In order to prevent fatal pulmonary embolism TED stockings, foot pumps and early mobilisation on the second post-operative day are used at our centre. Only patients deemed to be high risk (previous DVT/PE or obese) are given Clexane as an inpatient and Warfarin for six weeks post op. 1137 primary hips and 1017 primary knees were identified using the hospital database and the figures confirmed with the theatre implant order books. Those patients now deceased on the database had their death certificates obtained from the coroner. No patients had died from pulmonary embolism within three months post operation. 34 patients had been discharged on Warfarin according to the pharmacy records. We would therefore not recommend the routine use of chemical thromboprophylaxis following joint replacement.

Locking of the MCP joint of the finger, except with stenosing tenosynovitis, is relatively rare. The middle finger is most frequently involved. We treated 7 patients who had locking of the MCP joint of the middle finger because of osteophyte of the metacarpal head. The locking of the MCP joint usually occurred in the older patient as a result of significant osteophyte around the metacarpal head. Unlocking of the MCP joint was done by closed manipulation under local anaesthesia.

Locking of the MCP joint of the finger because of other causes than tenosynovitis has been reported infrequently.

Locking of the MCP joint caused by osteophyte of the head of the metacarpal is characterised by painful loss of extension of the MCP joint without loss of flexion.

We have treated 7 patients who had locking of the MCP joint occurring in the middle finger with an obvious osteophyte of the metacarpal head. Seven patients, 4 women and 3 men, were treated in our Department. None of the patients had a history of trauma to their hands, and in all of them it was the dominant hand which was affected and usually due to powerful full flexion movement of the fingers. The average age was 73.8 years (65 – 81). The duration of locking was from 3 hours to 14 days. All the patients were treated within 30–60 minutes after reporting to our Clinic. The presentation of the patients was extremely similar. In all cases active and passive extension was blocked and they had pain around the finger. Full flexion was possible. The MCP joint was tender around the palmar aspect with slight diffuse swelling around the dorsal aspect.

Radiographs of the MCP showed degenerative changes in all the patients and oblique views demonstrated an osteophyte either on the ulnar or the radial side of the head

Local anaesthetic Lignocaine 1% 5ml was injected in the MCP and around the joint and after 5–10 minutes manipulation was performed, unlocking achieved and the patients straightaway extended and flexed the finger fully. No-one underwent surgical release. Follow-up from 3 to 8 months, average 6 months. No recurrence of the locking.

Akio Minami reported 4 cases of MCP joint locking of the middle finger, treated surgically. Williams classified the locking of the MCP joint in 3 groups. Langenskiold reported 2 cases of intrinsic locking of the MCP due to catching of the collateral ligament on the lateral bony projection of the metacarpal head.

It is very difficult to explain why the middle finger is most likely affected. Kessler noted that the MCP joint seldom participates in a generalised degenerative OA.

Introduction: There has been significant development in computer technology in recent years and this has led to applications in orthopaedic surgery. Of particular interest is computer assisted joint arthroplasty to enable accurate insertion of the components based on CT generated images of the patient’s bones.

Methods: Twenty-five patients have undergone computer assisted total knee arthroplasty using a computer guidance system (Vector Vision, Brain Lab, Munich) implanting a PFC cruciate retaining total knee replacement (TKR) (Depuy, Leeds). Pre-operative CT scans were obtained from each patient and alignment and sizing were calculated before surgery. Intra-operatively, an infrared camera tracked the instruments and the patient’s limb was accurately mapped in space by surface matching the bone and comparing it with the CT scan. For the purpose of the study the computer generated alignments and sizing were evaluated along with the use of traditional instruments and stored in a database.

Results: These have been evaluated comparing computer assisted and instrumented knee arthroplasty. Variables measured include the AP femoral cuts, rotational femoral alignment, and tibial axis alignment in AP and lateral planes.

Conclusions: Computer assisted orthopaedic surgery has undergone a rapid development in the last 18 months to enable real-time intra-operative images to be viewed in a moving limb with a degree of accuracy previously not possible. The use of this technology may lead to more accurate alignment of hip and knee prostheses and therefor help to reduce wear in the long-term.