We report a retrospective study of the major complications following one-stage and two-stage bilateral unicompartmental knee replacements (UKR). Between 1999 and 2008, 911 patients underwent 1150 UKRs through a minimally- invasive approach in our unit. Of these, 159 patients (318 UKRs) had one-stage bilateral UKR and 80 patients (160 UKRs) had two-stage bilateral UKRs. The remainder were unilateral UKRs.

The bilateral UKR groups were comparable in age and ASA grade, but more females were in the two-staged group (p=0.019). Mechanical thromboprophylaxis was used in all cases. Major complications were recorded as death, pulmonary embolus, proximal deep vein thrombosis (DVT) and adverse cardiac events within 30 days of surgery.

No statistical differences between the groups were found regarding operating surgeon, tourniquet time or minor complications (excepting distal DVT). Anaesthetic times were greater for the two-stage group (p= 0.0001). Major complications were significantly more common with one-stage bilateral UKR (13 patients, 8.2%) compared to two-stage bilateral UKR (no patients) (p=0.005). Distal DVT was more frequent in the two-stage group (p=0.036).

This series reports significantly higher risks of major complications are associated with one-stage bilateral UKR when compared to two-stage bilateral UKR. There is no evidence that the addition of chemical thrombo-prophylaxis would change this risk. We advocate caution before undertaking a one-stage bilateral UKR.

Introduction: The BOA recommends clinical and radiological arthroplasty follow up at one year then every five years. Increasing pressures placed on NHS Trusts with the implementation of the 18 week pathway and limitation on new:follow-up ratios has increased the use of patient reported outcome scores in arthroplasty follow-up. No single score is validated for this purpose, and there is no data surrounding their effectiveness as a screening tool for aseptic loosening.

Patients & Results: Patients undergoing their 10 year follow were included in the study and scored with the Harris (HHS), Hospital for Special Surgery (HSS), Merle d’Aubigne (MDA), Visual Analogue (VAS) or Oxford Hip Score (OHS) according to the unit’s established follow-up protocol. All patients underwent clinical and radiographic review in addition to scoring. Patients subsequently listed for revision surgery were defined as failure. Statistical analysis included significance testing and ROC analysis to determine the predictive value of the individual scores.

Four hundred and twelve patients were included in the study. The mean Harris, VAS and HSS were significantly different between the failed and well fixed groups. However there was no statistically significant difference between the mean Oxford and MDA scores. ROC analysis demonstrated the Harris (0.97), VAS (0.98) and HSS (0.77) score to have good prediction of outcome.

Discussion: The scores in our study have been validated as outcome measures for joint arthroplasty, however they perform differently in the follow-up setting. There is evidence that a failing hip is reflected in a poorer VAS, Harris, Oxford and HSS scores however the VAS was more sensitive and specific than any hip score. Patient administered outcomes have a place in the follow up of joint replacement it must be remembered they are validated as outcome measures, not for follow up purposes.

Materials and Methods: The institution’s prospective database of unicompartmental knee replacements was reviewed for all Oxford Phase III Unicompartmental Knee Replacement (Biomet, UK) undertaken from January 2004 to July 2007. This identified a total of 645 procedures undertaken. We included all cases where there was pre-operative skyline radiographs and American Knee Scores, Oxford Knee Score and SF-12 data, in addition to skyline radiographs, OKS and SF-12 data with a minimum of 2 years follow-up. All patients without this baseline and follow-up data were excluded. This provided a total of 196 knees (162 patients)

Using Altman’s nomogram, the sample size was calculated to be 85 for a power of 90%, with an α significance level of 0.05.

Using this database, digital radiographs were assessed using the institution’s PACS system. Pre-operative and follow-up skyline radiographs following Jones et al’s (1993) patellofemoral scoring system were examined by four assessors utilising Jones’ patellofemoral scoring system. In addition, in cases where patellofemoral joint changes were evident, each assessor acknowledged whether this involved the medial, lateral or bilateral aspects of the patellofemoral joint.

Intra-observer reliability was made comparing the four assessors.

Statistical analysis was performed, using the Statistical Package for the Social Sciences (SPSS) 16.0 for Windows (SPSS Inc, Chicago, Illinois).

In order to determine whether changes in patellofemoral joint status related to patients function or quality of life, the difference in OKS and SF-12 from pre-operative to the follow-up period was assessed.

Results: There was a statistically significant progression of patellofemoral osteoarthritis as found on the preoperative and postoperative radiographs (p< 0.01, Mann Whitney), there was a correlation between a low OKS and Jones patellofemoral score (P< 0.05, Mann-Whitney). However, there was no correlation between the site of patellofemoral involvement and outcome scores.

Conclusion: Due consideration should be taken when offering medial unicompartmental knee replacement to patients with patellofemoral involvement and this is independent of the site of patellofemoral involvement.

The objective of our study was to assess the efficacy of infection control measures (pre-admission screening and patient segregation) on reducing inpatient exposure to methicillin-resistant Staphylococcus aureus (MRSA).

A prospective case-control study was undertaken, analysing all admissions to three wards over an 83-month period from September 1995 to July 2002 inclusive (a total of approximately 34 000 patients). An orthopaedic ward with active infection control measures was compared with two controls, an orthopaedic ward with no measures and a general surgical ward with no measures. A statistical analysis was performed of the difference between the 3 wards in numbers of new cases of MRSA infection or colonisation. There was a statistically significant difference in numbers of new cases between the ward with the active infection control measures and the two control wards.

The infection control methods described are shown to reduce the exposure of patients to MRSA, which is of importance in orthopaedics, and has further benefits that may be applied in other surgical specialties, notably the choice of antibiotic used with the associated risk of side-effects of the specific anti-MRSA agents, the cost for surgical prophylaxis and patients’ confidence in the admitting surgical unit. As a useful by-product, such segregated inpatient beds are effectively ring-fenced, ensuring availability even during a hospital bed-shortage.

Introduction and Aims: Despite comprehensive literature on knee arthroplasty outcomes there is a paucity of data on patient satisfaction and functional outcomes. We have examined patient satisfaction, function, and time to return to sport and activities of daily living.

Method: A retrospective cohort study using self-assessment forms reviewed all patients who had undergone an Oxford uni-compartmental knee replacement in one centre from 2000 to 2003 at a minimum one-year post-surgery. One hundred and fifty patients with 183 UKRs were reviewed. Twenty-two had bilateral surgery. The cohort contained 76 males and 74 females of mean age 71.5 years (range 52–90). Patients were assessed using the Oxford knee score and a further score of how ‘normal’ their knee felt. Physical activity was assessed according to Grimby’s scale. Sporting activity was assessed with regards to pre- and post-operative frequency, time taken to return to sport, and pain during and after exercise. Time to return to work was also noted.

Results: Mean Oxford knee score for males was 21.6 (range 12–43, SD 8.25) and females 22.8 (range 12–54, SD 9.78). Mean Grimby’s score for males was 4.1 (range 1–6, SD 1.2) and for females 3.6 (range 1–6, SDI.2). Mean time to return to walking as exercise was 7.9 weeks (range 1–47.6, SD 8.9), to swimming was 10 weeks (range 1–34.6, SD 9.9), to cycling 11.8 weeks (range 1–34.7, SD 11) to lawn bowling 24.5 weeks (range 4–104, SD 26.2) and golf 12.3 weeks (range 3–33.3, SD8.73). Return to sport, activities of daily living and return to work positively correlated to the patients’ perception of how ‘normal’ their knee felt.

Conclusion: This study observes activity levels and times to return to ADLs, work and sport that is a guide for patient education and post-operative expectation. When compared to a recent study of total knee arthroplasty patients from our institution the uni-compartmental patients were more satisfied and more active. Patients were more active pre-operatively and post-operatively, they were less likely to give up sport following surgery.

Aims: To compare the results between intramedullary hip screw (IMHS) and dynamic hip screw (DHS) regarding operative time and radiation exposure time Methods:We reviewed radiation exposure times obtained during the fixation of 281 extracapsular proximal femoral fractures. Dynamic hip screw was used in 148, and intramedullary hip screw was used in 133. Results: The results showed that there was no statistical difference in ionising radiation exposure in closed reduction of these fractures regardless of fracture configuration or surgical experience of the surgeon, but there was a statistical difference in implant insertion time and radiation exposure (p= < 0.05). Conclusions: We conclude that intramed-ullary implant takes more radiation exposure because they take more time for insertion, which is irrespective of surgical experience and complexity of fracture.