This study assessed factors responsible for exclusion of patients from bone donation at primary hip arthroplasty in order to improve bone banking.

Fifty-five patients underwent screening in preoperative clinics assessing their suitability for femoral head donation. Records at the bone bank were then reviewed post operatively to check whether bone had been harvested from these individuals during surgery.

Overall, 95% of the patients screened did not proceed to bone banking. After the initial screening stage 60% of patients were excluded. The majority of exclusions (70%) were unacceptable as donors because of their potential risk of transmission of disease to recipients. Although 40% were consented for donation, femoral heads from only 5% were harvested and sent for storage in the bone bank during hip arthroplasty.

Orthopaedic surgeons must take an active part in bone banking and alternative sources of bone grafts require exploration in the future to meet the increasing demand.

The purpose of this study was to assess the incidence of pelvic osteolysis following the use of a one piece all polyethylene acetabular component a mean of 9.6 years following implantation. The radiographs of 86 hips followed for a mean of 9.6 years were reviewed. All had had primary total hip arthroplasty using a titanium plasma spray backed all polyethylene acetabular component. Radiographs were assessed for pelvic osteolysis in the three zones described by Charnley and Delee. There was no osteolysis seen in any cup in any of the three zones. There were no loose cups and no obvious cup migration. This acetabular component shows superior performance compared with all two pieced components in terms of the development of pelvic osteolysis. The use of two-piece cups should be reviewed.

A prospective randomised study was carried out to compare two methods of pain control following arthroscopically assisted ACL reconstruction.

Twenty patients each were randomly recruited to receive either femoral nerve block with 0.5% Bupivicaine or an intra-articular injection with the same. Both groups were prescribed Diclofenac regularly and Coproxamol as required. Visual analogue scores (VAS) were used to assess pain levels preoperatively, four hours postoperatively and on the morning after. The duration between surgery and the first dose of PRN analgesia was recorded, along with the total quantity of analgesia required before discharge. Patients with associated PCL or collateral ligament injuries were excluded beforehand.

Both groups were evenly matched for age (t-test p< 0.05). Tourniquet time did not differ significantly between the groups (t-test p:0.24). The VAS pain levels were not significantly different at four hours and the first morning postoperatively in both groups. Femoral block (Ave VAS: 21 & 25) did not confer a significant advantage (t-test p: 0.69, 0.7) over intra-articular injections of Bupivicaine (Ave VAS: 25 & 22). The total quantity of Coproxamol consumed did not vary significantly (p=0.99). There was no correlation between tourniquet time and postoperative pain (r=0.19, 0.08). All but one patient was discharged home on the first postoperative morning.

Our study demonstrates that pain levels can be sufficiently controlled by intra-articular infiltration of Bupivicaine coupled with oral analgesia. The level of pain relief achieved could allow this procedure to be increasingly performed in a day surgery setting without the need for femoral block thereby allowing for quicker mobilisation.