In law, doctors owe “a duty of care” to their patients to ensure that they are properly informed of treatment risks and are not harmed by their doctor’s negligent acts. This term is well established, however, a recent case in the New South Wales Supreme Court has considered the proposition of whether a duty of care, of this type, extends to ancillary medical staff; in this case the receptionist.

The court in the case Alexander v Heise [2001] NSW SC 69 has found that ancillary non-medical staff can owe patients a duty of care, for which a medical practitioner can be vicariously liable, and furthermore that this duty of care can begin when a person books an appointment either for or as a prospective patient and even before the prospective patient has been seen by the doctor. It is clear from this decision that the duty of care has widened somewhat.

Many important issues arise from this case; ensure that your practice has adequate insurance to cover all staff. There is no excuse for lack of training. Training should be focused, regular and documented. Extra care needs to be exercised when a patient is disclosing symptoms on behalf of a third party.

Introduction: The viscosity of bone cement used in total joint arthroplasty is an important for determining the proper handling characteristics of the cement and its interlock with bone. The degree of penetration and, therefore, the integrity of the arthroplasty are dependent on the viscosity of the bone cement system. As yet there is still no standard measurement of the efficacy of each bone/cement system with regard to the ability of the cement to penetrate the interstices of the bone.

Aim: To quantify the rheological properties of bone cement systems with the view to assisting in cement selection for orthopaedic purposes

Material & Methods: The rheological properties of a variety of current bone cements were determined using a novel apparatus developed at the CSIRO called the Micro Fourier Rheometer (MFR). This device measures the complex viscosity and complex modulus by subjecting a sample to small amplitude oscillatory squeezing between two parallel plates. The force transmitted through the sample is detected by a dynamic load cell and the complete signal spectrum is then analysed using Fourier Techniques. The bone cement is mixed according to manufacturers’ instructions and placed between the plates and is then subjected to a random displacement. Subsequent Fourier analysis lends itself to rheological parameters such as real and imaginary modulus, viscosity and phase (1–100 Hz).

Results: Consistent with earlier studies, it was found that the viscosity increased with time in an almost linear manner due to the progression of the polymerisation reaction of the cement. Thereupon the cement mass began its exothermic phase and the viscosity increased exponentially until fully set. The complex modulus at this time, when extrapolated to zero frequency, corresponded to the static modulus (as in conventional mechanical testing). The viscosity was highly dependent upon the shear rate (or frequency). As the cement was sheared the viscosity reduced, establishing the pseudo-plastic or shear-thinning nature of these materials. The phase provided an accurate measure of the setting and working time of the cement brands corresponding with studies by Krause (1982) and Ferracane (1981).

Conclusions: The results supported the conclusion that rapid insertion of the prosthesis is recommended, creating high shear stresses, thus decreasing the cement’s viscosity and allowing better cement penetration and mechanical interlock. The study highlights the differences between the major brands of bone cement.