Aim: To determine the epidemiology of total knee replacement in our hospital over two 12 month periods 5 years apart to see if patient BMI and demographics have changed.

Methods: Hospital theatre log books were examined to determine all primary total knee replacements carried out in our hospital during May 2000 – April 2001 and May 2005 – April 2006. Patient notes were examined and the following details were recorded: age, sex and BMI. Data was recorded on an excel spreadsheet.

Results: There was a significant increase in the number of patients undergoing TKR in the 2005 – 2006 time period despite no change in population served (100 vs 228, p< 0.0001). This is also a higher than expected increase in TKR surgery when compared to the national data from the arthroplasty register. There was no significant change in the age of patients undergoing TKR. There was a significant increase in the average BMI of female patients 30.2+\−5.33 vs 32 +\− 6.98 (p=0.03) but no significant difference in the BMI of males. There was also a significant increase in the number of female patients with morbid obesity (BMI> 40) 3\64 vs 19/153 p=0.047.

It would appear that there has been a significant increase in the demand for TKR over a relatively short time period and that there are approximately twice as many women needing TKR than men. Within the females there has been a significant increase in BMI and also a significant increase in those who are morbidly obese undergoing TKR. This data helps predict future demand for both primary and revision arthroplasty services in our hospital.

Introduction: Ankle Arthroplasty is an alternative to arthrodesis for patients with disabling ankle arthritis. It aims to remove pain and preserve joint motion. We aimed to review the outcome of all total ankle replacements carried out in our institution between 2002 and 2006.

Materials and Methods: We retrospectively reviewed the results of all patients who underwent the Agility ankle replacement performed by a single surgeon. Case notes and radiographs were reviewed and outcome assessment included standardised questionnaires.

Results: 30 arthroplasties were performed in 30 consecutive patient. 11 males, 19 females, Pre operative diagnosis was rheumatoid arthritis (16), primary osteoarthritis (12) and post-traumatic osteoarthritis (2) with a mean age of 61.8 yrs. 8 patients required an additional procedure at the time of arthroplasty : tendoachilles lengthening (6); Calcaneal osteotomy (2); triple arthrodesis (2); tip post reconstruction (1). Intra operative technical complications included: Fracture of medial malleolus (3); nerve injury (3); tendon injury (1). 8 patients had wound problems: Delayed healing > 3/52 (8); Superficial infection (2); Deep infection (2). 1 patient had delayed union of the syndesmosis (> 6 months) and 6 had non-union (> 12 months).

After a mean follow up of 3.2 years 2 patients had died and 9 patients had required further surgery: Implant removal for infection (1); Talar revision for loosening (1); Re-fusion of the syndemosis (4); Removal of syndesmosis screws (3); Calcaneal osteotomy for valgus hindfoot (1).

Discussion: We found a high rate of complications which may be related to the surgeons learning curve, although some are specific to the design of implant which requires a tibio-fibular fusion.

Conclusion: The first 30 agility ankle replacements performed in our centre demonstrates several potential complications and shows that there is often a need for subsequent surgery. Short term survivorship of the implant is acceptable and long term review is required.

Introduction: Acetabular introducers have an inbuilt inclination of 45 degrees to the shaft. With the patient in the lateral position the operator aims to align the introducer shaft to vertical to implant the acetabulum at 45 degrees. We examined if a bulls-eye spirit level attached to an introducer improved the accuracy of implantation.

Methods: A small circular bulls-eye spirit level was attached to the handle of an acetabular introducer directly over the shaft. A sawbone hemipelvis was fixed to a horizontal, flat surface. A cement substitute was placed in the acetabulum and subjects asked to implant a polyethylene cup into the acetabulum, aiming to obtain an angle of inclination of 45 degrees. Two attempts were made with the spirit level dial masked and two attempts made with it unmasked. The distance of the air bubble from the spirit level’s centre was recorded by a single assessor. The angle of inclination of the acetabular component was then calculated. Subjects included a city hospital’s Orthopaedic consultants and trainees.

Results: Eighteen subjects completed the study, with no significant difference in performance between consultants and trainees. Accuracy of acetabular implantation when using the unmasked spirit-level improved significantly in all grades of surgeon. With the spirit level masked, 11 out of 36 attempts were accurate at 45 degrees, 19 attempts ‘closed’ (< 45degrees) and 6 were ‘open’ (> 45 degrees). With the spirit level visible, all subjects achieved an inclination angle of exactly 45 degrees on both attempts. The mean difference between masked and unmasked implantation angle was 0.94 degrees (95% CI 0.64 to 1.24, p< 0.0001).

Discussion: A simple device attached to the handle of an acetabular introducer can significantly improve the accuracy of implantation of a cemented cup into a saw-bone pelvis in the lateral position. This technique may be easily transferable into an in-vivo study

Introduction: Lumps of the foot present relatively infrequently to the orthopaedic service. There have been very few published studies looking at the differential diagnosis of such lesions and there is no clear evidence for the prevalence of malignant lesions in patients presenting with foot lumps.

Aim: To assess the prevalence of malignant lesions identified in patients presenting with a lump on the foot.

Methods: All patients presenting to a regional centre with a foot lump who required surgical excision of their lesion were identified over a 3 year period. All case notes were retrospectively reviewed. Data recorded included patient demographics, presenting characteristics, pre-operative diagnosis and histological diagnosis The centre includes a tumour service and serves a population of 550,000 patients. Tertiary referrals from out-with the direct catchment area of the centre were excluded.

Results: 101 cases presenting during this study period underwent surgery. Average age was 47.3 years (range 14–79) and there was a significant female preponderance with 73 females and 28 males. There was only one malignant tumour although 32 different histological diagnoses were identified. Only 58 out of the 101 lumps were correctly diagnosed prior to surgery.

Conclusions: We have shown that the prevalence of malignant lesion presenting as foot lumps is low but there are a wide variety of potential diagnoses which have to be considered. Pre-operative diagnosis is often inaccurate, therefore surgical excision and histological diagnosis should still be sought if there is any uncertainty.