Aim

To find out the usefulness of knee arthroscopy with debridement in patients of 60 years or more.

Long-term implant survivorship in total knee arthroplasty (TKA) depends on the alignment of the tibial and femoral components, as well as on the mechanical alignment of the leg. Computer navigation improves component and limb alignment in TKA compared to the manual technique. However, its use is often associated with an increase in surgical time. We aimed to evaluate the use of adjustable cutting blocks (ACB) in navigated TKA. We hypothesised that the use of ACB would (1) improve tibial and femoral component positioning; (2) improve postoperative mechanical leg alignment; and (3) decrease tourniquet time, when compared to conventional cutting blocks (CCB).

This was a retrospective cohort study of 94 navigated primary TKA. Patients were classified into two groups according to whether the surgery had been performed using ACB or CCB. There were sixty-four patients in the CCB group and 30 patients in the ACB group. Charts were reviewed to obtain the following data: age, gender, body mass index (BMI), tourniquet time and operated side. Pre- and postoperative standing full-leg radiographs and lateral radiographs were reviewed.

Mean coronal femoral alignment for the CCB group was 0.8® varus (SD = 1.95®) and for the ACB group it was 1.1® varus (SD = 1.5®) (P = 0.12). Mean coronal tibial alignment for the CCB group was 0.1® valgus (SD = 1.3®) and for the ACB group it was 0.5® varus (SD = 1.01) (P = 0.15). Sagittal tibial alignment was a mean 0.5® of anterior slope (SD = 2.9®) for the CCB group and 0.7® anterior slope (SD = 2.5®) for the ACB group (P = 0.38).

Preoperatively, the CCB group had a mean mechanical alignment of 1.8® varus (SD = 9.6®), while the ACB group had a mean 1.8® varus (SD = 9.37®) (P = 0.88). After surgery, mechanical leg alignment for the CCB group improved to a mean 0.7® varus (SD = 2.7®) (P = 0.0001), while the ACB group improved to 1.8® varus (SD = 1.7®) (P<0.0001). There was significantly less variability in postoperative mechanical alignment in the ACB group (P = 0.0091).

Mean tourniquet time for the CCB group was 91 minutes (SD = 17.7 minutes). The ACB group a mean tourniquet time of 76 minutes (SD = 16.7 minutes) (P = 0.01). In the multiple linear regression model, the use of an ACB reduced tourniquet time by 16.8 minutes (P = 0.001).

Adjustable cutting blocks for TKA significantly reduced postoperative mechanical alignment variability and tourniquet time compared to conventional navigated instrumentation, while providing equal or better component alignment.

The incidence of hip fractures is rising worldwide. Hip fracture patients with a cardiac murmur have an echocardiogram pre-operatively in our unit. We assessed the impact of obtaining a pre-operative echocardiogram on treatment of such patients, using National Confidential Enquiry into Patient Outcome and death (NCEPOD) report 2001 as gold standard. We undertook a retrospective audit of hip fracture patients (N=349) between 01/06/08 and 01/06/09. 29 patients had pre-operative echocardiogram (echo group). A computer generated randomised sample of 40 patients was generated from N, ‘non-echo’ group. Data was obtained from medical records and the Hospital Information Support System. The groups were compared using Student's t test. Age and gender distribution were similar in both groups. 29 patients had pre-operative echo. The indication for requesting an echocardiogram pre-operatively was an acute cardiac abnormality in 4 cases. 25 patients had echocardiogram for no new cardiac problem. In the latter group, the reason for requesting an echo was a cardiac murmur in 23 patients and extensive cardiac history in 2 cases. A specialist input from the cardiologist was sought in 5 cases. Most patients with aortic valve abnormality had surgery under general anaesthetic. No patient required cardiac surgery or balloon angioplasty pre-operatively. There was a significant delay to surgery in the patients who had a pre-operative echo (average 2.7 days, range 0–6 days) compared to ‘non-echo’ group (average 1.1 days, range 0–3 days), (P< 0.001). There was no significant difference in length of stay and mortality at 28 days between the two groups. We are now developing departmental guidelines for requesting echo in hip fracture patients with cardiac murmur to prevent unnecessary avoidable delay. We are developing a link with the cardiology department to expedite echocardiogram requests in hip fracture patients.