Background

Current literature of definition, classification and outcomes of fractures of talar body remains controversial. Our primary purpose is to present an unusual combination of fractures of talar body with pantalar involvement / dislocation / extension as a basis for modification of Müller AO / OTA Classification.

Aim

Thromboprophylaxis in total hip replacement (THR) and total knee replacement (TKR) remains controversial, conspicuous by absence of consensus. Because of protracted and variable mobilisation, there is an extended risk of Venous Thromboembolism (VTE). We hypothesised that a combination of low molecular weight heparin and miniwarfarin would minimise the initial and extended risk. Therefore we evolved a protocol of enoxaparin sodium 40 mgs for 5 days starting preoperatively and miniwarfarin 1-2mg for 6 weeks following surgery. We undertook a retrospective study of total hip and knee replacements in a District General Hospital between January 2000 and December 2005 to determine the effectiveness of the protocol.

Aim:To determine the outcome of patients whose hemiarthroplasty dislocate after treatment for displaced fracture of the neck of femur in a district general hospital.

Method: A retrospective analysis of 636 hemiarthroplasties performed in Weston General Hospital between 1998 and 2003, data collected from case records. A simple method of scoring from literature was used for this study based on two factors: Status and Mobility. Patients were scored for both status and mobility four times: prefracture, at 1,3 and finally 6 months after surgery.

Results: The overall dislocation rate was 1.2% (8 ) of which 2 were male and 6 female. The mean time to dislocate was 14 days (2–21 ) and subsequent relocation time 7.5hr (4–8). Three patients had cemented Bipolar hemiarthroplasty and five had cemented Thompsons hemiarthroplasty. Three had died within 6 months of surgery, three died two years after surgery, mortality rate of 37.5% at 6 months. There was a high rate of dislocation 87.5% (7), four had undergone Thompsons and other three had Bipolar hemiarthroplasty. Six of them underwent further procedures. Two of the cemented Thompsons were revised to a similar prosthesis, another Thompsons was converted to a Girdlestone due to comorbid factors, remaining Thompsons did not undergo any further surgery. In the Bipolar group one was converted to a Total hip replacement, another was revised to monopolar hemiarthroplasty and the third patient in this group was initially revised to bipolar hemiarthroplasty which was also unstable and had to be converted to a girdlestone. The overall mortality following redislocation was 40% at 6 months. Comparing the surviving and non-surviving group, the predictor for favourable outcomes were prefracture status and mobility scores. Mean prefracture status score for the surviving group was 5 compared with 3.5(2–5) in the non-surviving group and the mean prefracture mobility score for the surviving group was 5 compared with 3.3(2–5) in the non surviving group.

Conclusion: In this review we have found that 37.5% of patients will not survive 6 months after dislocation of hemiarthroplasty and if redislocation occurs in this group then the 6 month mortality increqases to 40%. Careful surgical technique and proper implant choice will reduce dislocation and probably lead to increased survival mainly in patients who have higher prefracture status and mobility scores.

Aims: The purpose of this study was to assess whether auto Ðtransfusion of drainage blood in Total Knee Replacement is cost effective. Methods: This was a prospective study and the subjects were elective patients who underwent primary total knee arthroplasty between Dec 1999- Dec 2000. The subjects were randomly selected and identiþed from the theatre lists. Blood haemoglobin levels were obtained from the hospital pathology system. All the patients received an astra bellovac auto transfusion system re infusion drain. There was a protocol established for using the auto- transfusion system. Results: 27 patients were identiþed from which two had to be excluded and from the remaining 25, there were 10 men and 15 women. The mean post operative haemoglobin in the study was 12.3g/dl (m) and 10.8g/dl (f). 23 patients had blood auto-transfused and two did not have blood auto transfused due to problems with the transfusing blood. An average of 315 ml was re transfused. 22 patients did not require any allogenous blood transfusion post operatively. The requirement for homologous blood when using auto transfusion system was 0.12 unit, while an internal audit carried by the hospital haematology department found the requirement for homologous blood when standard drains were used to be 0.87 unit. The amount saved when re infusion drain used was £35.04 per patient which represents a 38% reduction in transfusion costs. As per the Hospital Episodes Statistics the average number of total knee replacements performed in the NHS (UK) during 2000/01 was 30,000. The cost savings to the National Health Service would be £1,051,200/yr if autotransfusion of drained blood was used. Conclusions: Auto transfusion of drainage blood in primary total knee arthroplasty is safe and cost effective. It signiþcantly reduces the requirement for homologous blood transfusion.