Knee arthroscopy is the most commonly performed orthopaedic operation world wide. There is however little data on the incidence of DVT and consequently there is no consensus regarding the need for periopeartive thromboprophylaxia. Hoppener et al,2003 reported a high incidence of 11% DVT without the use of thromboprophylaxis.

The aim of our study was to establish the incidence of venous thromboembolic complications in day case knee arthroscopy without any thromboprophylaxis

A retrospective review of 458 consecutive knee arthroscopies done in our unit between Feb 1998 to May 2007 were carried out. They were all day cases and did not receive any chemical thromboprophylaxis. All the case notes were carefully scrutinized for any readmissions for symptoms of venous thromboembolism(VTE). The clinical signs documented were pain, tenderness, swelling or redness of the legs, dyspnoea, chest pain and haemoptysis leg pains or redness following the surgery.

There were 278 males and 180 females. The age group ranged from 15 to 88 years. The average age group was 57.7years. The primary out come of the study was the incidence of symptomatic and asymptomatic venous thromboembolic complications after the knee arthroscopy during the 2 week and 8 week followup period. Our study showed there were no cases of symptomatic deep vein thrombosis in any of the patients.

The pooled overall estimate of the incidence of all VTE, without the use of thromboprophylaxis was 7.4%, symptomatic 2% and asymptomatic 5.4%. This is not in agreement with our study. The limitation of our study, it is a retrospective analysis and no investigative tools were used.

We conclude that until more extensive studies have been performed, it seems justified to withhold thromboprophylaxis in patients undergoing uncomplicated knee arthroscopic procedures in a daycare setting..

One of the many challenges in revision hip arthroplasty is massive bone loss. Subsidence of the collarless stem with impaction allografting has been reported by several authors. Impaction grafting has emerged as a useful technique in the armamentarium of the revision total hip arthroplasty surgeon. The original technique proposed by Ling has been associated with complications, including femoral shaft fractures, recurrent dislocations, and uncontrolled component subsidence. Modifications in that technique seem to be associated with a reduction in complications.

The aim of this study was to assess the functional outcome of radial impaction grafting in femoral bone defects and the use of collared long stem prosthesis.

A total of 107 patients underwent radial impaction allografting and collared long stem prosthesis during revision THA between 1997 and 2005. The patients with Paprosky type II, IIIA and IIIB defects were included in this study. Average duration between the primary and revision surgery was 9.4 years (Range 6–23 years). Assessment was done using Oxford Hip Score, Harris Hip Score and with plain X-rays. Three patients were lost to follow-up and three patients died due to unrelated causes.

The follow-up period lasted between 12 to 114 months (average – 68.8 months). Three patients who sustained post-operative peri-prosthetic fracture had standard stem inserted in them. None of the patients with long stem sustained peri-prosthetic fracture. Four patients had infection and underwent revision procedure. In this study, using revision for any cause as the end-point, survival of the femoral stem was 93.8%. Subsidence was not recorded in any of the patients in this study. Oxford Hip Score improved from mean pre-operative value of 41.2 to 19.2 post-operatively. Mean Harris Hip Score improved from 40.8 pre-operatively to 83.4 post-operatively.

Subsidence of the prosthesis is commonly encountered with collarless stems and this was not a problem in this study. The risk of peri-prosthetic fracture can be reduced by using long stem prosthesis which bypasses the existing cement mantle by at least two femoral diameters. The radial impaction grafting technique permits the use of revision femoral components with variable stem lengths, neck lengths, and neck offsets.

We conclude that radial imaction graftind along with collared long stem prosthesis is a good solution for massive femoral bone defects while performing total hip arthroplasty.

There are about 63,000 primary total knee replacements done annually in England and Wales. One of the biggest challenges of modern NHS is to ensure high quality care for the patients. A reduced length of stay in the hospital following primary total knee replacements could be the key factor in significant cost reduction.

The aim of the study was to assess the efficacy of our rapid recovery programme following total knee replacements in terms of reducing length of stay, morbidity, complications, and readmissions rates.

A prospective study of 252 patients who underwent primary total knee replacement for a period of one year between October 2006 to 2007 were included in the programme. There were 123 (49%) males and 129 (51%)females. The average age was 71 (range-53 to 86). The average BMI was 30 (range-22 to 46). The median ASA grade was 2 (range-1 to 4). There were no exclusion criteria. The programme included pre-operative education of patient and relatives, standardised operation protocols, infection control, pain management, continuous motivation by nursing staff and physiotherapists in the ward as well as intensive rehabilitation by a community based physiotherapy team in patient’s own environment. The patients were discharged when they had achieved the ward physiotherapy requirements.

The average length of stay was 5.2 days. The complications encountered during inpatient stay was wound discharge(43), surgical site infection(1), DVT (1), pneumonia(1).12 patients needed post operative blood transfusion. The readmissions rate was 4%. Deep infection was noted in 4 patients, DVT(1), pulmonary embolism(1)and 3 patients had medical complications.

In conclusion the rapid recovery programme following total knee replacement is an efficient method of speeding the recovery and reducing the length of hospital stay after primary knee replacements. It is useful for the modern NHS to achieve a balance between financial savings and a consistent, responsive and high-quality care for patients.

Purpose: The aim our study was to establish the existence of a symptomatic humero-radial synovial plica causing lateral elbow pain and the resection of which has improved pain and restored elbow function

Materials & Methods: Our study included 117 consecutive elbow arthroscopies performed by two surgeons for a period of 18 months from January 2002 to July 2003.

All patients were treated non operatively before undergoing arthroscopy. Conservative treatment included rest, activity modification, physiotherapy including ultrasound bracing, NSAIDS and corticoste-riod injection.

Results: Radial head plica were found in 21(18%) out of 117 elbow arthroscopies and were resected using a soft tissue resector. There were 16 men and 5 women in the study group,all of whom were young and active: mean age 38 years (range 24 to 56 years). All patients were scored pre op and post op using the Mayo clinic performance index for the elbow. Of the 21 patients 17(81%) had a post op score 90 or more(excellent) and 5(19%) had a score 75-89(good)

Conclusion: The synovial fold of the humero-radial joint is documented and considered as a meniscus between the two articulation(Duparc f etal 2002). They can also present present as symptoms suggesting intra articular loose bodies(Clarke R.P etal 1998).

In the case of resistant tennis elbow the existence of a radial head synovial plica should be considered. Our study concludes that by resecting the synovial plical fold will relieve the pain and restore the elbow motion.

Introduction: It may not be possible to obtain anatomical reduction of displaced supracondylar fractures in children by closed manipulation. We have found difficulties performing open reduction using the described surgical approaches. We report an approach based on studies of the vascular anatomy of triceps, which provides a wide exposure facilitating surgery.

Material And Methods: Between 2002 and 2004 we performed open reduction and internal fixation on 12 children (8 girls, 4 boys: mean age 6).

Our vascular injection studies indicate that the blood supply to triceps brachii is proximally based. We used a posterior approach identifying the ulnar nerve. We mobilised lateral triceps and anconeus in continuity preserving the vascularity and separated the components of distal triceps through an intermuscular septum. The fractures were reduced and fixed using K wires.

Results: The fractures healed in the anatomical position in each child and all 12 demonstrated a full range of elbow movements within 6–8 weeks of K wire removal. We observed no complications.

Discussion: Although closed reduction and percutaneous K wire fixation remains the treatment of choice for displaced supracondylar humeral fractures, anatomical reduction must be achieved ideally and residual rotation of the fracture fragments avoided. We have found that this surgical approach has reduced our reluctance to proceed to surgical treatment of these difficult fractures and consequently a tendency to accept sub optimal reduction.

Conclusion: A surgical approach based on the vascular anatomy of triceps can be used to provide a wide, symmetrical and safe exposure facilitating open reduction and internal fixation of supracondylar fractures of the humerus in children whilst avoiding complications including residual elbow stiffness.