Current UK NICE guidelines on the prevention of thromboembolism state that all patients undergoing elective Hip or Knee Replacement surgery should be offered combined mechanical and pharmacological VTE prophylaxis. The original audit was performed between October 1999 and January 2009, totaling 7,532 patients. Updated to the full 10 years, a total of 8,140 patients underwent hip or knee replacement surgery (revision and primary) in our unit. Using a targeted thromboprophylaxis policy 83% of patients received mechanical A-V foot pumps only until mobile. High risk patients (12%) received in addition LMWH or fondaparinux, with only very high risk patients continuing on chemical prophylaxis post-discharge. All data are collected and stored on our own joint registry database with patients being assessed pre-operatively to determine their level of VTE risk.Background
Methods
Successful tendon repairs are reliant on the suture material having high tensile strength, no or little tissue response, good handling characteristics and little elastic/plastic deformation. Plastic deformation contributes to gap formation at a tendon repair site. Previous research has shown a gap greater than 4mm is likely to fail. Pre-tensioning is a commonly used method to improve the handling properties of sutures. This study investigates whether the plastic deformation demonstrated by two suture materials used in flexor tendon repair is affected by manual pre-tensioning. Twenty lengths of 3/0 Prolene (Ethicon, UK) and 3/0 Ethibond Excel (Ethicon, UK) were selected. Half of the sutures in each group were manually pre-tensioned (longitudinal stretch of 15N for 3s) prior to knot tying (standard surgical knot with six throws) and half were knotted without pre-tensioning. The suture lengths were measured before and after a standardised cyclical loading regime on a tensile tester. The regime was designed to represent the finger flexion forces produced in an active rehabilitation programme after tendon repair. All sutures were subsequently tested to their ultimate tensile strength.Introduction
Material/Methods
