Purpose of the study

The aim of this study was to prospectively study the safety, functional outcomes and complications of all patients undergoing bilateral single-stage sequential (BSSS) unicompartmental knee arthroplasty (UKA) in our unit.

Despite a lack of evidence, the UK's Department of Health introduced a policy of ‘Bare below the elbows’ attire to try to reduce the incidence of nosocomial infection. This study investigates the link between attire and hand contamination. A prospective observational study of doctors working in a District General Hospital was performed. The fingertips were imprinted on culture medium, and the resulting growth assessed for number of colony forming units, presence of clinically significant pathogens and multiply resistant organisms. These findings were correlated with attire, grade, gender and specialty. 92 doctors were recruited of which 49 were ‘Bare below the elbows’ compliant and 43 were not. There was no statistically significant difference between those doctors who were ‘bare below the elbows’ and those that were not for either the number of colony forming units (p=1.0), or the presence of significant organisms (p=0.77). No multiply resistant organisms were cultured from doctors' hands. ‘Bare below the elbows’ attire is not related to the degree of contamination on doctors' fingertips or the presence of clinically significant pathogens. Further studies are required to establish whether investment in doctor's uniforms and patient education campaigns are worthwhile.

Introduction

The Rapid Recovery Program (RRP) is a holistic perioperative accelerated discharge process that aims to improve efficiency and quality of care, improve patient education, standardise protocols and pathways and encourage early mobilisation & discharge.

Statement : A prospective review of the clinical outcome following reconstruction of isolated posterolateral corner (PLC) injuries to the knee.

Method : 10 patients underwent an isolated PLC reconstruction for symptomatic instability. All patients had preoperative and post operative clinical examination, and functional knee scores.

Results : There were 9 males and 1 female, mean age of 35, with 100% follow up. Median length of follow up was 46 months (range 2 – 69). At the latest follow up, the mean Lysholm scores were 89.9, with an average increase in Tegner scores of 3.3 (range 2–10). IKDC scores showed a median of 93 (66 – 100). All patients had < 3 mm mean side to side difference using the KT1000 arthrometer, and no increase in PLRI. There were no complications and no clinical failures requiring further surgery. All the patients said they would undergo the surgery again.

Conclusion : In this series of patients with symptomatic PLC injury, hamstring graft reconstruction has restored knee stability with good functional outcomes.

Purpose- To review the operative treatment of patients with chondrosarcoma of the pelvis and to study the long-term survival analysis of this cohort group.

Methods- A retrospective case study analysis was performed of patients with a diagnosis of chondrosarcoma of the pelvis treated in our hospital between 1990 and 2003. The operative notes and histopathological records were used along with the latest follow up letters.

Results- 54 cases (32 males and 22 females) with a mean age of 48.4 years ( 18–77) were identified. The aetiology was primary ( 38), recurrences ( 9) and secondaries ( 7).The sites in the pelvis were in the anatomical epicentre I(24), II(20) and III(10).The surgical procedures performed were local resection (28) , local resection and hip arthoplasty (6), hemipelvectomy (+ endoprosthesis) (16), hemipelvectomy (+ fibular strut graft) (2) and hindquater amputation (2).The histological grade was grade 1 (27), grade 2 (20) and grade 3(7). The complications rate was 24% – Wound revision (9%), dislocation (8%) and infection (7%). There was a 14-year cumulative survival rate of 46 % and 24 patients are surviving to date. The median follow up was 52 months.

The cumulative 14-year recurrence rate was 40% and the mean time to recurrence was 20.2 months.

Conclusion- There is an increased recurrence rate with epicentre I and III tumours and with those treated by local excision.

Chondrosarcoma is the second most common bone tumour and occurs in the third to sixth decades of life. It most commonly arises in the pelvis and proximal femur.

We performed a clinical, operative and histological review of all patients seen at our unit with chondro-sarcoma of the pelvis over a ten-year period. We iden-tified 36 cases of chondrosarcoma of the pelvis and a retrospective analysis of cases was performed examining the rate of tumour recurrence and mortality rate with respect to tumour grade, anatomical site and type of surgery performed.

25 patients had a primary tumour diagnosed, 6 tumours were secondary to MHE and the remaining 5 were recurrent tumours. The tumours were situated in the acetabulum (14), the pubic / ischial rami (7), and the iliac wing (15). Surgical procedures included wide local excision (18), wide local excision and total hip arthroplasty (4), hemipelvectomy and endoprosthesis (13), and hind quarter amputation (1). The median follow up period was 48 months.

10 year cumulative survival rate was 40% and poor survival was associated with iliac tumours and higher grade tumours. Mean time to recurrence was 18.5 months and cumulative 10 year recurrence rates were 44%. Increased recurrence was associated with iliac and rami tumours and those excised by local resection alone. High tumour grade was not associated with increased recurrence in our study. The overall surgical complication rate of the operative procedures was 27%. These included dislocation and infection of prosthesis. Conclusions: This disease continues to be a surgical challenge with a clear association between more radical surgery and low tumour recurrence rates. However this must be balanced against the potentially devastating complications associated with this major reconstructive surgery.