Introduction: Tourniquets are commonly employed in surgical procedures of the knee. The use of the same tourniquet on a repetitive basis without a standard protocol for cleaning has recently been questioned as a potential source of cross-infection. This study examines the contamination of the tourniquets in our institution and results of cleaning the tourniquets with a disinfectant and detergent wipe.

Material and methods: Tryptone soya agar plates were used to take samples from 20 tourniquets employed in knee replacement. Four specified sites on each tourniquet were cultured and incubated at 37° for 48 hrs.

Results: All sampled tourniquets were contaminated with colony counts varying from 9 to > 385.

Coagulase negative Staphylococcus was the most commonly grown organism from the tourniquets (96%).

Some tourniquets had growths of important pathogens including MRSA, Pseudomonas and Staphylococcus aureus (these organisms have not been previously cultured from tourniquets). On cleaning five tourniquets with clinell (detergent and disinfectant) wipes, there was a 99.2% reduction in contamination of the tourniquets five minutes after cleaning.

Conclusion: Contamination is more worrying in relation to pneumatic tourniquets, as they are commonly employed in knee surgery where implants are frequently used with the tourniquet lying within inches of the operative wound.

We have found a 99% reduction in contamination of tourniquets by employing disinfectant wipes. This is a simple, cost-effective and quick method to clean tourniquets and we recommend the use of wipes before every case in addition to the manufactures guidelines for general cleaning of tourniquets.

Introduction: NICE guidelines (2000) stipulated three-year follow-up data compatible with satisfactory performance at 10 years as a minimum requirement for hip implants. We reviewed the performance of two devices in use in our department which fell outside these requirements. The Cenator cup (Corin Medical) is a cemented device, and the EPF cup (Plus Orthopedics) is uncemented (equatorially expanded, screw option, polished inside, porous HA coated).

Patients and Methods: 117 Cenator and 110 EPF cups inserted during the period 12/09/2000–28/01/2003 were assessed at 3 years by the following: Oxford Hip Score, satisfaction (visual analogue scale), details of femoral component, age, sex, BMI and any complications. Radiological assessment included Charnley Grade, concentricity, superior cover, cup inclination, migration, radiolucent lines, and linear wear at 3 years. Statistical associations with radiolucent lines or linear wear were calculated.

Results: The mean age of patients with Cenator cups was 81 (range 61–102) and EPF cups 67 (39–86). Oxford Hip Scores averaged 10 (0–41)(Cenator) and 7 (0–29)(EPF). Cup inclination range was 30–65° (mean 47). Linear wear > 1mm was observed in 18 Cenator and 53 EPF cups. Early radiolucent lines behind EPF cups closed (all cases), and superior cover improved in 8%. Progressive radiolucencies > 1mm were seen behind 37 Cenator cups. One of each type was revised for deep sepsis. Four other minor reoperations occurred. Statistical association was demonstrated between superior cover and progressive radiolucencies (Cenator), and between sex, cup size and inclination and linear wear (EPF).

Discussion: Crucial markers of prognosis were observed (progressive radiolucencies and linear wear) but survivorship at three years for aseptic loosening was 100%. Our results indicate satisfactory performance at three years in accordance with NICE guidelines, and suggest acceptability of both devices. Our methods may be applicable to similar implants currently in use but not yet endorsed by suitable published outcome data.

Aim:To determine the outcome of patients whose hemiarthroplasty dislocate after treatment for displaced fracture of the neck of femur in a district general hospital.

Method: A retrospective analysis of 636 hemiarthroplasties performed in Weston General Hospital between 1998 and 2003, data collected from case records. A simple method of scoring from literature was used for this study based on two factors: Status and Mobility. Patients were scored for both status and mobility four times: prefracture, at 1,3 and finally 6 months after surgery.

Results: The overall dislocation rate was 1.2% (8 ) of which 2 were male and 6 female. The mean time to dislocate was 14 days (2–21 ) and subsequent relocation time 7.5hr (4–8). Three patients had cemented Bipolar hemiarthroplasty and five had cemented Thompsons hemiarthroplasty. Three had died within 6 months of surgery, three died two years after surgery, mortality rate of 37.5% at 6 months. There was a high rate of dislocation 87.5% (7), four had undergone Thompsons and other three had Bipolar hemiarthroplasty. Six of them underwent further procedures. Two of the cemented Thompsons were revised to a similar prosthesis, another Thompsons was converted to a Girdlestone due to comorbid factors, remaining Thompsons did not undergo any further surgery. In the Bipolar group one was converted to a Total hip replacement, another was revised to monopolar hemiarthroplasty and the third patient in this group was initially revised to bipolar hemiarthroplasty which was also unstable and had to be converted to a girdlestone. The overall mortality following redislocation was 40% at 6 months. Comparing the surviving and non-surviving group, the predictor for favourable outcomes were prefracture status and mobility scores. Mean prefracture status score for the surviving group was 5 compared with 3.5(2–5) in the non-surviving group and the mean prefracture mobility score for the surviving group was 5 compared with 3.3(2–5) in the non surviving group.

Conclusion: In this review we have found that 37.5% of patients will not survive 6 months after dislocation of hemiarthroplasty and if redislocation occurs in this group then the 6 month mortality increqases to 40%. Careful surgical technique and proper implant choice will reduce dislocation and probably lead to increased survival mainly in patients who have higher prefracture status and mobility scores.