Introduction: There is paucity in guidance on when and what should be said or who should take the consent for patients undergoing lower limb arthroplasty. Never before, the specialists been contacted for current practice and their recommendations on the content and timing of obtaining the consent in these patients.

Materials and Methods: A postal questionnaire was sent to 154 Orthopaedic consultants in the 14 units in NorthWestern region of England. We acquired information on their current practice, awareness of the guidelines and their preferences and recommendations.

Results: A total of 117/154 (76%) consultants responded, of which 84 (55%) fulfilled the inclusion criteria. Currently, 36% patients are consented at preoperative assessment clinic and 40% on admission. 75% of the consultant consent themselves or are consented by their registrars. 70% were aware of local or national policies on who should consent patients and 40% on what should be explained and documented. 75% recommended that operating surgeon should obtain consent. The recommended time for the consent was at preoperative assessment by 57%.

Discussion: If the act of signing the consent form is to be more meaningful it should be signed by the surgeon who is going to perform the operation. This study demonstrates that the consultants agree on the common complications but have a varied threshold for giving the less common risks. With shortening of the waiting time, there is a growing body of surgeons suggesting that the consent should be done at the listing itself.

Aims: As part of the guidelines recommended by NICE (National Institute of Clinical Excellent), we are presenting the early results of this new hip replacement component.

Methods: We reviewed 65 consecutive primary total hip replacements in 59 patients in which the Opera Flanged cemented acetabular component (smith & nephew) had been used. The mean follow-up was 47 months (36 to 63). In all cases a Charnley femoral prosthesis had been used. There were 39 women and 26 men with a mean age at operation of 67.4 years (33 to 90). Survival analysis of the acetabular components was performed.

Results: Two components were revised due to deep infection, and one of these cups was discovered to be well fixed at operation. None of the acetabular components required revision for aseptic loosening. After 5 years survival was 97% using the worst-case scenario. Radiological analysis of all acetabular components at 12 months post-operation and at yearly intervals revealed no cases of aseptic loosening. Radiolucencies around the cemented socket were noted in five patients, but were not progressive on sequential radiographs.

Conclusions: The early results are encouraging and the follow-up will be continued to assess the 10 years results.

We present the early results of the Bernese osteotomy via an ilioinguinal approach performed at an U.K. district general hospital with no links to the Bernese group.

Between 1997 and 2002, 19 such osteotomies have been performed at our institution. Average follow-up is 3.2 years (range: 1–5.5 years). The male: female ratio was 1: 8.5. Average age at time of operation was 32.3 years (range 18 – 48). 14 were classified as having Severin grade 2 dysplasia and 5 as having Severin grade 3 dysplasia. The average preoperative Merle d’Aubigne and Postel score was 12.7 points (range 6 – 15). 21.1% of patients were rated as good, as 57.8% fair and 21.1% poor.

At most recent follow-up of preserved hip joints total mean score had increased to 16.3 (range 13 – 18). 26.3% of hips were graded as excellent, 58.9% as good and 14.8% as fair. The average postoperative values for the lateral centre-edge angle and acetabular index were 42.3° and 10.0° respectively which represents an average of 31.4° and 24.7° of improved lateral and loading zone coverage after osteotomy. The preoperative severity of osteoarthritis according to the criteria of Tonnis was grade 1 in 15.8% and grade 2 in 26.3%. Only one joint deteriorated sufficiently for it to be converted to a total hip arthroplasty. There was an overall complication rate of 59.9% comprised of 47.4% trivial, 10.4% moderate and 0.05% major complications. Our early results demonstrate the steep learning curve of this technically demanding operation and are encouraging.

The aim of this randomised prospective study was to establish whether the use of knee splints following total knee replacement is necessary.

The study included 81 patients undergoing total knee replacement who were randomised into a ‘splint’ and a ‘no splint’ group postoperatively. Patients in the ‘splint’ group had their knee splinted in extension in the early post-operative period but the splint was removed for the patients to do exercise. Splintage was completely removed when the patient could straight leg raise. Patients in the ‘no splint’ group had a wool and crepe bandage applied around their knee and allowed to fully mobilise from the first postoperative day. The following parameters were recorded: The range of movement preoperatively, 5 days post-operatively and 6 weeks postoperatively; the length of time to straight leg raise; the blood drained from the wound. and the amount of postoperative analgesia required.

Using the unpaired 2 tailed t-test it was found that patients in the four ‘no splint’ group achieved significantly greater flexion at 5 days and 6 weeks post-operatively but drained significantly more blood from the wound. Transfusion requirements were similar in the two groups. There was no other significant difference in the parameters measured between the two groups.

In conclusion we found no evidence to advocate the use of knee splints following total knee arthroplasty.