Aims

The diagnosis of joint infections is an inexact science using combinations of blood inflammatory markers and microscopy, culture, and sensitivity of synovial fluid (SF). There is potential for small molecule metabolites in infected SF to act as infection markers that could improve accuracy and speed of detection. The objective of this study was to use nuclear magnetic resonance (NMR) spectroscopy to identify small molecule differences between infected and noninfected human SF.

Aims

Metabolic profiling is a top-down method of analysis looking at metabolites, which are the intermediate or end products of various cellular pathways. Our primary objective was to perform a systematic review of the published literature to identify metabolites in human synovial fluid (HSF), which have been categorized by metabolic profiling techniques. A secondary objective was to identify any metabolites that may represent potential biomarkers of orthopaedic disease processes.

Congenital talipes equinovarus (CTEV) is a complex three-dimensional deformity with an incidence of 1–3 per 1000 live births. The Ponseti method is widely accepted and practiced, giving reliably good long-term results. There are a number of studies showing the benefits of a physiotherapy led Ponseti service with outcomes similar to a consultant led service. We present the first prospective randomised series comparing a physiotherapy led Ponseti service with a standard orthopaedic surgeon led series.

16 infants with bilateral CTEV were randomised into two groups. Each infant had one foot treated by a physiotherapist and the other foot treated by an orthopaedic surgeon using the Ponseti technique. Both groups had a premanipulation Pirani score of 5.5. All patients were followed up for a minimum of 12 months and the results demonstrated no significant difference in the post-treatment Pirani scores (p=0.77) and no significant difference in the success rate the Ponseti technique (p=1.00).

This study is the first of its kind and demonstrates the value of a physiotherapy led Ponseti service in the management of CTEV. Although overall supervision by a paediatric orthopaedic surgeon is still necessary, this service will allow the surgeon to spend more time dealing with more complex problems.

Over 80% of patients are satisfied following total knee arthroplasty (TKA). Female gender was one of the factors found to be a predictor of poorer satisfaction. The landmarks commonly used to achieve correct rotation of the femoral component are the posterior condylar axis, the transepicondylar axes (TEA) & the anteroposterior axis (Whiteside’s line) of the distal femur. The design features of most conventional jig based TKA instrumentation assumes a constant relationship of 3 degrees external rotation between the posterior condylar axis & the epicondylar axis. However during TKA using computer assisted navigation, we observe that these rotational landmarks do not have a constant relationship & there is wide variation among the arthritic population & between the male & female rotational profile. We hypothesise no consistent relationship between the posterior condylar axis, the TEA & the anteroposterior axis of the distal femur.

125 Computerised Tomography (CT) scans of the knee were performed using a 3D helical CT scanner in subjects who did not have any pre-existing clinical & radiological evidence of knee arthritis. CT slices 3 mm in thickness were obtained over the distal femur from the level of the proximal pole of the patella. Standard protocols were established for identifying the bony landmarks & taking measurements. The posterior condylar axis, the TEA & the anteroposterior axis were constructed. The condylar twist angle (CTA), the posterior condy-lar angle (PCA) & the angles made by the TEA & the line perpendicular to the anteroposterior axis were then measured using the PACSWEB digital measurement tools. The data was analysed to determine the consistency of the angular relationship between the reference axes using the STATA data analysis & statistical software. Linear regression was used to investigate any differences in the angle measurements between genders.

125 CT scans of the knee were performed in 111 patients (60 males [65 knees] & 51 females [60 knees]). The mean age was 45 years (SD, 15 years). The results showed no significant difference between the rotational axes of the distal femur between men & women (CTA male(SD): female(SD): 5.9(1.6): 6.3(2.0) [p=0.317], PCA male(SD): female(SD): 2.3(1.5): 2.5(1.9) [p=0.648]). The results also showed it would be inappropriate to assume a constant relationship of 3 degress external rotation between the posterior condylar axis & the epicondylar axes (PCA mean (SD) 2.39(1.70) [p< 0.001], CTA mean (SD) 6.11(1.81) [p< 0.001]).

Our study suggests no significant difference between the rotational reference axes of the distal femur between men & women. Furthermore, most jig-based systems result in 3 degress external rotation of the femoral component. Our results show this is not consistent & may be responsible for the pain in 20% of patients post TKA because of abnormal patellar tracking.

Introduction: The aims of this study were to determine whether patients were transfused appropriately, after a Unilateral Cemented Primary Total Knee Replacement (TKR), and whether it would be cost effective to use autologous transfusion drains compared with standard group & save and cross match protocols.

Method: Retrospective study of the pre- and postoperative day 1 haemoglobin values of all patients who underwent unilateral primary cemented TKR between November 2004 – November 2005 at the Kent & Sussex Hospital, Tunbridge Wells. Haemoglobin data and length of stay was obtained from computerised records & transfusion data from the blood transfusion department.

Results: 150 patients were assessed: 97 (65%) female and 53 (35%) male. 20 (14.6%) patients required blood transfusion. The mean preoperative haemoglobin for non-transfused and transfused patient’s was 13.7 and 12.5g/dl respectively (P = 0.0029). The mean postoperative haemoglobin for non-transfused and transfused patient’s was 11.1 and 9.27g/dl respectively (P< 0.001). The mean blood loss for non-transfused and transfused patient’s was 2.64 and 3.26g/dl respectively (P< 0.001). There was no significant correlation between length of stay and either preoperative haemoglobin or blood loss after surgery; Spearman’s correlation coefficient was 0.0222 and 0.0036 respectively. The cost of a standard group & save and cross match, plus the 56 required units of blood in this study was £15,443.60. The theoretical cost of using a CellTrans Autologous Transfusion System on these 150 patients would be £14,355.00, a saving of only £1,088.60. However, by only using the autologous drains on patients with a preoperative haemoglobin ≤ 12.5g/dl, this saving could be increased to £4,131.20 per annum.

Conclusion: Using autologous transfusion drains on patients with a preoperative haemoglobin ≤ 12.5g/dl would save over £4,000 per annum at Maidstone & Tunbridge Wells Hospital Trust. There is no correlation between length of stay in hospital and either preoperative haemoglobin or blood loss after surgery. Patients transfused had significantly lower pre- and postoperative haemoglobins.