Objectives

Tranexamic acid (TXA) is an anti-fibrinolytic medication commonly used to reduce perioperative bleeding. Increasingly, topical administration as an intra-articular injection or perioperative wash is being administered during surgery. Adult soft tissues have a poor regenerative capacity and therefore damage to these tissues can be harmful to the patient. This study investigated the effects of TXA on human periarticular tissues and primary cell cultures using clinically relevant concentrations.

Objectives

Staphylococcus aureus (S. aureus) is the most commonly implicated organism in septic arthritis, a condition that may be highly destructive to articular cartilage. Previous studies investigating laboratory and clinical strains of S. aureus have demonstrated that potent toxins induced significant chondrocyte death, although the precise toxin or toxins that were involved was unknown. In this study, we used isogenic S. aureus mutants to assess the influence of alpha (Hla)-, beta (Hlb)-, and gamma (Hlg)-haemolysins, toxins considered important for the destruction of host tissue, on in situ bovine chondrocyte viability.

Introduction: The Lapidus procedure is a fusion operation of the 1st tarso-metatarsal joint for the treatment of moderate to severe hallux valgus (HV) in association with first ray hypermobility. This procedure has been shown to produce excellent correction of the deformity but is associated with complications such as prolonged healing and non-union. This study aims to determine the effectiveness of the procedure in correcting the HV deformity; record patient satisfaction and the incidence of complications.

Materials and Methods: Patients who underwent a Lapidus procedure at Glasgow Royal Infirmary between November 2001 and October 2006 were reviewed. Gender, age, previous surgery for HV, complications and outcome were investigated. Pre and post-operative HV and intermetatarsal (IM) angles were obtained from weight-bearing radiographs.

Results: 24 Lapidus procedures were performed on 21 patients, all female. 3 underwent bilateral procedures. The average age was 50.9 years. 7 feet (29%) had been operated on previously for HV. The HV angle improved from a pre-operative mean value of 44.3° to 15° post-operatively (average reduction 29.4°). The IM angle improved from 13.4° to 8.1° (average reduction 5.2°). There were 7 (29%) non-unions. 10 patients (42%) had minor transient complications. 12 patients (57.14%) were happy with the outcome while 7 patients (33.33%) expressed dissatisfaction. 2 patients remain under review.

Discussion: Excellent anatomical correction of the HV deformity can be achieved with the Lapidus procedure. It is, however, a technically challenging procedure and only just over half of the patients were satisfied with the results. In addition, we encountered higher non-union rates than previous studies.

Conclusion: The Lapidus procedure is extremely effective in correcting severe HV deformities but patient satisfaction is low and the complication rate is significant. In our view, the role of this procedure in HV corrective surgery requires further evaluation.