Background: Tourniquet provides a blood less field for surgery, but it has few complications and contraindications. There are several studies identifying the tourniquet as a factor for increased risk of complications in knee arthroscopy, we reviewed 200 consecutive knee arthroscopies done in our hospital with out tourniquet to analyse the outcome.

Aim: To analyse the out come of 200 knee arthroscopies done with out use of tourniquet; with respect to visualisation, time of surgery, bleeding, analgesia and post operative complications.

Materials and methods: We retrospectively analysed 200 consecutive knee arthroscopies with out tourniquet done in our institute. Average age of these patients was 39 (21–81). All patients underwent soft tissue procedures under general anaesthesia, supine, with sole support, no antibiotics and were done by same surgeon as day case. Same arthroscopic kit (Dyonics) with pump was used for all patients, using 2 litre saline bag and pump set at 65 mm Hg pressure. First few cases had tourniquet applied but not inflated, but later even this was avoided. Procedures included were diagnostic arthroscopies, arthroscopic debridements, meniscal repairs and partial or complete meniscal resections. Procedures like arthroscopic ACL reconstruction and other bony procedures were excluded. We looked at any visualisation problems, time of surgery, bleeding, analgesia and post operative complications. We also looked weather any of these patients visited the consultant or GP for any wound related problem or pain before the usual review at 2 weeks.

Results: There was no problem with visualisation noted in any of the cases, or any incidence where arthroscopy was unduly prolonged. There was no incidence of bleeding, stiffness or increased need for analgesia in any of these patients. None of the patients had any wound problem or haemathrosis requiring intervention. There was no record of any patients reattending the clinic or their GP for pain or bleeding.

Conclusions: Many orthopaedic units continue to use a tourniquet routinely for soft tissue procedures in knee arthroscopy, probably in the belief that a clear operative view can only be achieved with one. However, the findings in our study indicate that knee arthroscopy for soft tissue procedures may be performed adequately without the use of a tourniquet provided a pump system is used and the pressure maintained above venous pressure. Therefore we recommend that its use for routine soft tissue arthroscopic procedures be discontinued.

Hallux Valgus (HV) surgery is the most common surgery performed in the foot. The Cochrane review done in 2004 showed that no osteotomy is superior to another, however, surgery was shown to be superior to conservative or no treatment for Hallux Valgus deformity. We performed a postal survey in August 2005, to determine the most common procedures performed for HV deformity, type of anaesthesia used, and the length of stay for Hallux Valgus surgery across the United Kingdom.

A list of foot and ankle surgeons was obtained from the BOFAS register and a questionnaire was sent. We received 122 (61%) responses from 200 questionnaires sent. Out of which 4 had retired and 118 were available for analysis.

The table below demonstrates the common procedures performed by those who replied. Eight-eight percent of the surgeons used foot block along with GA, 9% used GA only and 3% performed the surgery under regional anaesthesia only. Forty percent of surgeons performed the surgery on an overnight stay basis and 30% performed the surgery as a day case. Twenty-five percent of surgeons mentioned that they performed unilateral surgery as a day case and bilateral surgery on an overnight stay basis. Less than 5% kept the patients for more than 2 days.

From the responses, most surgeons in the United Kingdom perform Scarf osteotomy with or without Akin osteotomy for Hallux Valgus correction. The majority performed it on an overnight stay basis or as a day case. Most commonly, foot block along with NSAID’s were used for post-operative pain relief.

Aim: To compare the difference in periprosthetic bone density between cemented and uncemented total hip replacement at a minimum follow up of 10 years.

Patients and methods: We looked at a cohort of 17 patients who have had bilateral total hip replacement with cemented Charnley total hip on one side and uncemented Furlong total hip on the other side between 1984 and 1994 (minimum follow up 10 years). Harris and Oxford hip scores were used to determine the function, SF 36 was used to measure quality of life and Dual energy X-Ray absorptiometry (DEXA) scan was used to quantify bone mineral density adjacent to the prosthesis. The results from the DEXA scan for cemented and the uncemented hips were analysed using Paired samples two tailed t-tests. To compare the Harris hip scores, a non-parametric Wilcoxon test was used. Pearson correlations were carried out to examine the relationship between the bone density measures (averaged for each zone) and the quality of life measures.

Results: Bone mineral density was higher on the Furlong side in Gruen Zones 2, 3, 5 and 6 of the proximal femur and DeLee Charnley Zone 1 of the acetabulum. In all other zones there was no statistical difference. Comparison of Harris hip scores and Oxford hip scores showed no statistically significant difference between the two hips (p = 0.108). Age is negatively correlated with bone density in Gruen zones 6 and 7 and acetabular zones 2 and 3.

Conclusion: Bone density is better preserved around the uncemented HAC coated stem compared to the Charnley cemented stem.

The emergence of minimally-invasive total knee replacement (TKR) has led to the refinement of several surgical approaches, including the quadriceps-sparing and sub-vastus. There is some disagreement as to the precise definition of the term ‘minimally-invasive’, especially in regard to the preservation of vastus medialis obliquus (VMO). It is known that the termination of VMO is variable and may make these approaches difficult. We have attempted to assess the factors influencing the insertion of VMO and the impact which they have on the approach for TKR.

The MR scans of 198 knees were examined to assess the variation in the insertion of VMO in relation to the patella and the effect of variables such as age, gender and the presence of concurrent osteoarthritis of the knee on the insertion.

Our findings showed that both age and the presence of osteoarthritis were contributing factors to changes in the level of insertion of VMO. Therefore, not all capsular incisions which extend proximal to the midpole of the patella will violate the quadriceps tendon.