Introduction

The MHRA guidelines for metal on metal (MOM) suggest cobalt and chromium levels of more than 7ppb as potential for soft tissue reaction. However, in some patients soft tissue reaction is seen even in the presence of normal serum metal ions levels.

Total knee replacement (TKR) can be associated with significant post-operative blood loss requiring blood transfusion and haematinics. With increase in the use of navigation for total knee replacement, it is anticipated the blood loss may be lower as the medullary cavity is not breached. Hence, a prospective study was performed to compare the blood loss and the transfusion rates between patients with navigated and conventional total knee replacement.

Between September 2006 and December 2009, nearly 100 patients underwent total knee replacement by a single surgeon. Patients who underwent revision total knee replacement and complex primary total knee replacement were excluded. There were 73 patients with an average age of 70.3 (47-91) years. There were 37 males and 36 females with an average BMI of 30. Thirty eight patients underwent navigated TKR and 35 patients conventional TKR. Left knee was replaced in 29 patients, right knee in 40 patients and 4 patients underwent non-simultaneous bilateral total knee replacements. Cruciate retaining prosthesis was used in 17 patients and cruciate substituting prosthesis in 56 patients. Patella was not replaced in any patient.

The average pre-operative haemoglobin was 13.26 (8.7-18.4) g/dl in the navigated group and 13.47 (9.6-15.8) g/dl in the conventional group. The average tourniquet time was 110(90-150) minutes in the navigated group and 96.7(60-145) minutes in the conventional group. Seven patients in the navigated group and 3 patients in the conventional group did not have documentation of the tourniquet time. The average post-operative haemoglobin in the navigated group was 10.34 (7.5-14.8) g/dl and 10.03 (7.5-12.2) g/dl in the conventional group. Six patients each in the navigated group and conventional group required blood transfusion. Six patients in the navigated group and 8 patients in the conventional group were started on haematinics.

This study does not show any significant difference in the blood loss as estimated by the average drop in the post-operative haemoglobin between navigated and conventional total knee replacement. There was also no difference in the rates of blood transfusion between both the groups. However the average operative time was marginally higher in the navigated group than the conventional group.

Introduction: Several techniques have been described for revision of acetabulum associated with severe superior bony defects. An Oblong cup inserted without bone cement has the advantage of restoration of the centre of hip rotation and maintenance of bone stock. The aim of this study was to analyse the medium-term results of acetabular revision using Oblong cup for severe superior bony defects.

Methods: Thirty-five acetabular revisions using porous coated Oblong cups (S-Rom, Depuy) in 34 patients were performed by the senior author between 1998–2001. All patients were followed-up clinically and thirty-one hips were analysed radiologically for a mean duration of 39.6 months (range 18 to 60). The clinical assessment was performed using Harris hip score and subjective patient’s satisfaction. The acetabular defects were classified according to the method described by Paprosky et al. The position of the acetabular implant, restoration of the centre of hip rotation and the extent of osseo-integration of the acetabular shell were assessed in the post-operative radiographs.

Results: The mean Harris hip score has improved from a preoperative value of 40.6 to 69.4 post-operatively. According to the Leprosy’s method, two acetabula were classified as type 2B, 12 as type 3A and 17 as 3B. The post-operative radiographs showed a mean abduction angle of the Oblong cups of 54.2 degrees (range 40–80). Osseointegration was achieved in 29(94%) of cups. Three cups showed early migration, of which two eventually stabilised and osseointegrated by 12 months. The centre of rotation of hip improved from a mean lateral migration of 8.3 mm and superior migration of 23.5 mm in the pre-operative radiographs to 2.8 mm and 4.3 mm respectively post-operatively.

Discussion: Acetabular revision using porous coated oblong cup for severe superior acetabular defects provides satisfactory medium-term results with predictable restoration of hip centre of rotation.

Aims: Review the results of Long Gamma nail in the treatment of a select group subtrochanteric meta-static lesions of femur. Methods: From 1996 to 2002, 34 patients with subtrochanteric metastatic lesions of femur treated with Long Gamma Nail were included in this retrospective study. Hospital records and x-rays were reviewed for collecting the data. Results: 37 met-astatic femoral subtrochanteric lesions (3 bilateral) in 34 patients, 17 male and 19 female, with an average age of 65 yrs, had reconstruction with Long Gamma Nail. Right femur was affected in 15 and left in 22. Most common primary cancer was breast in 15, prostrate in 5, lung in 5, and others in 9 cases. Prophylactic nailing was preformed in 28 femurs (75%) and nailing of actual fracture in 9 femurs (25%). All femurs had distal locking bolts except in 2. Postoperatively pain relief was achieved and pre-op mobility was regained in all patients. 5 patients (13.5%) had medical complications including a death due to chest infection. 4 patients (10%) had implant related complications but none required any further surgery. There were no implant failures. From the time of surgery 20 patients (60%) died with a mean survival of 9 months, and 13 patients (40%) are alive, pain free and independent with a mean survival of 18 months. The overall patient survival rates after operation are 73% at 6 months, 56% at one year and 40% at 4 years. Conclusion: Reconstruction of met-astatic subtrochanteric femoral lesions with long gamma nail is highly effective in achieving local pain control, restoring limb function and better quality of remaining life with acceptable rate of complications.