Introduction

Orthopaedic departments are increasingly put under pressure to improve services, cut waiting lists, increase efficiency and save money. It is in the interests of patients and NHS organisations to ensure that operating theatre resources are used to best effect to ensure they are cost effective, support the achievement of waiting time targets and contribute to a more positive patient experience.

Patients in the UK are expected to have undergone surgery once decided within 18 weeks. A good system of planning and scheduling in theatre enables more work, however is largely delegated to non-clinical managerial and administrative staff. After numerous cancellations of elective cases due to incomplete pre-operative work-up, unavailable equipment and patient DNAs, we decided to introduce a surgeon-led scheduling system.

Introduction

Squeaking is a potential problem of all hard on hard bearings yet it has been less frequently reported in metal-on-metal hips. We compared a cohort of 11 squeaking metal-on-metal hip resurfacings to individually matched controls, assessing cup inclination and anteversion between the groups to look for any differences.

Introduction

The Morse taper was adapted into orthopaedics as a connecting junction in total hip replacements. The benefit of modular systems includes the adjustment of leg length, offset and the ability to remove the head for acetabular exposure during revision surgery. The design of the Morse taper facilitates the intimate contact of the conical trunnion of the femoral stem (male component), with the conical bore of the femoral head (female component). Design consideration for tapers involve physical parameters (angle, length, diameter and contact points), and manufacturing finish (surface characteristics). Orthopaedic trunnion tapers are not standardized and vary in length, taper angle and base dimension. Variations in the design and surface characteristics of the trunnion, which directly reflects on the interface at the taper junction can influence the likelihood of subsequent wear, corrosion and ultimately effect longevity of the implant.

Introduction

The success of total hip arthroplasty has meant its indications have been extended to the younger more active patient. Due to the higher activity levels and increased demands of these patients, revision rates have been traditionally higher than when compared to older patients [1]. Ceramic on ceramic bearings may offer a viable long term solution as manufacturing methods have evolved resulting in improved mechanical properties, particularly of third and fourth generation ceramics. We report the outcome of primary cementless, alumina-on-alumina hip arthroplasty with a minimum 10 year follow up in 110 patients under the age of 55 years of age at time of surgery.

Anterior Cruciate Ligament (ACL) injuries are increasing in prevalence amongst younger patients. Concerns exist as to the possibility of growth impairment due to transphyseal reconstruction techniques. However, due to the poor results of conservative treatment, reconstructive procedures have been employed to improve the outcome of these injuries. A growing body of evidence supports the safety of transphyseal reconstruction in older children. This study evaluates the safety and results of these techniques in younger patients.

Between 1999 and 2006, 17 patients of Tanner stage 1 or 2 underwent unilateral transphyseal ACL ligament reconstruction, using ipsilateral, four-strand hamstring grafts. Patients were aged between 9.5–14.0 years (mean, 12.1 years), and were followed up for a minimum of two years and a mean of 44 months (range 25–100 months). Graft survival, functional outcome and complications were recorded.

There was one graft failure after re-injury (6%). Of the remaining patients, all reported a good or excellent result and a normal IKDC score. Mean postoperative Lysholm score was 97.5 ± 2.6, mean Tegner activity scale was 8.1 ± 0.8 pre-injury, 4.2 ± 1.0 post-injury, and 7.9 ± 1.4 post-operatively. One patient had mild valgus deformity which caused no functional disturbance; otherwise examination was normal in all patients. There were no leg length discrepancies and KT1000 arthrometer measurements showed no significant difference between normal and operated legs.

Based on the results of this series, transphyseal reconstruction appears to be a safe option for the treatment of anterior cruciate ligament injuries in the young child.

The locked plates are commonly used to obtain fixation in periarticular and comminuted fractures. Their use has also gained popularity in fixing fractures in osteoporotic skeleton. These plates provide stable fixation and promote biological healing. We have used over 150 locked plates with varying success in last 3 years to fix periarticular fractures involving mainly Knee and Ankle. These plates need to be removed if indicated which may be implant failure, infection, non-union or a palpable symptomatic implant. There are no reports in the literature regarding complications associated with removal of these locked plates. We report our clinical experience of removing locked plates in 28 adult patients. The procedure of implant removal was associated with a complication rate of 25%. The main problems encountered were difficulty in removing the locked screws and the implant itself. The locking plate could not be removed in two patients and had to be left in situ. We recommend that surgeon should be aware of these potential complications whilst removing these plates and that fluoroscopic control and all available extra equipment mainly metal cutting burrs and screw removal set should be available in theatre.

Computer Navigation systems are becoming more widely used for knee replacement surgery. We used the Stryker Navigation System® to assess the alignment of twenty-two knees intraoperatively. We compared alignment readings of valgus angle of the knee in extension before and after cementing of the prosthesis.

We found that in twenty of the twenty-two cases (91%), a change in alignment occurred between bone cuts stage, and final cemented prosthesis. The mean change between trial alignment and final cemented alignment was 1.5 degrees (0.5 to 4.5 degrees). Twelve cases showed an improvement in alignment on cementing (ie. tended towards zero degrees) with a mean of 1.4 degrees (0.5 to 3.5). Eight cases showed a deterioration in alignment (ie. tended further away from zero degrees) with a mean of 1.1 degrees (0.5 to 2.5). Two cases showed change in alignment without being considered worse or better ie. changed from varus to valgus or vice versa to the same degree.

We conclude that in order to benefit maximally from the accuracy of the computer navigation system, care must be taken to ensure accurate seating of the prosthesis following cementing. The changes we observed in some cases between trial alignment and final cemented result, suggest that the high level of accuracy in alignment gained by the computer navigation system may be lost at the cementing stage. We therefore recommend that alignment is rechecked immediately following cementing, and valgus or varus force carefully applied as appropriate to achieve ideal alignment before cement polymerisation.