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Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 227 - 227
1 Jul 2008
Palmer S Venn R Coates J Umarjii S Middleton F
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Purpose: The aim was to determine whether intra-articular bupivacaine provides effective analgesia following ankle arthroscopy and whether it reduces the need for supplemental analgesia.

Methods: A power calculation revealed that 40 patients were required to provide a 5% significant level using a visual analogue scale. 40 patients were therefore randomised to receiving 20 mls of either bupivacaine or saline (control) after routine anterior ankle arthroscopic surgery. The tourniquet was released 10 minutes later. In recovery, supplementary analgesia of 2 tablets of co-codomol 30/500 orally or 50–100mg tramadol IV was available on request. A 10 day supply of 50mg diclofenac (8 hourly) and co-codomol 30/500 2 tablets (6 hourly) was provided.

A visual analogue scale (VAS) was employed as a direct indicator of pain and indirectly, supplemental analgesic requirement. Measurements were made pre-operatively and postoperatively.

Age, weight and tourniquet times were compared with Mann Whitney U test and Chi-square. Pain scores and analgesic requirements were compared using ANOVA at a 5% significance level.

Results: Pain scores were lower in the bupivacaine group compared to the control as was the need for supplemental analgesia.

Significance: We conclude that postoperative intraarticular bupivacaine provides effective analgesia following ankle arthroscopy.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 129 - 129
1 Mar 2006
Middleton F Trikha S Matthews H Raynam O Lewis J Ward D
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Periprosthetic fractures present an increasing workload as more hip arthroplasties are performed. They are often challenging to treat due to poor bone stock and patient frailty. We compare the early clinical and radiological results in 2 centres of 24 consecutive periprosthetic hip fractures in 24 patients, using a cannulated interlocked long stemmed titanium alloy femoral component with or without a hydroxyapatite (HA) coating (Cannulok revision prosthesis).

The mean age at the time of operation was 79 years (range 65 to 92.4 years). The average length of follow up was 1.17 years (range 3 months to 5.3 years). All patients receiving a Cannulok revision stem with a minimum follow up of 3 months were included regardless of their primary aetiology and number of previous surgical procedures. Patients were reviewed and scored using the Merle d’Aubigne and Postal Score, Harris Hip Score and the WOMAC index at latest review. Periprosthetic fractures were classified using the Vancouver classification. At latest radiological review we measured subsidence, new bone formation (including presence of callus), osteolysis and radiolucent lines in all areas of the stem.

Of the 24 fractures, 22 healed. In the 14 who had HA coated implants there was a 50% increase in bone. In the non-HA coated stems there was a 36% increase in bone radiologically. The mean Harris hip score was 74 at the latest post-operative review. The mean WOMAC and MDP scores were 48.7 and 7.7 respectively. The mean pain visual analogue score was 1.6 overall and 0 specifically for mid-thigh pain.

We present encouraging early clinical and radiological results of the Cannulok stem system for treatment of complex periprosthetic fractures. This implant provides early fracture stability and subsequent biological bonding with an improvement in bone mass.