In a prospective randomised controlled trial, 51 patients who did not receive a bone plug during total knee replacement surgery were compared to 49 patients who received a bone plug. The primary outcome measure was the need for allogenic blood transfusion requirement and the secondary outcome was the post-operative blood loss and decline in haemoglobin levels. The patients had autologous re-transfusion from their closed drainage system. The two groups did not differ in the demographics. The mean intra-operative blood loss was slightly more in the no plug group (difference of 41.25 millilitres), which was not statistically significant. There was no statistically significant difference in total post-operative blood loss and drop in haemoglobin levels. Only one patient had two units of allogenic blood transfusion in the no bone plug group while none required allogenic blood in the bone plug group. There was no statistically significant difference in the amount of blood re-transfused from the drain between the two groups. Our findings did not show any statistically significant difference in post-operative blood loss, decline in haemoglobin levels and the need for allogenic blood transfusion in total knee replacement surgery.

We undertook a retrospective audit to assess the effectiveness of use of Quixil in reducing the amount of blood transfusion requirements following revision THR. As Quixil was used from mid 2007 for revision THRs, we looked at blood transfusion requirements for 1 year before introduction of Quixil and compared it with requirements after introduction of Quixil for a similar period.

Method and Materials: 44 patients underwent revision THR by the senior author during the period from June 2007 – June 2008 (Quixil group) while 45 patients did not have Quixil during revision THR for the period May 2006 – May 2007 (Non-quixil group). In the quixil group, M: F = 18:26 and average age 75.3 (range: 63 – 88 yrs). In the non-quixil group, M: F = 17:28 and average age 71.3 (range: 47 – 85 yrs). The duration of surgery was similar in both groups. Blood loss during the operation was evaluated by measuring the volume in the suction apparatus and by estimating the amount of lost blood in the swabs at the end of the operation. Drains were not used in these procedures. All blood transfusions were recorded.

Results: The average blood loss was 1010 mls (range: 300 – 2200 mls) in the quixil group vs. 1021 mls (range: 500 – 2000 mls) in the non-quixil group. The use of cell saver and intra-operative blood transfusion were similar in both groups. The mean pre-op Hb in quixil vs. non-quixil group was 13.0 g/dl (range: 9.7– 16.2) vs. 12.4 g/dl (range: 8.8 – 16.2). The mean post-op Hb in quixil group vs. non-quixil group was 10.2 g/dl (range: 6.4 – 13.2) vs. 9.1 g/dl (range: 5.3 – 12.9)(a difference of 1.1 g/dl). There was a difference in the blood transfused post-operatively between the two groups – 21 vs. 29 patients. Total units of blood transfused in quixil vs. non-quixil group were 60 vs. 86 (a difference of 26 units stastically significant) and total units of intra-op blood transfused in quixil vs. non-quixil group were 16 vs. 23 (a difference of 7 units).

Limitations of the study: Retrospective study, Small numbers of patients

Conclusion: The use of fibrin tissue adhesive in revision total hip arthroplasty seems to be an effective and safe means with which to reduce blood loss and blood-transfusion requirements as well as prevent in the postoperative decrease in the level of hemoglobin.

Introduction: We undertook a questionnaire study to assess the compliance with DVT prophylaxis following lower limb arthroplasty surgery and evaluate reasons for non-compliance (if any).

Method: Following joint replacement surgery, 50 patients (45 had THR, 5 had TKR) were asked to fill in anonymised questionnaire at 6 weeks. They were asked about awareness for DVT, information given, prevention methods, duration and type of prophylaxis given and their compliance with treatment.

Results: Most of the patients (45) were aware of the risk of DVT while 2 were not aware and 3 were not sure. 37 patients were given information during their clinic visit while 7 did not receive any information and 6 can’t remember. 32 patients remembered discussing risk of developing DVT while 9 did not and 9 were not sure. 34 patients (68%) were aware of prophylactic methods. Except for 2 patients, the rest 48 patients (96%) confirmed receiving prophylaxis. 48 patients (96%) had mechanical prophylaxis in the ward while 6 continued at home as well. 46 patients (92%)remembered receiving chemical prophylaxis both in the ward and at home thereafter.

36 patients received chemical prophylaxis (injections) for 10 days, 5 for 7 days, 8 for a few days and 1 patient for 6 weeks post-op. 38 patients (76%) self administrated the injections while 6 had family members help and 3 had district nurse visit. 47 patients (94%) received injections for the complete duration. 3 patients did not receive injections regularly at home (missed nurse visit – 1, not advised – 1, forgot to inject – 1).

Discussion: DVT compliance is still an issue in surgery especially when patients were asked to self-administer the injections. We achieved 94 % compliance with our protocol. This study shows that greater emphasis on patient education, awareness and motivation may help improve compliance.

Studies comparing the biomechanical properties of different meniscal repair systems are limited, and most have simply investigated load to failure. Meniscal tissue is highly anisotropic, and far weaker under tension in the radial direction. Loading to failure using high radially orientated loads may, therefore, not be the most physiologically relevant in-vitro test for repair of circumferential tears, and determining increases in gapping across repair sites under cyclical loading at lower loads may be of greater importance. This study aimed to determine the load to failure for 4 different meniscal repair techniques, and to assess gapping across repairs under cyclical loading.

Bovine menisci were divided vertically, 5mm from the peripheral edge to simulate a circumferential tear, and then repaired using 1 of 4 techniques: vertical loop sutures using 2-0 PDS, bioabsorbable Meniscal Arrows (Atlantech), T-Fix Suture Bars (Acufex) or Meniscal Fasteners (Mitek). 9 specimens were tested in each group using an Instron 5565 materials testing machine with Merlin control software to determine load to failure. A further 9 specimens in each group were tested by cyclical loading between 5N and 10N at 20mm/min for 25 cycles. Gapping across the repairs under cyclical loading was measured using a digital micrometer and a Differential Voltage Reluctance Transducer.

The peak load to failure values for each repair method did not appear to fit a Gaussian distribution, but were skewed to the left due to some samples failing at lower loads than the main cluster. Results were analysed using the Kruskal-Wallis test, with Dunn’s multiple comparison post test. The results for gapping across the repairs from the cyclical testing all appeared to fit the Gaussian distribution, and these were analysed by Analysis of Variance, with Tukey’s multiple comparison post test. All analysis was performed using Prism (Graph-pad) Software.

The mean loads to failure for each of the repair groups were: Sutures 72.7 N, T-Fix 49.1 N, Fasteners 40.8 N, and Arrows 34.2 N. The load to failure was significantly greater with the Suture group compared to the Arrows (p< 0.01) or the Fasteners (p< 0.05). The mean gapping across the repairs for each of the repair groups after 25 loading cycles were: Sutures 3.29mm, Arrows 2.18mm,Fasteners 3.99mm,andT-Fix 3.47mm.The mean gapping was significantly less for the Arrows compared to the Sutures (p< 0.05), the Fasteners (p< 0.01), or the T-Fix (p< 0.05).

The results confirm that meniscal repair by suturing gives the highest load to failure, but show that Arrows give superior hold under lower loads, with the least gapping across repairs under cyclical loading by this testing protocol.

Aims: To determine load to failure for four different meniscal repair techniques, and to assess gapping across repairs under cyclical loading.

Background: Studies comparing the biomechanical properties of different meniscal repair systems are limited, and most have simply investigated load to failure. Meniscal tissue is highly anisotropic, and far weaker under tension in the radial direction. Load to failure using high loads may, therefore, not be the most physiologically relevant in-vitro test for repair of circumferential tears, and measuring increases in gapping across repair sites under cyclical loading at lower loads may be of greater importance.

Methods: Bovine menisci were divided vertically, 5mm from the peripheral edge to simulate a circumferential tear, and then repaired using one to four techniques: vertical loop sutures using 1 -PDS, bioabsorbable Meniscal Arrows (Atlantech), Meniscal Fasteners (Mitek) or T-Fix Suture Bars (Acufex). Nine specimens were tested in each group using an Instron 5500 materials testing machine to determine load to failure. A further nine specimens in each group were tested by cyclic loading between 5N and 10N at 20mm/min for 25 cycles, using a digital micrometer to measure initial gapping, and a Differential Variable Reluctance Transducer to measure the progressive increase in gapping across the repair site during the cyclical loading. Data was analysed by ANOVA and Tukey’s multiple comparison post test using Prism (GraphPad) software.

Results: The mean loads to failure (with s.d.) in Newtons were: Sutures 72.7 (22.0), Arrows 34.2 (15.4), Fasteners 40.8 (13.4), and T-Fix 49.1 (13.8). The load to failure was significantly greater with the Sutures compared to the Arrows (p< 0.001), the Fasteners (p< 0.001) or the T-Fix (p< 0.05).

The mean gapping across the repairs after 25 load cycles (with s.d.) in millimetres was: Sutures 3.3 (1.0), Arrows 2.2 (0.9), Fasteners 4.0 (0.6) and TFix 3.5 (0.7). The mean gapping was significantly less for the Arrows compared to the Sutures (p< 0.05), the Fasteners (p< 0.01), or the T-Fix (p< 0.05).

Conclusions: These results confirm that meniscal repair by suturing gives the highest load to failure, but show that Arrows give superior hold with the least increase in gapping across a repair under cyclical loading by this test protocol.