Aims: Most centres cross-match blood preoperatively for primary joint arthroplasty operations. But is it really necessary? Background of study: We did a audit involving 110 primary hip and 105 knee arthroplasty operations 5 years ago. Results showed that only 35% of our patients used cross-matched blood. Around 7% were transfused on the day of surgery and none urgently. After this we changed our practice to cross-match only those patients with preoperatively haemoglobin less than 10 or ones with antibodies in blood. We re-audited our practice this year in a study. Methods: We looked prospectively at 100 primary total hip and 100 primary total knee arthroplasty operations in a audit. None of these patients were cross-matched. Exclusion criteria were bilateral operations, Pre-operative haemoglobin of less than 10, antibodies in blood. Risk factors included taking drugs like NSAIDS, steroids or aspirin or those suffering from diseases causing vascular fragility like Rheumatoid arthritis or those with any blood coagulation disorders. Results: Blood loss was increased by various risk factors however our study did not prove its (signiþcant) effect on blood transfusion requirement. None of our patients required urgent transfusion. 5% of our patients required transfusion within 24 hours of surgery and in all 20% required post-operative transfusion. Blood transfusion requirements are increased by increased intra-operative blood loss but it does not correlate with post-operative drainage. Conclusions: We advocate a routine practice of only group and save of blood in a standard unilateral joint arthroplasty surgery. This method is advocated by British Transfusion Society, validated in literature and is cost effective.

Aim: To assess long-term outcome of Silastic Joint Replacement of the þrst metatarsophalangeal joint. Methods: 32 patients (42 feet) with double stem silicone implant arthroplasty of the 1st MTPJ were reviewed at average 8 years (range 4 Ð 19 years). Surgery was for Hallux rigidus in 25 cases and for Hallux valgus with degenerative osteoarthritis in 17 cases. Patients with Rheumatoid arthritis were excluded. Mean patient age was 64 years. Results: 28 of the 32 patients were very satisþed with the procedure. No patients were dissatisþed. Pain relief was subjectively excellent or good in 28 patients. Three of the four patients with fair or poor relief of pain had surgery for Hallux Valgus with degenerative osteoarthritis. Radiographs showed sclerosis around all prostheses with cysts with bony erosions in 17 cases. 12 had clinical features of silicone synovitis in the early postoperative period but this was not present at þnal review despite radiological þndings of new bone formation (57%) and localised osteolysis (40%). Two patients had transfer metatarsalgia with a stress fracture. No patients required revision surgery. Conclusion: Our long-term study shows patients to have very good subjective and objective results despite poor radiological results. There is a role for double stemmed silicone implant arthroplasty in low demand patients.