BACKGROUND

Theatre-listed trauma patients routinely require two ‘group and save’ blood-bank samples, in case they need perioperative transfusion. The Welsh Blood Service (WBS) need patients to have one recorded sample from any time in the last 10 years. A second sample, to permit cross-matching and blood issuing, must be within 7 days of transfusion (or within 48 hours if the patient is pregnant, or has been transfused within the last 3 months). The approximate cost of processing a sample is £15.00.

Introduction: In the evaluation of the major joints, self assessment tools have become wide spread aiming at a more precise quantification of joint function. Different tools have been developed for the elbow joint. However, there are only few data on the relationship between subjective self-assessment of joint function and objective measures.

We developed a comprehensive assessment set for the evaluation of subjective elbow function and objective clinical findings and investigate long-term results after implantation of GSB III Elbow arthroplasties in a first study. The PREE-G was cross-culturally adapted, following the recommendations of the American Association of Orthopedic Surgeons.

Material and Methods: 79 patients (56 female, 23 male, mean age 64 years) after elbow arthroplasty between 1984 and 1996 due to rheumatoid (59) or posttraumatic (20) arthritis underwent an assessment of the joint function using the PREE, the Short Form 36 (SF-36), the Disabilities of Arm, Shoulder, Hand (DASH)) and the modified American Shoulder and Elbow Surgeons (mASES) for a clinical evaluation. In 62 patients implantation was performed unilaterally and in 17 patients bilaterally, resulting in 96 elbow joints altogether. The mean follow up time was 11,2 years

Results: In the SF-36 score, the mean physical component scale (PCS) was worse (37,2 vs 41,7, p=0,004), the mean mental component scale (MCS) better (52,3 vs 50,3, p=0,092) than normative values of a German population. Subjective assessment by the PREE revealed a mean of 66,8, by the mASES of 63,1 and by the DASH of 56,5 points. Clinical examination resulted in a mean mASES score of 71,6 points. Comparison between the patients self assessment and the objective score revealed a significant correlation between the DASH (r=0,46, p< 0,001), PREE (p=0,54, p< 0,001) and mASES (r=0,60, p< 0,001) with the clinical mASES. In contrast, no significant correlation was found between the physical component scale (PCS) and mental component scale (MCS) of SF-36 and the clinical mASES. Also the patients assessment scores DASH, PREE and mASES showed a strong significant correlation among one another (r=0,74–0,92, p< 0,001) and (PCS) (r=0,58–0,75, p< 0,001) but not with the (MCS) of SF-36.

Conclusion: Assessment of long term results after elbow arthroplasty yielded favourable clinical and subjective results. The clinical outcome tended to be higher than results of the patient self-rated scores. Hereby, the newly developed assessment set proved to be a feasible tool for a comprehensive assessment of elbow function. In addition to clinical outcome assessment, with this set it is possible to gain important and new insights on the relationship between objective measures and subjective patients-assessment of elbow disorders and postoperative conditions.

One of the advantage in using unicondylar prosthesis seems to be the preservation of the bone stock, which allows most often easily revision to a total knee replacement if required. The purpose of the study was to compare the patients outcome after revision of unicondylar prosthesis with a group of patients who have received total knee replacement primarily.

Material and Method: 28 patients after revision unicondylar prosthesis (group A) and 28 patients after primary total knee replacement (group B) were included in the study. The two groups were matched according to age, sex, weight, height, type of prosthesis and follow-up time. The patients’ evaluation was based on the Knee-Society-Score and the WOMAC-score. X-rays of the knee were taken in the AP weight bearing and lateral view.

Results: In group A the average follow-up time was 55±15 months and in group B 56±13 months. The knee-score showed 71.8±18 and 80.4±10.4 points and the function-score 56.1±15 and 62±19 points for group A and group B respectively without any statistical difference. The subjective assessment according to the WOMAC score showed difference in the functional outcome. A better range of motion of 110±11° was noticed for group B in comparison with group A 102±8° (p=0.004). The revised patients required a significantly higher poly-ethylene-inlay (12.9±3mm) compared to the primarily implanted ones (10.3±3mm) (p=0.004).

Discussion: Based on our findings revision of unicondylar to total knee replacement provides comparable results to primarily implanted total knee arthroplasty and should be considered for the treatment of unicompartmetal osteoarthritis even in younger patients, where a revision operation during lifetime is more likely. Despite the difference regarding the height of the inlay of 3mm, adequate bone stock was still found in order to implant an unconstraint type of knee prosthesis. The impaired functional outcome seems to be related to the fact of the reoperation and a significant longer history of osteoarthritis for group A in comparison with group B.