We explored the outcome of staged bilateral total
knee replacement (TKR) for symmetrical degenerative joint disease
and deformity in terms of patient expectations, functional outcome
and satisfaction. From 2009 to 2011, 70 consecutive patients (41
female) with a mean age of 71.7 years (43 to 89) underwent 140 staged
bilateral TKRs at our institution, with a mean time between operations
of 7.8 months (2 to 25). Patients were assessed pre-operatively
and at six and 12 months post-operatively using the Short Form-12,
Oxford knee score (OKS), expectation questionnaire and satisfaction
score. The pre-operative OKS was significantly worse before the
first TKR (TKR1), but displayed significantly greater improvement
than that observed after the second TKR (TKR2). Expectation level
increased from TKR1 to TKR2 in 17% and decreased in 20%. Expectations
of pain relief and stair-climbing were less before TKR2; in contrast,
expectations of sporting and social activities were greater. Decreased expectations
of TKR2 were significantly associated with younger age and high
expectations before TKR1. Patient satisfaction was high for both
TKR1 (93%) and TKR2 (87%) but did not correlate significantly within
individuals. We concluded that satisfaction with one TKR does not
necessarily translate to satisfaction following the second. Cite this article:
1. Study of 200 cases investigated by pneumarthrography has shown that the introduction of air or oxygen into the knee joint is followed by a specific reaction characterised by transient localised eosinophilia in synovial membrane and synovial fluid. 2. Complications after meniscectomy seem to be more frequent when operation is performed during the phase of eosinophil reaction. 3. The significance of these observations has been discussed in relation to other causes ofeosinophilia and it is suggested that this method of local production of eosinophils may be of experimental importance.
1. A series of one hundred consecutive cases of trochanteric fractures treated conservatively by the authors has been reviewed. 2. Analysis of the results obtained and a study of the relevant literature has led us to the firm conclusion that the routine treatment of this group of fractures should be conservative. 3. Internal fixation should be reserved for those exceptional cases where traction is found to be inadequate: this is specially likely in cases associated with an upper motor neuron lesion, where difficulty is experienced in maintaining reduction owing to muscle spasm. 4. The basal type of fracture offers a special problem because it merges imperceptibly into that of the true transcervical fracture. No difficulty has been experienced in this series in the conservative treatment of such fractures, but we recognise that they might well be regarded as a variety of transcervical fracture and treated by nailing in order to avoid the risk of non-union.
