In February and March 2004, 35 hip and 15 knee arthroplasties were performed. Indications for surgery included primary OA, avascular necrosis and fractures. Revision surgery was performed for aseptic loosening and recurrent dislocations. There were three revision hip arthroplasties and three arthroplasties were done for subcapital femoral fractures. The mean age of the patients was 64.2 years (33 to 84). The male to female ratio was 1:1.5. Both cemented and uncemented implants were used.

In the hip arthroplasties, the mean intraoperative blood loss was 515 ml (300 to 1520 ml). Intraoperative blood loss was minimal in the knee arthroplasties. Postoperative suction drainage averaged 477 ml for the hips and 925 ml for the knees. Postoperative blood transfusions were administered in seven patients. The mean time to mobilisation was 3 days postoperatively, and discharge was on day seven.

Early complications included superficial cellulitis in four patients, who were treated with intravenous antibiotics. After a knee replacement one patient developed a haematoma, which drained spontaneously. One patient had an early dislocation. Three patients developed upper respiratory tract infections. One 32-year-old man developed intraoperative pulmonary fat embolism and required ventilation for 24 hours. Following a knee replacement, one patient developed a transient drop foot, which improved after 24 hours. No incidence of clinical DVT was encountered.

Hip and knee arthroplasties are major procedures. Adequate preoperative evaluation to identify potential risks could limit major complications.

This study was undertaken to identify certain high-risk patient groups admitted following trauma, in an attempt to improve their management.

We retrospective reviewed 207 patients admitted to the ICU with orthopaedic injuries between 1997 and 2003, excluding from the study spinal patients, paediatric orthopaedic patients, and patients having elective surgery. The mean age of the patients was 36.7 years.

The mean duration of stay in the ICU was 8.4 days. In 32% of patients, the only injuries were orthopaedic, with 51% of this group having multiple fractures. Of the patients with associated injuries, 34% had chest injuries. Acute respiratory distress syndrome (ARDS) developed in 46 patients (22%), of whom 33 (71%) had more than one long bone fracture. The incidence of ARDS in patients with no associated injuries was 11%. The overall mortality rate was 13.5% (28 patients), and the mortality rate of patients with only orthopaedic injuries was 5% (10 patients). Death occurred on the day of admission in 28.5% and 70% of the deaths occurred after 8 days in the ICU. Overall, there was a 10% mortality rate in patients admitted to the ICU for more than a day.

We advise close observation of all orthopaedic patients with associated chest injuries and recommend appropriate fracture management within 8 days of admission.