The aim of this study is to assess the accuracy of patients' shoe size as a predictor of femoral component size of Oxford unicompartmental knee replacement (UKR).

A retrospective study was conducted to identify the correlation between patients' shoe size (British system) and the femoral component size. After excluding patients who died (n=2) and patients in whom the implanted femoral component size was inaccurate (n=13), the remaining cases (93 UKR in 88 patients) formed the study sample. Postoperative radiographs were reviewed to determine femoral component fit. We found positive correlation between shoe size and femoral component size. In females; a shoe size from 2.5 to 6 predicted a small femoral component and shoe size from 6.5 to 8.0 predicted a medium femoral component. In males, a shoe size from 6 to 9.5 predicted a medium femoral component and a shoe size from 10 to 13 predicted a large femoral component. This relation predicted the femoral component size accurately in 80% of cases. In the rest of cases, the prediction was only one size smaller or larger than the ideal size. A subgroup analysis, after excluding patients who changed their shoe size during adulthood after foot surgery or pathology (n=20), showed an accuracy rate of 81%.

Shoe size is a simple method that predicts femoral component size more accurately than other methods currently used such as templating, tibial component size and height based on gender.

The study was designed to assess the reproducibility and reliability of Mirels scoring system and the conventional scoring system for impending pathological fractures. The results of both classification systems influence the choice of therapeutic procedures offered to these patients.

Blinded plain antero-posterior radiographs from forty-seven patients with bone metastases were scored by eight independent observers (four orthopaedic surgeons and four radiologists with varying clinical experience). Each observer scored the radiographs as per the Mirels and the conventional systems. After twelve weeks, the radiographs were scored again by the same observers. Inter– and intra-observer agreement was assessed based on the weighted kappa coefficient values for both systems.

For intra-observer reproducibility, kappa values for the conventional system had a mean of 0.495 (SD 0.12) showing a moderate agreement, while Mirels scoring system had a mean of 0.386 (SD 0.143) showing a fair agreement. For inter-observer reliability, kappa values for the conventional scoring system were 0.322 for the first test and 0.47 for the second test giving fair and moderate agreements respectively. For Mirels’ scoring system, kappa coefficient for inter-observer reliability was 0.183 for the first test and 0.218 for the second giving poor and fair agreements respectively.

The conventional scoring system showed a better inter and intra-observer agreement compared to Mirels’ scoring system. Consultants had a better intra-observer agreement compared to their registrars. We also found that radiologists, in our study, had better intra-observer agreement compared to orthopaedic surgeons. Radiographs should be scored cautiously by experienced doctors in a multi-disciplinary setting to achieve the best decision of whether to proceed with a prophylactic surgery or not.

The objective of our study was to assess the efficacy of infection control measures (pre-admission screening and patient segregation) on reducing inpatient exposure to methicillin-resistant Staphylococcus aureus (MRSA).

A prospective case-control study was undertaken, analysing all admissions to three wards over an 83-month period from September 1995 to July 2002 inclusive (a total of approximately 34 000 patients). An orthopaedic ward with active infection control measures was compared with two controls, an orthopaedic ward with no measures and a general surgical ward with no measures. A statistical analysis was performed of the difference between the 3 wards in numbers of new cases of MRSA infection or colonisation. There was a statistically significant difference in numbers of new cases between the ward with the active infection control measures and the two control wards.

The infection control methods described are shown to reduce the exposure of patients to MRSA, which is of importance in orthopaedics, and has further benefits that may be applied in other surgical specialties, notably the choice of antibiotic used with the associated risk of side-effects of the specific anti-MRSA agents, the cost for surgical prophylaxis and patients’ confidence in the admitting surgical unit. As a useful by-product, such segregated inpatient beds are effectively ring-fenced, ensuring availability even during a hospital bed-shortage.

Failure of an acetabular cup is uncommon and has been attributed to wear or creep, trauma or bony irregularities in the acetabulum. We report ten cases in which fracture of the cup occurred at the site of drill holes used to anchor the marker wire. The role of such indentations as stress raisers has not been previously reported; we suggest that deep indentations or grooves should not be placed in the most highly stressed areas and that the cup thickness should allow for predicted wear rates.