Fracture neck of femur (NOF) in elderly is a serious debilitating injury and has been presenting in increasing proportions. Some of these patients are unfortunate to come back with a contralateral injury. We attempted at looking into the incidence of these episodes in a cohort attending our trust and compared various parameters

We retrospectively assessed our hospital theatre data for fracture NOF in patients over 60 years in the last 3 years. We reviewed their demographics, mode of injury, time to contralateral injury, incidence of any other insufficiency fracture, operative procedure and any complications.

There were 1435 patients who underwent surgery for fracture NOF over the 3 years. Forty-three of these had bilateral fractures. Females had 3 times more incidence as compared to males; average age at first injury was 84 years and at contralateral side was 85 years. Time between the two injuries ranged from 20 to 855 days (Median 242 days). Almost equal incidence of intra / extracapsular fractures was noted. Contralateral fracture pattern (Intra vs Extracapsular) for the was similar in 34 patients. Twelve patients had an associated insufficiency fracture.

Fracture NOF in elderly is a rising epidemic. Only 3% of these patients suffer a contralateral fracture NOF which usually occurs within a year. The fracture pattern is frequently similar to the first fracture in and hence similar implants have been used. Only 21% patients were on bone protection medications. It is rather difficult to identify this small group and hence prevent a second contralateral incident.

Background of study

Total Knee Replacement (TKR) is one of the commonest elective arthroplasty operations. Crepe dressings are used following TKR by most surgeons as it may provide comfort and hemostasis through external pressure however, may reduce early range of motion (ROM). Avoiding crepe dressings after TKR saves operating time, avoids bulky dressings (which may reduce ROM) and allows interventions such as cryotherapy in the early post-operative period. There are no published studies comparing the use of crepe dressing after TKR with an impermeable dressing alone

Background

Outcomes for patients with acute illnesses may be affected by the day of the week they present to hospital. Policy makers state this ‘weekend effect’ to be the main reason for pursuing a change in consultant weekend working patterns. However, it is uncertain whether such a phenomenon exists for elective orthopaedic surgery. This study investigated whether a ‘weekend effect’ contributed to adverse outcomes in patients undergoing elective hip and knee replacements.

We prospectively reviewed a consecutive series of 101 patients with mobile bearing total knee replacement (TKR) and 72 patients with the fixed bearing cruciate retaining TKR. Patients were assessed for diagnoses, range of motion, pre- and post-operative Oxford knee scores and complications. In the mobile bearing group of 113 knees in 101 patients, 97 had minimum 10-year follow up. By ten years, 16 patients had died of unrelated causes. Mean Revised Oxford Knee score improved from 16 pre-operatively to 42 at last follow up. The mean range of flexion was 115 degrees (75 – 130). One patient dislocated the bearing and needed manipulation. One patient reported superficial infection which resolved with antibiotics. One patient had deep vein thrombosis and one had non-fatal pulmonary embolism. In the fixed bearing group, 89 TKR's were performed in 72 patients. The mean age was 71.9 years and the mean follow up was 12.1 (10–14.1) years. 19 patients died during this study period. The mean range of flexion was 111.2 (80–135) degrees of flexion at latest follow- up. There was an improvement in the mean Oxford knee score from 16.2 preoperatively, to 42.5 to date. One patient required revision surgery at 12 years for polyethylene wear. One patient developed deep infection 10 years after the primary procedure but declined revision surgery. At ten years no revisions were performed in either group. This series has highlighted excellent results with both fixed and mobile bearing CR knees with hundred percent survival at ten years.

Severe deformity and bone loss in patients with degenerative changes of the knee present a challenging surgical dilemma to the knee surgeon. We present the outcome following complex primary total knee replacements at our unit over 12 years undertaken by a single surgeon.

Aim

To undertake a biomechanical study to determine the existence of any difference in the early tibial component fixation to bone, between two widely used techniques of cementation, which may confer an influence on implant survival.