Prosthetic joint infection continues to remain a diagnostic challenge for unhappy primary arthroplasty of hip and knees. There is increasing dependence upon alpha-defensin test to make key decisions like whether to revise or not & to decide between one-stage versus two-stage.

Post-operative swelling and wound ooze following primary Total Knee Replacement (TKR) can lead to complications such as wound infection, and delays in achieving adequate range of motion. The aim of the study is to examine the effectiveness of using an additional layer of a self-adherent elastic wrap (CobanTM) in reducing post-operative swelling and wound ooze after Primary TKR.

Seventeen pairs of patients who had had a primary TKR were studied in a prospective, age and gender-matched cohort study. Half of the patients had wool and crepe dressing (Group A) and the other half with an additional layer of CobanTM dressing (Group B), applied to the wound. Limb circumference was measured at three levels (below knee, knee and above knee) preoperatively and 3 consecutive days post-operatively. The area of wound ooze was measured using AutoCAD software.

Group B showed a significant reduction difference in the mean of post-operative limb circumference at above knee level (3.2 vs 4.9 cm. p =0.023). This trend in reduction was seen at below knee and knee levels, though not statistically significant. There is a clinical difference in the wound ooze measured area of 17.8cm2 Vs 22.9 cm2, in Group B and A, respectively.

Within the relative small size of this study, there appeared a significant reduction in post-operative limb swelling and wound ooze when using CobanTM in TKR. It is promising preliminary results, however the study groups must be extended.

In England and Wales more than 175 000 hip and knee arthroplasties were performed in 2012. There continues to be a steady increase in the demand for joint arthroplasty because of population demographics and improving survivorship. Inevitably though the absolute number of periprosthetic infections will probably increase with severe consequences on healthcare provision. The Department of Health and the Health Protection Agency in United Kingdom established a Surgical Site Infection surveillance service (SSISS) in 1997 to undertake surveillance of surgical site infections. In 2004 mandatory reporting was introduced for one quarter of each year. There has been a wide variation in reporting rates with variable engagement with the process. The aim of this article is to improve surgeon awareness of the process and emphasise the importance of engaging with SSISS to improve the quality and type of data submitted. In Exeter we have been improving our practice by engaging with SSISS. Orthopaedic surgeons need to take ownership of the data that are submitted to ensure these are accurate and comprehensive.

Cite this article: Bone Joint J 2015;97-B:1170–4.

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are recognised and proven interventions for patients with advanced arthritis. Studies to date have demonstrated a steady increase in the requirement for primary and revision procedures. Projected estimates made for the United States show that by 2030 the demand for primary TKA will grow by 673% and for revision TKA by 601% from the level in 2005. For THA the projected estimates are 174% and 137% for primary and revision surgery, respectively. The purpose of this study was to see if those predictions were similar for England and Wales using data from the National Joint Registry and the Office of National Statistics.

Analysis of data for England and Wales suggest that by 2030, the volume of primary and revision TKAs will have increased by 117% and 332%, respectively between 2012 and 2030. The data for the United States translates to a 306% cumulative rate of increase between 2012 and 2030 for revision surgery, which is similar to our predictions for England and Wales.

The predictions from the United States for primary TKA were similar to our upper limit projections. For THA, we predicted an increase of 134% and 31% for primary and revision hip surgery, respectively.

Our model has limitations, however, it highlights the economic burden of arthroplasty in the future in England and Wales as a real and unaddressed problem. This will have significant implications for the provision of health care and the management of orthopaedic services in the future.

Cite this article: Bone Joint J 2015;97-B:1076–1081.

Limited literature exists providing comprehensive assessment of complications following opening wedge high tibial osteotomy (OWHTO). We performed a retrospective study of local patients who underwent OWHTO for isolated medial compartment knee osteoarthritis from 1997–2013.

One hundred and fifteen patients met inclusion criteria. Mean follow-up = 8.4years. Mean age = 47 (range 32–62). Mean BMI = 29.1 (range 20.3–40.2). Implants used included Tomofix (72%), Puddu plate (21%) and Orthofix (7%) (no significant differences in age/ sex/ BMI). Wedge defects were filled with autologous graft (30%), Chronos (35%) or left empty (35%).

Five year survival rate (conversion to arthroplasty) = 80%. Overall complication rate = 31%. 25% of patients suffered 36 complications including minor wound infections (9.6%), major wound infections (3.5%), metalwork irritation necessitating plate removal (7%), non-union requiring revision (4.3%), vascular injury (1.7%), compartment syndrome (0.9%), and other minor complications (4%). No thromboembolic complications were observed.

A higher BMI (mean 34.2) was apparent in those patients suffering complications than those not (mean 26.9). No significant differences existed in complication rates relative to implant type, type of bone graft used or patient age at surgery.

Complications following OWHTO appear higher than previously reported in the literature; serious complications appear rare.

Comparison of the safety and efficacy of Bilateral Simultaneous Total Hip Arthroplasty (BSTHA) with that of staged (SgTHA) and unilateral (UTHA) was conducted using DerSimonian–Laird heterogeneity meta-analysis. A review of the English-language literature identified 23 citations eligible for inclusion. A total of 2063 bilateral simultaneous THR patients were identified. Meta-analysis of homogenous data revealed that there were no statistically significant differences between rates of thromboembolic events (p=0.268 and p=0.365) and dislocation (p=0.877) when comparing staged or unilateral with bilateral simultaneous THR procedures. A systematic analysis of heterogenous data demonstrated that mean length of hospital stay was shorter after bilateral simultaneous THR. Blood loss was reduced after bilateral simultaneous THR in all studies except for one, and surgical time was not different between groups. This procedure was also found to be economically and functionally efficacious when performed by experienced surgeons in specialist centres.

Controversy still remains as to whether patella resurfacing in total knee arthroplasty (TKA) should be conducted as a matter of routine. Some authors recommend routine resurfacing of the patella and advocate this due to the reduction in post-operative anterior knee pain and the reduction in requirement for revision surgery.

A database search was conducted to identify prospective randomized controlled studies only. Eighteen prospective randomized trials were identified and found eligible for inclusion. A cumulative sample of 8006 knees were involved, 3418 undergoing resurfacing and 4588 undergoing no resurfacing. Primary outcome data extracted was incidence of secondary operations, incidence of anterior knee pain and functional outcome scores including subgroup analysis of the type of prosthesis used in each study. Der Simonian Laird metanalysis was conducted if studies were found to be homogenous where statistical significance was defined as an overall alpha error of < 0.05.

No statistically significant differences were found to exist between patients undergoing patella resurfacing as a primary total knee replacement and those who preserved the native patella. No differences could be found between specific prosthetic design when subgroup analysis was conducted.

The study does not offer evidence to suggest any advantage of resurfacing versus non-resurfacing. Furthermore, no significant discrepancy existed when comparing different types of total knee prosthesis. This may be due that all the knees analysed are designed to be patella friendly and allow conformity of articulation of both a native and patella button equally

Comparison of the safety and efficacy of Bilateral Simultaneous Total Hip Arthroplasty (BSTHA) with that of staged (SgTHA) and unilateral (UTHA) was conducted using DerSimonian–Laird heterogeneity meta-analysis. Twenty three citations were eligible for inclusion. A total of 2063 BSTHA patients were identified. Meta-analysis of homogenous data revealed that there were no statistically significant differences between rates of thromboembolic events (p=0.268 and p=0.356) and dislocation (p=0.877) when comparing SgTHA or UTHA versus BSTHA procedures. Systematic analysis of heterogenous data demonstrated that mean length of stay was shorter in BSTHA as compared to SgTHA and UTHA procedure, blood loss was lower in BSTHA in all studies except one, whilst the surgical time was not different between groups. BSTHA was also found to be economically and functionally efficacious.

Comparison of the safety and efficacy of bilateral simultaneous total hip replacement (THR) and that of staged bilateral THR and unilateral THR was conducted using DerSimonian-Laird heterogeneity meta-analysis. A review of the English-language literature identified 23 citations eligible for inclusion. A total of 2063 bilateral simultaneous THR patients were identified. Meta-analysis of homogeneous data revealed no statistically significant differences in the rates of thromboembolic events (p = 0.268 and p = 0.365) and dislocation (p = 0.877) when comparing staged or unilateral with bilateral simultaneous THR procedures. A systematic analysis of heterogeneous data demonstrated that the mean length of hospital stay was shorter after bilateral simultaneous THR. Higher blood transfusion requirements were expected following bilateral simultaneous THR than staged or unilateral THR, and surgical time was not different between groups. This procedure was also found to be economically and functionally efficacious when performed by experienced surgeons in specialist centres.

Purpose: We report the 10 to 13 year results of the PFC knee system at our institution.

Method/Results: Between 1992 and 1995 97 PFC primary knee arthroplasties were performed consecutively in 82 patients. 32 patients have subsequently died (37 knees) and four (4 knees) are lost to follow-up. Clinical and radiological review of 46 patients (56 knees) was performed at a mean of 11.1 years post-operatively. Outcome was assessed using the Charnley modification of the Merle D’Aubigne score, with a median of 5 for pain and 4 for function. Radiological failure was defined as progressive radiolucency (1 case), lysis (1 case) or subsidence (1 case). Polyethylene wear was detectable in 10 cases, with > 50% in two. There was 100% survivorship with revision for aseptic loosening as an endpoint. There has been one revision for infection and one patella resurfacing, giving a 98% survivorship with no re-operation. In addition one periprosthetic fracture above a well fixed femoral component, required a supracondylar nail.

Conclusions: The PFC gives excellent outcome and survivorship at 13 years, regardless of the experience of the operating surgeon. This demonstrates that with careful training the PFC is a reliable knee replacement in the long-term for trainers and trainees alike.

Introduction: Although the functional outcomes after severe lower limb injury ( Gustilo grade IIIb and IIIc ) managed with various surgical techniques is well described in the literature, there is limited information on appearance related psychological impact after complex lower limb reconstruction. We sought to determine the aesthetic problems in patients with open tibial fractures with extensive soft tissue injury.

Materials and methods: Data on patients with open tibial fractures managed with free flaps between 1999–2003 admitted to our trauma unit was collected and analysed. Patients who had finished their treatment at least one year ago with isolated leg injury were identified, patients with surgery related disability were excluded. we used Derriford Scale (DSA24) with additional questionnaire for analysis .

Results: In total 31 patients were contacted out of which 18 provided with completed questionnaires, 14 male and 4 female with mean age of 41.8(17–69) year. Appearance of the leg following surgery significantly effected relationships (3 divorced, 2 split up, 3 worse, 8 same and 2 better). Nine (56.2%) patients experienced poor sexual relationship following surgery and four (22.2%) reported to avoid undressing in front of partners. Five patients (27.7%) requested debunking and two under went surgery. Twelve (66.6%) patients were still taking pain killers. Ten (55.5%) patient complained of donor site weakness or painful scar. Six (33.3%) patients required to change jobs. Thirteen (72.2%) were unconfident in themselves, (66.6%) were distressed to see there legs in mirror. Nine (50%) felt hurt and irritable at home, (61.1%) patients avoided going to beach. Nine (50%) disliked using communal changing areas or even going for shopping and felt closed in a shell. Eight (44.4%) patients felt rejected and chose not to attend social events.

Conclusion: The psychological impact of trauma is generally neglected, sudden and unexpected nature of events and interventions have significant effect on post operative quality of life.