There is no agreement as to the superiority or specific indications for cast treatment, percutaneous pinning or open fracture fixation for Bennett's fractures of the thumb metacarpal. We undertook this study to compare the outcomes of treatment for patients treated for Bennett's fracture in the medium term. We reviewed 33 patients treated in our unit for a bennett's fracture to the thumb metacarpal with closed reduction and casting. Each patient was matched with a patient treated surgically. Patients were matched for sex, age, Gedda grade of injury and hand dominance. Patients were reviewed at a minimum of 5-years and 66-patients were reviewed in total. Patients were examined clinically and also asked to complete a DASH questionnaire score and the brief Michigan hand questionnaire. Follow up plain radiographs were taken of the thumb and these were reviewed and graded for degenerative change using the Eaton-Littler score. Sixty-six patients were included in the study, with 33 in the surgical and non-surgical cohorts respectively. The average age was 39 years old. In each cohort, 12/33 were female, 19/33 were right-handed with 25% of individuals injuring their dominant hand. In each coort there were 16 Grade 1 fractures, 4 Grade 2 and 13 Grade 3 fractures. There was no difference between the surgically treated and cast-treatment cohorts of patients when radiographic arthritis, pinch grip, the brief Michigan Hand Questionnaire and pain were assessed at final review. The surgical cohort had significantly lower DASH scores at final follow-up. There was no significant difference in the normalised bMHQ scores. Our study was unable to demonstrate superiority of either operative or non-operative fracture stabilization. Patients in the surgical cohort reported superior satisfaction and DASH scores but did not demonstrate any superiority in any other objectively measured domain

We define the long-term outcomes and rates of further operative intervention following displaced Bennett's fractures treated with Kirschner (K)-wire fixation. We prospectively identified patients who were treated for displaced Bennett's fractures over a 13 year period between 1996 and 2009. Electronic records for these patients were examined and patients were invited to complete a Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in addition to a patient satisfaction questionnaire. We identified 143 patients with displaced Bennett's fractures treated with K-wire fixation and followed them up at a mean of 13 years. The mean patient age at the time of injury was 33.2 years. At the time of follow up, 11 patients had died and 1 had developed dementia and was unable to respond. 9 patients had no contact details. This left 122 patients available for recruitment. Of these, 60 did not respond leaving a study group of 62 patients. Patients reported excellent functional outcomes and high levels of satisfaction at follow up. Mean satisfaction was 89% and the mean DASH score was 3.2. The infection rate was 3%. None of the 122 patients had undergone salvage procedures and none of the responders had changed occupation or sporting activities. Long-term patient reported outcomes following displaced Bennett's are excellent. Fusion surgery or trapeziectomy was not undertaken for any patient in this series nor did this injury result in sporting or occupational changes. The rate of infection is low and similar to the literature for other surgical procedures with percutaneous K-wires

Introduction: Wear, and the resultant loosening and revision, of Total Hip Replacements (THRs) remains the limiting factor in the long term success of the prosthesis. Over 1 million Total Hip Replacements (THRs) are implanted each year, of which about 15% are revisions, most of which are a consequence of loosening of either femoral or acetabular components. This is frequently caused by either the mechanical (. Wroblewski, 1986. ) or biological (. Besong et al, 1997. ) response to the wear of ultra-high molecular weight polyethylene (UHMWPE) acetabular component. In a previous study . Bennett (2002. , . 2000. ) has demonstrated that the walking patterns of THR patients 5 years post operation directly correlated with the wear of the acetabular component, as measured radiographically. The present study considers THR patients 10 years post-operatively, ensuring more accurate wear measurements and more meaningful outcome measures. Materials and Methods: Gait Analysis was performed on a number of THR patients following routine review using a Vicon 370 data capture system and a lower body marker set. This data was processed using Polygon software and joint angles were derived for the hip in the sagittal, coronal and transverse planes. A computer simulation was used to determine the path which each of 20 points on the prosthetic femoral head traces on the acetabulum during walking. Results: It was found that patients exhibited different patterns of movement ranging from liner to multi-directional. Normal subjects have previously been found to exhibit multi-directional movement. Patients with mult-directional movement showed evidence of greater wear (. Bennett et al., 2000. ). Discussion and conclusion: Linear movement causes orientation hardening and wear resistance while multi-directional movement cause increased shear and greater wear rates. These differences in movement loci have a significant influence on UHMWPE wear rate and the long term survival of the implant

Objectives. The surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function. Methods. Follow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures. All respondents underwent short-form (SF)-12 scoring; those retaining their limb also completed the American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS F&A) outcomes questionnaire. A multivariate regression analysis identified injury features associated with poor functional recovery. Results. In 12 years of conflict, 114 patients sustained 134 fractures. Follow-up consisted of 90 fractures (90/134, 67%), at a median of five years (interquartile range (IQR) 52 to 80 months). The median Short-Form 12 physical component score (PCS) of 62 individuals retaining their limb was 45 (IQR 36 to 53), significantly lower than the median of 51 (IQR 46 to 54) in patients who underwent delayed amputation after attempted reconstruction (p = 0.0351). Regression analysis identified three variables associated with a poor F&A score: negative Bohler’s angle on initial radiograph; coexisting talus and calcaneus fracture; and tibial plafond fracture in addition to a hindfoot fracture. The presence of two out of three variables was associated with a significantly lower PCS compared with amputees (medians 29, IQR 27 to 43 vs 51, IQR 46 to 54; p < 0.0001). Conclusions. At five years, patients with reconstructed hindfoot fractures have inferior outcomes to those who have delayed amputation. It is possible to identify injuries which will go on to have particularly poor outcomes. Cite this article: P. M. Bennett, T. Stevenson, I. D. Sargeant, A. Mountain, J. G. Penn-Barwell. Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years. Bone Joint Res 2018;7:131–138. DOI: 10.1302/2046-3758.72.BJR-2017-0217.R2

Work carried out by Bennett [. 1. ], identified a link between patient gait pattern and total hip prothesis wear rate. This study found that the shape of the patient gait pattern (as quantified by aspect ratio) and sliding distance of the movement loci were found to have an improved positive correlation with wear rate compared to the factors of activity and patient weight. The distribution of theoretical shear stresses at selected points on the acetabular cup suggests that orientation of the polymer chains may occur. Wang et al, 1997 [. 2. ] has shown that failure of the UHMWPE wear surfaces occurs in the form of transverse rupture between oriented molecules. This work investigates the hypothesis that the gait pattern of pre-revision THR patients has an effect on the wear, surface characteristics and material properties of the artificial hip joint, in particular the degradation of chemical and mechanical properties of the UHMWPE acetabular socket. Gait analysis is performed on patients prior to revision of a primary THR, with the retrieved socket used for subsequent analysis. Chemical and mechanical analysis of a large number of retrieved UHMWPE acetabular sockets has shown clear structural changes, which are dependent on the length on time in-vivo. Increasing the length of time in-vivo between 2 and 20 years results in an increase in the percentage crystallinity of the UHMWPE of 12.7 %. A positive linear correlation (R2 = 0.765) between percentage crystallinity and number of years in-vivo is shown. This suggests recrystallisation of the polymer at a constant rate over time. This partial recrystallisation of the amorphous region correlates with degradation in the mechanical properties of the material. This pilot study aims to assess the effect of patient gait pattern on the chemical and mechanical degradation of UHMWPE, which will ultimately affect the clinical performance of the prothesis

The June 2012 Wrist & Hand Roundup. 360. looks at; radial osteotomy and advanced Kienböck's disease; fixing the Bennett fracture; PEEK plates and four-corner arthrodesis,;carpal tunnel release and haemodialysis; degloved digits and the reverse radial forearm flap; occupational hand injuries; trapeziometacarpal osteoarthritis; fixing the fractured metacarpal neck and pyrocarbon implants for the destroyed PIPJ

Periprosthetic femoral fracture (PFF) incidence following hip replacement surgery continues to rise. There is a national drive to centralise PFF treatment within specialist centres to improve clinical outcomes and cost-effectiveness. The financial implications of treating PFFs must be analysed to guide allocation of funding.

Data were collected for 129 PFFs admitted from 02/04/2014–19/05/2020. Financial data were provided by the Patient Level Information and Costing Systems (PLICS) team. Primary outcomes were cost, revenue and margin for each PFF. Additional data were collected on length of stay (LOS), critical care requirements and clinical outcomes. Statistical comparisons were made between treatment type (fixation vs revision). Significance was set to p<0.05.

Across the entire cohort, total cost was £2,389,901, total revenue was £1,695,435 and total loss was £694,481. Highest costs were ward stay (£714,591), theatre utilisation (£382,625), and overheads (£249,110). Median cost was £15,863 (IQR, £11,092-£22,221), median revenue was £11,305 (IQR, £7,147-£15,222) and median loss was £3,795 (IQR, £605-£8687). Median LOS was 21 days (IQR 13–34) and 28.7% patients required critical care admission.

Ninety-six patients were treated operatively with either fixation (n=53) or revision (n=43). Median operating time was lower for fixation versus revision (132 [IQR, 115–185] vs 201 [IQR, 159–229] minutes, p=0.001). Median cost (£17,455 [IQR, £13,095-£22,824] vs £17,399 [£13,394-£23,404]) and median loss (£5,774 [IQR, £2,092-£10,472] vs £3,860 [IQR, £96-£7,601]) were similar for fixation and revision (p=0.99 and p=0.18, respectively). Median revenue was greater for revision versus fixation (£13,925 [IQR, £11,294-£17,037] vs £12,160 [IQR, £8,486-£14,390], p=0.02). There was no difference in LOS (21 [13–34] vs 21 [14–30] days, p=0.94), critical care requirements (20 [37.7%] vs 11 [25.6%], p=0.30), reoperations (3 [5.7%] vs 6 [14.0%], p=0.29], local complications (8 [15.1%) vs 12 [27.9%], p=0.20) or systemic complications (11 [20.8%] vs 11 [25.6%], p=0.75) between fixation and revision.

PFF treatment costs are high with inadequate reimbursement through tariff. Work is needed to address this disparity and reduce costs associated with LOS, theatre utilisation and implants. Treatment cost should not be used when deciding between fixation and revision surgery.

Over the past two decades much has been written regarding pain and disability following whiplash injury. Several authors have reported on the relationship between insurance claims and whiplash-associated disorders. Our own experience of over 10-years suggests that fracture may be protective of whiplash injury following road traffic accident (RTA). We exported all ‘medical legal’ cases due to RTA from our EMR system and combined this with patient-reported outcome measures. 1,482 (57%) of all medicolegal cases are due to RTA: 26% ‘head-on’, 34% ‘side-impact’ and 40% ‘rear-ended’. Over half of the vehicles involved are subsequently written-off. While the mean BMI is 27.1, ¼ of this cohort has a BMI over 30 (obese). 163 (11%) patients report a fracture occurring as a result of RTA. Type of impact is significant for fracture (p < 0.05). 47% of RTA which result in fracture are due to ‘head-on’ collision; conversely only 21% are due to ‘rear-ended’ impacts. In 1,324 (89%) of RTA without fracture, patients are twice as likely to report whiplash injury as one of their top-3 sources of pain (p < 0.01). Gender is statistically significant for age (M 44.4, F 38.6, p < 0.05). While the BMI of this cohort is alarming, it is consistent with Irish obesity statistics. Type of impact, in particular ‘head-on’ collision (high kinetic energy event), is significant for fracture. Finally, we report that fracture is significantly protective (p < 0.01) of whiplash injury following RTA.

First Metatarsophalangeal joint fusion has been successfully used to treat Hallux rigidus. We have attempted to evaluate commonly used methods of fixation and joint preparation. To the best of our knowledge, this is the single largest comparative study on first MTPJ fusion. We aimed to evaluate the radiological union and revision rates. We included 409 consecutive MTPJ fusions performed in 385 patients. We collected demographic, comorbidities and complication data. We evaluated the radiographs for the status of the union. Logistic regression was used to calculate the Odds ratio (OR) of non-union for the collected variables. Our union rate was 91.4% (34/409). 29.4% of our non-unions were symptomatic (10/34). Hallux valgus showed a statistically significant relation to non-union (Odds ratio 9.33, p-value 0.017). Other potential contributing factors like sex (OR1.9, p-value 0.44), diabetes (OR 0, p-value 0.99), steroid use (OR 2.07, p-value 0.44), inflammatory arthritis (OR 0, p-value 0.99) and smoking (OR 2.69, p-value 0.34) did not attain statistical significance. Further, the methods of fixation like solid screws (OR 0, p-value 0.99), plate (OR 3.6, p-value 0.187) or cannulated screws (OR 0.09, p-value 0.06) showed no correlation with non-union. We compared two techniques of joint preparation and found no significant difference in union rates (Chi-Square 1.0426, p-value 0.30). Our crude cost comparison showed the average saving to the trust per year could be 33,442.50£ by choosing screws over plate. Only Hallux Valgus had a statistically significant relation to non-union. Solid screw could be economically the most viable option and a valid alternative.

Aims

This study aimed to identify patients receiving total hip arthroplasty (THA) for trauma during the peak of the COVID-19 pandemic in the UK and quantify the risks of contracting SARS-CoV-2 virus, the proportion of patients requiring treatment in an intensive care unit (ICU), and rate of complications including mortality.

A vertical scapular osteotomy was first described by Wilkinson in 1980.

We report six children with a mean age of 9 years 6 months at operation (range 4–16). Mean abduction pre-operatively was 77 degrees (range 70–160 degrees). Cosmetically all were Cavendish grade three except one grade four. Five of the six had associated abnormalities of the cervical spine (three Klippel-Feil and one hemivertebra) and four had omovertebral bars. One boy had a full range of movement pre-op and had a cosmetic correction. One girl had a preceding Erbs palsy which had resolved completely prior to surgery.

Mean follow-up is five years (range 1–12 years). All patients have an excellent cosmetic result, four graded Cavendish one, two graded two, and one grade three. Mean abduction improved to 148 degrees and mean improvement was 77 degrees.

Sprengel’s deformity presents significant cosmetic and functional deficits. We have found the vertical scapular osteotomy as described by Wilkinson a simple and reliable procedure with predictably good results. With regards to the omovertebral bone, we concur that its presence has no influence on functional outcome. Cosmetically, when clothed, the result is excellent, with the shoulders level. Undressed, however, asymmetry is still obvious with a truncated shoulder girdle and persistence of some webbing or fullness in the base of the neck. This appears more marked when an omovertebral bone was present.

We conclude that a vertical scapular osteotomy is a reliable operation for improving shoulder girdle function, but that cosmetic objectives must be reliable.

It is unclear whether combat casualties with complex hindfeet fractures would have an improved outcome with reconstruction or amputation. This study aimed to determine the outcomes of British military casualties sustaining calcaneal fractures. In the 12 years of conflict in Iraq and Afghanistan there were 116 calcaneal fractures in 98 patients. Seventy-four patients (74/98 76%) were contactable, providing follow up data for 85 fractures (85/116 73%). Median follow up was 5-years (64 months, IQR 52–79). Thirty limbs (30/85 35%) had undergone trans-tibial amputation at time of follow-up: there was no association between open fractures and requirement for amputation (p=0.06). Definitive treatment choice had a significant association with later requirement for amputation (p=0.0479). Fifty-two patients (52/74 70%) had been discharged from the military due to their injuries: there was a significant association between amputation and military discharge (p=0.001). Only 17 patients (17/74 23%) had been able to complete a military fitness test since their injury. The median physical component score of the SF-12 quality of life outcome tool for those undergoing amputation was 51.9 (IQR 48.1–54.3). The median for those retaining their limb was 44.1 (IQR 38.6–53.8). The difference between the two cohorts was not statistically significant (p=0.989).

This is a retrospective study examining the injury pattern, management and short-term outcomes of British Military casualties sustaining hindfoot fractures from the conflicts in Iraq and Afghanistan. In the 12-years of war, 114 patients sustained 134 hindfoot injuries. The calcaneus was fractured in 116 cases (87%): 54 (47%) were managed conservatively, with 30 (26%) undergoing internal fixation.

Eighteen-month follow-up was available for 92 patients (81%) and 114 hindfeet (85%). Nineteen patients (17%) required trans-tibial amputation in this time, with a further 17 (15%) requiring other revision surgery. Deep infection requiring surgical treatment occurred in 13 cases (11%) with S. aureus the commonest infective organism (46%). Deep infection was strongly associated with operative fracture management (p=0.0022). When controlling for multiple variables, the presence of deep infection was significantly associated with a requirement for amputation at 18 months (p=0.001). There was no association between open fractures and requirement for amputation at 18 months (p=0.926), nor was conservative management associated with amputation requirement (p=0.749).

Revision total hip replacement is often associated with significant blood loss and subsequent transfusion. Intra-operative cell salvage is one approach to minimising this allogenic transfusion.

We carried out a retrospective study of 158 consecutive revision THRs carried out by one surgeon between June 2003 and September 2006 in the Southern General Hospital, Glasgow.

In the study group (79 patients, operated upon after October 2005) Intra-operative cell salvage was routinely used for all cases. In the control group (79 patients, operated upon before October 2005) Intra-operative cell salvage was not available.

Data was collected on transfusion of salvaged blood, transfusion of allogenic blood, operation type, indication for surgery, complications and length of hospital stay.

Results showed a 53% reduction (p=0.002) in the number of units of allogenic blood transfused in the study group compared with the control group. (1.59 units per case compared with 3.41 units).

In the study group 51% of patients received allogenic blood transfusion, compared with 68% of patients in the control group, a relative reduction of 17% (p=0.02).

There was no difference between the two groups regarding haemoglobin drop and length of hospital stay. Data regarding complications yielded no significant results due to small cohort size.

We conclude that intra-operative cell salvage leads to a significant reduction in allogenic blood transfusion with subsequent implications upon cost, resource management, and patient safety and should be used for all patients undergoing revision hip arthroplasty.

Objective: To study the incidence of MRSA (Methicillin resistant Staphylococcus aureus) at pre-operative screening and relate this to positive cultures of the tissue in joint replacement surgery. Setting: Elective joint replacement centre with routine MRSA screening facility. Design: Retrospective review of MRSA screening and positive tissue samples taken during one year period from 1.11.99 to 31.10.00 in hip and knee replacements. Results: Eighteen (18) out of the 2867(0.7%) screens performed on patients undergoing joint replacement surgery had MRSA isolated from one source or other. However, no MRSA was found from tissue samples taken during the surgery. But 63 isolates from 499 tissue samples (12.6%) were reported as coagulase negative staphylococcus, out of which 28(44%) were resistant to Methicillin. After observing the incidence of Methicillin resistant coagulase negative staphylococcus during one year, we reviewed the tissue culture reports in revision hip replacements from May 1974 till July 1999. Two hundred ninety-one (291) positive organisms were isolated from 337 cultures, out of which 57.5% were coagulase negative staphylococcus 11.9% staphylococcus aureus. Methicillin resistance was noted in 30.8% of coagulase negative staphylococcus as opposed to 6% of staphylococcus aureus. Conclusion: Staphylococcus epidermidis is the most prevalent and persistent species on human skin and mucous membranes, constituting 65–90% of all staphylococci (Mandell, Douglas & Bennett, 2000). Since a majority of isolation in tissue samples constitute methicillin resistant coagulase negative staphylococcus, would it be more appropriate to screen for Methicillin resistant Staphylococcus epidermidis (MRSE), rather than MRSA, in patients undergoing joint replacement surgery?

This study aimed to characterise severe open femoral fractures sustained by military personnel and to describe their orthopaedic management and preliminary outcomes. The UK Military Trauma Registry was searched for open femoral fractures sustained between 2006–2010. Clinical records and radiographs were reviewed and data gathered on demographics, injury, management and preliminary outcomes.

Thirty-four patients with 34 open femoral fractures were eligible for inclusion. The mean NISS was 22.4 (SD 12.28). Nineteen fractures were caused by gunshot wounds (56%), with the remainder due to blasts. Three patients (9%) suffered Grade 4 segmental bone loss. Intramedullary nailing was used in 22 patients (69%). A minimum of 12 month follow up was available for 33 patients (97%). Twenty-three patients (70%) had achieved fracture union within the first twelve months. One patient suffered deep infection requiring surgical debridement. Ten patients (30%) underwent a revision procedure due to femoral shortening or malunion: two required a transfemoral amputation. There was a significant association between bone loss and a poor outcome (revision surgery) at 12 months (p=0.00016). Infection rates were significantly lower in open femoral fractures when compared to similar published work on open tibial fractures (p=0.0257).

Revision total hip replacement is a procedure often associated with significant blood loss and subsequent transfusion. Intra-operative cell salvage is one approach to minimising this problem.

We carried out a retrospective study of 134 consecutive revision total hip carried out by one surgeon between June 2003 and September 2006 in the Southern General Hospital, Glasgow, 134 replacements (excluding those performed in the presence of active infection where cell salvage is contra-indicated).

In Group A (56 patients), operated upon after October 2005, Intra-operative cell salvage was routinely used. In Group B (78 patients), operated upon before October 2005, Intra-operative cell salvage was not used.

Data was collected on transfusion of salvaged blood, transfusion of allogenic blood, operation type, indication for surgery, complications and length of hospital stay.

In Group A, an average of 1.52 units of allogenic blood was transfused per case, compared with an average of 3.35 units in Group B (p=0.01), a reduction of 55%.

In Group A 50% of patients received allogenic blood transfusion, compared with 68% of patients in Group B, a relative reduction of 26% (0.1> p> 0.05).

There was no difference between the two groups regarding haemoglobin drop and length of hospital stay. Data regarding complications yielded no significant results due to small cohort size.

Further Breakdown of data by operation type and indication did not yield significant results due to the small cohort size.

Our results show that routine use of intra-operative cell salvage in revision total hip replacement leads to a significant reduction in allogenic blood transfusion with subsequent implications upon cost, resource management, and patient safety.

The Trent Arthroplasty Audit Group has been prospectively collecting data on primary knee arthroplasty since 1990 and revision procedures since 1992. Details of 27 000 primary and 1300 revision knee arthroplasties have been registered. In 2001 hospitals in Wales joined the group, increasing the catchment population to 8 million (14% of the UK population). The register has enabled evaluation of changes in the demography and surgical practice of knee arthroplasty in the Trent region over the past 13 years.

Over this period there has been a steady increase in the number of arthroplasties registered, from 1330 cases in 1990 to 2855 in 2002. Whilst there has been a slight increase in the proportion of men undergoing surgery, the age distribution remains consistent (mean age 69 years). PFC/Sigma is currently the most commonly used prosthesis in the region.

Since 1990 the number of patients registered with rheumatoid arthritis has fallen by almost 50%. During this period there has also been a slight decrease in the proportion of uncemented joints and a decline in the number of bilateral simultaneous procedures taking place.

The ratio of primary to revision knee arthroplasty has not changed significantly since 1992 but there is some evidence of specialisation of revision knee surgery. There has been no significant change in patient satisfaction rates since the start of the registry, with 80% of patients reporting that they are satisfied with their joint replacement at 1 year.

Conclusion: It is reasonable to assume that these findings reflect practice across the UK as a whole, given the diversity of hospitals contributing and the large population base of the Trent & Wales register.

Hand injuries are common in military personnel deployed on Operations. We present an analysis of 6 years of isolated hand injuries from Afghanistan or Iraq. The AEROMED database was interrogated for all casualties with isolated hand injuries requiring repatriation between April 2003 and 2009. We excluded cases not returned to Royal Centre for Defence Medicine (RCDM). Of the 414 identified in the study period, 207 were not transferred to RCDM, 12 were incorrectly coded and 41 notes were unavailable. The remaining 154 notes were reviewed. 69% were from Iraq; only 14 % were battle injuries. 35% were crush injuries, 20% falls, 17% lacerations, 6% sport, 5% gun-shot wounds and 4% blast.

Injuries sustained were closed fractures (43%), open fractures (10%), simple wounds (17%), closed soft tissue injuries (8%) tendon division (7%), nerve division (3%), nerve/tendon division (3%) complex hand injuries (4%). 112 (73%) of the casualties required surgery. Of these 44 (40%) had surgery only in RCDM, 32 (28%) were operated on only in deployed medical facilities and 36 (32%) required surgery before and after repatriation. All 4 isolated nerve injuries were repaired at RCDM; 2 of the 4 cases with tendon and nerve transection were repaired before repatriation. Of the 10 tendon repairs performed prior to repatriation 5 were subsequently revised at RCDM.

This description of 6 years of isolated hand injuries in military personnel allows future planning to be focused on likely injuries and raises the issue of poor outcomes in tendon repairs performed on deployment.

Introduction and Aims: To assess the 10-year outcome of knee arthroplasty surgery in a generalist setting, across a single UK health region.

Method: The Trent Arthroplasy Audit Group has been collecting prospective data on primary knee replacements since 1990. 4677 primary knee replacements were performed in the period 1990–92. A validated self-administered questionnaire, including a EuroQol health evaluation questionnaire, was mailed to all surviving patients. The mean age at the time of surgery was 70 years.

Results: Thirty-nine percent of the patients had died by 10 years. Responses were received from 87% of patients. Eighty-two percent of patients had been satisfied with the result of their knee replacement. Twenty-one percent of patients felt that it was not as good as they had been led to believe before surgery. Forty percent of patients had had problems with their knee in the 10 years since surgery. Twenty-one percent had had some form of surgical intervention. Eighty-two percent of patients were taking medication to alleviate pain in their replaced knee.

Eighteen percent complained of constant pain in this knee. When the pain occurred it was described as being severe in 16% and moderate in 40%. Most patients were on prescribed medication, but had not been referred to a surgeon to identify if there was a problem with their implant. The revision rate, for all causes at 10 years was 13%.

Conclusion: The results of knee arthroplasty at 10 years are disappointing. Patients’ responses indicate that previously successful knees are becoming painful. At the present time there appears to be inadequate long-term follow-up/re-referral of patients and surgeons have a high threshold for revision surgery. More detailed clinical examination is planned for this group of patients.