Frictional resistance to tendon gliding is minimised by surrounding loose areolar tissues. During periods of prolonged immobilisation, for example post tendon-repair, adhesions can form between the two adjacent tissues, thereby limiting function. Whilst agents applied during surgery are recognised to succeed in adhesion prevention, they have also been reported to provide some reduction in friction during in vitro tendon-bony pulley investigations. This study investigated the effectiveness of common anti-adhesion agents in lubricating the tendon-surrounding tissue contact by comparison with a control study. By using a validated apparatus and with reference to the Stribeck curve, it was determined that the natural in vivo contact is likely to be lubricated by a film of synovial-like fluid. Application of all anti-adhesives generated a similarly efficient lubricating system, and hence administration of these agents should be encouraged to all regions of the tendon disrupted during surgery. Minimising frictional resistance to gliding will reduce the likelihood of tendon ‘gapping’ - and subsequently failure - at the repair site.

The Rotaglide+ knee arthroplasty was introduced in 2000 as a successor to the Nuffield and Rotaglide knees. Both prosthesis were used in our unit and data was collected prospectively on sex, diagnosis, range of motion, pain score and American knee association score (AKSS). All operations were done under the care of one Surgical team (BBM) using the same instrumentation and the same pathway. Between 1987 and 2000 444 primary Nuffield were performed. 278 primary Rotaglide+ knees between 2000 and 2006.

65% of Nuffields implanted were in female candidates and 55% in the Rotaglide+. 75% of Nuffields were performed for Osteoarthritis, 69% in the Rotaglide+, this reflects the authors growing interest in inflammatory arthritis. Pre-operative functional range of motion and pain scores were similar. Both series showed a significant and sustained improvement in pain score, and walking time. Similar improvement was seen in range of motion. Comparison of the two series showed the Nuffield knee scored better on AKSS at year’s one and two and on pain score at year one but other than this outcomes were similar for both series. Revision rate in the Nuffield series is 9% at 25 years and in the Rotaglide+ series 4% at 8 years. This compares favourably with other published knee series’.

Despite being introduced as an improved design the Rotaglide+ fails to demonstrate any improvement in function and pain compared to its predecessor the Nuffield knee. Knee surgeons need to maintain a healthy cynicism of manufacturers ‘improved’ implants.

Introduction: Reinfusion drains are used to minimise the need for allogenic blood transfusion, and its potential complications. Tranexamic acid {TA} is an antifibrinolytic agent that is used to decrease blood loss in total knee arthroplasty surgery. The effect of TA on reinfusion volume of drained blood has received little attention. The aim of our study is to measure the effect of TA on reinfusion volumes in primary total knee replacement {TKR}.

Methods: A cohort of consecutive patients undergoing primary total knee replacement between November 2006 and January 2008 were studied. Each patient was operated upon by the same surgeon, and had the same pros-thesis inserted. Patients operated upon before June 2007 did not receive TA but had reinfusion drains, while those who underwent surgery after June 2007 received TA along with the reinfusion drain. We measured pre and post operative haemoglobin {Hb}, drainage volume and reinfusion volume. The need for allogenic blood transfusion was recorded. TA and non TA groups were compared.

Results: Seventy patients were included in the study. There was no significant difference between the TA and non TA groups in pre operative Hb {13.2, 13.1g/dl} or post operative Hb {10.95, 10.9}. There was a significantly lower drainage volume {250 v 600ml} and subsequent reinfusion volume {100 v 465ml} in the TA group versus non TA groups respectively. There were no cases of thromboembolism or allogenic blood transfusion in either group.

Conclusion: Tranexamic acid significantly decreased post operative blood loss and subsequent reinfusion volumes in TKR. TA and reinfusion drains greatly decrease the demand for allogenic blood transfusion. Drainage volume is so low when TA is used in routine primary TKR, that the need for reinfusion drains is questionable. TA is cost-effective compared to reinfusion drains in TKR.

Multiple treatments of Sacro-iliac joint (SIJ) dysfunction have been adopted by various disciplines that treat low back pain. The aim of this audit is to evaluate the effect of steroids and Local anaesthetic injection (LA) in the management of SIJ dysfunction and to determine the relation between road traffic accident and low back pain (LBP).

We retrospectively reviewed 31 patients who were diagnosed as having SIJ dysfunction. All patients had steroids and LA injection under x-ray control. Based on previous history of road traffic accident patients were divided into RTA and non-RTA group. Through a postal questionnaire the severity of LBP and leg pain (pre and post injection) were assessed using visual analogue scale (VAS). Functional level was evaluated through the Oswestery disability Index (ODI).

All patients showed improvements in LBP and leg pain post injection with mean improvement in VAS of 2.95 (SD 3.0, p-value < .0001) for LBP and mean improvement of 3.3 (SD 3.3, p-value < 0.001) for leg pain. Similarly the ODI showed mean improvement of 15.0 (SD 17.0, p-value < 0.0001). Patients in the RTA group showed greater improvement than the non RTA group, however this did not reach statistical significance.

We conclude that steroids and LA injection is an effective method in management of SIJ dysfunction. Also our study suggests that RTA can be a potential cause of back pain by causing SIJ dysfunction. We accept that our sample size is small and needed to be confirmed through a prospective randomised controlled trial which is currently taking place in our institution.

In 2000 the Nuffield and Rotaglide Knee prostheses were combined into the Rotaglide+ system. This allowed a choice of either mobile or fixed meniscal bearing in the same prosthesis.

Between 1988 and 2000 460 primary Nuffield knee prostheses were implanted and between September 2000 and September 2005 185 primary Rotaglide+ prostheses have been used. A Prospective review using a pain score, range of movement, time walked, and the American Knee Surgeons score was performed. The Rotaglide+ cases have been age, sex, and diagnosis matched with 185 Nuffield knees. All prostheses have been implanted by one surgical team, using the same technique and the same instruments. All are inserted cementless with patella replacement if possible.

Statistical analysis was performed on the first 5 years of follow-up for both sets of prostheses (STATA).

The Nuffield prostheses was significantly better at relieving pain in all years post-operatively. The Rota-glide+ has a slightly better range of flexion, but this is significant only at the 2nd year. There is no significant difference in the walking time, and the AKSS is significantly better for the Nuffield prosthesis only at the first year. Statistical significance is difficult to obtain in years 4 and 5 due to the small numbers of Rotaglide+ prosthe-ses that have reached this stage of review.

Conclusion: A change in design has not improved the short term outcome of these prostheses, and may have worsened the results especially in terms of pain relief. This could be due to the change in stem size and the tibial fins. It is recommended that all changes in prostheses should undergo a limited controlled clinical trial before being released onto the open market