Introduction

Hip and knee replacements are predictable orthopaedic procedure with excellent clinical outcomes. Discharging or leaking wounds affect length of hospital stay, affect bed planning and predispose to superficial and potentially deep wound infection. Predictable wound healing therefore remains the first hurdle. This trial aims to study the effectiveness of portable disposable incisional negative pressure wound therapy (NPWT) dressings in hip and knee replacements.

This trial aims to study the effectiveness of portable disposable incisional negative pressure wound dressings in hip and knee replacements and the impact on wound healing, length of stay and wound complications.

Objectives

The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which one can apply new technologies that can minimise complications. One such technology is the use of negative pressure wound therapy to manage and accelerate healing of the closed incisional wound (incisional NPWT).

In order to manage painful subluxation/dislocation secondary to cerebral palsy, 12 hips in 11 patients received combined femoral and Chiari pelvic osteotomies with additional soft tissues releases at an average age of 14.1 (9.1-17.8) years. Pain relief, improvement in the arc of movement, sitting posture and ease of perineal care was recorded in all, and these features have been maintained at an average follow-up of 13.1 (8-17.5) years.

The improvement of general mobility was marginal, but those who were community walkers benefited the most. Pre-operative radiological measurements have been modified post-operatively to use lateral margin of the neo-acetabulum produced by the pelvic osteotomy. The radiological migration index improved from a mean of 80.6% to 13.7% [p<0.0001]. The mean changes in CE angle and Sharp's angle were 72° (range 56°- 87°) [p<0.0001] and 12.3° (range 9°- 15.6°) [p< 0.0001] respectively. Radiological evidence of progressive arthritic change was seen in only one hip, in which only a partial reduction had been achieved, and there was early joint space narrowing in another. Heterotopic ossification was observed in one patient with athetoid quadriplegia who remained pain free. In seven hips the lateral Kawamura approach, elevating the greater trochanter, provided exposure for both osteotomies and allowed the construction of a dome-shaped iliac osteotomy, while protecting the sciatic nerve.

This combined procedure provides a stable hip with sustained pain relief for the adolescent and young adult presenting with pain.

Introduction: Studies have shown that the addition of adrenaline to the saline wash used in total knee replacements reduces blood losses. Our aim was to see if this held true for patients undergoing Total Hip Replacement (THR).

Materials and Methods: Between January 2007 and March 2008 we retrospectively looked at all total hip replacements performed by the senior author. The same standard peri-operative regimen was used throughout. All patients received Aspirin 150mg post operatively for six weeks as thrombo-embolic prophylaxis (unless specifically contra-indicated). All patients had a Bellovac A.B.T (Astra Tech) drain placed deep to the fascia lata at the end of each operation. Blood drained in the first 6 hours was re-infused. After six hours the drain continued to function as a ‘normal drain’. All drains were removed within 24 hours following surgery. Patients were assigned to two groups: one control group of 80 patients, in which a saline solution was used to wash the surgical field, and a second group of 59 patients, in which a saline solution containing a low dose of adrenaline (4mg of 1:1000 in a litre) was used to wash the surgical field.Haemoglobin was determined preoperatively and on the first postoperative day. The total blood loss was calculated. We also measured the decrease in haemoglobin for each patient. Statistical analysis was carried out using the SPSS statistical package.

Results: A total of 139 patients were reviewed. The patient characteristics in both groups were closely matched. No significant differences found in the drop in haemoglobin between both groups P = −0.426. The mean volume of blood lost intraoperatively was also similar. Study 299ml and Control 313ml respectively.

Discussion: Our study suggests that the use of adrenaline wash in patients undergoing THR is of minimal benefit in reducing blood losses. As there is no tourniquet used in THR perhaps this may be explained by the fact that as the circulation is not temporarily disrupted then the local effect of the adrenaline may be lost as it is being washed away at the time of application and local levels do not become sufficiently high to have the desired vaso-constrictor effect.

Purpose: This is a retrospective study, analysing the long term outcome following Chiari osteotomy and varus derotation osteotomy, which was performed as a part of one stage surgical reconstruction for painful subluxed or dislocated hips in cerebral palsy patients

Methods: Between 1986 and 1993, 12 hips in 11 patients underwent the above procedure. Adequate hip reduction was achieved in 11 hips and an acceptable reduction in the other. Immediate pain relief and subsequent improvement in range of movement of the hip, sitting posture and ease of perineal care was recorded in all. Average age at the surgery was 14.1 (9.1–17.8) years. At the recent follow-up, patients were seen along with the parents or carers and reassessed for pain, sitting comfort, mobility and ease of perineal care. Radiographs were obtained and assessed for acetabular cover, degree of femoral head lateralisation, changes in the hip joint including secondary arthritic changes

Results: At an average follow-up of 13.4 years (range 8.1–17.2 years), all patients remain pain free and continue to maintain improved sitting posture and personal hygiene. Improvement to mobility was marginal, but those who were community walkers to begin with benefited the most. No significant progressive arthritic changes or lateral migration were seen in any of the patients except one, in whom only a partial reduction was achieved. Minor joint changes were seen in 2 other patients.

Conclusions: Overall, Chiari osteotomy produces lasting benefits and the possible avascular necrosis and secondary arthritic changes in the hip joint appear to be minimal when compared with the long term benefits

Introduction The Zweymuller tapered cementless titanium femoral stem has been in widespread use since 1986.1 Stress shielding of the proximal femur has been a concern with pressfit cementless femoral stems. Radiolucent lines (RLLs) are signs of stress shielding and possibly over time, may lead to aseptic loosening.2

Aim To evaluate the longterm radiographic bone response in the femur following Zweimuller total hip replacements.

Study Design Consecutive case study (serial radiographic analysis)

Material and Methods 49 Total Hip Replacements in 42 patients (M:F=25:17) with a mean age of 59 years (range 49–70 years), were included in the study. All patients were operated on by the senior surgeon (JRW). 28 Alloclassic and 21 Endoplus stems were implanted. AP and Lateral radiographs were assessed. A gap of 1mm or more at the bone prosthesis interface was recorded as positive for RLLs in the Gruen zones. The mean duration of follow-up was 46 months (range 24–140 months). 17 patients had follow up of more than 5 years. Other measurements included subsidence, bone remodelling and heterotropic ossification.

Results After 2 years there were distinct radiological changes (RLLs), mainly in Gruen zones 1 and 7, in 18/49(36%) femora. Though there was evidence of RLLs in zones 2 and 6, the numbers were insignificant. Subsidence of more than 3mm was noted in 16 stems (33%). Heterotropic ossification was found in 4 patients (8%), one of whom required excision. Persistent pain due to trochanteric bursitis was noted in 10 patients. 4 patients needed revision due to reasons other than aseptic loosening. There were two dislocations, which needed revision of the acetabular component.

RLLs were more common in the Endoplus group (10/21) compared to the Alloclassic group (8/28). There was no clinical compromise (all had pain free mobility) in these patients and no progression of RLLs was noted.

Conclusion Proximal femoral stress shielding following Zweimuller femoral stem implantation is observed in significant number of patients. The RLLs do not correlate with symptoms and patient satisfaction.