Introduction

Revision surgery is generally recommended for recurrent dislocation following Total hip arthroplasty (THA). However, dislocation following revision THA continues to remain a problem with further dislocation rates upto 28% quoted in literature.

We present early results of one of the largest series in U.K. using dual mobility cemented acetabular cup for recurrent hip dislocation.

Introduction: There is an increasing trend for autologous blood transfusion in hip and knee replacement and we therefore felt the need to properties of the fluid reinfused.

Objectives of the study: The study objective was to determine the volume and Haemoglobin content of the reinfused blood.

Materials and methods: We prospectively studied 108 patients with primary Hip and knee arthroplasty. The drained blood was reinfused within 6 hours as recommended by the manufacturer. The volume of the drained and reinfused fluid was measured in millilitres.. The Haemoglobin (Hb.) of the patient was measured preoperatively and postoperatively in recovery. The Hb. of the drained blood and reinfused blood were also measured.

Results : The mean volume of the drained blood in the hip replacement group was 180.6 ml. while that of the reinfused blood was 132.7 ml. The mean volume of the drained blood in the knee group was 372.78 ml. while that of the reinfused blood was 362.76 ml.

The mean Haemoglobin of the reinfused blood in the hip group was 6.9 gm/dl significantly lower (p< 0.05) than the drained blood Hb. of 10.9. Similarly the Haemoglobin of the blood reinfused in knee replacements was significantly lower at 6.8 gm/dl. (p< 0.001). This was less than half of the average Hb. content of homologous blood transfusion.

Conclusion: The Haemoglobin content of the reinfused blood in Hip and knee replacement was quite low to be considered as a replacement for homologous blood transfusion and further studies may be required to confirm the efficacy of reinfusion drainage compared to homologous blood transfusion.

Purpose: The objective of the study was to determine the changes in the driving pattern – especially the capacity to use the steering wheel after carpal tunnel surgery so that recommendation for suitability to return back to driving can be made.

Methods Used: A computerised driving simulator normally used for driving assessment of drivers with disability at the regional mobility centre at the Wrightington Hospital was used to assess the patient’s driving. Static and dynamic steering torque was measured before and at 2 & 6 weeks after carpal tunnel release in 25 patients using the static assessment rig. Driving reaction time was also studied in these patients.

Results: There was decrease from preoperative static steering torque to that at 2 weeks postoperatively but the dynamic steering torque did not differ in most cases. By 6 to 8 weeks postoperatively, the mean torque values for static and dynamic steering capacity had significantly improved. The driving reaction times at preoperative assessment did not differ significantly from the post operative ones at all times.

Conclusion: Although at 2 weeks postoperatively the ability to use the operated hand for static steering had not returned in most patients, their overall steering capacity was not affected as suggested by their unaffected dynamic steering time and the reaction time.

Purpose: We present a 12 year follow up of a patient who presented with a multiple plexiform schwannoma of the median nerve with multiple recurrences, where it was possible to salvage the limb.

Patients and Methods: Multiple plexiform Schwannomas are rare nerve sheath tumours. In this case the tumour presented as a soft non-tender swelling in the palm of a child. On exploration the lesion was found to involve the median nerve from the digital nerves to the antecubital fossa. Histology confirmed a plexiform schwannoma.

The tumour was locally very aggressive with multiple recurrences initially in the median nerve and ulnar nerves and later in the nerve grafts used following excision of the primary tumour.

We present a pictorial review of the mode of presentation of the tumour; discuss different modalities used for limb salvage and the differential diagnosis of this rare tumour.

Conclusion: There are very few reports of PS involving main nerve trunks and none describe the long term follow-up. We report a twelve year follow up of a PS involving the main nerve trunks of the upper limb with salvage despite multiple recurrences. The clinical course of the tumour is presented up to the age of sixteen where the growth tumour appears to have regressed.