London's Air Ambulance (LAA) was first set-up in 1989 as a direct result of a Royal College of Surgeons of England Report highlighting poor trauma care provision. Since its inception, the service's mission is to be an innovative and effective provider of advanced pre-hospital care. The service provides a senior Doctor and senior Paramedic to the scene of any incident within the M25 by helicopter, during the day, and by fast-response car at night. The vast majority of doctors are usually Emergency Medicine Physicians or Anaesthetists. During a 6-month tenure, doctors will usually have completed a number of procedures, which include rapid sequence induction of anaesthesia, pre-hospital blood transfusion, and, procedural sedation. In terms of innovations, the organisation was the first in the UK to provide a 24/7 service. It was also the first to start pre-hospital Rapid Sequence Induction of Anaesthesia for the severely injured; Resuscitative Thoracotomy for the victims of penetrating trauma; and pre-hospital Blood Transfusion for shocked polytrauma patients. The service also has a very thorough induction programme, for new Doctors and Paramedics, and a highly structured Clinical Governance process. The post offers a unique and privileged opportunity to treat the most severely injured at the roadside.

Purpose of study: With the increasing demand for arthroplasty surgery, it is important to maintain a high quality of care. We describe a clinical governance framework for a simple, easy to implement method of assessing and monitoring radiological outcome following total knee arthroplasty.

Methods: We completed a two-year prospective study (January 2006 to December 2007 inclusive) of all total knee arthroplasty operations. This included 1,295 procedures, the majority of which were undertaken by two Consultant Surgeons and up to eight independent middle grade surgeons. The two Consultant Knee Surgeons assessed component position on standard post-operative weight-bearing antero-posterior and lateral knee radiographs on a weekly basis. They were blinded to both the patient and surgeon details, and used our own simple grading system, whose weighted Kappa variance showed ‘moderate’ interobserver (K = 0.41) and intraobserver reliability (K = 0.51). Our system comprised of only three ordinal scores, which were good (score of 1), acceptable (score of 2) and poor (score of 3).

Results: We provided individual surgeons with their results on a six-monthly basis. The average score for all the surgeons was good. The scores of the independent middle-grade surgeons were analysed by the Consultants, and feedback was provided in the form of formal advice and supervised surgery sessions. Repeat proportional analysis of their radiological scores showed significant improvements for all the individual surgeons (Pearson-Chi Square p value < 0.05).

Conclusions: Clinical governance is an important facet of excellence in medical practice. Our system allows continued prospective assessment of radiological outcome following total knee arthroplasty. By utilising such systems and ensuring an atmosphere of clinical excellence, we are able to employ more surgeons and undertake an increased workload, whilst maintaining high standards. This assessment tool can also be used to assess and appraise trainees during their progression.

Background: There remains no clear guidance from the British Orthopaedic Association regarding the use of closed suction drains after primary total knee replacement (TKR). Previous studies suggest no benefit in their use and no significant difference between the type of drain used.

Aims: To assess whether allogenic transfusion requirements are altered by the use of closed suction drainage and to establish if drains reduce post-operative complications and length of stay in hospital.

Materials and Methods: 60 patients undergoing TKR in Eastbourne between December 2008 and June 2009 were evaluated pre- and post-operatively. The population was divided into those with no drain, a Redivac drain (fluid discarded) and a re-transfusion drain (fluid filtered and transfused into the patient).

Results: 23 patients had Redivac drains and 5 (22%) required an allogenic blood transfusion. 37 patients had no drain and 2 (5%) required allogenic blood. For the 14 re-transfusion drain patients none received allogenic blood. There was no significant difference in the length of stay across all 3 groups (p=> 0.25). There was a significantly higher incidence of wound ooze and cellulitis in patients with no drain (50%; p=< 0.01). This is in comparison to the other two groups where only 30% of patients with a Redivac drain and 7% of patients with a re-transfusion drain experienced these complications. There was no significant difference in the average haemoglobin drop between the 3 groups (p=> 0.1).

Conclusions: The results suggest a benefit in using drains to reduce the risk of post-operative wound ooze and cellulitis after TKR. Re-transfusion drains also appear to reduce the requirement for allogenic blood transfusion in the post-operative period.

Purpose of study: With the increasing demand for arthroplasty surgery, it is important to maintain a high quality of care. We describe a clinical governance framework for monitoring radiological outcome following total hip arthroplasty.

Methods: We completed a two-year prospective study (January 2006 to December 2007 inclusive) of all total hip arthroplasty operations. This included 1,143 procedures, the majority of which were undertaken by three Consultant Surgeons and four independent middle grade surgeons. The three Consultant Hip Surgeons assessed component position on post-operative weight-bearing anteroposterior pelvic/hip radiographs on a weekly basis. They were blinded to both the patient and surgeon details, and used our own simple grading system. Weighted Kappa variance showed substantial interobserver (kappa = 0.60) and intraobserver reliability (kappa = 0.92). Our system comprised of only three ordinal scores, which were ‘good’ (score of 1), ‘acceptable’ (score of 2) and ‘poor’ (score of 3).

Results: We provided individual surgeons with their results on a six-monthly basis. The average score for all the surgeons was ‘good’. The scores of the independent middle-grade surgeons were analysed by the Consultants, and feedback was provided in the form of formal advice and supervised surgery sessions. Repeat analysis of their radiological scores showed significant improvements for certain individual surgeons (Pearson-Chi Square p value 0.006)

Conclusions: Clinical governance is an important facet of excellence in medical practice. Our system allows continued prospective assessment of radiological outcome following total hip arthroplasty. By utilising such systems and ensuring an atmosphere of clinical excellence, we are able to employ more surgeons and undertake an increased workload, whilst maintaining high standards. This assessment tool can also be used to appraise trainees during their progression.

Purpose of study: With the increasing demand for arthroplasty surgery, it is important to maintain a high quality of care. We describe a clinical governance framework for a simple, easy to implement method of assessing and monitoring radiological outcome following total knee arthroplasty.

Methods: We completed a two-year prospective study (January 2006 to December 2007 inclusive) of all total knee arthroplasty operations. This included 1,295 procedures, the majority of which were undertaken by two Consultant Surgeons and up to eight independent middle grade surgeons. The two Consultant Knee Surgeons assessed component position on standard post-operative weight-bearing antero-posterior and lateral knee radiographs on a weekly basis. They were blinded to both the patient and surgeon details, and used our own simple grading system, whose weighted Kappa variance showed ‘moderate’ interobserver (K = 0.41) and intraobserver reliability (K = 0.51). Our system comprised of only three ordinal scores, which were good (score of 1), acceptable (score of 2) and poor (score of 3).

Results: We provided individual surgeons with their results on a six-monthly basis. The average score for all the surgeons was good. The scores of the independent middle-grade surgeons were analysed by the Consultants, and feedback was provided in the form of formal advice and supervised surgical sessions. Repeat proportional analysis of their radiological scores showed significant improvements for all the individual surgeons (Pearson-Chi Square p value < 0.05).

Conclusions: Clinical governance is an important facet of excellence in medical practice. Our system allows continued prospective assessment of radiological outcome following total knee arthroplasty. By utilising such systems and ensuring an atmosphere of clinical excellence, we are able to employ more surgeons and undertake an increased workload, whilst maintaining high standards. This assessment tool can also be used to assess and appraise trainees during their progression.