The work of Sloof, Ling and Gie has established allografting as a modern technique in revision total hip arthroplasty. The use of allograft enhances the local bone stock and provides a secure fixation for cemented components. Its association with the problem of heterotopic ossification has not been previously considered.

The records and x-rays of 114 patients after revision hip surgery were reviewed. All had been operated upon by three Consultant Orthopaedic Surgeons using standard techniques.

35 patients had undergone revision with impaction allografting of both the femur and acetabulum, 29 had allografting of the femur only, 18 of the acetabulum alone and the final 32 patients (acting as controls) had cemented revision arthroplasty without impaction allografting. Fresh frozen allograft was used in all cases and prepared using a bone mill.

No patient was given radiation or Indomethacin after their revision surgery, even if they had pre-existing heterotopic ossification.

The immediate pre-operative x-rays and x-rays at least a year post-revision were assessed independently by a musculoskeletal radiologist. He was blinded to the type of revision procedure and graded the heterotopic ossification according to the Brooker Classification.

Our results report the incidence of heterotopic ossification after revision hip arthroplasty with fresh frozen allograft when compared with cemented revision arthroplasty from our unit and other studies.

Abstract: With the current shift in recommended practice towards being evidence based, we wished to see if Orthopaedic surgeons are using the current evidence with regards to the use of drains in knee arthroplasty.

Method: A questionnaire was faxed to all UK members of BASK to ascertain their current practice regarding the use of drains in knee arthroplasty and the rationale for their drain policy.

Results: The BASK members handbook identified 231 UK members and a questionnaire was faxed to them. 160 replies were received, of which 8 were excluded from analysis as they were either retired or non-surgeons. This gave a 68.2% response rate (1 52 results out of 223).

Drain usage:

Primary TKR: Always 136(89.5%); Sometimes 13(8.5%), Never 3(2.0%).

Revision TKR: Always 141(94.6%); Sometimes 3 (2.0%); Never 5(3.4%); Not applicable 3.

Unicompartmental: Always 66(57.9%); Sometimes 28(24.6%); Never 20(17.5%); Not applicable 3.1.

Hours drain removed at:

< 24 hours 77(50.7%); 24–48 hours 64(42.1%);

> 48 hours 4(2.6%); No answer 7(4.6%).

Rationale for drain use:

Prevent wound haematoma/haemarthrosis 74; personal reasons 27; to allow retransfusion 20; evidence based 12; despite evidence 5.

29.6% of the responders are currently using cell salvage drains, and a further 7.9% are keen to start using cell salvage drains when the circumstances in their hospitals change to allow them to do so.

Conclusion: The results of our questionnaire have shown that for primary TKR 89.5% always use a drain. With regard to the duration of drainage, 42.1 % of the respondents removed their drains at between 24 and 48 hours. The commonest reason given for the use of drains in total knee arthroplasty was to prevent haematorna or haemarthrosis development. However the published literature does not support these practices and beliefs. Only 12 people said that their practice was evidence based. We therefore have to conclude that the majority of practising members of BASK do not practice evidence based medicine with regard to the use of drains in knee arthroplasty.