Aims

To evaluate the effect of ultrasound-targeted simvastatin-loaded microbubble destruction (UTMD_SV) for alleviation of the progression of osteoarthritis (OA) in rabbits through modulation of the peroxisome proliferator-activated receptor (PPARγ).

Objective

Mortality rates reported by the National Joint Registry for England and Wales (NJR) were higher following cemented total knee replacement (TKR) compared with uncemented procedures. The aim of this study is to examine and compare the effects of cemented and uncemented TKR on the activation of selected markers of inflammation, endothelium, and coagulation, and on the activation of selected cytokines involved in the various aspects of the systemic response following surgery.

Post-operative pain is well recognised in patients undergoing shoulder surgery. With the recent advances in arthroscopic shoulder surgery over the last decade, a larger number of cases are being performed in day surgery units. These procedures are generally performed under general anaesthetic with either an interscalene or suprascapular nerve block or local anaesthetic infiltration.

The aim of our prospective audit was to investigate the adequacy of analgesia provided for patients, undergoing day case arthroscopic shoulder procedures in a rural district general hospital, to ensure best medical care and to tailor certain procedures to appropriate analgesic pathways in the future.

Fifty consecutive patients, who underwent day case arthroscopic shoulder surgery, were contacted by telephone one week post surgery, to assess their post-operative pain scores and analgesic requirements.

Patients who received a nerve block were found to have a significantly longer duration of pain relief (p < 0.001). These patients also had significantly less pain performing their usual activities of daily living in the immediate post-operative period (p = 0.05), compared to patients who only had local anaesthetic infiltration. There was no trend found between the type of procedure and post-operative pain scores.

Our audit has confirmed that nerve blocks provide longer pain relief, but has also highlighted the need to take into consideration pre-operative pain and pain perception to enable analgesia to be tailored.

The aim of this study was to examine the effects of cement in total knee arthroplasty on markers of inflammation and endothelial dysfunction, as surrogate markers for enhanced risk of vascular disease or precipitation of acute vascular events post-operatively.

A total of 36 patients were recruited, with 18 in each of the cemented and uncemented groups. Both groups were matched for age, sex and body mass index.

Venous blood samples were taken pre-operatively, day 1 and day 7 post-operatively. Serum levels of interleukin 6 (IL6), tumour necrosis factor (TNF□?, e-selectin, Von willebrand factor (vWF), tissue plasminogen activator (tPA) and soluble CD40 ligand were analysed. Also, real time analysis of the expression of CD40 and CD14/CD42a aggregates on monocytes was carried out using flow cytometry. Patients were excluded from the study if there were signs of either superficial or deep infection.

The only variable to demonstrate a significant difference between the two groups was the CD1442a count. There was a significant difference in the first 24 hours (p=0.00) and from day 1 to day 7 (p=0.02)

Our study suggests that the use of bone cement causes a significant rise in CD1442a count which has been linked to atherothrombosis and acute coronary syndromes. These changes may explain the increased incidence of venous thrombosis and thromboembolism post-operatively. However more research required in this field to delineate the exact pathways involved.

Obtaining informed consent for an operation is a fundamental daily interaction between orthopaedic surgeon and patient. It is based on a patient's capacity to understand and retain information about the proposed procedure, the potential consequences of having it and the alternative options available. We used validated tests of memory on 59 patients undergoing lower limb arthroplasty to assess how well they learned and recalled information about their planned procedure. All patients showed an ability to learn new material, however, younger age and higher educational achievement correlated with better performance. These results have serious implications for orthopaedic surgeons discussing planned procedures. They identify groups of patients who may require enhanced methods of communicating the objectives, risks and alternatives to surgery. Further research is necessary to assess interventions to improve communication prior to surgery.

We aimed to determine the impact of anaesthetic techniques on post-operative analgesic utilisation in people undergoing total knee arthroplasty. We conducted a prospective study at a district general hospital to assess post-operative analgesia use via patient controlled analgesia (PCA) in patients undergoing a elective total knee arthroplasty. Subjects were divided into three groups; group 1 (general anaesthetic and local nerve block, n = 39), group 2 (spinal only, n= 39) and group 3 (general anaesthetic only, n = 38). The primary outcome measure was post-operative morphine consumption through a PCA within the first 24 hours. All subjects were followed up post-operatively by a dedicated pain control nurse. Data was analysed using SPSS version 17 for Windows (SPSS Inc, Chicago, IL, USA).

Results are reported as mean (SD) unless stated otherwise. No significant difference in the age or sex distribution between groups was demonstrable. There was no statistical difference in the average usage of morphine when comparing Group 1 compared to group 2, (77.57 (49.56) vs 65.80 (44.71), p=0.27), group 1 compared to group 3, (77.57 (49.56) vs 77.80 (45.52) p=0.98) and finally group 2 compared to group 3, (65.80 (44.71) vs 77.80 (45.52), p=0.25).

In this cohort of patients undergoing total knee arthroplasty the anaesthetic technique used does not appear to have an influence on the post-operative pain management.

Aim

To examine the effects of total knee arthroplasty on markers of inflammation and endothelial dysfunction, as surrogate markers for enhanced risk of vascular disease or precipitation of acute vascular events post-operatively.

Introduction: Early treatment with antibiotics is advocated in the management of septic arthritis. Whilst some argue for mandatory arthrotomy we have used arthrotomy selectively. The results of this approach over a ten year period were reported 20-years ago.

Aim: To review the outcome of joint aspiration and selective rather than mandatory arthrotomy for the management of septic arthritis in children.

Method: We compared the outcome for cases of septic arthritis in children reported from this centre in the decade 1982–1991 (Group I) with a contemporary cohort, from 1997–2006 (Group II) using the same criteria for diagnosis and the same treatment principles.

Results: Group I comprised 61 children, Group II 42. The mean incidence of septic arthritis in children (< 13 years old) was similar for Groups I and II (2.9/100,000 and 3.1/100,000). Infection caused by Haemophilus species declined from 10 of 56 (18%) in Group I to none in Group II. Staphylococcus Aureus reduced from 27/56(48%) in Group I to 13(31%) in Group II. As previously, infections particularly of the infant hip were at highest risk of causing permanent joint damage. There were eleven (18%) sequellae in Group I and two (5%) in group II.

Conclusions: These results continue to support joint aspiration for the management of early acute septic arthritis in children. However involvement of the hip in infants requires arthrotomy, as does late (≥4 days) diagnosis in older children.

Aim: To assess the effectiveness of povidone-iodine alcoholic tincture and the alcoholic chlorhexidine gluconate solution in the eradication of bacteria in forefoot surgery, and to assess any added benefits with the use of surgical bristles.

Methods: Fifty consecutive patients were prospectively enrolled into the study and randomised to receive one of two surgical skin preparations.

Results: The use of povidone-iodine with prior surgical scrubbing had a better eradication rate compared to povidone-iodine alone in the interdigital web-spaces. Prior surgical scrubbing with both solutions had a better eradication rate for the skin over the 1st metatarso-phalangeal joints. But neither solution with or without the use of surgical scrubbing was superior at eradicating organisms from the medial hallucal fold. However none of these results were statistically significant. None of the patients developed any post-operative wound infection.

Conclusions: Our results did not show any statistically significant advantage with either solution nor was there any apparent advantage with the use of the surgical scrub prior to the skin preparation. The authors believe that eradication of bacteria in forefoot surgery is dependant on a meticulous and methodical skin preparation technique and less so on the solution used and method of application.