Background

A pedobarograph is a device that records pressures exerted by the foot on contact with the ground. Clinically most publications using pedobarography investigated diabetic foot pressures for prevention of ulcers, and assessing gait and sway. Only limited work was done on the effects of foot surgery on foot pressures. Any comparison between papers is hampered by the absence of available defined normal ranges of foot pressures.

Purposes of the study: Demographic s Description and Pattern Recognition.

Methods: We reviewed the revision total knee replacements performed between 2001 and 2005, which were recorded on the Trent and Welsh knee register. We looked at the total number recorded in the register, the number of operations entered every year and the performance of each of the hospitals on the register through the 5 years period. We looked as well at the male: female ratio, the median age of revisions, the side of the operation, whether the implants were cemented or not and the seniority of the operating surgeon.

Results: Total number of revisions between 2001–2005 was 662. In the year 2001 we had 69 revisions, in 2002 we had 129 revisions, in 2003–2004 we had 201 revisions and in 2005 we had 263 revisions.

Out of the grand total of 662, 3 were form Bangor hospital, 10 were from Barnsley, 20 were from Basset-law, 2 were from Cardiff, 1 was from Claremont, 38 were from Derby, 18 were from Doncaster, 138 were from Leicester, 1 was from Glan Glwyd, 17 were from Grantham, 121 were from KMH, 2 were from Lincoln, 23 were from Llandough Hospital, 131 were from NGH, 86 were from Nottingham City, 2 were from Parkhill Hospital, 1 was from Pilgrim Hospital, 2 were from Prince Phillip Hospital, 4 were from QMC, 28 were from Royal Gwent, 2 were from Rotherham, 1 was from Thornbury Hospital, 4 were from WWG, 3 were from WWQ. The rest of the revisions were anonymous to place.

344 cases were males, 304 were females and the rest were anonymous.

The average age for males was 74 years and the average age for females was 75 years.

330 operations were carried out on right knees, while 302 were on the left side. The rest were anonymous.

491 revisions were carried out by Consultants, 19 were carried out by a Staff Grade, 37 were carried out by Registrars, 28 were carried out by others and the rest were anonymous. To be noted is that in 414 revisions the surgeons had no assistant.

253 knees were cemented, 10 were marked as uncemented and the rest were anonymous. Bone Grafts were used in 71 patients and augments were used in 107.

Conclusions: The input of the numbers of revisions has improved over the years. Poor documentation of whether the implant was cemented or not. 84 revisions were performed by Trainees/Staff Grades, does this have an impact on the outcome?. In 414 revisions the consultants didn’t have an assistant, this should not occur as revisions are complex operations and the lack of an assistant might have an impact on the outcome.

Background Our hospital operates a consultant led rapid review process of X-rays and case notes of patients referred to fracture clinic from Accident & Emergency (A& E) and General Practitioners (GP) on a daily basis. This compares with other centres where patients are reviewed in outpatient fracture clinics soon after injury.

Aim Evaluate effectiveness of consultant led rapid review process compared to standard consultant fracture clinics.

Patients and Methods Prospective study of the rapid review process over 4 weeks of all patients referred to fracture clinic by A& E and GPs. Total number of patients referred per day, time taken to review these patients case notes and X-rays, number of recalls and reason for recall were documented. This was compared to consultant led fracture clinics, which included time taken to review patients.

Results 797 patients were processed through the rapid review over 4 weeks. 53 (6%) patients were recalled, 32 (4%) for a change of management and 21 (2.6%) because of lack of information. The mean number of patients referred per day was 28 taking a mean of 28 minutes; thus the mean time to review one patient was 1.0 minute. The mean number of patients recalled per day was 2. The mean time taken to review a patient in a standard fracture clinic was 11 minutes. Therefore, the total time that would have taken to review 28 patients in the standard fracture clinic would be 308 minutes.

Conclusion A consultant led rapid review process of all patients referred to fracture clinic is a very efficient process. Rapid review process saves clinic time and resources, minimises delays in clinical decision-making and saves the patient an unnecessary visit to the outpatient department.