224 patients from the Cardiff and Vale NHS Trust who had total knee replacements at the NHS Treatment Centre in Weston-Super-Mare by surgeons from overseas appeared to have significantly worse results than those recorded in the published literature. We wished to establish whether a group of patients treated in the same hospital with the same prosthesis at a similar time by local NHS orthopaedic surgeons in substantive posts would have a similar outcome.

Follow-up of all 214 patients (223 knee replacements) treated in 2004 was conducted with questionnaires, clinical review and x-ray assessment. In cases of no response, contact was made with GPs to establish the outcome of the surgery.

The outcome of all patients was known and of the 125 knee replacements available for clinical review at six years (mean), 119 cases (96%) achieved satisfactory coronal alignment with reference to the published literature. There were six revisions, five for loosening and one for malalignment. The cumulative survival rate for re-operation at six years was 97.2% (95% confidence interval 95.2 to 99.1).

This study shows that the results of total knee replacement performed by a group of NHS orthopaedic surgeons were comparable with other institutions and were significantly better than those reported from the NHS Treatment Centre in Weston-Super-Mare, using the same facilities and implant over the same period of time. This work supports previous recommendations for single surgeon supervision of the patient pathway and appropriate follow-up procedures.

Clinical, haematological or economic benefits of post-operative blood salvage with autologous blood re-transfusion have yet to be clearly demonstrated for primary total hip replacement. We performed a prospective randomised study to analyse differences in postoperative haemoglobin levels and homologous blood requirements in two groups of patients undergoing primary total hip replacement.

A series of 158 patients was studied. In one group two vacuum drains were used and in the other the ABTrans autologous retransfusion system. A total of 58 patients (76%) in the re-transfusion group received autologous blood. There was no significant difference in the mean post-operative haemoglobin levels in the two groups. There were, however, significantly fewer patients with post-operative haemoglobin values less than 9.0 g/dl and significantly fewer patients who required transfusion of homologous blood in the re-transfusion group. There was also a small overall cost saving in this group.