The contents of 3 orthopaedic journals [JBJS (Am), JBJS (Br) and CORR] during 2001 and 2011 were compared for publication bias.

There were total of 2028 articles. After exclusion 1662 scientific articles were analysed for statistical results, clinical conclusion, sub-speciality topics studied, the geographical region the study been conducted and the statistical method used. The articles classified into 7 categories: THR, TKR, Basic sciences, Trauma, Spinal disorders, Paediatric disorders and Tumour.

91% of articles on THR and 95% of articles on TKR were positive studies in 2001. Articles dealing with trauma had the lowest proportion of positive studies (74%) as compared to all other topics. We noted that JBJS (Br) published more negative studies as compared to JBJS (Am) and CORR. In 2011 less articles on THR and TKR had positive studies (68% and 76% respectively). Spinal surgery articles report less number of non significant studies nowadays (24% in 2001 and 2% in 2011).

There is a significant change in the trend towards reporting more negative studies in relation with THR and TKR (p < 0.05). Articles dealing with Basic sciences, Trauma, Paediatric disorders and Tumour did not have any significant change in reporting negative studies in the last decade. Significant findings in spinal disorders were 3.8 times more likely to be published than non significant stdies. Overall, JBJS (Br) continued to publish more negative studies as compared to JBJS (Am) and CORR.

Journals seem to prefer reporting more significant results with spinal disorders and more non significant results in relation with Hip and Knee arthroplasty in last ten years. This might be because of authors' perceptions of the importance of their findings and journals preferences for significant results.

In the current climate of increasing financial pressures and reducing bed numbers, a predictor of length of stay (LOS) may have a bearing on hospital finances. Independent sector treatment centres may also skew the ASA grade and co-morbidity of the patient group treated in a hospital setting. We performed a study of 100 consecutive patients undergoing Total hip or knee arthroplasty between April and September 2006.

Median age was 71 years (35 – 88) with 75% of patients having significant (cardiac, renal or respiratory) pre-existing medical conditions (24% with 3 or more conditions). Average ASA grade was 2 (15% grade 3) and average BMI was 30. A significant reduction in LOS from 8.47 to 5.87 days was seen in under 70 year olds when compared with those over 70 years (p = 0.0004), having 3 or more co-morbidities (compared with 2 or less) increased average LOS from 6.61 days to 9.3 days (p = 0.002), ASA grade of 3 increased LOS to 9.56 days from 6.27 and 6.87 for grade 1 and 2 respectively (p = 0.014) and living alone (compared with cohabiting) increased LOS from 6.55 days to 9.19 days (p = 0.0017). However no statistical significance was seen for BMI with an average of 7.19 days for < 30 and 7.37 days for patients with BMI of 30 or above (p = 0.82)

Regardless of this patient group being elderly and obese with significant co-morbidity, an acceptable outcome was seen, with 70% of patients discharged within 7 days and only 4% staying > 14 days. Although BMI did not predict outcome, number of co-morbidities, ASA, age greater than 70 years and living alone all demonstrated a significant increase in LOS. Increased resources in this at risk group within a pre-admission setting could reduce length of hospital stay.

Background: Patients suffering from hip osteoarthritis (OA) are frequently symptomatic, and the disease can result in significant limitation of patients’ activity and high social costs. Viscosupplementation, which aims to restore physiological and rheological features of the synovial fluid, is a well-accepted therapeutic option in knee OA patients, but limited data exist in the literature about its potential benefit for the treatment of hip OA.

Aim: To evaluate the efficacy and safety of viscosupplementation (VS) with hyaluronic acid (Hylan GF 20) under fluoroscopic guidance in patients with symptomatic hip OA

Methods: Forty six patients (26 men, 20 women, mean age 56.4 years) with symptomatic hip OA were treated with one injection of 2 ml of hylan G-F 20(Synvisc) under fluoroscopic guidance which could be repeated after at least 3 months. Treatment efficacy was assessed by functional index oxford hip score, pain evaluation on a visual analogue scale and NSAID consumption. All such parameters were recorded at baseline as well as 2, 6 and 12 months after the beginning of the treatment.

Results: We observed a statistically significant reduction of all considered parameters at the timepoints 2 and 6 months, when compared to baseline. At 12 months the changes were still statistically significant for all parameters for about 50% of the patients. Three patients reported self-limited mild, local pain post-injection otherwise no systemic adverse events were observed.

Conclusion: Viscosupplementation with hylan G-F20 is feasible, easy to perform as well as safely relieves osteoarthritis hip pain, facilitates an improved activity level, decreases the need for pain medication, physiotherapy, and assistive devices.

Introduction: Infection following TKR is a catastrophic complication. Few authors have highlighted the need for screening of patients (nose, axilla and groin) before TKR. Despite the fact that some of the centers in UK now routinely perform preoperative screening for TKR patients the overall incidence of surgical site infection in the year 2004 was 2.9%.

Methods and Materials: We introduced a new admission policy and SSI surveillance protocol for TKR patients in the year 2004 at our center. According to the new admission policy all TKR patients who were preoperatively screened were admitted into a clean elective ward. Care was taken not to admit anybody with positive infection screening in that ward, irrespective of the diagnosis. Further we also introduced a new policy of SSI surveillance according toNINSS protocol carried out by dedicated trained nurses.

Results and conclusions: Following the introduction of these policies our surgical site infection has come down to 0% in the year 2004–5 in contrast to 1.7% in the year 2002–3. These results showed that simple measures like having dedicated infection free clean wards and dedicated trained surveillance nurses can significantly reduce the infection rate following TKR

Introduction: Infection following THR is a catastrophic complication. Few authors have highlighted the need for screening of patients (nose, axilla and groin) before THR. Despite the fact that some of the centres in UK now routinely perform preoperative screening for THR patients the overall incidence of surgical site infection in the year 2004 was 2.9%.

Methods and Materials: We introduced a new admission policy and SSI surveillance protocol for THR patients in the year 2004 at our centre. According to the new admission policy all THR patients who were preoperatively screened were admitted into a clean elective ward. Care was taken not to admit anybody with positive infection screening in that ward, irrespective of the diagnosis. Further we also introduced a new policy of SSI surveillance according to NINSS protocol carried out by dedicated trained nurses.

Results and conclusions: Following the introduction of these policies our surgical site infection has come down to 0% in the year 2004–5 in contrast to 1.7% in the year 2002–3. These results showed that simple measures like having dedicated infection free clean wards and dedicated trained surveillance nurses can significantly reduce the infection rate following THR.

Introduction: Surgeries in elderly individuals should be less invasive and less time consuming to reduce immediate postoperative morbidity and mortality. Nevertheless it should also give optimal long-term outcome thereby avoiding subsequent procedures in these high risk individuals. Bipolar hemiarthroplasty is a commonly performed orthopaedic surgery in elderly patients with fracture neck of femur. It is commonly believed that the type of implant and the nature of fixation (cemented or uncemented) influences both the short term and the long term outcome of this procedure. In this retrospective study we compared uncemented and cemented JRI furlong prosthesis.

Method and materials: We had cohort of 60 patients who underwent cemented JRI bipolar hemiarthroplasty in the year of 2003 and 2004. We compared this cohort with the matched sample of 60 patients who underwent uncemented JRI bipolar hemiarthroplasty. We matched variables like age, ASA grade and the experience of surgeon.

Results and Discussion: The perioperative variables like duration of surgery, amount of blood loss, length of hospital stay and postoperative complications (DVT, chest infection, mortality) were found to be less in the uncemented JRI group. However there are concerns about the long-term outcome of uncemented JRI hemi-arthroplasty in the form of peri prosthetic fractures. Out of 60 patients of uncemented JRI group 3 had peri prosthetic fracture as compared to none in the cemented JRI group. We believe this complication more likely could be due to excessive canal preparation and the press fit necessary for the primary stability of the implant. This warrants further prospective controlled trials to provide more evidence on this finding.

Introduction: Outcome reporting following THR constitute a significant proportion of orthopaedic publications. Publication bias in the form of underreporting of studies showing non satisfactory or negative results is a well recognised problem in other specialities. We tried to find out the magnitude of this problem in orthopaedics publications dealing with THR.

Method and materials: We reviewed all publications on THR in the year 2004 in three general orthopaedic journals namely JBJS (BR), JBJS (Am), CORR. Of the 1034 original articles published in these three journals more than 400 articles were concerned with total hip replacement.

Results and Discussion: In this study we found only 6% of the published articles were showing non significant or negative results. This raises concerns about evidence based approach in THR and the need for preventive measures like registering all clinical trials and change in the attitude of editorial board.

Background: Several hospitals within the NHS now run specialist teams that look after assisted discharge plans for patients following elective surgeries. Joint replacements form a significant segment of elective majors in orthopaedics. In the second half of the last year alone, the National Joint Registry estimated that there were over 100,000 joint replacements carried out within England and Wales. Such schemes are designed to: 1. Enable patients to be discharged to their home as quickly and safely as possible, to maximise recovery and rehabilitation. 2. Ensure the most effective use of acute orthopaedic beds. 3. Reduce risks of hospital acquired infection 4. Streamline inpatient care so as to positively impact upon inpatient and outpatient waiting times. There is scarce information available about the experience of NHS hospitals with such schemes.

Aims And Objectives: 1. Investigate patient expectations of and satisfaction with discharge planning on the early discharge scheme. 2. Assess areas of concern to the patient and difficulties encountered by the patient in the home environment. 3. Improve our understanding of patient requirements, functional recovery and planning of discharge. 4. Investigate whether our lengths of stay compare with others in the NHS/literature and what factors are influencing the figures. 5. Investigate overall success of the scheme.

Patient And Methods: The study identified 100 consecutive patients who have had joint replacement surgery after August 2003 and have been discharged under the scheme. A Patient Satisfaction Questionnaire was used and the patients completed different sections at discharge and then at about six. Notes were reviewed for any complications or problems.

Conclusions: The scheme to discharge patients early is highly successful and well received by staff and patients. All consultants now use the service and the initial aims have been met, saving approximately 335 bed days in the first six months. The average inpatient stay has been reduced by half in the last 18 months. 98% of patients stated that the scheme met their needs. The majority of comments were positive. Only two patients needed readmission within the first fortnight from discharge, one with a dislocated hip and the other was a knee with wound infection. There were two complaints, which were deemed serious enough for a mention.

Proximal tibial epiphyseal injuries are rare. Reported incidence varies from 0.5 – 3% of epiphyseal injuries. Proximal tibial epiphysis is well protected unlike distal femoral epiphysis. Thus, the distal femoral injuries are 7 times more frequent than proximal tibial epiphyseal injuries.

Case Report: 12-year old boy, hit a pole at the bottom of a dry ski slope and presented to A& E within 20 minutes. He had a swollen, deformed knee and leg that was immobilised in a temporary splint. He had absent posterior tibial and dorsalis pedis pulses. Emergency manipulation under GA and further stabilised with K-wires, A/K Back Slab in 450 flexion. Distal pulses returned on table. K-wires were removed after 4 weeks and physiotherapy started. At 3 months, he was back to normal activities except sports. At 2 years, he was longer by 1 cm in left tibia, valgus of 120 at the knee, full ROM, no ligament laxity and reports occasional anterior knee pain.

Discussion: Posteriorly displaced proximal tibial Salter Harris II injuries are very rare. Emergency reduction and stabilisation, absence of popliteal artery tear had prevented the immediate complications. The late complications did not warrant a surgical intervention.