Introduction: A critical determinant of early dislocation following total hip arthroplasty (THA) is correct positioning of the acetabular component. This challenging aspect of THA has not been lessened by the introduction of more minimally invasive techniques. In this paper we introduce a simple and reproducible technique, which uses the transverse acetabular ligament (TAL) to determine cup orientation. We have used this technique as the sole method of cup orientation in our last 1000 consecutive primary total hips.

Methods: One thousand consecutive patients were studied in order to determine the prevalence of early dislocation (within 3 months) following acetabular component placement determined by reference to the transverse ace-tabular ligament. All patients underwent primary total hip arthroplasty via a posterolateral approach with a posterior repair.

Results: At a minimum follow-up of 9 months (range 9–39 months) 6 of the 1000 hips (0.6%) had dislocated.

Conclusion: Although multiple factors are known to contribute to this rate correct placement of the acetabular component is critical. As our results compare favourably with other published series where a posterior repair has been performed by extrapolation we feel that that the TAL does provide an acceptable method of determining cup orientation. The fact that it is independent of patient position on the table and is easy to locate with a minimally invasive approach makes it an attractive method.

Introduction: Blood loss is a major concern following total knee arthroplasty (TKA) frequently resulting in blood transfusions postoperatively. Various strategies exist to reduce blood loss and allogenic transfusion requirements. This study investigates the effect of immediate postoperative flexion on blood loss and transfusion requirements following TKA.

Methods: 180 consented patients undergoing primary TKA by a single surgeon were enrolled into a prospective randomised controlled study. 90 patients were randomised to have the operated knee nursed in extension postoperatively, and 90 patients to have the knee nursed in flexion for six hours postoperatively. Both groups followed a strict transfusion protocol. Data collected included calculated pre- and postoperative haemoglobin and haematocrit which was used to calculate total blood loss. Units transfused and postoperative complication rates were also recorded.

Results: There was no significant difference in demographics or factors predisposing to bleeding between the groups. The mean total blood loss was 1841mls for those in the extension group compared with 1587mls in the flexion group (p=0.02). The mean number of units transfused in the extension group was 0.78 units/patient compared with 0.36 units/patient in the flexion group (p=0.004). There was no significant difference in pain scores between the groups (p= 0.62).

Conclusion: This study shows that the use of immediate postoperative flexion significantly reduces calculated total blood loss and transfusion rates following TKA.

Patients and Methods: One hundred and fifty patients with pre-operative haemoglobin levels of 13.0g/dl or less were enrolled into a randomised controlled trial comparing the blood saving effect of intravenous tranexamic acid and topical fibrin spray on blood loss following primary total knee arthroplasty.

Those randomly assigned to the Tranexamic Acid group received 500mg intravenously five minutes prior to tourniquet deflation and a repeat dose three hours later. Those assigned to the Topical Fibrin Spray group received 10mls of the combined product intra-operatively. Those in the control group received no pharmacological intervention.

Results: There was a significant saving in total calculated blood loss for those in the topical fibrin spray group (p=0.016) and the tranexamic acid group (0.041) compared with the control group with losses of 1190mls, 1225mls and 1415mls respectively. The increased reduction in blood loss in the topical fibrin spray group was not significantly different to that in the tranexamic acid group (p=0.72).

Isolated patellofemoral osteoarthritis has been reported to occur in approximately 5% of patients with gon-arthrosis of the knee. A number of options are available for the surgical management of these individuals. We reported the short-term outcomes on thirty three patients (33 knees) with isolated patellofemoral osteoarthritis who underwent LCS total knee arthroplasty (TKA) without resurfacing who had been operated on between 1996 – 1999¹.

Barrack et al² in 2001 reported on the incidence of anterior knee pain in two groups of TKA patients, one with patella resurfacing and one without. They reported an increase incidence of anterior knee pain in both groups.

We now report the longer-term outcomes with an average follow-up of 80.2months (range 54–94 months). At latest review, 9 patients experienced night time pain, all describing it as improved from their preoperative level. Twelve patients walked with the use of a walking aid, compared with 21 preoperatively. Disease specific scores at latest review showed improved outcome measures at latest review.

We also report our outcomes in an additional fifty-five patients (59 knees) with isolated patellofemoral osteoarthritis who were treated between 1999–2004 receiving an LCS total knee arthroplasty without patellar resurfacing. Our preliminary findings suggest that this technique continues to be an option in the management of the older patient with isolated patellofemoral osteoarthritis.