We have reviewed the complication rate over a ten year period for removal of screws placed for slipped capital femoral epiphysis (SCFE) and have surveyed the views of orthopaedic surgeons with an adult hip practice in Scotland on leaving the metalwork in situ. Whilst screw removal is favoured by many orthopaedic surgeons, a recent review of the literature reported that the complication rate for removal of implants placed for SCFE was 34%.

Between 1998 and 2007 84 patients had insertion of screws for SCFE. Of these 54 patients had screws removed, 51 of these records were available. The median duration between insertion and removal of screws was 2 yrs 7 months. Of the 51 children, overall five (9.8%) had complications - three (5.9%) major and two (3.9%) minor. Two screws could not be removed; one patient sustained a fracture after screw removal and two developed an infection.

We assessed the attitudes of adult hip surgeons on this topic using an electronic questionnaire which was completed by 29 out of 40 recipients. 78.6% of respondents support routine removal and 21.4% favour leaving the screw permanently in place. 82.2% had needed to remove metalwork from a hip requiring arthroplasty in a patient whose metalwork was inserted during childhood; and described their experience of this including the complications encountered.

We have identified a lower complication rate following screw removal inserted for SCFE than in published series. Most adult hip surgeons support routine removal once the physis is closed but studies regarding the long-term outcome of retained orthopaedic implants are needed since even with this lower complication rate the question of routine removal remains unclear.

The aim of this study was to evaluate the rate of surgical site infection (SSI) in all patients undergoing a primary total knee arthroplasty (TKA) and to audit the outcomes for those who were obese.

We retrospectively reviewed data for 839 primary TKAs done at a National Arthroplasty Centre over one year (April 2007 – March 2008). Body mass index (BMI) data was available for 824 (98%) of the patients. Surgical site infection (SSI) data had been collected prospectively by the Infection Control team for up to 30 days post-operatively and was available for all patients.

There were 23 patients with SSIs, 22 having superficial SSI and only one patient with a deep SSI. The overall superficial SSI rate was 2.7%. For the BMI< 25 group (9.6% of patients) SSI rate was 1.3%. For BMI 25–30 (31.6% of patients) SSI rate was 2.3%. For BMI 30–35 (31.2% of patients) SSI rate was 1.6%. For BMI 35–40 (19.0% of patients) SSI rate was 3.2%. For BMI > (8.6% of patients) SSI rate was 8.5%. Fisher’s Exact Test between all obese patients (BMI< 30) and those with BMI< 30 showed no significant difference in superficial SSI rates (p = 0.39) but did show a significant difference between superficial SSI rates in the obese class III patients (BMI> 40) and the rest of the cohort (p = 0.008).

Obese class III (BMI > 40) patients are at an increase risk of superficial SSI as compared to other patients undergoing primary TKA. However, obese class I and II patients (BMI 30–40) do not appear to have an increased likelihood of superficial SSI as compared to patients who have BMI< 30.

Introduction: The prevalence of obesity continues to increase in the United Kingdom leading to a growing burden on the healthcare system. A significant percentage of patients who undergo total knee arthroplasty are obese. A review of the literature reveals that obese patients are at an increased risk of complications including wound problems. The aim of this study was to evaluate the rate of surgical site infection in all patients undergoing a primary total knee arthroplasty and to audit the outcomes for those who were obese.

Methods: We retrospectively reviewed data for 839 primary total knee arthroplasties done at a National Arthroplasty Centre over one year (April 2007 – March 2008). BMI data was available for 824 (98%) of the patients and was obtained from the patients’ clinical records. Surgical site infection data had been collected prospectively by the Infection Control team for inpatient stays and up to 30 days post-operatively. Infection data was available for all patients. Patients were grouped based on their BMI and the WHO classifications (WHO Technical Report Series 894). The infection rates were analysed to establish if there were poorer outcomes for obese patients.

Results: Based on the WHO classifications, 31.2% of the patients were obese class I (BMI 30 – 35), 19.0% were obese class II (BMI 35 – 40) and 8.6% were obese class III (BMI > 40). There were 23 patients with infections, 22 having superficial infection and only one patient with a deep infection. The overall superficial surgical site infection rate was 2.7%. The superficial surgical site infection rate for the normal weight group was 1.3%, for the overweight group was 2.3%, obese class I was 1.6%, obese class II was 3.2% but for obese class III was 8.5%. The Fisher’s Exact Test between all obese patients and those with BMI < 30 showed no statistically significant difference in superficial surgical site infection rates (p = 0.39). However, it did show a statistically significant difference between superficial surgical site infection rates in the obese class III patients and the rest of the cohort, p = 0.008.

Conclusion: Obese class III (BMI > 40) patients are at an increase risk of superficial surgical site infection as compared to other patients undergoing primary total knee arthroplasty. However, obese class I and II patients do not appear to have an increased likelihood of superficial surgical site infection as compared to patients who have BMI < 30. It is therefore important that surgeons are aware of the higher risk of surgical site infection in obese class III patients and recommended that patients in this category should be informed of this by their surgeon when considering primary total knee arthroplasty.

Purpose: The aim of this study was to evaluate the rate of surgical site infection (SSI) in all patients undergoing a primary total knee arthroplasty (TKA) and to audit the outcomes for those who were obese.

Methods/Results: We retrospectively reviewed data for 839 primary TKAs done at a National Arthroplasty Centre over one year (April 2007 – March 2008). BMI data was available for 824 (98%) of the patients. SSI data had been collected prospectively by the Infection Control team for up to 30 days post-operatively and was available for all patients. Patients were grouped based on their BMI and the WHO classifications (WHO Technical Report Series 894).

31.2% of the patients were obese class I (BMI 30 – 35), 19.0% were obese class II (BMI 35 – 40) and 8.6% were obese class III (BMI > 40). There were 23 patients with SSIs, 22 having superficial SSI and only one patient with a deep SSI. The overall superficial SSI rate was 2.7%. The superficial SSI rates for each group were as follows: normal (BMI < 25) = 1.3%; overweight (BMI 25 –30) = 2.3%; obese class I = 1.6%; obese class II = 3.2%; obese class III = 8.5%. The Fisher’s Exact Test between all obese patients and those with BMI < 30 showed no significant difference in superficial SSI rates (p = 0.39) but did show a significant difference between superficial SSI rates in the obese class III patients and the rest of the cohort (p = 0.008).

Conclusions: Obese class III (BMI > 40) patients are at an increase risk of superficial SSI as compared to other patients undergoing primary TKA. However, obese class I and II patients do not appear to have an increased likelihood of superficial SSI as compared to patients who have BMI < 30.

Patients with osteoarthritis of the knee reviewed by the General practioners, are usually referred for further management to the orthopaedic surgeon. It was our observation that patients were usually referred with supine knee X-rays. This meant weight-bearing films were repeated at the clinic.

Methods: We sent out questionnaires to GPs inquiring whether they asked for X-rays of the knee prior to patient referral and whether they asked for weight bearing films. We also reviewed the policy in one National Hospital Service trust and one teaching hospital with regards to GPs asking for weight bearing films. The time patients spent waiting at the X-rays department was noted. Finally we inquired about the cost of a knee X-ray.

Results: A total number of 65 questionnaires were sent and the response was 44 i.e. 67%. 80% of the GPs asked for non weight bearing X-rays prior to referral. Only 5% asked for weight bearing films. The radiology departments of hospitals in one NHS trust and the teaching hospital did not accept weight bearing requests from GPs. The time taken for a patient to get an X ray in the department was at least 30 minutes and the cost of X rays of the knee was £51. With an average of two patients with osteoarthritis of the knee per clinic, the cumulative waiting time for repeated X-rays was 1 hr per clinic, 5 hrs per week and 240 hrs per year. With an average of two X rays per clinic the cumulative cost was £102 per clinic, £510 per week and £24480 per year.

Discussion: Non weight bearing X-rays of the knee do not add any value in making or confirming a diagnosis of osteoarthritis yet they are costly both in terms of time and money. Weight bearing films were repeated for patients with these X-rays. The cumulative cost in terms of time can be better used to review other patients and therefore reduce the waiting time before surgeons can see referrals. The other issue is the cumulative cost which can be put to better use in the trust. The time wasted by the patients who have repeated X-rays was not considered, but is also of importance.

Conclusion: Patients with osteoarthritis of the knee should have weight bearing films from the initial onset. This will save time for the patient and the surgeon and will save the hospital money.

The purpose of our study was to compare the alignment achieved by navigated mobile bearing unicompartmental arthroplasty with that of standard instrumentation. We looked at postoperative X-Rays of 18 unicompartmental mobile bearing arthroplasties performed by two surgeons. 12 of these performed by one surgeon, consisting of 6 navigated E-Motion™ mobile bearing knees and 6, Phase 3 Oxford™ unicompartmental mobile bearing knees. The remaining 6 were Phase 3 Oxford™ unicompartmental mobile bearing knees, performed by a different surgeon. Radiological measurements using the criteria in the Oxford™ manual were taken. All navigated E-motion™ components were within the defined Oxford™ parameters, while a quarter of both all the femoral and all tibial implants were malaligned using standard instrumentation. Our study shows that better and more consistent alignment was achieved when navigation was used for mobile bearing unicompartmental arthroplasty as opposed to the use of standard instrumentation.