When performing scarf osteotomies some surgeons use intraoperative radiography and others do not. Our experience is that when using intraoperative radiography we often change the osteotomy position to improve the correction of the hallux valgus angle and sesamoid position.

We report the results of a single surgeon series of 62 consecutive patients who underwent a scarf osteotomy for hallux valgus. The first 31 patients underwent surgery without the use of intraoperative radiographs and the subsequent 31 patients underwent surgery with the use of intraoperative radiographs, this reflects a change in the surgeons practice. Hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle and sesamoid position using the Hardy Clapham grading system were recorded. All patients had measurements recorded from weight baring radiographs taken pre operatively as well as at 6 and 12 weeks post operatively. Intraoperative measurements were also recorded for all patients in the intraoperative radiography group.

The mean hallux valgus angle preoperatively was 28.5° in the control group and 30.5° in the intraoperative radiography group. The mean hallux valgus angle in the control group at 6 weeks was 12.4° and at 12 weeks was 12.6°. The mean hallux valgus angle in the intraoperative radiography group at 6 weeks was 10.5° and at 12 weeks was 9.8°.

The median sesamoid position pre operatively was 4 for both groups. At 6 and 12 weeks the sesamoid position improved by a median of 1 position in the control group and 2 positions in the intraoperative radiography group (p<0.05).

We recommend that surgeons who do not routinely use intraoperative radiography undertake a trial of this. We have found that the use of intraoperative radiography improves the correction of hallux valgus angle and sesamoid position. These have been shown to increase patient satisfaction and reduce recurrence.

Patients with hip fractures should have surgery within 36 hours of admission to hospital. This reduces mortality and is required for hospitals to receive the NHS Best Practice Tariff. Many patients with hip fractures take Warfarin and reversing the effect of this frequently delays surgery.

We report the results of a case-control study. The primary outcome measure was the number of patients with an INR of 1.7 or less on the day following admission to hospital. This is considered an acceptable INR for hip fracture surgery in our department. In the control group the dose of Vitamin K given was decided by the admitting doctor based on the patients' INR. In the intervention group all patients received 5mg of IV Vitamin K on admission. They had their INR rechecked at 6:00am the following morning and a further 2.5mg of Vitamin K was given if it was 1.8 to 2.0 and a further 5mg of Vitamin K was given if it was greater than 2.0.

350 patients with hip fractures were admitted to our department and 26 (7.4%) of these were taking Warfarin. The control group contained fourteen patients who had a mean INR of 3.3 on admission. The time taken to achieve an INR of 1.7 or less was one day for four patients; two days for nine patients and three days for one patient. The intervention group contained twelve patients who had a mean INR of 2.7 on admission. The time taken to achieve an INR of 1.7 or less was one day for eleven patients and two days for one patient. There were no complications caused by Warfarin reversal.

A high proportion of patients with hip fractures take Warfarin. This can be reversed promptly and safely using our protocol.

Zirconium total knee replacements theoretically have a low incidence of failure as they are low friction, hard wearing and hypo allergenic; we present the five year survival data.

Data was collected prospectively from 212 patients who underwent Profix zirconium total knee replacements with an all-polyethylene tibial component. Revision surgery or a Knee Society Roentgenographic Evaluation System (KSRES) score of 10 or more was considered failure. SF 12 and WOMAC scores were recorded preoperatively, at three months, at one year, at three years and at five years. KSRES scores were recorded at all postoperative intervals.

There were 92 male and 120 female patients with a median age of 63 years, range 25 to 87. 188 implants were for osteoarthritis and 24 were for rheumatoid arthritis. Eight patients died and six were lost to follow up, the remaining 198 patients reached a minimum of five year follow-up.

At five years, the mean WOMAC score improved from 56 to 35 and the mean SF12 physical component score improved from 28 to 34. The mean SF12 mental component score remained unchanged at 51.

The five year survival with failure due to implant related reasons was 99.5% (95% CI 97.3 - 100). This was due to one tibial component becoming aseptically loose in the first year.

Reoperations excluded from this analysis were downsizing of the tibial component for stiffness and patella resurfacing. When these were included the five year survival was 98.1% (95% CI 95.1 - 99.3).

Our results demonstrate that the Profix zirconium total knee replacement has a low medium term failure rate comparable to the best implants. Further research is needed to establish if the beneficial properties of zirconium improve long term implant survival.