Background: The purpose of this study was to evaluate the relationship between body mass index and early complications following total knee joint replacement surgery.

Methods: 527 patients who underwent a primary knee replacement were included in this study. All these patients were subjected to a pre-operative assessment and then followed up at six weeks and one year following surgery. Any complication that occurred during this period was recorded. Complications were grouped into systemic and local, each group being subdivided into minor and major. Collected data were analysed by the SPSS version 12. Chi-square tests, t-test analysis, univariate logistic regression studies and multivariate analysis were performed.

Results: 64 patients (12,1%) were found to have an early complication following knee replacement surgery. 36 patients (6.8%) were found to have a major local complication. Overall BMI did not seem to influence the rate of complication. After stratification of patients per BMI, there appeared to be a weak correlation between BMI and early complications but this was not statistically significant. A stronger correlation was found between the surgeon and presence of complication.

Conclusions: BMI has a weak correlation to early complications following joint replacement surgery. The operating surgeon seems to have a stronger correlation to early complications as compared to BMI.

A 5 year review into the workload and subsequent financial implications of pelvic and acetabular reconstruction at a regional tertiary referral centre.

To ascertain the level and means of financial recompense for performing pelvic/acetabular reconstruction on patients from other healthcare trusts at a tertiary referral centre.

The records of all 120 patients who underwent either pelvic or acetabular reconstruction between 1995–2000 were examined. Epidemiological data and information on all possible costs of their stay was accumulated (itemised finance department figures were used).

The individual patient billing system of ECRs (Extra Contractual Referrals) was changed in 1998 and replaced by the OATs system (Out of Area Treatments) whereby an annual lump sum was received based on historic referral patterns. We investigated the financial effects that occurred.

60 out of 120 patients treated, were from other health-care trusts. From 1995–1998, 25 ECR patients were treated at an estimated cost of £480, 000. The trust received £280, 000, a net loss of £200, 000. From 1998–2000, 34 OATS patients were treated at an estimated cost of £650, 000, amounting to a net gain of £1. 15 million pounds.

‘Out of area’ referrals for pelvic and acetabular reconstruction have increased by 50 % in the last 2 years. However the new payment system i. e. OATS has resulted in the tertiary referral centre being generously rewarded, unlike prior to 1998 and the old ECR system. It is therefore recommended that annual review must be carried out to ensure that funding will meet the demand for specialist services in the future and prevent subsidisation of some centres by other trusts.

To demonstrate the potential clinical benefits and safety of recombinant human bone morphogenetic protein-2 (rhBMP-2)/Absorbable Collagen Sponge (ACS) in the treatment of open tibial shaft fractures, as measured by the reduction of secondary interventions to promote fracture healing. In this prospective, controlled, multinational trial, patients were randomized to standard care (intramedullary nail and soft tissue management) or to standard care and rhBMP-2/ACS (0. 75mg/ml, 1. 5 mg/ml) implanted at definitive wound closure. 450 patients were enrolled at 49 centres. RhBMP-2 dose-dependently decreased the risk of secondary intervention for delayed union (p=0. 0004). Safety was similar among treatment groups.