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.

The use of ultrasound-guided wire localisation of lesions is not well described in the orthopaedic literature. We describe a case of an impalpable schwannoma of the femoral nerve and another of sacroiliitis with an associated pelvic abscess. In both, surgical localisation was difficult. Peri-operative ultrasound-guided wire localisation was used to guide surgery and minimise tissue damage, thereby optimising the results and recovery of the patient.

Aim: To assess the long-term treatment outcome following conservative treatment of wrist ganglions by aspiration and steroid injections.

Materials and Methods: Between December 2001 and November 2003, 49 patients with wrist ganglions were seen and treated by one surgeon*. There were 20 males and 29 females with an average age of 37 years (range 13 to 70 years). Anatomically we had 41 dorsal wrist, 5 volar wrist and 3 digital ganglions. Diagnosis was made on clinical examination, explained to patients about the condition and given three options of treatment.

Reassurance,

39% (14) were satisfied with reassurance alone, 69%(34) had aspiration and steroid injection and one opted for surgery.

Those who opted for aspiration and steroid injection are included in the study.

The aspiration was carried out under sterile technique, area infiltrated with 1% lignocaine, followed by aspiration of ganglion content using 16 G needle and injection of Methyl-prednisolone Acetate BP 40 mg/ml. The patients were advised to carry out their normal activities and followed up at 6 weeks, 3 months and 6 months.

Follow up period range between 6 weeks to 6 months (average of 3.8 months).

Results: 34 ganglia treated with aspiration and steroid injection had a cure rate of 47%(16), 31%(10) and 12%(4) respectively after 1,2 and 3 treatments with a cumulative success rate of 88%(30 of 34). We had recurrence rate of 12% (4 of 34) after 3 injections and two patients with skin discoloration.

Conclusion: Treatment options should be given to patients with wrist and digital ganglions. Conservative treatment is quite successful, which will avoid surgery and associated complications. Even though our sample size is too small to make any statistical significance, cumulative success rate of 88% following multiple treatments of aspiration and steroid injections are in comparable with other studies.