Introduction: Although knee athroplasty is a very successful operation, British knee surgeons have a wide variation in their methods of patient management. Aims: To determine current knee practice within the United Kingdom. Material and Methods: A postal survey was conducted of all members of the British Association of Knee Surgery. They were asked about pre-operative assessment, type of prosthesis used, antibiotic prophylaxis, DVT prophylaxis, bilateral arthroplasty, preferred anaesthetic, urinary catheter, patella replacement, autologous blood transfusion, mobilisation, duration of hospital stay and patient follow up. Results: 71% (221) members replied. The results and implications will be presented in full at the presentation. Some of the more interesting findings included: 18% did not have a pre-admission clinic, 18% use thromboprophylaxis for medicolegal reasons only (do not believe it works), 19% never replace the patella, 48% perform unicondlyar arthroplasty, 41% follow up patients indefinitely, one discharges patients at 6 weeks, 77% perform bilateral arthroplasty. Discussion and Conclusion: Comparison with a 1996 study of UK knee practice shows that most techniques are unchanged although slightly more surgeons routinely use an uncemented implant. (4.8% 1996, 12% 2001). There remains a wide variation in UK practice. The authors would be grateful if colleagues from other countries would contact them so that comparable studies of practice could be performed in their countries. This data may be used to compare international attitudes to knee arthroplasty.

Aims: High evacuation pressure is known to increase drained blood loss following uncemented total knee replacements (TKRs). However, the effect of different evacuation pressures on drained loss or total blood loss in cemented TKRñs is unknown. We set out to investigate this effect. Methods: One hundred patients undergoing cemented TKRñs were randomised to receive high or low-pressure suction drains after surgery. The following were observed:-

The volume of blood evacuated from the knee joint,

The calculated total blood loss,

Time to discharge, range of movement and incidence of wound problems.

Results: Greater drainage volumes were seen with the higher evacuation pressures. However, total blood loss from the circulating volume was not statistically different between the two groups. No difference was seen in morbidity or clinical outcome. Drained volumes were substantially less than published values for uncemented TKRs. Conclusions: For a given drop in total blood volume, the high-pressure drains were more efþcient in evacuating haemarthrosis. However, the lower pressures drains demonstrated no increase in morbidity or worsened clinical outcome. The relevance of these þndings in the context of autologous salvage drainage systems, which operate at similar low-pressures to avoid haemolysis, is presented.

Aim: The arthroscopic þndings after a knee injury in the general population, and the inßuence of Cause of injury, Gender and Age upon Meniscal, ACL and Combined Meniscal and ACL tears is presented.

Methods: Patients (n:215) with no history of previous knee injury or surgery, no history of arthritis, and normal X-rays that underwent arthroscopy by the same surgeon. The data was analysed by an independent bio-statistitian using unconditional logistic regression analysis.

Results: Patients with Sports related injuries (62.8%) were younger than patients with Non-sporting injuries (37.2%), (p< 0.001). More men than women underwent arthroscopy in both groups. Patients in sporting group had greater odds than patients in non-sporting group to have: an ACL tear, an ACL and meniscal tear (combined), a lateral meniscal tear. Women had lower odds than men to have: a meniscal tear, a combined tear.

Conclusions: In the general population (a) more patients underwent arthroscopy after a sporting than after a non-sporting injury (b) men were more than women in both groups (c) the cause of injury was predictive for an ACL and combined meniscal and ACL tears as well as the meniscus involved (d) in both sporting and non-sporting injuries women had less odds to have a meniscal and a combined meniscal and ACL tear.

Aims: To establish whether the Ôidealñ concentric positioning of acetabular components within the acetabular cement mantle is achieved during routine cemented total hip arthroplasty.

In vitro studies recommend concentric placement of the acetabular component. There are however no in vitro studies on acetabular component positioning.

Methods: Radiographs of 100 primary cemented total hip replacements were studied. Acetabular component positioning and cement mantles were assessed with respect to implant type, grade of surgeon and operated side.

Results: 78% of the components were eccentrically placed, with increasing cement mantle thickness from zones 1 to 3. Concentricity occurred in only 13% of the Charnley Ogee, and 28% of the IP Lubinus components. The Charnley Ogee was more superiorly eccentric than the IP Lubinus (p< 0.001). The IP Lubinus was generally more open than the Charnley Ogee and Stanmore (p=0.053). Surgical grade affected neither cement mantle nor opening angle.

Conclusions: This study indicates that the ideal component position in the acetabulum is very difþcult to achieve consistently in most patients, using the two commonly used cemented prostheses in this study. The practical difþculty of concentric component positioning while obtaining simultaneous pressurisation is illustrated.

Objective: To assess the early results of the TC3 knee prosthesis, a modular system with stems and augments, in difficult primary and revision knee arthroplasties.

Method: 13 index procedures were undertaken for gross varus or valgus deformities with severe ligamentous incompetence and/or major bone defects. 18 procedures were revision arthroplasties, 7 being undertaken for sepsis.

28 knees underwent full clinical and radiological review at a mean of 25.8 months post-operatively, using the Hospital for Special Surgery Score and the Knee Society Score. 2 patients were interviewed by phone with recent radiological follow-up. One patient had died from unrelated causes.

Results: All patients were very pleased with the outcome of surgery.

The mean pre-operative alignment for the primary arthroplasties was 28° for the varus and 32° for the valgus knees. The mean postoperative alignment was 7°. The mean Hospital for Special Surgery score was 72.4 for primary arthroplasties and 72.7 for revision surgery. The mean Knee Society Knee Score was 79.8 and 75.1 respectively, and the mean Functional Score was 60.8 and 49.4 respectively. The latter reflects the elderly age, multiple joint involvement and constitutional status (including rheumatoid arthritis) of many of these patients. 4 patients experienced retropatellar pain. One patient with severe rheumatoid developed sepsis of the revision implant.

Difficulties with tibial tray lateralisation and stem fixation will be discussed.

Conclusion: The TC3 knee system affords an excellent modular option to compensate for bone defects and ligamentous incompetence, achieving restoration of the joint line and satisfactory function.

Introduction: Knee arthroscopy is one of the most commonly performed orthopaedic procedures. All orthopaedic surgeons have heard anecdotal stories of thermal injury and drape combustion, yet a literature search has failed to find any papers reviewing the nature of such risks.

Materials and methods: A thermocouple attached to a laptop computer was used to record the temperature at the arthroscope tip, the light cable end and the light source generator. All potentially flammable materials commonly used during arthroscopic surgery (various disposable drapes, cotton drapes, gowns, paper towels and swabs), were placed at measured distances from a) the light cable end and b) the arthroscope tip.

Results: The arthroscope tip reached a maximum temperature of 41.90° in 200 seconds. The light cable tip reached 80° at 100 seconds and a maximum temperature of 110°C in 342 seconds. The light source generator reached a temperature of 153°C. All materials tested (except cotton swabs) underwent signs of combustion. The disposable drapes burnt most rapidly. None of the materials considered had any evidence of thermal damage when placed at distances of 2.5 cm beyond the light cable and 0.5 cm beyond the arthroscope tip. Combustion was most rapid at a distance of 5mm from the instruments.

Most surgeons consider the arthroscope tip or light cable end to be the site most likely to induce combustion. Fuel, heat and oxygen are required to produce combustion. Direct contact with the tip results in greater exposure to heat but lower oxygen availability. The fasted combustion occurred at 5mm due to higher oxygen availability despite a lower temperature.

Conclusions and Recommendations:

Disposable drapes will burn with the light cable and the arthroscope tip.