Abstract

Optimal management of acute patellar dislocation is still a topic of debate. Although, conventionally it has been managed by non-operative measures, recent literature recommends operative treatment to prevent re-dislocations. Our study recommends that results of non-operative measures comparable to that of operative management.

Our study is the retrospective with 46 consecutive patients (47 knees) of first time patellar dislocation managed between 2012 and 2014. The study methodology highlighted upon the etiology, mechanism of injury and other characteristics of first time dislocations and also analysed outcomes of conservative management including re-dislocation rates. The duration of follow up ranged from 1 to 4 years.

Average age at first-time dislocation was 23 years (Range 10–62 years). Male:Female ratio was 30:17. Twisting injury was the commonest cause. 1 patient required open reduction but all others relocated spontaneously or had successful closed reduction. Medial Patello-Femoral Ligament injury was frequent associated feature. 11 knees (24%) re-dislocated during follow up. Age was the significant risk factor for re-dislocations. All patients with re-dislocation were less than 30 years old. Maximum redislocations happened between 6 months to 1 year after index dislocation. Skeletal abnormality was the commonest pathology in re-dislocators. Only 4 patients (8.6%) finally required surgical intervention. One patient had persistent knee pain as a complication.

Conservative management of primary patellar dislocation is successful in majority of patients. Surgery should be reserved for the carefully selected patients with specific indications.

There is an increasing body of evidence that allogenic blood transfusion is harmful and blood itself is a valuable resource not to be dispensed lightly. Therefore, a review was undertaken into the need for allogenic blood transfusion following primary unilateral hip arthroplasty in our unit. An initial audit was performed retrospectively on 191 consecutive patients, revealing that 73 of the 191 (38%) received allogenic blood either intra-operatively or postoperatively. Guidelines were drawn up, then implemented, with the assisistance of the anaesthetic and haematology departments. The threshold for transfusion was a post-operative haemoglobin of less than 8g/dL. A trial period of 2 months was used to study the impact of these guidelines. No patients were excluded at the outset due to age or co-morbidity. During this period 96 patients were identified for inclusion in the study, of which only 19 (20%) required blood transfusion. In order to ensure these guidelines were not unsafe we compared the length of hospital stay following surgery in both groups of patients as a surrogate measure of postoperative complications. There was no significant difference between the lengths of stay in each groups. The conclusion was drawn that these new guidelines are not detrimental to the patient, and roughly halve the need for allogenic blood transfusion.