The aim of the study is to compare the postoperative pain relief provided by continuous perfusion of wound by bupivacaine and fentanyl with that of patient controlled analgesia using morphine in elective shoulder surgery. This retrospective case control study included 76 consecutive patients who had elective shoulder surgery. 39 patients had patient controlled analgesic system (PCA) with morphine and 37 patients had a continuous wound perfusion(intra bursal) with bupivacaine and fentanyl via a disposable Silicone Balloon Infuser. Patients were also given additional oral NSAIDs or morphine if needed. The pain score measured postoperatively based on a 10 point Visual Analogue Scale (VAS) at 1, 2, 3 and 18 hours was noted. The use of antiemetics and additional painkillers was recorded. The complications of both methods were also noted.

We found that the analgesia provided by continuous perfusion of wound by bupivacaine and fentanyl was constant and comparable to that provided by the patient controlled analgesic system using morphine. PCA with morphine was associated with significantly high incidence of nausea and vomiting (p < 0.001).We conclude that continuous perfusion of the wound by bupivacaine and fentanyl appears to be a simple, effective and safe method of providing analgesia following elective shoulder surgery.

Aim: To assess the medium term survival and radiological outcome of primary cemented modular Freeman Samuelson total knee replacement at Dumfries and Galloway Royal Infirmary, UK

Material and methods: 115 patients (118 knees), who underwent primary cemented modular Freeman Samu-elson total knee replacement from 1991 to1998, were reviewed retrospectively. Proximal cementing technique was used ti fix the metal backed tibial implant. The follow-up x-rays were also reviewed and presence of osteolysis, aseptic loosening and polyethylene wear was noted. The Knee Society radiological evaluation was used to record the osteolysis and the WOMAC score was used to evaluate functional outcome.

Results: The operation was performed for osteoarthritis (87), rheumatoid arthritis (23), psoriasis (4), Pagets disease (2), avascular necrosis (1) and gout (1). The average follow-up was 7.25 yrs (range 5–13 yrs). At the latest review 25 patients had died and 14 had undergone revision surgery. The indications for revision were aseptic loosening and polyethylene wear (3), osteolysis (3), infection (6), instability (1) and loosening of patellar component (1). Patella was resurfaced in 80 patients using press fit uncemented all-polyethylene component. Two patients with unreplaced patella underwent re-operation for patellar resurfacing due to anterior knee pain. Cumulative survival of the implant at 10 years was 93.4% for revision due to aseptic loosening or osteolysis and 86.8% for revision due to any cause. Radiolucent lines were observed in 22 patients. In 4 of these patients, the radiolucent lines were progressive and 3mm or more in size. Osteolytic lesions were seen in 10 patients. None of the patients with osteolysis or radiolucent lines were symptomatic. There was no statistical association between thickness of polyethylene and presence of osteolysis or occurrence of aseptic loosening (chi squared test)

Conclusion: Freeman Samuelson knee replacement provided good and predictable medium term outcome in our patients with tricompartmental arthritis of knee. The results of uncemented press fit all-polyethylene patellar replacement were also excellent. However, the high incidence of osteolysis even though asymptomatic, at an average follow-up of 7.25 yrs is a matter of some concern. Proximal cementing technique may lead to increased incidence of osteolysis and should be avoided in the modular Freeman Samuelson total knee replacement