The aim of this retrospective cohort study was to investigate the reasons for total knee arthroplasty (TKA) revisions at a tertiary hospital over a four-year period. The study aimed to identify the primary causes of TKA revisions and shed light on the implications for patient care and outcomes.

The study included 31 patients who underwent revisions after primary knee arthroplasty between January 2017 and December 2020. A retrospective approach was employed, utilizing medical records and radiological findings to identify the reasons for TKA revisions. The study excluded oncology patients to focus on non-oncologic indications for revision surgeries. Patient demographics, including age and gender, were recorded. Data analysis involved categorizing the reasons for revision based on clinical assessments and radiological evidence.

Among the 31 patients included in the study, 9 were males and 22 were females. The age of the patients ranged from 43 to 81, with a median age of 65 and an interquartile range of 18.5. The primary reasons for TKA revisions were identified as aseptic loosening (10 cases) and prosthetic joint infection (PJI) (13 cases). Additional reasons included revision from surgitech hemicap (1 case), patella osteoarthritis (1 case), stiffness (2 cases), patella maltracking (2 cases), periprosthetic fracture (1 case), and patella resurfacing (1 case). The findings of this retrospective cohort study highlight aseptic loosening and PJI as the leading causes of TKA revisions in the examined patient population.

These results emphasize the importance of optimizing surgical techniques, implant selection, and infection control measures to reduce the incidence of TKA revisions. Future research efforts should focus on preventive strategies to enhance patient outcomes and mitigate the need for revision surgeries in TKA procedures.

In the first year of existence of the Acute Spinal Injury Unit, 162 patients were admitted. A large number of injuries were the result of interpersonal violence. Case notes and radiographs of 49 consecutive patients with gunshot injuries to the spine were reviewed.

The mean age of the 38 male and 11 female patients was 27.5 years (15 to 51). The mean length of stay in the unit was 30 days (4 to 109). The 46 associated injuries were 11 fractures, 14 haemopneumothoraces, and one soft palate, nine visceral, two vascular, four brachial plexus, three oesophageal and two tracheal injuries. Non-spinal surgery was required in 17 patients. The spinal injury was complete in 38 patients and incomplete in eight. Three had no neurological deficit. The involved level was cervical in 13, thoracic in 24 and lumbar in 12. The spine was considered stable in 43 patients. Six patients underwent surgical stabilisation. In 11 patients the bullets were in the canal and were removed. One case of discitis was debrided. Complications included three deaths, discitis in three patients, pneumonia in six and pressure sores in six. The ASIA motor score improved marginally in nine patients and one patient had true functional improvement.

Gunshot injuries lead to a high incidence of permanent severe neurological deficit, but usually the spine remains mechanically stable. Most of the management revolves around the associated injuries and consequences of the neurological deficit.