Introduction. There is no established evidence to support the use of drains after total knee replacement; however 94% of orthopaedic surgeons in UK routinely use closed suction drains. Haematomas can form with or without using drains, presence of which in addition may provide portal for infection and may increase blood loss. Blood group and save is routinely performed for every patient undergoing total knee replacement, however actual cross match and transfusion is needed for a small percentage of patients. Aim. To compare the requirement for blood transfusion after total knee replacement with and without the use of closed suction drains and the cost analysis of performing routine blood group and save pre-operatively. Materials and Methods. In this retrospective study, we reviewed the data over the last 2 years (2008–2009). Patients were divided into 2 groups (drains versus no drains). 11 surgeons preferred drains and 2 did not use drains. We also compared the results of one particular surgeon who used drains for patients operated in the years 2006 and 2007 and did not use drains in the years 2008 and 2009. Results. 1564 knee replacements were performed by 13 surgeons. 8.1% patients (n=128) received blood transfusion post operatively. In the drainage group (n=1451), 8% patients (n=117) received transfusion. In the non-drainage group (n=113), 9.7% patients (n=11) received transfusion. Comparing the results of one particular surgeon (2006–2007), 5.7% patients (n=5) received transfusion (total n=87 with the use of drains) while 5.3% patients (n=3) operated by the same surgeon (2008–2009) had blood transfusion (total n=56 without using drains). As only 8.1% patients received blood transfusion, the blood samples for the remaining 91.9% patients remained unused. A single group and save sample currently costs £30.30. This suggests we could potentially save £21,750 per year by selectively performing group and save. Conclusion. There was no statistically significant difference in blood transfusion requirement in the two groups. In the current financially driven society, we can cut the costs significantly by selectively performing group and save and post operatively, if blood transfusion is indicated clinically, it can be arranged within safe time limit even in the absence of a pre-arranged sample

Aims

Musculoskeletal infection is a devastating complication in both trauma and elective orthopaedic surgeries that can result in significant morbidity. Aim of this study was to assess the effectiveness and complications of local antibiotic impregnated dissolvable synthetic calcium sulphate beads (Stimulan Rapid Cure) in the hands of different surgeons from multiple centres in surgically managed bone and joint infections.

Over a five-year period, adult patients with marginal impaction of acetabular fractures were identified from a registry of patients who underwent acetabular reconstruction in two tertiary referral centres. Fractures were classified according to the system of Judet and Letournel. A topographic classification to describe the extent of articular impaction was used, dividing the joint surface into superior, middle and inferior thirds. Demographic information, hospitalisation and surgery-related complications, functional (EuroQol 5-D) and radiological outcome according to Matta’s criteria were recorded and analysed. In all, 60 patients (57 men, three women) with a mean age of 41 years (18 to 72) were available at a mean follow-up of 48 months (24 to 206). The quality of the reduction was ‘anatomical’ in 44 hips (73.3%) and ‘imperfect’ in 16 (26.7%). The originally achieved anatomical reduction was lost in12 patients (25.8%). Radiologically, 33 hips (55%) were graded as ‘excellent’, 11 (18.3%) as ‘good’, one (1.7%) as ‘fair’ and 15 (25%) as ‘poor’. A total of 11 further operations were required in 11 cases, of which six were total hip replacements.

Univariate linear regression analysis of the functional outcome showed that factors associated with worse pain were increasing age and an inferior location of the impaction. Elevation of the articular impaction leads to joint preservation with satisfactory overall medium-term functional results, but secondary collapse is likely to occur in some patients.

Cite this article: Bone Joint J 2013;95-B:230–8.

Our aim was to evaluate the efficacy of a two-level reconstruction technique using subchondral miniscrews for the stabilisation of comminuted posterior-wall marginal acetabular fragments before applying lag screws and a buttress plate to the main overlying posterior fragment. Between 1995 and 2003, 29 consecutive patients with acute comminuted displaced posterior-wall fractures of the acetabulum were treated operatively using this technique.

The quality of reduction measured from three standard plain radiographs was graded as anatomical in all 29 hips. The clinical outcome at a mean follow-up of 35 months (24 to 90) was considered to be excellent in five patients (17%), very good in 16 (55%), good in six (21%) and poor in two (7%). The use of the two-level reconstruction technique appears to provide stable fixation and is associated with favourable results in terms of the incidence of post-traumatic osteoarthritis and the clinical outcome. However, poor results may occur in patients over the age of 55 years.

Surgical dislocation of the hip in the treatment of acetabular fractures allows the femoral head to be safely displaced from the acetabulum. This permits full intra-articular acetabular and femoral inspection for the evaluation and potential treatment of cartilage lesions of the labrum and femoral head, reduction of the fracture under direct vision and avoidance of intra-articular penetration with hardware. We report 60 patients with selected types of acetabular fracture who were treated using this approach. Six were lost to follow-up and the remaining 54 were available for clinical and radiological review at a mean follow-up of 4.4 years (2 to 9).

Substantial damage to the intra-articular cartilage was found in the anteromedial portion of the femoral head and the posterosuperior aspect of the acetabulum. Labral lesions were predominantly seen in the posterior acetabular area. Anatomical reduction was achieved in 50 hips (93%) which was considerably higher than that seen in previous reports. There were no cases of avascular necrosis. Four patients subsequently required total hip replacement. Good or excellent results were achieved in 44 hips (81.5%). The cumulative eight-year survivorship was 89.0% (95% confidence interval 84.5 to 94.1). Significant predictors of poor outcome were involvement of the acetabular dome and lesions of the femoral cartilage greater than grade 2. The functional mid-term results were better than those of previous reports.

Surgical dislocation of the hip allows accurate reduction and a predictable mid-term outcome in the management of these difficult injuries without the risk of the development of avascular necrosis.