Peri-prosthetic wound infections can complicate total knee arthroplasty (TKA) in 1–1.5% of cases and may require the input of a combined orthopaedic and plastic surgery team. Failure of optimal management can result in periprosthetic joint infection, arthrodesis or in severe cases limb amputation.

A retrospective 11-year review of TKA patients was undertaken in a single unit. Data was collected on a proforma and patient demographics were identified by case note analysis. Incidence of periprosthetic wound infections was recorded. A protocol to standardise treatment was subsequently developed following multidisciplinary input.

56 patients over 11 years developed periprosthetic wound infection. 33 patients were available for analysis. The male:female ratio 1:0.7 with a mean age of 70 years (range: 32–88 years). 5 (15%) developed superficial infections, 4 (12%) patients developed cellulitis requiring antibiotics, 14 (42%) with superficial wound dehiscence and 2 (6%) required washout of the prosthesis with long-term antibiotic therapy. 4 (12%) were managed without plastics involvement, one leading to arthrodesis and 4 (12%) had plastic surgical input, with one leading to arthrodesis. The mean time before plastic surgical review after initial suspicion of infection was 13 weeks.

The management of periprosthetic wound infections following TKA are variable and can require a multidiscplinary ortho-plastic approach. Early plastic surgical involvement in specific cases may improve outcome. Our proposed management protocol would facilitate in standardising the management of these complex patients.

129 knees suitable for a standard PCL retaining cemented total knee replacement were randomised into two groups, one in which PCL was retained in the normal way, the other group having the PCL fully resected. Both groups received a PCL retaining implant. The two groups were well matched with a predominance of females and a mean age of 67 years.

There was no statistically significant difference in the HSS scores at an average of 57 months (range 56–60 months) in the two groups. Pain relief, deformity correction, range of motion, stability and strength were comparable in the two groups. A radiological assessment revealed femoral rollback in approximately 20% of cases with a slightly higher incidence in the PCL sacrificed group. There was no significant loosening detected in either of the categories at two years review.

At five years one TKR in the PCL retained group has been revised due to an infection and one each in the two groups are awaiting revision surgery for loosening. Our findings have shown that there is no significant difference in the 5 year results of a PCL-retaining total knee replacement if the PCL is excised or preserved. This suggests two significant points:

the PCL is not functional in most patients with a total knee replacement even when retained:

Background Open reduction and internal fixation for displaced intra-articular fractures of the calcaneum has become an established method of treatment. A recent randomised, controlled trial has questioned the benefits of surgery, in particular, pain relief.

Method We reviewed the cases undertaken in our department, complications which have arisen, and their treatment. We have devised a management plan in conjunction with the department of plastic surgery to minimise the effect of these complications. There were 124 procedures carried out over a 12-year period, 116 unilateral and 4 bilateral in 120 patients (106 males and 14 females, age range 18–66). Two further patients were included who had had surgery in another hospital and had been referred to our plastic surgery unit with significant wound complications.

The patients were retrospectively assessed with a case note review and an updated clinical evaluation. The assessment focussed particularly on wound complications including breakdown classified as either major or minor, and association with infection, haematoma and drainage. Neurological symptoms were also noted.

Results There were five major wound complications, three from our unit and two from another hospital. Infection was present in three cases. Four healed uneventfully but one of the infected group subsequently had a below knee amputation for refractory infection. Minor wound breakdown was more common. There was no association with haematoma or drainage but wound breakdown occurred more frequently in patients who smoked. Neurological complications were infrequent and temporary.

Conclusion This study confirmed that there is a significant morbidity associated with the surgical management of these fractures, although the vast majority of patients’ wounds healed uneventfully. With a sensible management plan, which involves working in conjunction with plastic surgeons, even major soft tissue complications may be addressed.

Aims: To evaluate the role of Blatt’s capsulodesis and scapholunate ligament repair in patients with chronic scapholunate instability. Methods: Nineteen (15 males, 4 females) patients with chronic scapholunate instability underwent surgical repair and dorsal capsulodesis. At a mean follow-up of 28 months, all patients were assessed to identify any improvement in analogue pain scores, grip strength, range of movement of wrist and overall result of surgery. Results: Pre-operative arthroscopic findings revealed a scapholunate gap of > 2mm and ease at visualising the capitate by passing the scope through the scapholunate interval confirming the diagnosis. Surgery consisted of repair of torn ligament and supplementary dorsal capsulodesis (Blatt’s technique). 12 patients (63%) had returned to normal working activities at pre-injury level. There was a marked improvement in level of pain (mean pain level= 8.7 pre-operative vs. 2.3 postoperative, p=0.003). Seventeen patients (89.5%) would recommend this operation to others with similar problems. Only one patient (5%) rated the results as worse off following surgical intervention. Statistically significant pain improvement and grip strength were noted. ROM of wrist did not improve in most patients. Conclusion: Treatment of the chronic scapholunate instability remains contentious. It is suggested early surgical intervention will benefit majority of the patients. Our result concluded that Blatt’s capsulodesis has a role in chronic scapholunate instability.