The effectiveness of intravenous tranexamic acid (TA) in reducing blood loss and transfusion requirements during total hip replacement (THR) is well recognised. The aim of this study was to assess the effectiveness of a fibrin sealant in comparison to intravenous TA and a control group.

We prospectively studied 270 patients with primary hip osteo-arthritis who underwent a straight forward THR between February 2012 and September 2013. The first 70 patients acted as the control group. The next 100 consecutive patients received fibrin sealant spray before closure and the last 100 patients received 1g TA on induction. Demographic data, comorbidities, surgical time, surgeon grade, anaesthetic type, haemoglobin drop post-operative and transfusion requirements were analysed using one-way ANOVA.

The demographic characteristics, surgical time, surgeon grade, anaesthetic type and pre-operative haemoglobin of the 3 groups were comparable. Both fibrin sealant and intravenous TA were effective in reducing blood loss during THR (15%, p = 0.04 & 22.5%, p = 0.01, respectively), when compared to the control group. However, neither treatment was found to be superior to the other in preventing blood loss p = 0.39. Tranexamic acid was superior to fibrin sealant in decreasing allogeneic transfusion requirements (0% vs 10%, p = 0.05). The LOS was significantly shorter in the tranexamic acid group than fibrin sealant group and in the fibrin sealant group compared with control group. There was no significant difference between the groups with regards to proportion of patients with wound leaking problems. No other complications (e.g. VTE) were encountered

Both fibrin sealant and intravenous tranexamic acid were effective in reducing blood loss. However, tranexamic acid use reduced post-operative transfusion requirements.

Trauma ward rounds (TWR) are usually preceded by trauma meetings where previous day admissions are discussed and management decisions made. Therefore, one would expect TWR to be relatively quick and efficient. We measured the distance walked during TWR over a one week period and examined effects of number of patients and their location on distance walked.

We used a pedometer (after calibration) to measure the distance walked by a single consultant orthopaedic surgeon during his trauma week. The consultant conducted a daily TWR after the trauma meeting where previous day admissions and postoperative patients were reviewed. We initially measured the distance required to visit five wards where trauma patients could be found (trial distance) and used that for comparison. We recorded number of patients reviewed and wards visited daily.

The distance walked daily during TWR was 1.37–2.4 times longer than trial distance. There was no correlation between number of patients reviewed or number of wards visited and distance walked. Despite the larger number of patients towards the end of the week (33 patients on 3 wards on last TWR), the distance walked remained shorter than on the first TWR (11 patients on 3 wards). The distance walked during the whole week was 30.8 miles!

We found no correlation between number of patients reviewed or their location and distance walked during TWR. The relatively shorter distances walked towards the end of the week could be explained by more familiarity and therefore, better organisation by the team as the week progressed.

Introduction

We reports the accuracy of direct Magnetic Resonance Arthrography (MRA) in detecting Triangular Fibrocartilage Complex (TFCC), Scapho-Lunate Ligament (SLL) and Luno-Triquetral Ligament (LTL) tears using wrist arthroscopy as the gold standard.

The aim of this study is to assess the accuracy of patients' shoe size as a predictor of femoral component size of Oxford unicompartmental knee replacement (UKR).

A retrospective study was conducted to identify the correlation between patients' shoe size (British system) and the femoral component size. After excluding patients who died (n=2) and patients in whom the implanted femoral component size was inaccurate (n=13), the remaining cases (93 UKR in 88 patients) formed the study sample. Postoperative radiographs were reviewed to determine femoral component fit. We found positive correlation between shoe size and femoral component size. In females; a shoe size from 2.5 to 6 predicted a small femoral component and shoe size from 6.5 to 8.0 predicted a medium femoral component. In males, a shoe size from 6 to 9.5 predicted a medium femoral component and a shoe size from 10 to 13 predicted a large femoral component. This relation predicted the femoral component size accurately in 80% of cases. In the rest of cases, the prediction was only one size smaller or larger than the ideal size. A subgroup analysis, after excluding patients who changed their shoe size during adulthood after foot surgery or pathology (n=20), showed an accuracy rate of 81%.

Shoe size is a simple method that predicts femoral component size more accurately than other methods currently used such as templating, tibial component size and height based on gender.

We compared 5341 patients with an initial fracture of the hip with 633 patients who sustained a second fracture of the contralateral hip. Patients presenting with a second fracture were more likely to be institutionalised, female, older, and have lower mobility and mental test scores. There was no significant difference between the two groups with regards to the change in the level of mobility or return to their original residence at one year follow-up. However, the mortality rate in the second fracture group was significantly higher at one year (31.6% vs 27.3%, p = 0.024). In two thirds of patients, the second fracture was in the same anatomical location as the first. In an analysis of 293 patients, approximately 70% of second fractures occurred within three years of the first.

This is the largest study to investigate the outcome of patients who sustain a second contralateral hip fracture. Despite the higher mortality rate at one year, the outcome for surviving patients is not significantly different from those after initial hip fractures.

Introduction: The role of prophylactic antibiotics in reducing the incidence of infection following hip and knee arthroplasty is well established. The British Orthopaedic Association (BOA) published best practice guidance on the use of prophylactic antibiotics in hip and knee arthroplasty. The guidance stated that all patients should receive prophylactic antibiotics at induction of anaesthesia and that each unit should have a locally agreed policy with advice from microbiologist. The aim of this audit was to compare the practice in our unit with the BOA guidance and implement necessary changes.

Patients and Methods: A prospective audit was conducted over a one month period in 2007 and included all patients undergoing elective primary hip and knee replacements. A similar re-audit was conducted over one month period in 2008 after the initial audit recommendations were implemented.

Results: Forty patients (40) were included in the initial audit. All patients received prophylactic antibiotics at induction but the choice, dose and duration of administration of antibiotics varied widely among surgeons in the unit. After discussion with the local microbiologist, we recommended a departmental policy for prophylactic antibiotics. The policy recommended a single dose of Cefuroxime and Gentamycin for standard cases and a single dose of Teicoplanin and Gentamycin for high-MRSA risk cases. A re-audit was conducted after the new policy was agreed. The re-audit included 33 patients. All patients received prophylactic antibiotics at induction. The choice of antibiotics was concordant with the policy in 79% of cases and duration of administration was appropriate in 85% of cases. Overall, the policy was adhered to in 22 cases (67 %).

Discussion & Conclusions: The closed audit cycle resulted in improvement of our practice but the compliance rate with the new policy was lower than expected. Although it is the primary responsibility of the operating surgeon to ensure the appropriate prophylactic antibiotics are administered, more awareness of other team members is necessary to improve the compliance rate with the new policy.

Heterotopic ossification is a recognised complication of surgery on the hip joint that can adversely affect the outcome. The aim of this study was to determine the incidence of heterotopic ossification following surgical hip dislocation and debridement for femoro-acetabular impingement using Ganz trochanteric flip osteotomy approach. We also compared the incidence of heterotopic ossification between two subgroups of patients; in the first group, a shaver burr was used to reshape the femoral head and in the second group, an osteotome was used.

Methods: We reviewed postoperative radiographs of all patients who underwent surgical hip dislocation and debridement during the period between March 2003 and July 2007. We excluded patients with radiographic follow-up of less than one year. Brooker classification was used to grade heterotopic ossifications.

Results: Ninety eight patients (mean age 35 years, range 12–65 years) were included with a mean radiological follow-up of 23 months (range 12–61 months). The overall incidence of heterotopic ossification was 31%. None of the patients developed Brooker grade III or IV heterotopic ossifications. The incidence of heterotopic ossifications in the shaver burr group (n=57) and in the osteotome group (n=41) was 30% and 32%, respectively.

Conclusions: Heterotopic ossification of minor grade is a common complication of surgical hip dislocation using trochanteric flip osteotomy approach. The use of a shaver burr did not result in higher rates of heterotopic ossifications despite the formation of large amounts bone debris.

The aim of Femoro-Acetabular Impingement (FAI) surgery is to improve femoral head-neck clearance by resection of the osseous bump deformity. The purpose of this study was to investigate whether osseous bumps will re-grow and to compare two instruments used for resection osteoplasty; a shaver burr and an osteotome.

We reviewed records of patients who underwent surgical hip dislocation and debridement via Ganz flip osteotomy between March 2003 and July 2007. We excluded patients with less than one-year radiographic follow-up.

Ninety-five patients (95) underwent 98 surgical hip dislocations and were included (mean radiological follow-up 23 months, range 12–61 months). Bump re-growth occurred in 16 cases (16%). Pre and postoperative Non-Arthritic Hip Scores (NAHS) were available for 12 of the 16 patients. The mean pre- and postoperative NAHS were 62 (range 26–95) and 83 (range 41–104) respectively (p= 0.02). In the shaver burr group (n=57), there were 6 cases of bump re-growth (12%) compared to 10 cases in the osteotome group (n=41) (32%).

In this study, recurrence of osseous bumps did not affect the outcome. Using shaver burrs resulted in lower rates of bump re-growth than using osteotomes. This could be related to heat osteonecrosis at the femoral head-neck junction.