Aim: To establish the effectiveness of using the intra-operative cell saver in spinal surgery.

Methods: Patients undergoing posterior instrumental lumber spine fusion with iliac crest bone graft were selected to have intra-operative red cell salvage using the cell saver machine (Dideco Electra-Auto-transfusion Cell Separator). 20 patients were in the study group. The control group consisted of 28 patients who had undergone similar surgery prior to introducing the cell saver. The parameters identified were: pre and post operative haemoglobin, clotting state, volume of transfused allogenic blood, volume of transfused autollogous blood using the cell saver and indications for transfusion. Statistical analysis: the chi-square and the t-test.

Results: The average age in the cell saver group was 43.8 years and in the control group 48.3 (p> 0.09). The number of levels fused was comparable between the two groups (p> 0.1). There was no difference in the pre and post operative haemoglobin level in the two groups (p> 0.7 & p> 0.3 respectively). No patient had a pre-operative coagulopathy. Two patients (10%) in the cell saver group received an intra-operative allogenic transfusion, 14 patients (50%) in the non-cell saver group received a transfusion. The difference was significant (p< 0.004). Conclusion: The use of the cell saver significantly reduces the need for allogenic blood transfusion in major spinal surgery. We therefore recommend its routine use in such procedures.

Aims: Schuss radiographs are PA weight bearing views of the knee taken in 30 degrees of ßexion. Several studies have shown them to be more sensitive detectors of osteoarthritic changes in the knee than standard extension AP views. The aim of this study was to determine whether the increased severity of degenerate change shown on these radiographs is sufþcient to alter proposed orthopaedic management of patients. Methods: Fifty consecutive patients aged 45–75 presenting to clinic with symptoms suggestive of tibiofemoral osteoarthritis were included. Each underwent standard clinical assessment and weight bearing extension AP and lateral radiographs of the knee. In addition a digital photograph of the legs and a single schuss radiograph were taken. This information was collated onto slides, two per patient. One slide included the history and examination þndings plus the photograph, extension AP and lateral radiographs. The other was identical save that the extension AP was replaced by the schuss radiograph. The slides were randomised and shown to eight consultant orthopaedic surgeons. For each slide each consultant was asked to give his preferred management. Responses for the two slides of each patient were compared. Results: The panel changed their management plan in over 40% of cases. This represented a reduction of almost 50% in arthroscopies in the schuss group with a move towards deþnitive surgery. Total number of procedures proposed was also reduced. Conclusion: The schuss radiograph is a valuable tool in the assessment of knee osteoarthritis the use of which can alter clinical management. By reducing non-therapeutic arthroscopies it may signiþcantly reduce total number of operations to be performed in this patient group.

Our audit examined the rates of complication in the surgical wounds of patients having surgery for fractured neck of femur, comparing the use of skin clips and an absorbable subcuticular suture.

The initial part of the audit compared the commonly used methods of skin closure at our institution, as outlined above. One hundred consecutive patients with fractured necks of femur (NOF) were studied. The closure of the wounds was randomly allocated between skin clips and subcuticular suture. The wounds were monitored for signs of complications, including infection, for the duration of hospital stay. It was found that the use of skin clips carried with it a significantly higher rate of complication (11.1% ) when compared with use of subcuticular absorbable suture (0% ). At this stage, we concluded that the latter method be adopted as departmental policy.

A further study was performed one year later to reevaluate the efficacy of the new practice. A further fifty consecutive patients with NOF were studied using the same parameters as before. Our results demonstrated that the rate of complication was clinically and statistically significant.

We closed the loop of the audit cycle and concluded that the use of an absorbable subcuticular suture should be the preferred method of closure of hip wounds in NOF surgery.