Controversy remains regarding the optimal post-operative analgesic regimen following total knee replacement. A delicate balance is required between the provision of adequate pain relief and early mobilisation. By reviewing 29 randomised trials we sought to establish whether local infiltration of analgesia directly into the knee during surgery provides better pain relief and a more rapid rehabilitation. Although we were able to conclude that local infiltration can provide improved post-operative pain relief, and to suggest the most promising technique of administration, there is no evidence that it reduces hospital stay.

The National Institute for Clinical Excellence (NICE) published the guidelines on the selection of prostheses for primary hip replacement in 2000. They supported the use of cemented hip prostheses to the exclusion of uncemented and hybrid implants. The information from the Trent (and Wales) Regional Arthroplasty Study has been examined to identify retrospectively the types of hip prostheses used between 1990 and 2005, and to assess the impact that the guidelines have had on orthopaedic practice.

The results show that the publication of the NICE guidelines has had little impact on clinical practice, with the use of uncemented prostheses increasing from 6.7% (137) in 2001 to 19.2% (632) in 2005. The use of hybrid prostheses has more than doubled from 8.8% (181) to 22% (722) of all hips implanted in the same period. The recommendations made by NICE are not being followed, which calls into question their value.

Aim: To analyze early clinical outcome and patients satisfaction following Oxford phase 3 Unicompartmental Knee arthroplasty at a mean follow up of 30 months from a single centre in the Trent arthroplasty register.

Methods: Between 1999 and 2002, 180 Oxford phase 3-unicompartmental knees were implanted in 173 patients. Average age at operation was 66 years. All patients were assessed pre and post-operatively using Oxford Knee questionnaire. At a mean follow up of 30 months (range 12–48 months); ninety knees in 83 patients were assessed using Oxford and EuroQol health questionnaire. Subjective patient’s satisfaction was also assessed.

Results: Seven knees out of 180 were revised early in the series giving a failure rate of 4%. Three patients had died due to unrelated causes. 90 knees were assessed at recent follow-up. The mean Oxford knee score improved from 48 preoperatively to 28 post-operatively. Subjectively 76% of the patients felt that the operation was successful and 74% were able to resume their leisure activities with out any pain.

Conclusion: This study shows that the short-term results following minimally invasive Oxford phase 3-unicompartmental knee implantation technique can yield satisfactory clinical and functional results. Using stringent selection criteria, Oxford phase 3-unicompartmental knee offers a good alternative to total knee arthroplasty.

We determined the rate of contamination of donated femoral heads at primary hip arthroplasty within a single region between July 1992 and July 2001. We established the null hypothesis that culture results played no role in predicting early failure of the joint because of infection.

The rate of contamination was 9%. A positive culture, at the time of retrieval, was found in 367 of 4045 femoral heads. Coagulase-negative staphylococcus was isolated in 77% of the positive cases. At a minimum follow-up of one year, there was no statistically significant difference in the rate of complications or of revision of age-matched patients whose femoral heads had a positive culture compared with those whose femoral heads were sterile.

Our findings confirm that culture of the femoral head plays no part in determining future failure of joint replacement in the donor.

Aim: Assessment of the management of painful paediatric snapping hips by a novel alternative, ie. proximal TFL release.

Materials and Methods: A retrospective study was undertaken between 1989 – 2002, reviewing 15 patients (21 hips) who had had proximal tensor fascia lata release. Diagnosis was made on the basis of history and physical examination. All hips were X-rayed and other causes of an audible snap were excluded. Physiotherapy had been attempted in all cases and most had failed to improve pre-operatively. All cases were followed up for a minimum period of 6 months.

Results: There were 2 males and 13 females. The mean age of operation was 15 years. 2 hips required a revision procedure. 81% had a pain-free, non-snapping hip at the time of discharge. There was 1 case of numbness in the thigh secondary to damage to the lateral cutaneous nerve of the thigh. No cases had a long-term Trendelenberg limp.

Conclusion: It was felt that proximal release of the tensor fascia lata from the pelvis is a good operation for painful, snapping hips with an excellent result in 81%. This has a similar success rate to the Brignall & Stainsby procedure, ie. Z-plasty of the tensor fascialata.

Background: Femoral heads donated at primary arthroplasty are screened microbiologically. Contaminated femoral heads are either discarded or irradiated in an effort to protect recipients from the risk of transmitted infection.

Aims:

Determine the contamination rate of donated femoral heads at primary arthroplasty within the Trent Region between July 1992 and July 2001.

Method: We reviewed the culture results of all femoral heads donated to the Leicester Bone Bank. All patients with a contaminated femoral head that were operated upon in the Leicestershire region were then compared to a control group of patients with no contamination of their femoral heads. The two groups of patients were then cross-referenced against the data in the Trent Arthroplasty Audit Group database. Hospital records of all patients who had a complication or re-operation were also reviewed to determine their outcome

Results: A contamination rate of 9% was present with 365 of 4043 femoral heads culturing positive at the time of retrieval. Coagulase negative Staphylococcus was isolated in 75% of the cases. At a minimum of one year follow up, there was no statistically significant difference in the complication or revision rate of age matched patients whose femoral heads cultured positive compared to those whose heads were sterile.

Conclusion: The allograft contamination rate is similar to other published series with coagulase negative staphylococcus being the most prevalent contaminant. The available evidence confirms what has been anecdotal in the past. Femoral head culture results play no role in determining future joint failure in the donor

The proportion of very elderly people within the general population is steadily increasing.

These people, who often have coexisting medical problems and a limited life expectancy, may pose a dilemma for Orthopaedic Surgeons when referred for elective Orthopaedic procedures. The purpose of this study is to review the outcome of primary hip and knee arthroplasty in patients aged 90, and over, who are registered with the Trent Regional Arthroplasty Database.

Between 1990 and 2000, prospective data was collected on patients aged 90, and over, undergoing primary total hip and knee arthroplasty. Data collection was carried out on behalf of the Trent Regional Arthroplasty Audit Group. The present living status of these patients was confirmed using patient administrations systems of the hospitals involved.

Missing data was obtained from the Office for National Statistics. Those patients alive at one year were sent a simple satisfaction questionnaire regarding their operation.

144 patients underwent 149 hip or knee arthroplasty procedures over this eleven year period. The group comprised 122 (85%) females and 27 (15%) males. There were 93 (62%) total hip replacements and 56 (38%) total knee replacements. Ostcoarthritis was the predominant reason for surgery. There was only one intra-operative complication, comprising a fractured femur during a total hip replacement. 78 patients have died since their surgery. The crude mortality rate at one year was 11. 5%. The median survival was 34 months. 51% of the patients returned satisfaction questionnaires one year after the operation. From this group the satisfaction rates for hip and knee arthroplasty were 93. 6% and 92. 6% retrospectively.

With suitable pre-operative assessment, primary total hip and knee arthroplasty can be a successful operation with a high satisfaction rate. This is an age group with a high mortality regardless of surgery, and age alone should not be a determining factor in deciding whether a patient will benefit from primary hip or knee arthroplasty.