Aims

In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this. The secondary aim of this study was to describe the barriers to making sustainable changes within orthopaedic surgery.

Aims

The aims of this study were to assess mapping models to predict the three-level version of EuroQoL five-dimension utility index (EQ-5D-3L) from the Oxford Knee Score (OKS) and validate these before and after total knee arthroplasty (TKA).

This is a prospective study looking at 116 consecutive total hip replacements in 110 patients using the C-Stem total hip replacement system (Depuy International, Leeds, UK) between March 2000 and October 2002. This is the first documented study of results of the C-Stem outside Wrightington Hospital where it was developed.

There were 69 females and 41 male patients. Average age was 66 years (Range 32 – 89 years). 64 patients had a right hip replacement, 52 patients had a left hip replacement and 6 were bilateral. The duration of follow up was from 24 to 55 months, with an average of 38.75 months.

All patients had a cemented C-stem via a posterior approach. 107 with a metal head and 9 with a ceramic head. Cemented, all polyethylene cups were used. 82 hips had an Opera cup inserted and 34 had an Ogee cup inserted. Palacos R with Gentamicin was used for the cement.

103 femoral stems were neutral.12 stems were in varus (5–10 degrees) and 1 stem was in valgus (5–10degrees). No stems were greater than 10 degrees in either direction. There were no lucencies in any of the zones described by Gruen. The average amount of subsidence of the stem was 0.86mm (range 0–4mm).

The average cup angle was 44.29 degrees (SD = +/− 4.85). 8 acetabular components had a 0.5mm lucent area in zone 1 and 2 acetabular components had 1mm lucent area in zone 1. All of these lucencies were present on the immediate postoperative x-ray and none were progressive.

There were no lucencies in the other zones. There have been no incidences of deep infection, fatal P.E, dislocation or revision.

We conclude that the C-Stem has produced excellent results in the short term in keeping with the criteria of the NICE guidelines.

Bladder catheterisation following joint arthroplasty is not uncommon but delaying catheterisation in the postoperative period until the patient is symptomatic can produce an atonic bladder due to the distension. This can prolong catheterisation and increase the risk of urinary tract infection. We prospectively determined if we could identify patients needing pre-operative catheterisation.

Method: 150 consecutive patients undergoing knee and hip arthroplasty were recruited. Pre-operative symptoms of frequency, nocturia, retention, incontinence and previous bladder or prostate surgery along with prior history of catheterisation were recorded. The type of anaesthesia and post-operative analgesia was noted. Details of catheterisation included duration, antibiotic administration, and reason for catheterisation and incidence of urinary tract infection.

Results: Patients mean age was 67.7 years. 47 patients required catheterisation of which 56.6% were female. The mean age of patients catheterised was 70.6 years in comparison to 66.3 years (Mann-Whitney P< 0.01). The frequency of catheterisation was unrelated to the surgical procedure.

Nocturia was significantly more common in-patients requiring catheterisation (Kruskal Wallis P=0.04) and its combination with pre-operative symptoms of frequency, retention or incontinence increased the significance further to P=0.001.

Patient age of greater then 66 years had a 76.6% predictive value for the subsequent need of catheterisation. This further increased to 91.5% when combined with a previous history of either catheterisation or nocturia. The type of anaesthesia or the post-operative analgesia did not significantly influence catheterisation frequency.

Conclusion: Patients aged greater then 66 years undergoing joint arthroplasty with previous history of catheterisation or nocturia may benefit from pre-operative bladder catheterisation. Peri-operative catheterisation of high-risk patients in theatre reduces patient discomfort caused by the observation period and avoids bladder atonia consequent of the distention, which may subsequently prolong catheterisation.

Aims: As part of the guidelines recommended by NICE (National Institute of Clinical Excellent), we are presenting the early results of this new hip replacement component.

Methods: We reviewed 65 consecutive primary total hip replacements in 59 patients in which the Opera Flanged cemented acetabular component (smith & nephew) had been used. The mean follow-up was 47 months (36 to 63). In all cases a Charnley femoral prosthesis had been used. There were 39 women and 26 men with a mean age at operation of 67.4 years (33 to 90). Survival analysis of the acetabular components was performed.

Results: Two components were revised due to deep infection, and one of these cups was discovered to be well fixed at operation. None of the acetabular components required revision for aseptic loosening. After 5 years survival was 97% using the worst-case scenario. Radiological analysis of all acetabular components at 12 months post-operation and at yearly intervals revealed no cases of aseptic loosening. Radiolucencies around the cemented socket were noted in five patients, but were not progressive on sequential radiographs.

Conclusions: The early results are encouraging and the follow-up will be continued to assess the 10 years results.