Purpose: The purpose of this study was to establish patient mortality following salvage treatment (debridement, retention of prosthesis and antibiotic therapy) for infection of primary joint replacement, performed at the unit.

Method: A series of 89 patients underwent salvage treatment for infected primary total joint replacement (47 hips and 42 knees) between 1998 and 2003. The average age of the patients was 70.3 years (range 31.8 to 89.1). A survival analysis was performed using death as the sole endpoint and there were no patients lost to follow-up.

Results: There were a total of 26 deaths with a mean time to death of 3.3 years (range 0.8 to 7.2). The 7-year cumulative patient survival of was 66% (CI 5, number at risk 21).

Conclusions: The morbidity associated with infected total arthroplasty has been well documented. This study highlights that patients undergoing salvage treatment for this condition have significant mortality, with up to a third of patients potentially dying by 7 years.

The purpose of this study was to determine the effect of the use of a system to retransfuse salvaged drainage blood in patients undergoing primary THR with the aim of avoiding the significant risks that allogeneic blood transfusion poses to the patient. This was a retrospective cohort study where records of 109 patients undergoing elective THR following the introduction of an autologous retransfusion system at the institution were compared with a cohort of similar patients who underwent the same procedure prior to the introduction of the autologous system. The two groups were matched for age, surgeon, approach and technique and the results were subjected to statistical analysis. The use of a system to retransfuse postoperative salvage drainage blood, without concomitant use of predonation or intraoperative blood salvage, significantly reduced the need for allogeneic blood transfusion from 30% to 9%(p< 0.001). Patients who received salvaged blood also had a significantly smaller haemoglobin drop (Difference 0.56g/dL p=0.001) in the perioperative period, even though the preoperative haemoglobin level was not significantly different in the two cohorts. The overall cost of using the retransfusion system was similar to that of routine vacuum drainage when the savings of reduced allogeneic blood transfusion were considered. In conclusion the retransfusion of postoperative salvage drainage blood is a simple, effective and economical way of providing autologous blood for patients undergoing primary THR

A prospective assessment of the cause and results of surgery for recurrent carpal tunnel syndrome.

All patients undergoing revision carpal tunnel surgery over a five year period in a specialist hand surgery unit were reviewed. The physical signs, symptoms, ENIG, operative findings and operative outcome were recorded prospectively.

The selection criteria for surgery included an appropriate history, positive neurophysiology and one or more positive physical signs (Tinel’s, Phalen’s or pressure signs). Patients with normal neurophysiology results only underwent open release if the signs and symptoms were clear-cut, typically with at least 2 out of 3 positive signs.

Twenty-two patients (twenty-four wrists, mean age 55, range 33 to 91) underwent revision surgery. The mean time to re-operation was 7 years. 20 wrists had a positive Tinel’s test, 18 had a positive Phalen’s test, 19 had a positive pressure test and 18 had positive neurophysiology.

At operation, 20 wrists were noted to have compression proximally, 3 mid-retinacular and 3 distally. The proximal end of the primary wound scar was 1 cm or more from the distal wrist crease in 9 patients.

All patients reported some benefit. Significant or complete relief of symptoms were reported in 19 wrists. Better results were achieved in patients who had noted some improvement after primary surgery that had lasted for at least 4 months before relapse.

Most papers report inadequate distal release as the most common cause of re-operation but this study found inadequate proximal release to be more common. Less experienced surgeons may be apprehensive about performing an adequate closed proximal release but should be encouraged to take the scar to the distal wrist crease and if in doubt, incise across it in a standard manner.