Increasing the accuracy of information provided through X-Rays maximises pre-operative planning. Aim of this project is to determine the necessity of calibration probes that would improve the accuracy of pre-operative templating. This is a retrospective study involving leg length and pelvis X-Rays performed across the NHS Lanarkshire from 01/03/2023 until 31/04/2024.

A total of 87 leg length X-Rays were identified, 18 had a calibration probe present. Leg length was measured on each and the X-Rays were calibrated against the existing probe. In 66.7% of cases there was a major leg length discrepancy of over 2cm between the pre-calibrated and post-calibrated X-Rays. Pelvic X-Rays of 80 patients that underwent total hip replacement were reviewed. Preoperative templating was compared to the implants inserted. An average of 1.94 discrepancy in the size of the acetabular implant was identified whilst in 30 cases the size of the femoral stem was incorrect by at least 1 size. Magnification of 119.7% on X-Rays was found to provide the most accurate templating. Seventy seven cases of pelvic X-Rays before and after hip hemiarthroplasty were also reviewed. The implant head was templated incorrectly in 74% of cases and the stem in 51%. It was identified that pelvic X-Ray magnification of 121.7% would provide the most accurate results.

X-Rays with no calibration probes provide inaccurate measurements leading to faulty preoperative planning. Standardised use of a calibration sphere is strongly suggested and whenever that is not available, we suggest magnification of 121%.

Abstract

Aims

To investigate factors that contribute to patient decisions regarding attendance for arthroplasty during the COVID-19 pandemic.

This study presents the intraoperative findings of a cohort of 201 cases of failed Unicompartmental knee arthroplasties (UKA) from the Trent Wales arthroplasty audit group (TWAAG) register from 1990 to 2008. The main objectives of the study were to determine the common modes of failure and trends in implant systems used using sex and age matching criteria.

Results demonstrate the varying reasons for revision, use of augmentation and surgical preference in revision system. Results include survival rates and revision rates of UKA from the Trent Wales arthroplasty audit group. The average patient age at revision surgery with the average times from primary UKA to total knee arthroplasty are demonstrated. Aseptic loosening was the commonest reason for revision in both younger and older age groups, closely followed by Polyethylene wear in the younger age group versus progression of osteoarthritis in the other compartments in the older age group. The commonest implant used was Oxford unicompartmental knee system at primary surgery with the PFC implant used in almost 50% of all cases that were revised. This study demonstrates the survival rate of UKAs to be significantly higher in female patients and in those patients with primary UKAs at a younger age. The trends in revision systems have changed over the years. In the early years, over 50% used the PFC knee systems, compared to the latter eight years where the majority used revision knee systems, (e.g. LCCK and Legion). This trend is due to increased availability and ease of use of revision systems. The commonest site of augmentation was for tibial bone defects. Approximately 50% of all augmented cases required tibial blocks or wedges.

Although current thinking suggests most UKAs can be revised to a primary total knee system without difficulty, a significant proportion required revision implant systems with associated implications.

Introduction: We present a modification of surgical technique of Mitchell’s Osteotomy for hallux Valgus and the follow-up results in a consecutive series of patients operated by a single surgeon using this technique.

The modification involves: 1/not using any form of fixation of the osteotomy – neither a bone suture nor any k wires or pins. 2/a capsulodesis was preformed to correct the Hallux Valgus deformity by suturing the capsule to the distal metatarsal shaft using vicryl through 2mm drill hole.

Patients and Methods: Ninety nine patients operated on, 54 patients were seen in the clinics, 26 answered telephone questionnaire and 19 patients were unable to attend. The 54 patients who attended the clinics were examined and roentgenograms of the feet were taken. AOFAS forefoot score was used to assess the outcome.

Results: Of the 54 patients seen, 29 patients scored > 90 (AOFAS), 17 patients scored between 80 to 90 points in AOFAS and 8 patients scored < 80 points. Of the patients who answered the questionnaire, 22 patients were satisfied with the surgery and four had minor discomfort during activity. Three patients had secondary surgery for transfer metatarsalgia /hammer toes. On statistical analysis, there was no correlation between the outcome and factors such as age, degree of deformity and the post operative shortening of the first ray.

Discussion: Our surgical technique did not result in any acute instability of the osteotomy. There was no evidence of any symptomatic stiffness of the metatarsophalangeal joint because of capsulodesis.

Introduction: We report a prospective study of the effect of body mass index and the length of the tourniquet time on the blood loss in total knee replacement in 70 consecutive patients.

Methods and materials: The patients’ weight and height were recorded to establish the body mass index (BMI). The patients were classified into four groups according to their BMI. The blood loss both intra-operative and post-operative was recorded. In addition, the tourniquet time was recorded.

Results: No significant increase in blood loss was demonstrated in patients with a high BMI, and there was no significant increase in the blood loss with longer tourniquet times.

Conclusion: Obesity does not increase the overall bleeding in total knee replacement.