Background

The functional outcome and risk of recurrence following arthroscopic stabilisation for recurrent anterior shoulder instability is poorly defined in large prospective outcome studies. This is the first study to prospectively evaluate these outcomes in patients who have been treated using this technique.

Metastatic osteosarcoma is seen in 10-20% of patients at initial presentation with the lung the most common site of metastasis. Historically, prognosis has been poor. We studied trends in survival in our small developed nation and aimed to identify correlations between the survival rate and three factors: newer chemotherapy, advances in radiological imaging and a more aggressive approach adopted by cardiothoracic surgeons for lung metastases.

Our national bone tumour registry was used to identify patients at the age of 18 or under, who presented with metastatic disease at initial diagnosis between 1933 and 2006. There were 30 patients identified. Kaplan-Meier analysis was used to determine survival rates and univariate analysis was performed using the Cox regression proportional hazards model.

Median survival has improved over the last 50 years; highlighted by the ‘Kotz’ eras demonstrating incremental improvement with more effective chemotherapy agents (p=0.004), and a current 5-year survival of 16%. Aggressive primary and metastatic surgery also show improving trends in survival. Three patients have survived beyond five years. The introduction of computerised tomography scanning has led to an increase in the prevalence of metastases at initial diagnosis.

Metastatic osteosarcoma remains with a very poor prognostic factor, however, aggressive management has been shown to prolong survival.

Metastatic osteosarcoma is seen in 10-20% of patients at initial presentation with the lung the most common site of metastasis. Historically, prognosis has been poor. We studied trends in survival in our small developed nation and aimed to identify correlations between the survival rate and three factors: newer chemotherapy, advances in radiological imaging and a more aggressive approach adopted by cardiothoracic surgeons for lung metastases.

Our national bone tumour registry was used to identify patients at the age of 18 or under, who presented with metastatic disease at initial diagnosis between 1933 and 2006. There were 30 patients identified. Kaplan-Meier analysis was used to determine survival rates and univariate analysis was performed using the Cox regression proportional hazards model.

Median survival has improved over the last 50 years; highlighted by the ‘Kotz’ eras demonstrating incremental improvement with more effective chemotherapy agents (p=0.004), and a current 5-year survival of 16%. Aggressive primary and metastatic surgery also show improving trends in survival. Three patients have survived beyond 5 years. The introduction of computerised tomography scanning has led to an increase in the prevalence of metastases at initial diagnosis.

Metastatic osteosarcoma remains with a very poor prognostic factor, however, aggressive management has been shown to prolong survival.

Introduction

We report the results of a prospective study of 1349 patients undergoing 1509 total knee replacements, identifying factors increasing the risk of infection.

Aim: To investigate factors that influence outcomes one year after distal radial fractures To investigate how deformity (radiologically), functional outcome and patient satisfaction affect one another.

Background: Identifying the factors that influence outcome in DRF is important in anticipating and treating patients with potentially correctable factors that may affect recovery. Previous studies have looked at different sub-sets of the DRF group most often with patient reported outcomes. We have reviewed a large consecutive group of DRF looking at which factors influenced the outcomes.

Methods: Data on 640 distal radial fractures was prospectively recorded over a 24 month period. The database was reviewed and validated. Mechanism of injury, hand dominance and occupation were noted. Initial, post reduction, one week, 6 week and one year x-rays were taken. The volar and dorsal shortening, tilt and angulation were recorded. Any operative intervention or complication was noted.

At one year follow up functional testing was performed including range of movement. This tested for grip strength, multiple postional strengths and a functional score looking at activities of daily living.

Results: Prediction of functional outcome was significantly associated with age, volar communition, dorsal angulation and pain. The grip strength after a distal radial fracture is significantly stronger in dominant side fractures compared with non dominant, in younger patients and those without dorsal communition.

We also showed that fractures that are most likely to malunite show a significantly poorer functional outcome and weaker grip strength.

Conclusion: This study identifies factors that predict the functional outcome in Distal Radial fractures. Although many assumptions are made that certain fractures lead to poorer results this has rarely been shown in such a large, diverse group of DRFs.

In an age where patients and practitioners strive to ever increasing levels of knowledge this study allows us to counsel patients in their likely functional outcomes more accurately.

In Scotland, the number of primary total knee replacements (TKRs) performed annually has been steadily increasing. Data from the Scottish Arthroplasty Project has recently demonstrated that the number of knee replacements performed annually has now outstripped the number of hip replacements. The price of the implant is fixed but the length of hospital stay (LOHS) is variable. An understanding of what currently influences LOHS may therefore be of paramount importance in order that we can influence some of these parameters, with resulting benefit to our patients as well as contributing significantly and favourably towards the health economics of this procedure. This study investigates the influence of intra- and post-operative variables on LOHS.

All patients who underwent primary unilateral TKR in the region of Fife, Scotland, United Kingdom, during the period December 1994 to February 2007 were prospectively investigated. The following intra and postoperative details were recorded: length of operation, need for urinary catheterisation, patella resurfacing, lateral release, blood transfusion, the presence of superficial or deep infection, day 1 post-operative haemoglobin and haemoglobin drop (haemoglobin drop between admission haemoglobin and day 1 post-operative haemoglobin). The data was analysed using univariate and multiple linear regression statistical analysis.

Data on LOHS was available from a total of 2105 primary unilateral TKRs. The median LOHS was 8.0 days. The highly significant intra and post-operative factors associated with an increased LOHS were lateral release, post-operative haemoglobin, blood transfusion, urinary catheterisation, deep and superficial infection. An awareness and understanding of these factors may enable us to influence them favourably with resulting reduction in the LOHS and, therefore, the associated costs.

Introduction: In Scotland, the number of primary total knee replacements has been steadily increasing since 1992. It has been predicted that the number of total knee replacements performed annually will soon outstrip the number of hip replacements. The price of the implant is fixed but the length of hospital stay, and associated cost, is variable. An understanding of what currently influences length of hospital stay may be of paramount importance in order that we can influence some of these parameters, with resulting benefit to our patients as well as contributing significantly and favourably towards the health economics of this procedure.

Materials and Methods: All patients who underwent primary unilateral total knee replacement in the region of Fife, Scotland, UK, during the period December 1994 to February 2007 were prospectively investigated. The following information was gathered: age, sex, body mass index (BMI), year of operation, day of operation, diagnosis, surgeon grade, consultant performing the operation, walking score, walking aids score, stair score, American Knee Society score (pain, stability and range of motion), length of operation, need for lateral release, patella replacement, urinary catheterisation, blood transfusion, presence of deep or superficial infection, pre and post-operative haemoglobin values, haemoglobin drop, and length of hospital stay. All the data was analysed using univariate and multiple linear regression statistical analysis.

Results: Data on length of hospital stay was available from a total of 2105 unilateral total knee replacements. Length of stay varied from 4 to 70 days, with a mean of 9.4 and a median of 8.0. There were numerous highly significant predictors of increased length of hospital stay, when considered separately. Many of these independently significant factors remained significant when adjusted for the effects of the others. These included age of the patient, year of admission, consultant performing the operation, use of a walking aid, lateral release, deep and superficial infection, pre and post-operative haemoglobin values, urinary catheterisation and blood transfusion. Of note, the day of operation and high BMI did not influence the length of stay.

Conclusion: Prolonged hospital stay following total knee replacement is associated with demographic, preoperative, intra-operative and post-operative factors. An awareness of these factors gives us the opportunity to make attempts to influence them favourably with resulting reduction in length of hospital stay and, therefore, the associated costs.

As blood transfusion is associated with various risks, a prospective study was carried out to see if it was possible to predict patients more likely to require transfusion following TKR.

Data was collected prospectively on 1532 patients undergoing primary TKR between 1998 and 2006. This was collected at a preadmission clinic and various demographics were measured including haemoglobin, BMI, and a knee score. All patients had a tourniquet and the same approach. All received a LMWH until discharge. Patients with a post op haemoglobin less than 8.5 g/dl were transfused as were those less than 10 g/dl who were symptomatic as per unit protocol.

Each of the predictive factors was tested for significance using t-tests and chi-squared tests as appropriate. Multiple logistic regression was used to test for the independent predictive of factors after adjusting for one another.

Results show transfusion is more likely if the patient was older, female, short light or thin. Also those undergoing a lateral release or a bilateral procedure, having a low pre-op haemoglobin or a large post-op drop were more likely to be transfused. There was also a 2 fold difference between surgeons.

After regression analysis 4 important factors were identified. These were a bilateral procedure, low pre-op haemoglobin, a low BMI or having a post-op drop greater than 3g/dl.

Following this all patients with pre-op haemoglobin less than 11g/dl are postponed and investigated and treated as required. For those with the above predictive factors, measures can be taken to try and reduce the rate of transfusion such as pre-donation, cell salvage or tran-sexamic acid.