Abstract

Introduction

There is no established evidence to support the use of drains after total knee replacement; however 94% of orthopaedic surgeons in UK routinely use closed suction drains. Haematomas can form with or without using drains, presence of which in addition may provide portal for infection and may increase blood loss. Blood group and save is routinely performed for every patient undergoing total knee replacement, however actual cross match and transfusion is needed for a small percentage of patients.

To investigate the clinical effectiveness and complications of caudal epidural steroid injections in the treatment of sciatica in patients with an MRI proven sacral tarlov cyst.

A Prospective case control study. All patients with corresponding radicular pain received a course of three caudal epidural steroid injections, two weeks apart and patients were reviewed at 3 months, 6 months and 1 year interval in a dedicated epidural follow up clinic. Data including demographics, MRI results, diagnosis and complications were documented. Outcome measures included the Oswestry Disability Questionnaire (ODQ), the visual analogue score (VAS) and the hospital anxiety and depression (HADS) score.

Overall patient satisfaction was recorded on a scale of 0-10.

38 patients with a sacral tarlov cyst were compared to a matched control group. In the sacral cyst group, mean VAS for axial pain reduced from 5.859 to 2.59 at three months (p<0.001). VAS for limb pain reduced from 6.23 to 2.53(<0.005). Mean ODI reduced from 45.49 at first visit to 21.98 at 3 months. Mean HADS also improved from 17 to 7. There was no statistical difference between the two groups. BMI did not affect the outcome in either group.

Based on our study, we conclude that presence of a sacral tarlov cyst is not a contraindication to caudal epidural steroid injection, as comparable significant improvement in both axial and limb pain in the short and intermediate periods was achieved without any major complications.

Background: Aetiology of venous thromboembolism is multifactorial and thromboprophylaxis includes mechanical and chemical agents. There is no clear consensus on the choice of chemical agent in elective total hip arthroplasty (THA), although National Institute of Clinical Excellence (NICE) recommends low molecular weight heparin or fondaparinux to all patients.

Aim: The aim of our study was to define the efficacy and safety of various chemical agents currently used for venous throboprophylaxis – namely aspirin, warfarin and low molecular weight heparin in primary THA.

Methods: We retrospectively reviewed 905 consecutive patients with primary THA during an 18 month period. Medical notes were reviewed to record demographic data, inpatient and outpatient thromboprophylactic agents, total hospital stay, readmission, incidence of DVT, pulmonary embolism and death following surgery. Post-operative mobility, transfusion requirements and complications were noted. Suspected thromboembolic events were investigated with venous Doppler ultrasound scanning and CTPA.

Results: 417 (46%) patients received aspirin, 253 received enoxaparin, 190 patients had low dose warfarin and 45 patients had none or multiple agents for inpatient thromboprophylaxis. 615 patients had cemented and 290 patients received uncemented total hip arthroplasty. Patients predominantly received aspirin (61%) as outpatient prophylactic agent. 41 patients were investigated for a suspected thromboembolic event. 2 patients had DVT and 2 patients had PE. There were 3 deaths within 6 weeks, one each due to PE, sepsis and unknown cause. All 4 patients with thromboembolism were on enoxaparin for prophylaxis.

Conclusion: In our study aspirin was the preferred choice for thromboprophylaxis following total hip arthroplasty. We found that aspirin was most effective with no complications and enoxaparin was least effective. We advise the use of aspirin as the first choice drug for thromboprophylaxis as reiterated by some recent studies.