We report the frequency of door-opening (“theatre traffic”) in orthopaedic operations at three metropolitan hospitals with different theatre policies. Published studies have correlated “theatre traffic” with airborne bacteria levels, which have been associated with raised wound infection rates.

Hospital A had one scoliosis operation and two hip replacements, Hospital B had one knee revision and one knee replacement. Hospital C had one scoliosis operation. A second scoliosis operation was performed at Hospital C after “theatre traffic” education and door signage discouraging entry.

One pair of surgeons performed the scoliosis operations and a different pair did the hips and knees.

Hospital A is private and Hospitals B and C are public.

The scoliosis operation in Hospital A (private) had an average door opening rate of 0.45/min compared to the same operation in Hospital C (public) with an average door opening rate of 1.0/min. The two hip replacements in Hospital A (private) had an average rate of 0.43/min and 0.51/min while the knee revision and knee replacement in Hospital B (public) had average rates of 0.91/min and 0.77/min respectively.

Of concern is the total number of door openings that result from this rate of “theatre traffic”. In the Hospital C (public) operation the total number of door openings equalled 140 over the course of the scoliosis operation. In Hospital B the total number of door openings for the knee revision was 169 and the knee replacement was 72. In contrast, for Hospital A (private) the total number of door openings for the scoliosis operation was 73 and the two hip replacements equalled 30 and 36.

The second study at Hospital C after staff education revealed a 35% decrease to 0.65/min.

There was a difference in “theatre traffic” between private and public hospitals for the same or similar operations. Staff education and door signage dramatically reduced “theatre traffic” in Hospital C. Surgeons and theatre staff need to be aware of “theatre traffic” and its influence on infection rates.

A series of 100 consecutive osteoarthritic patients was randomised to undergo total knee replacement using a Miller-Galante II prosthesis, with or without a cemented polyethylene patellar component. Knee function was evaluated using the American Knee Society score, Western Ontario and McMaster University Osteoarthritis index, specific patellofemoral-related questions and radiographic evaluation until the fourth post-operative year, then via questionnaire until ten years post-operatively. A ten-point difference in the American Knee Society score between the two groups was considered a significant change in knee performance, with α and β levels of 0.05.

The mean age of the patients in the resurfaced group was 71 years (53 to 88) and in the non-resurfaced group was 73 years (54 to 86).

After ten years 22 patients had died, seven were suffering from dementia, three declined further participation and ten were lost to follow-up. Two patients in the non-resurfaced group subsequently had their patellae resurfaced. In the resurfaced group one patient had an arthroscopic lateral release. There was no significant difference between the two treatment groups: both had a similar deterioration of scores with time, and no further patellofemoral complications were observed in either group.

We are unable to recommend routine patellar resurfacing in osteoarthritic patients undergoing total knee replacement on the basis of our findings.

Introduction Early complications of revision total hip replacement (rTHR) with femoral impaction allografting have included stem subsidence and loosening. In this comparative study, the impact of new techniques, including the use of longer stems, non-irradiated washed allograft, larger bone chips and medial mesh, on early clinical and radiographic outcomes was examined.

Methods The initial series of rTHRs with femoral impaction allografting comprised 20 hips (19 patients, median age 68 years) with a median follow-up of eight years. In the current series where the new techniques were used, there are 11 hips (11 patients, median age 69 years) with a median follow-up of 1.5 years. Three surgeons at one hospital undertook all rTHRs using a polished cemented collarless double tapered stem. Patients were mobilised on day one with partial weight bearing for 12 weeks. The femoral deficiencies commonly comprised extensive cavitatory loss combined with segmental deficiencies. Regular clinical and radiographic assessment was undertaken.

Results In the initial series, there were three early rerevisions for subsidence and stem loosening and one rerevision for infection. Periprosthetic fracture occurred early in three hips. EBRA FCA was used to assess stem subsidence. By two to four years, nine femoral stems had subsided more than five millimetres. At mid-term follow-up of eight years there have been no further rerevisions. In comparison, there has been minimal stem subsidence in the current series, with no stems subsiding more than five millimetres. To-date there have been no periprosthetic fractures and no complications requiring re-revision.

Conclusions Prospective monitoring of rTHR is important to identify factors that may be associated with poor outcome. Current techniques of femoral impaction grafting at rTHR, that includes washing of allograft and the use of long length stems and proximal mesh support yield good early-term radiographic and clinical results.