Introduction. This study aimed to assess the relationship between preparation times and operative procedures for elective orthopaedic surgery. A clearer understanding of these relationships may facilitate list organisation and thereby contribute to improved operating theatre efficiency. Methods. Two years of elective orthopaedic theatre data was retrospectively analysed. The hospital medical information unit provided de- identified data for 2015 and 2016 elective orthopaedic cases, from which were selected seven categories of procedures with sufficient numbers to allow further analysis - primary hip and knee replacement, spinal surgery, shoulder surgery (excluding shoulder replacement), knee surgery, foot and ankle surgery (excluding ankle replacement), Dupuytrens surgery and general orthopaedic surgery. The data analysed included patient age, ASA grade, operation, operation time, and preparation time (calculated as the time from the start of the anaesthetic proceedings to the patient's admission to Recovery, with the operating time [skin incision to skin closure] subtracted). Statistical analysis of the data was undertaken. Results. A total of 1596 procedures performed over the two year period were analysed. Preparation times for the different procedures were assessed, along with the relationship to the procedure complexity. Neither age nor ASA correlated strongly with preparation times. Spine procedures had greater preparation times than hip and knee arthroplasty. Greater uniformity in preparation times for hip and knee arthroplasty was seen across the anaesthetic group than operative times across the surgeon group. Discussion. Preparation times are just one aspect that may be evaluated with regard to theatre utilisation. This study did not address the theatre turn-over time between cases, which includes transfer of the patient from the admitting/pre-operative area into the theatre. Conclusion. Preparation times for elective procedures follow a pattern which may be used to inform list planning, with the potential for greater theatre efficiencies with regard to list utilisation and staff allocation

Platelet-rich plasma (PRP) has been demonstrated to benefit a variety of disciplines. But there exists heterogeneity in results obtained due to lack of standardization of the preparation protocols employed in them. We aim to identify and standardize a preparation protocol for PRP with maximum recovery of platelets to obtain reproducible results across studies. Blood samples were collected from 20 healthy volunteers. The double spin protocol of PRP preparation was analyzed for variables such as centrifugal acceleration, time, and volume of blood processed and final product utilized. The final PRP prepared was investigated for platelet recovery, concentration, integrity, and viability. We noted maximum platelet recovery (86-99%) with a mean concentration factor of 6-times baseline, with double centrifugation protocol at 100xg and 1600xg for 20 minutes each. We also noted that 10 ml of blood in a 15 ml tube was the ideal volume of blood to be processed to maximize platelet recovery. We demonstrated that the lower 1/3rd is the ideal volume to be utilized for clinical application. We did not note a loss of integrity or viability of the platelets in the final product from the above-said protocol. Preparation of PRP by the double spin protocol of 10 ml of blood at 100xg and 1600xg for 20 minutes each in a 15ml tube and using the lower 1/3rd of the final product demonstrated consistent high platelet recovery (86-99%) and concentration (6x) without disturbing the platelet integrity or viability

To document and assess the available evidence regarding single bundle, hamstrings autograft preparation techniques for Anterior Cruciate Ligament reconstruction (ACLR) and provide graft preparation options for different clinical scenarios. Three online databases (Embase, PubMed and Ovid [MEDLINE]) were searched from database inception until April 10, 2021. The inclusion criteria were English language studies, human studies, and operative technique studies for single bundle hamstrings autograft preparation for ACLR. Descriptive characteristics, the number of tendons, number of strands, tendon length, graft length and graft diameter were recorded. The methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) instrument and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for non-randomized and randomized studies, respectively. The initial search yielded 5485 studies, 32 met the inclusion criteria. The mean MINORS score across all nonrandomized studies was 8.2 (standard deviation, SD 6.6) indicating an overall low quality of evidence. The mean MINORS score for comparative studies was 17.4 (SD 3.2) indicating a fair quality of evidence. The GRADE assessment for risk of bias in the randomized study included was low. There were 2138 knees in 1881 participants, including 1296 (78.1%) males and 363 (21.9%) females recorded. The mean age was 30.3 years. The mean follow-up time was 43.9 months when reported (range 16-55 months). Eleven studies utilized the semitendinosus tendon alone, while 21 studies used both semitendinosus and gracilis tendons. There were 82 (3.8%) two-strand grafts, 158 (7.4%) three-strand grafts, 1044 (48.8%) four-strand grafts, 546 (25.5%) five-strand grafts, and 308 (14.4%) six-strand grafts included. Overall, 372 (19.7%) participants had a single-tendon ACLR compared to 1509 (80.2%) participants who had a two-tendon ACLR. The mean graft diameter was 9.4mm when reported. The minimum semitendinosus and gracilis tendon lengths necessary ranged from 210-280mm and 160-280mm respectively. The minimum graft length necessary ranged from 63-120mm except for an all-epiphyseal graft in the paediatric population that required a minimum length of 50mm. The minimum femoral, tibial, and intra-articular graft length ranged from 15-25mm, 15-35mm and 20-30mm respectively. Thirteen studies detailed intra-operative strategies to increase graft size such as adding an extra strand or altering the tibial and/or femoral fixation strategies to shorten and widen the graft. Two studies reported ACL reinjury or graft failure rate. One study found no difference in the re-injury rate between four-, five- and six-strand grafts (p = 0.06) and the other found no difference in the failure rate between four- and five- strand grafts (p = 0.55). There was no difference in the post-operative Lysholm score in 3 studies that compared four- and five-strand ACLR. One of the five studies that compared post-operative IKDC scores between graft types found a difference between two- and three- strand grafts, favoring three-strand grafts. There are many single bundle hamstrings autograft preparation techniques for ACLR that have been used successfully with minimal differences in clinical outcomes. There are different configurations that may be utilized interchangeably depending on the number, size and length of tendons harvested to obtain an adequate graft diameter and successful ACLR

Despite the growing success of OCA transplantation in treating large articular cartilage lesions in multiple joints, revisions and failures still occur. While preimplantation subchondral drilling is intended to directly decrease allograft bioburden and has been associated with significant improvements in outcomes after OCA transplantation, the effects of size, number, and spacing of subchondral bone drill sites have not been fully evaluated. This study aimed to investigate the effects of drill size with or without pulse-lavage of OCA subchondral bone by quantifying remnant marrow elements using histomorphometry. With IRB and ACUC approvals, human and canine OCAs were acquired for research purposes. Portions of human tibial plateau OCAs acquired from AATB-certified tissue banks that would otherwise be discarded were recovered and sectioned into lateral and medial hemiplateaus (n=2 each) with a thickness of 7 mm. Canine femoral condyles and tibial plateaus were split into lateral and medial components with a thickness of 7 mm (n=8). Using our clinical preimplantation preparation protocol, holes were drilled into the subchondral bone of each condyle and hemiplateau OCA using either 1.6 mm OD or 3.2 mm OD drill bits from the cut surface to the cortical subchondral bone plate. One femoral condyle and one hemiplateau per drill bit size were pulse-lavaged while the corresponding OCAs were not. The mean total %-fill remaining marrow elements for each treatment group was calculated. Little to no quantifiable bone marrow element retention was noted to remain within the subchondral bone of human or canine OCA specimens after subchondral drilling of allograft bone with either drill bit size evaluated and with or without pulse-lavage. The %-fill was consistent across zones, ranging from 1-5%. This project was designed to provide a preliminary histologic evaluation of the effects of drill size on OCA preimplantation preparation efficacy based on amount of remaining bone marrow elements in human and canine femoral condyle and tibial plateau specimens. Based on these initial findings, choice of drill bit size for OCA subchondral drilling may need to be based on the associated biomechanical effects rather than effects on donor bone marrow element removal

The purposes of this study were to evaluate the accuracy and feasibility of a robotic preparation for acetabular metal augments in patients with developmental dysplasia of the hip (DDH). Mako robotic arm reaming was used in 7 DDH to prepare the bony cavities for both Trident PSL cups and Tritanium acetabular wedge augments in six hips with Crowe 2 or 3 DDH. In CT-based planning, a properly sized cup was placed in the original acetabulum, and the same sized cup was also placed to fit the superolateral acetabular defect. The coordinates of the planned positions of cup and augment were recorded to manage the robotic arm reaming. After registration of the patient's pelvis, robotic reaming was performed first for the augment, then, for the cup by changing the target position of reaming as planned. The accuracy of the cup and augment placement was assessed on postoperative CT. To evaluate the feasibility of the robotic procedure, the OR time and blood loss were compared with those of 13 patients who received the same cup and augment systems with a conventional technique. All procedures were done without fracture or fixation failure. There were no differences in OR time or blood loss between the two procedures. Postoperative CT measurements of the distance between the cup center and the augment sphere center showed less than 2mm difference from the Mako preoperative planning. Although a longer time of follow up evaluation is mandatory, our robotic acetabular augment preparation technique is accurate and feasible

Objectives. This study was conducted to evaluate the cytokine-release kinetics of platelet-rich plasma (PRP) according to different activation protocols. Methods. Two manual preparation procedures (single-spin (SS) at 900 g for five minutes; double-spin (DS) at 900 g for five minutes and then 1500 g for 15 minutes) were performed for each of 14 healthy subjects. Both preparations were tested for platelet activation by one of three activation protocols: no activation, activation with calcium (Ca) only, or calcium with a low dose (50 IU per 1 ml PRP) of thrombin. Each preparation was divided into four aliquots and incubated for one hour, 24 hours, 72 hours, and seven days. The cytokine-release kinetics were evaluated by assessing PDGF, TGF, VEGF, FGF, IL-1, and MMP-9 concentrations with bead-based sandwich immunoassay. Results. The concentration of cytokine released from PRP varied over time and was influenced by various activation protocols. Ca-only activation had a significant effect on the DS PRPs (where the VEGF, FGF, and IL-1 concentrations were sustained) while Ca/thrombin activation had effects on both SS and DS PRPs (where the PDGF and VEGF concentrations were sustained and the TGF and FGF concentrations were short). The IL-1 content showed a significant increase with Ca-only or Ca/thrombin activation while these activations did not increase the MMP-9 concentration. Conclusion. The SS and DS methods differed in their effect on cytokine release, and this effect varied among the cytokines analysed. In addition, low dose of thrombin/calcium activation increased the overall cytokine release of the PRP preparations over seven days, relative to that with a calcium-only supplement or non-activation. Cite this article: Professor J. H. Oh. Cytokine-release kinetics of platelet-rich plasma according to various activation protocols. Bone Joint Res 2016;5:37–45. doi: 10.1302/2046-3758.52.2000540

Many factors have been reported to affect the functional survival of OCA transplants, including chondrocyte viability at time of transplantation, rate and extent of allograft bone integration, transplantation techniques, and postoperative rehabilitation protocols and adherence. The objective of this study was to determine the optimal subchondral bone drilling technique by evaluating the effects of hole diameter on the material properties of OCAs while also considering total surface area for potential biologic benefits for cell and vascular ingrowth. Using allograft tissues that would be otherwise discarded in combination with deidentified diagnostic imaging (MRI and CT), a model of a large shell osteochondral allograft was recreated using LS-PrePost and FEBio based on clinically relevant elastic material properties for cortical bone, trabecular bone, cartilage, and hole ingrowth tissue. The 0.8 mesh size model consisted of 4 mm trabecular bone, 4 mm cortical bone, and 3 mm cartilage sections that summed to a cross-sectional area of 1600 mm2 (40 mm x 40 mm). Holes were modeled to be 4mm deep in relation to clinical practice where holes are drilled from the deep margin of subchondral trabecular bone to the cortical subchondral bone plate. To test the biomechanic variations between drill hole sizes, models with hole sizes pertinent to standard-of-care commercially available orthopaedic drill sizes of 1.1mm, 2.4 mm, or 4.0 mm holes were loaded across the top surface over a one second duration and evaluated for effective stress, effective strain, 1st principal strain, and 3rd principal strain in compressive conditions. Results measured effective stress and strain and 1st and 3rd principal strain increased with hole depth. The results of the present FEA modeling study indicate that the larger 4.0 mm diameter holes were associated with greater stresses and strains within OCA shell graft, which may render the allograft at higher risk for mechanical failure. Based on these initial results, the smaller diameter 2.4 mm and 1.1 mm holes will be further investigated to determine optimal number, configuration, and depth of subchondral drilling for OCA preparation for transplantation

Background. Cemented femoral stems have an excellent long-term outcome. Modern cement techniques should be used to optimize femoral stem fixation. Bleeding from the bone surface during cemented hip arthroplasty compromises the bone-cement interface. However, no studies have examined this bleeding in vivo nor the effect the different cleaning methods used. In the present study we evaluated bleeding patterns and efficacy of cleaning methods used in third generation cementing techniques. Methods. We prospectively performed a medulloscopy with a 10 mm laparoscope in 200 primary hip arthroplasties. Intramedullary bleeding was evaluated after femoral canal preparation and use of the different cleaning methods. The femoral canal was divided into three areas to facilitate comparison. The intramedullary bleeding was standardized on a four point scale. A non-parametric repeated measures ANOVA was used for statistical analysis. Results. Cotton swabs and brushes did not reduce the intramedullary bleeding significantly after broaching of the canal. Compared to these standard cleaning methods, pulsed lavage and the addition of brushing provided better blood removal (p<0.001). There was a trend, although not statistical significant (p=0.24), towards better canal cleaning if a canal filling tampon with suction was added. Arterial bleeding originating from the posterior wall of the canal was noticed in 26 cases (13 percent). These could only be controlled by diathermy tools. Conclusion. Most standard preparation techniques are insufficient to prepare the femoral canal before cement insertion. In case of severe intramedullary bleeding, an arterial bleeding should be ruled out and if necessary treated with the aid of diathermy tools. We recommend pulsed lavage combined with a brush and a canal filling tampon for femoral canal preparation in cemented primary hip arthroplasty for optimal reduction of intramedullary bleeding

Introduction: The Direct Anterior Approach (DAA) for hip replacement is an unfamiliar approach to most surgeons. The challenging portion of this approach is the preparation of the femur. In this study we determine factors that can assist in predicting the difficulty of femoral preparation to improve the learning curve. Methods: Data was collected prospectively on 151 consecutive cases utilizing the DAA for hip replacement. After each case the femoral preparation was rated into one of 5 categories: very easy, easy, medium, difficult and very difficult. Clinical and demographic data were collected prospectively using web based data entry software. Post-operative x-rays were evaluated by an independent reviewer unaware of the exposure difficulty. Using multivariate regression, we examined several different x-ray based pelvic measurements as predictors for difficulty of femoral exposure. Results: Univariate analysis demonstrated difficulty of femoral preparation was significantly (p< 0.05) correlated with height (OR=2.67, 95% CI = [1.03–6.94]), weight (OR=8.30, 95% CI=[2.35, 29.35]), male gender (OR=6.11, 95%CI=[1.97–18.97]), the distance from the greatertrochanter-to-ASIS (OR=0.30, 95%CI=[0.11–0.82]), teardrop-to-teardrop (OR=0.29, 95%CI=[0.11–0.79]), and greatertrochanter-to-greater-trochanter (OR=3.31, 95%CI=[1.23–8.95]). From this, we determined a simple pre-operative formula which allows the surgeon to predict difficult femoral preparations with an 87% sensitivity and easy preparations with > 95% specificity. Conclusion: In MIS hip surgery, the DAA has proven difficult to learn for many surgeons. Careful patient selection can facilitate the learning curve and improve patient outcomes. We describe a simple to implement preoperative rating scale, which gives the surgeon learning DAA an algorithm for appropriate patient selection. With new advances in surgical procedures, selecting the appropriate patient can reduce the risks to the patient and minimize the cost to society of integrating new surgical techniques

INTRODUCTION: Assessment of radiolucent lines (RLL) is the main component of the radiographic analysis of the glenoid component. The purpose of this study is to compare the radiographic results of two glenoid preparation techniques by analyzing periglenoid radiolucencies. MATERIEL AND METHODS: The series consists of seventy-two shoulder arthroplasties with primary osteoarthritis. Shoulders were divided into two groups based on glenoid preparation technique:. Group 1: Thirty-seven shoulders operated on between 1991 and 1995 with flat back, polyethylene glenoid implants cemented after “curettage” of the keel slot. Group 2: Thirty-five shoulders operated on between 1997 and 1999 with flat back, polyethylene glenoid implants cemented after cancellous bone compaction of the keel slot. At least three of the following four fluoroscopically positioned, postoperative AP radiographs were analyzed: immediate postoperative, between the 3rd and 6th postoperative months, at one year postoperative and at two years postoperative. The immediate and the two year radiograph were required for study inclusion. The radiolucent line score (RLLS) was calculated using the technique of Molé, involving the summation of radiolucencies in each of six specified zones. The RLLS was compared between the two groups. RESULTS: On the immediate postoperative radiographs the average of the total RLL score of the 9 analyzes was 2.39 in Group 1 and 1.67 in Group 2 (p=0.042). There was a statistically significant association between the glenoid preparation technique and the incidence of radiolucency around the keel as well (p=0.001). There was no significant difference in radiolucency behind the faceplate between the two groups (Group 1: 1.54 and Group 2: 1.41; p=0.394). On the 2-year postoperative radiographs the average RLL score of the 9 analyzes were 6.44 in the Group1 (4.05 under the tray, and 2.39 around the keel), and 4.19 in Group2 (p=0.0005) (2.86 under the tray, and 1.33 around the keel). The radiolucency around the keel and behind the faceplate (p=0.0005) was significantly more important (p=0.001) in the “curettage” glenoid preparation population. A significantly higher degree of progression of the total RLL score (p=0.002) and of the radiolucency behind the faceplate (p=0.001) was observed in the “curettage” glenoid preparation group. DISCUSSION/CONCLUSION: Preparation of the glenoid component keel slot with cancellous bone compaction is radiographically superior to the “curettage” technique with regard to periglenoid radiolucen-cies. Although new techniques of glenoid preparation may help to decrease the rate of RLL, this study shows that even with better technique, the RLL are evolutive and may appear after few years in initially perfectly implanted glenoid

Resurfacing hip arthroplasty is a successful option for the treatment of the young and active patient with hip arthritis. However, it is complicated by femoral neck fracture and avascular necrosis, which result from devascularisation during surgery. Devascularisation maybe caused by thermal necrosis. Thermal necrosis of bone has been shown to occur in temperatures of 47°C and above. We investigated the temperatures generated during femoral head preparation to see if the temperatures reached were great enough to induce osteonecrosis. Method: Eight patients with osteoarthritis underwent standard resurfacing hip arthroplasty through the posterior approach. From the first over-drilling of the femoral heads until the prosthesis was cemented in place the temperatures generated at the bone surface were recorded using an infra-red thermal imaging camera. Images were captured every 4 seconds as the operation was performed with no interference to the surgeon. Results: The maximum temperatures generated occurred during sleeve reaming at 88.4°C. Seven patients had a temperature recorded greater than 47°C. Removing the femoral caput with an oscillating saw had the highest mean temperature 62.2°C, followed by sleeve reaming (mean 48.7°C). Female patients had the lowest temperature rises and patients receiving the larger femoral prosthesis the greatest temperatures at the bone surface. Conclusions: Heat generated during femoral head preparation exceeded 47°C in all but one case. Osteonecrosis secondary to thermal insult is likely to occur during femoral head preparation. Strategies need to be devised to decrease the temperatures generated during femoral head preparation

Eradication of bacteria in forefoot surgery in necessary to prevent post-operative infections. Currently a lack of consensus exists on the optimum solution and preparation methods needed to achieve this. We compared the effect of povidine-iodine and chlorhexidine gluconate on lowering bacterial load and if any additional benefits are gained by pre-treatment with the use of a bristled brush. Fifty consecutive patients undergoing forefoot surgery were recruited into the study and randomised to receive one of two surgical skin preparations (Povidine-iodine 1% with isopropyl alcohol 23% or Chlorhexi-dine gluconate 0.5% with isopropyl alcohol 70%). In addition to the skin preparation of the foot with the randomised solution the other foot was also scrubbed with a sterile surgical bristled brush for a standardised period (3 minutes) and then painted again. Swabs were taken from three sites and analysed via qualitative and quantitative analysis. All four methods significantly decreased (p < 0.001), in all three sites, the number of colony forming units. Using two-way analysis of variance no significant interaction was observed between site of swab and method of preparation (p =0.970). This confirms that no preparation method was more superior in reducing the number of CFUs at any site than the others. We suggest that either povidone –iodine with no more that 23% isopropyl alcohol or chlorhexidine gluconate with 70% isopropyl alcohol be used for surgical preparation in forefoot surgery. No additional benefit in reduction in bacterial load is gained by scrubbing the foot prior to painting with bristles

Introduction: Resurfacing hip arthroplasty is a successful option for the treatment of the young and active patient with hip arthritis. However, it is complicated by femoral neck fracture and avascular necrosis, which may result from devascularisation during surgery. Devascularisation maybe caused by thermal necrosis. Thermal necrosis of bone has been shown to occur in temperatures of 47°C and above. We investigated the temperatures generated during femoral head preparation to see if the temperatures reached were great enough to induce osteonecrosis. Method: Eight patients with osteoarthritis underwent standard resurfacing hip arthroplasty through the posterior approach. From the first over-drilling of the femoral heads until the prosthesis was cemented in place the temperatures generated at the bone surface were recorded using an infra-red thermal imaging camera. Images were captured every 4 seconds as the operation was performed with no interference to the surgeon. Results: The maximum temperatures generated occurred during sleeve reaming at 88.4°C. Seven patients had a temperature recorded greater than 47°C. Removing the femoral caput with an oscillating saw had the highest mean temperature 62.2°C, followed by sleeve reaming (mean 48.7°C). Female patients had the lowest temperature rises and patients receiving the larger femoral prosthesis the greatest temperatures at the bone surface. Conclusions: Heat generated during femoral head preparation exceeded 47°C in all but one case. Osteonecrosis secondary to thermal insult is likely to occur during femoral head preparation. Strategies need to be devised to decrease the temperatures generated during femoral head preparation

Lavage and preparation of cancellous bone surface is essential to ensure adequate fixation of components in cemented total knee arthroplasty (TKA). Commonly used techniques for bone preparation such as pulse lavage, apart from adding to the cost, may cause local loss of loose cancellous bone and may even drive contaminants deeper into the tissue when used during TKA. We describe a simple, inexpensive and effective tool of using a sterilised toothbrush for preparing bone surface during cemented TKA

Introduction: The purpose of this study is to compare the radiographic results of two glenoid preparation techniques by analyzing periglenoid radiolucencies. Material and methods: The series consists of 72 shoulder arthroplasties with primary osteoarthritis. Shoulders were divided into 2 groups based on glenoid preparation technique:. Group 1: 37 shoulders operated on between 1991 and 1995 with flat back, polyethylene glenoid implants cemented after curettage of the keel slot. Group 2: 35 shoulders operated on between 1997 and 1999 with the same glenoid implants cemented after cancellous bone compaction of the keel slot. At least 3 of the following 4 fluoroscopically positioned, postoperative AP radiographs were analyzed: immediate postoperative, between the 3rd and 6th months, at one year and at two years postoperative. The immediate and the two year radiograph were required for study inclusion. The radiolucent line score (RLLS) was calculated using the technique of Molé, involving the summation of radiolucencies in each of six specified zones. The RLLS was compared between the two groups. Results: On the immediate postoperative radiographs the average of the total RLL score of the 9 analyzes was 2.39 in Group 1 and 1.67 in Group 2 (p=0.042). There was a statistically significant association between the glenoid preparation technique and the incidence of radiolucency around the keel as well (p=0.001). There was no significant difference in radiolucency behind the faceplate between the two groups (Group 1: 1.54 and Group 2: 1.41; p=0.394). On the 2-year postoperative radiographs the average RLL score of the 9 analyzes were 6.44 in the Group1 (4.05 under the tray, and 2.39 around the keel), and 4.19 in Group2 (p=0.0005) (2.86 under the tray, and 1.33 around the keel). The radiolucency around the keel and behind the faceplate (p=0.0005) was significantly more important (p=0.001) in the curettage glenoid preparation population. A significantly higher degree of progression of the total RLL score (p=0.002) and of the radiolucency behind the faceplate (p=0.001) was observed in the curettage glenoid preparation group. Discussion/conclusion: Preparation of the glenoid component keel slot with cancellous bone compaction is radiographically superior to the curettage technique with regard to periglenoid radiolucencies

Lavage and preparation of cancellous bone surface is essential to ensure adequate fixation of components in cemented total knee arthroplasty (TKA). Commonly used techniques for bone preparation such as pulse lavage, apart from adding to the cost, may cause local loss of loose cancellous bone and may even drive contaminants deeper into the tissue when used during TKA. We describe a simple, inexpensive and effective tool of using a sterilised toothbrush for preparing bone surface during cemented TKA

Aims: The purpose of this study is to compare the radiographic results of two glenoid preparation techniques by analyzing periglenoid radiolucencies. Methods: Seventy-two shoulder arthroplasties with primary osteoarthritis were divided into two groups based on glenoid preparation technique: thirtyseven shoulders with “curettage” of the keel slot, and thirty-five shoulders with cancellous bone compaction. The radiolucent lines were analyzed on fluoroscopically positioned, postoperative AP radiographs. The RLL Score (RLLS) was calculated using the technique of Molé. The RLLS was compared between the two groups. Results: On the immediate postoperative radiographs the average of the total RLL score was 2.39 in Group 1 and 1.67 in Group 2 (p=0.042). There was a statistically significant association between the glenoid preparation technique and the incidence of radiolucency around the keel as well (p=0.001). On the 2-year postoperative radiographs the average RLL score was 6.44 in the Group1, and 4.19 in Group 2 (p=0.0005). The radiolucency around the keel and behind the face-plate (p=0.0005) was significantly greater (p=0.001) in the “curettage” glenoid preparation population. A significantly higher degree of progression of the total RLL score (p=0.002) and of the radiolucency behind the face-plate (p=0.001) was observed in the “curettage” glenoid preparation group. Conclusions: Preparation of the keel slot with cancellous bone compaction is radiographically superior to the “curettage” technique

The aim of our study was to determine whether preoperative preparation by means of a video film could influence postoperative hip motion. The video shows a patient undergoing total hip replacement surgery covering the time period from admission to discharge, and keeping strictly to the patient’s perspective. In 1958 Janis opened up the field of research on preoperative psychological states and postoperative recovery. Since then, numerous studies have been performed and a variety of variables were demonstrated to influence postoperative outcome. Our study takes into consideration the results of previous research and provides a new combination of methods for psychological preparation prior to surgery. One hundred patients scheduled for elective total hip replacement surgery for osteoarthritis of the hip joint were randomly assigned to a control group (n=54) and a preparation group (n=46). The preparation group was shown the videotape on the evening before surgery. The video gives the pre-surgical patient the opportunity to identify with a patient who had successfully undergone surgery before. Physical examination, including motion analysis of the hip, was performed. Range of hip motion was documented in degrees with reference to neutral joint position. Flexion/extension, abduction/adduction, and external/ internal rotation in 90° hip flexion were investigated. For range of motion analysis, sum scores were calculated. Motion analysis revealed no preoperative difference between the groups. Three months after surgery, the increase of joint mobility (preoperative versus postoperative) in prepared patients was significantly better for internal rotation (32%, p=0.005), rotational range of motion (21%, p=0.03) and abduction (22%, p=0.04). Heterotopic ossifications were identified on plain AP radiographs and were judged according to the score of Brooker, et al. Incidence did not differ between groups. Twelve months postoperatively, the increase (preoperative versus follow-up) of rotational range of motion (24%, p=0.01) remained unchanged in prepared patients, whereas an increase of abduction could no longer be revealed. Flexion/extension and sagittal range of motion did not show any differences three and twelve months postoperatively. Our videotape preparation led to an increase of motion after total hip replacement. Regarding rotational range of motion, this effect still remained twelve months after surgery

Aim: To develop a device to improve the preparation of morcellised bone graft for use in revision arthroplasty surgery. Background: Washing morcellised graft prior to impaction has been shown to improve the stability of the graft after impaction. By removing the cellular debris the chance of contamination is potentially reduced. Methods: A readily available domestic appliance was identified which met the requirements of being able to contain the graft whilst allowing free drainage of the pulsed lavage solution. This hand held potato masher has an all metal construction with few moving parts and is therefore easily cleaned and sterilised between cases. The numerous perforations in the receiver of the masher ensure that the lavage solution rarely backs up and also that all of the cellular debris is washed through effectively. Results: This device has been in regular use in this institution over the last two years. It allows a no touch technique for the preparation of morcellised graft in complex cases that require replacement of the bone stock. This poster will demonstrate pictorially the technique for graft preparation and the quality of the prepared graft that can be obtained

Background. Deep infection rates of 1 - 2% following primary hip and knee arthroplasty are mainly due to endogenous contamination of the surgical site from bacteria within the patient's own skin. However surgical skin preparation removes only bacteria from the surface of the skin, leaving viable bacteria in the deeper layers of the skin within hair follicles and sweat and sebaceous glands. The aim of our study was to test the hypothesis that surface skin swabs taken after skin preparation with alcoholic povidone iodine would not grow bacteria, whereas full thickness biopsies taken from the line of surgical incision would grow bacteria. Methods. Under LREC approval, informed consent was obtained from 22 patients undergoing primary hip (n=9) or knee (n=13) arthroplasty. All patients received intravenous antibiotic prophylaxis at the time of induction of anaesthesia. After surgical skin preparation with alcoholic povidone iodine, a surface skin swab and full thickness skin biopsy, using an 8mm x 4 mm elliptical punch, were taken. The swab culture was incubated aerobically and anaerobically at 37°C. The skin biopsy was cut aseptically in half. One half was crushed using artery forceps, placed in 5mL anaerobe basal broth and incubated anaerobically at 37°C. The other half of the skin biopsy was frozen in isopentane and gram – stained after sectioning. Results. Seven of 20 surface swabs were positive for bacteria (2 S. epidermidis, 3 P. acnes, 1 S. aureus and 1 with both S. epidermidis and P. acnes). Ten of 22 full thickness skin biopsies were positive for bacteria (4 P. acnes, 3 S. epidermidis, 2 S. aureus and 1 S. capitis). Gram positive bacteria were seen in all gram – stained sections. Conclusions. This study shows that skin preparation with alcoholic povidone iodine does not completely remove viable bacteria from the skin. Surgeons need to be aware of this and to adapt their surgical technique to avoid coming into contact with the patient's skin when performing surgery involving implants. The continuing importance of appropriate antimicrobial prophylaxis is also emphasised