The National Joint Registry (NJR) was set up by the Department of Health to collect information on all joint replacements. The NJR data is externally validated against nationally collated Hospital Episode Statistics (HES).

Errors associated with the use of HES data have been widely documented. We sought to explore the accuracy of the NJR data, for a single surgeon, against a prospectively collected personal logbook.

The NJR and logbook were compared over a 3-year period (01/07/2009 to 30/06/2012).

Total procedure recorded in the personal logbook was 684 and in the NJR was 681. TKR in personal log book was 304 and in NJR 316, revision knee's in personal logbook 45 and in NJR 36, THR 274 in personal logbook and 271 in NJR, revision hip procedures in personal logbook 64 and 58 in NJR.

Whilst the total number of procedures captured correlates closely (681 vs 684) there is more variation with the different individual procedures. This may be due to the addition of 11% of HES data used for this time period by the NJR as it is known to be inaccurate. This therefore demonstrates the importance of maintaining your own accurate records.

The majority of orthopaedic surgeons routinely review their patients after six weeks, following surgery. During the first six weeks, orthopaedic surgeons are blissfully unaware of how frequently their patients seek medical attention related to problems with their arthroplasty. During this period of time, General Practitioners play a vital role in the care of the post-operative arthroplasty patient.

The aim of this study was to determine how frequently patients seek medical attention following primary joint replacement in this interim six-week period.

102 patients from a single practice who had undergone a primary hip or knee replacement from 2003 to 2011 were included and the notes of all these patients were analysed retrospectively. Within this group there were 33 men and 69 women. 45 (44.1%) patients sought medical attention during the 6-week period, which accounted for 69 GP led interventions. The maximum number of interventions was four and a minimum of zero. Of these, 45 patients (29.4%) were seen once, 9 (8.8%) were seen twice, 3 (2.9%) were seen three times and 3 (2.9%) were seen four times. The interventions were for the following reasons: 1(0.9%) for post operative anaemia, 5 (4.9%) for constipation, (1.9%) for post operative nausea, 8 (7.8%) for leg pain (1 scanned for DVT), 5 (4.9%) for leg swelling (2 scanned for DVT), 12 (11.7%) were administered antibiotics, of which 1 was for a chest infection (1 scanned for DVT), 7(6.8%) for a wound review (1 scanned for DVT) (2 patients were started on antibiotic) and 19.6% (20) patients were seen for post operative analgesia. In total, there were 5 (4.9%) patients scanned for DVT and all scans were negative.

GPs play a vital, often underestimated role in the post operative care of primary arthroplasty patients. The majority of interventions were required simply because of inadequate post-operative analgesia being given to patients upon discharge. This is an issue that the orthopaedic department can address, which will improve patient care and ease the burden on primary care. Patients still continue to see their GPs for suspected wound infections despite being instructed to contact the hospital. This issue needs to be addressed with further education, as any infection, even superficial, can have devastating consequences if it spreads to the prosthesis.

Aim: To assess whether use of the Pavlik harness for the management of developmental dysplasia of the hip (DDH) can safely be discontinued without weaning.

Method: The study group comprised babies diagnosed with DDH at the Royal Liverpool Children’s hospital over a 10 year period, between January 1995 and August 2004. The decision to instigate treatment with a Pavlik harness was based upon the Graf grade. We used Graf IIB or worse as our treatment threshold for the use of the Pavlik harness. In our practice the harness was removed when the hips were ultrasonographically and clinically normal, without a period of weaning.

Results: There were 368 hips (273 babies) for analysis, 178 cases of unilateral DDH (128 left hips and 50 right hips) and 95 bilateral cases. Mean age at diagnosis was 59 days (range 1 – 187 days) with twenty-six patients presenting late after the usual 120 day time limit. Treatment with the Pavlik harness was successful in normalising 323 hips (87.8%). The Pavlik harness was unsuccessful in reducing 45 dislocations (12.2%). Patients were followed-up for a mean of 4.1 ± 2.7 years with no deterioration of acetabular indices on plane radiographs, according to the Tonnis classification. There were 4 hips with possible grade I avascular necrosis. To date there have been no cases of late dysplasia.

Conclusions: Although many units remove the harness after a period of gradual weaning, practice is varied. Since we did not encounter any negative outcome despite not weaning we conclude that that weaning is unnecessary.

To assess the performance of calcium sulphate pellets as a bone graft substitute in an Orthopaedic Oncology practice using clinical and radiological outcomes.

Between 1998 and 2001, calcium sulphate pellets were used in cavitary defects in 38 procedures in 34 patients with bone tumours. In 29 calcium sulphate pellets were used alone, in 8 allograft and in 1 autograft bone was added. The diagnosis was unicameral bone cyst in 13, giant cell tumour in 11, non-ossifying fibroma in 2, chondroblastoma in 2, benign fibrous histiocytoma in 2 and another pathology in 8 procedures. The femur was involved in 12 procedures, the humerus in 8, the radius in 5, the tibia in 4, the fibula in 3, the calcaneus in 2, and one procedure each in the tarsal cuboid, a metatarsal, the talus, and the middle phalanx of a finger.

Median follow up was 14 months (3 to 48). Seven patients had wound complications. Pellets had absorbed completely in 26/28 (93%) evaluable procedures by 3 months. Healing of the defect occurred in 24/28 (86%) evaluable procedures by 6 months. In 6 cases, the healed defect contained cystic areas simulating local recurrence. In 3 cases, there was collapse of the defect.

In cavitary defects, calcium sulphate pellets reliably absorb. Some patients have wound complications, especially where the cavity is relatively superficial. The pellets do not provide mechanical stability where there is attenuated cortical bone. Cysts within the healed defect may simulate recurrence.