retaining (PCR) prosthesis of similar design.

Patients were eligible for the study if surgery had been performed more than two years ago and they were under 65 years of age and had no coexisting morbidity that markedly decreased their physical activities. One surgeon operated on 28 patients in group A (20 TKAs), routinely retaining the posterior cruciate ligament (PCL). A second surgery operated on 19 patients in group B (25 TKAs) and routinely sacrificed the PCL. A mobile bearing prosthesis of similar design was used in each group. Patients were independently selected and assessed using a questionnaire specifically developed to assess higher levels of activity not usually assessed by other knee scores. Patients in the two groups were matched in terms of age, range of motion and follow-up

The gross activity score was 3.36 in group A and 3.12 in group B. The combined walking, running and stair-climbing score was in group A (7.68) than in group B (6.64). Patients in group B had decreased anterior knee pain and perceived their TKA closer to a normal knee (2.00 compared to 2.32).

We conclude that retaining the PCL in TKA results in better patient function without obvious complications.