Introduction

Restrictions placed on the working hours of doctors have led to increasing time-pressures on surgical training. Consequently, there has been growing interest in developing new techniques to teach and assess technical skills. The primary aim of this study was to determine whether a novel set of visual parameters assessing visuospatial ability, fine motor dexterity and gaze control could objectively distinguish between varying levels of arthroscopic experience. The secondary aim was to evaluate the correlations between these new parameters and previously established technical skill assessment methods.

Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford and the Nuffield Orthopaedic Hospital, Oxford

Purpose

The purpose was to determine if the use of cold irrigation fluid in routine knee arthroscopy leads to a reduction in post operative pain.

Introduction

Total knee arthroplasty (TKA) accounts for 84% of all knee replacement surgery in the UK (NJR 2009) despite published epidemiological data showing that single compartment disease is most prevalent. We investigated this incompatibility further by describing the compartmental pattern and stage of cartilage loss of all patients with osteoarthritis (OA) presenting to a specialist knee clinic over one year.

The purpose of this prospective audit was to assess the efficacy of local infiltration analgesia in relieving postoperative pain following knee replacement surgery.

Methods and materials: Data was collected on 61 consecutive patients undergoing knee replacement. They formed 2 groups. Patients in Group I (n=33) had 30 mls of Bupivacaine 0.5%, Ketoralac 30 mg, 0.75ml of adrenaline 1:1000 concentration made up to100mls with normal saline while patients in Group II (n=28) had either patient controlled analgesia (PCA) or regional nerve blocks. The group I patients had the local analgesia cocktail infiltrated into the soft tissues before wound closure. Majority of these patients had spinal anaesthesia supplemented with sedation while some had general anaesthesia supplemented with regional nerve blocks. All the patients were prescribed morphine as rescue analgesia and patacetamol/co-codamol and/or naproxene as supplemental analgesia. Pain was assessed with Numerical Rating Scale (NRS 0 – 10) at 1 hr, 3 hr, 6 hr and 8 hrs post-operatively.

Results: The two groups were well matched for age, sex, ASA grade and body mass index. Pain control was generally satisfactory for group I (NRS range 0 – 2) compared to group II (NRS range 0 – 7). Most patients did not require morphine for post-operative pain control in group I (18/27 pts) while additional analgesics were not needed until 6 hours in this group. They were able to mobilise with assistance earlier compared to the other group. Moreover the pain levels as assessed by pain scores were lower with group I patients compared to group II patients. The nursing level of intensity was lower in group I patients as monitoring of PCA was not required compared to group II patients.

Conclusion: Local infiltration analgesia is practical, simple and safe procedure with good efficacy in relieving pain after knee surgery. Moreover monitoring levels are reduced relieving nursing staff to concentrate on other duties.

Background: Guidelines for the management of Low Back Pain (LBP) consistently recommend that the initial assessment focuses on the detection of serious spinal pathologies. In 1994 the UK Clinical Standards Advisory Group introduced the concept of “red flags”. One of these red flags is the first presentation of LBP in people over the age of 55 years. The aim of this study was to investigate the incidence of serious spinal pathologies in patients presenting with new onset of LBP over the age of 55 years.

Method/Results: This was a prospective analysis of all patients presenting to a secondary care spinal triage service over a 3 year period (2005–2008). During the study period, in excess of 3000 patients were seen. Of these, a total of 70 patients presented with a first onset of LBP aged over 55 years and had no other red flags. Analysis of this group of patients revealed 2 serious spinal pathologies. Both of which were osteoporotic vertebral compression fractures. Both patients were over age 75. In addition 1 patient had severe central lumbar canal stenosis. Therefore, 2.3% of patients presented with the first onset of LBP > 55 years, of which 2.9% has serious pathology. Patients > 55 years with cancer or infection had other red flags in addition.

Conclusion: In isolation the first onset of LBP over the age > 55 accounts for a small percentage of this secondary care population, of which 2.9% had vertebral compression fractures. Further research into the clinical value of this independent red flag or its added value in combination with other red flags is recommended.