Multiple studies have established an inverse relationship between ambient theatre temperatures and polymethyl methacrylate (PMMA) cement setting times. It is also known that allowing cement to equilibrate to ambient theatre temperatures restores expected setting characteristics. One overlooked entity is the transport and storage conditions of cement. This is important in tropical regions, where extreme temperature and humidity may cause rapid cement setting times, resulting in potentially significant intra-operative complications.

This study investigated the relationship between extreme transport and storage conditions of Antibiotic Simplex cement (Stryker), and the effect on setting times at Cairns Hospital, Far North Queensland, Australia.

Fifty units of cement were divided evenly into a control arm and four experimental arms. The experimental arms were designed to mimic potential transport and storage conditions. They included seven days of storage in a medication fridge, on the hospital loading dock, in a cane shed, and in a Toyota Landcruiser parked outdoors during January 2022. Humidity and temperature readings were recorded.

The samples in each group were evenly distributed to equilibrate to theatre conditions for 1 hour and 24 hours. Setting time was recorded when a no. 15 scalpel blade was unable to mark the surface.

All three ‘hot’ exposures setting times were significantly faster for both 1 hour (ρ=0.001) and 24 hours (ρ=0.024) equilibration times. The difference in setting times for the ‘cold’ exposure was not significant for either equilibration times (ρ=1).

To our knowledge, this is the first study investigating cement setting times in tropical climates. Further studies are required to address the effect of these conditions on biomechanical strength of PMMA cement. We conclude that extreme heat and humidity during transport and storage have a statistically significant effect on cement setting times.

The ‘cement reaction’ is a recognised cardio-respiratory response to methylmethacrylate bone cement, characterised by hypotension, reduced cardiac output, and on occasion fatal circulatory collapse. It is seen in 0.5-1% of cemented hip arthroplasties during the insertion and pressurisation of cement into the femur, and is believed to be secondary to marrow thromboembolism, the vasodilatory effect of methylmethacrylate, or a combination of the two. A number of steps, within the operating surgeon's control, can be undertaken to reduce the risk of the ‘cement reaction’ occurring.

An e-mail based questionnaire was sent to all trainees and consultants in the West of Scotland containing eight questions relating to cementing technique when performing hemiarthroplasty of the hip. The questions related to measures to reduce the potential for ‘cement reaction’, e.g.: whether or not they routinely use a cement restrictor.

Seventy-two complete replies were received. For five of the eight measures, the surgeons routinely employed the suggested practices. For the remaining three, the consensus opinion was contrary to the suggested practice for reduction of the risk of ‘cement reaction’. These were with respect to the surgical approach employed, whether or not to attempt to remove all cancellous bone from the proximal femur, and the use, or not, of a venting tube during cement insertion. In all three cases, the difference was statistically significant on chi-squared testing.

The cohort of surgeons questioned routinely employ more than half of the methods suggested to reduce the potential for ‘cement reaction’ in hemiarthroplasty of the hip. Further surveys of why they do, or do not, undertake certain practices during cementing would help improve awareness of ‘cement reaction’, and perhaps reduce the incidence of this potentially fatal phenomenon.

Background: Since 2003 we have offered correction of bilateral hallux valgus to suitable patients as a daycase but there is nothing in the literature to support this as safe practice. Two published series support unilateral hallux valgus surgery as a daycase. We prospectively evaluated 30 bilateral daycase patients assessing complications and overall satisfaction rating.

Methods: The study group comprised 15 bilateral Scarf osteotomies, 9 bilateral Chevron osteotomies, 4 unilateral Scarf plus unilateral Chevron osteotomies, 1 bilateral 1st MTP joint fusion and 1 bilateral Lapidus procedure. All surgery was performed as a daycase under GA and ankle block. All patients were evaluated clinically and radiologically pre & post-operatively and had AOFAS scores measured. 21 patients were telephoned on the 3rd post-operative day to document their pain scores (0–10) and all patients responded to a patient satisfaction questionnaire at their discharge around 4.5 months.

Results: 18 of the 21 patients interviewed on day 3 had mild pain (0–4) as their maximum pain score. 3 reported problems (2 of pain and 1 of poor mobility). There was one unilateral superficial wound infection which required oral antibiotics. No other patients required to call or attend their GP nor attend A& E. The mean overall patient satisfation rating (0–10) was 8.8 (median 9). If having similar repeat surgery 4 of the 30 patients (13%) would prefer an overnight stay. The reasons given by these 4 patients were: pain (1), poor mobility (1), a desire to be looked after by the nursing staff (2).

Conclusions: Bilateral hallux valgus surgery can be performed safely as a daycase and with acceptable levels of patient satisfaction. It does not appear to result in an increased complication rate. To our knowledge this has not been previously documented in the literature.