Nerve blocks are a common form of peri-operative analgesia that is administered for patients undergoing joint Replacement surgeries. The long term sequel following these peripheral nerve blocks used in total knee replacement not reported in the literature. Nerve blocks given under the guidance of nerve stimulators are in practice in most of the hospitals and are considered safe.

We report a series of two cases with residual neurological deficit following these peripheral nerve blocks in total knee replacements. In both these cases the femoral, sciatic, obturator and lateral cutaneous nerve of thigh were blocked with 0.25% of Bupivacaine with the help of a nerve stimulator.

First patient post operatively had residual numbness in the right lower leg after 4 weeks of surgery. Nerve conduction studies confirmed absent response in right Saphenous and superficial peroneal nerves. Patient has no improvement in her neurological deficit even after 16 months post operatively. Further to this she developed complex regional pain syndrome on the affected side.

Second patient post operatively developed knee extensor weakness of grade II/V and loss of sensation in femoral nerve distribution. Nerve conduction studies confirmed severe femoral nerve damage around groin. She went through a turbulent phase, knee stiffness range of movements 0–20 degrees requiring Manipulation Under Anaesthesia, later Exploration and Release of adhesions which improved her range of movements to 0–95 degrees. At 12 months post operative the neurological status improved to grade 3/5 in knee extensors.

Conclusion: Long term Complications of Peripheral nerve blocks in total knee replacements are not reported in the literature. These complications though uncommon, unfortunately for patients affect the surgical outcomes. The purpose of this case series is not only to report complications but also to share our experience of managing these complications, their outcomes and relevant literature review.

Abduction strength forms an important component of shoulder function assessment tools such as the Constant-Murley score. However, there is no consistency in literature with regards to the method used for its assessment. An extensive review of the literature failed to reveal any evidence to support any particular method. The purpose of this study was to compare the reliability of a single measurement with that of the maximum and average of three consecutive measurements. Sixty healthy volunteers participated in this study. Three measurements of shoulder abduction strength were taken on two occasions separated by 2 weeks. For each shoulder, two single (first) measurement values, two average values and two maximum values were obtained. For each method, 95 % limits of agreement were calculated. Both methods average and maximum have higher reliability than a single measurement. Furthermore, the reliability of the maximum is slightly higher than that of the average.

Aim: To evaluate the benefits of suction drainage following primary total joint arthroplasty.

Materials and Methods: A two year retrospective study was conducted on 126 consecutively selected patients who had primary total hip & knee replacements in a district general hospital. There were 63 patients (mean age 69 years) each in drain and non-drain groups. Sex distribution and anticoagulants use in both groups were similar. All patients underwent same operative technique and method of closure. Primary hip replacements were carried out by Hardinge approach and knee replacements by medial parapatellar approach.

Results: Mean postoperative fall in haemoglobin was 3.2 and 3.3 gm/dl in the drain and nondrain groups respectively. Blood transfusion was required in 34 patients with drains and 28 patients without drains. Mean blood transfusion requirements in both the groups were between 2–3 units. There was no statistically significant difference between the two groups in postoperative complications such as hypotension and wound infections (all negative for microbiology culture). The average rehabilitation time in both the groups was 8–9 days. Statistical analysis showed no difference in postoperative fall of haemoglobin, blood transfusion and rehabilitation time between the two groups (p> 0.05).

Conclusion: We concluded that the routine use of suction drain is unnecessary after an uncomplicated total joint arthroplasty.