Aim: Preliminary results and complications of AGC Total knee Arthroplasty with early results are presented.

Materials and Methods: 51 AGC Total Knee Arthroplasties were undertaken between October 2005 and September 2006. There were 22 males and 28 females. Indication for Total Knee Arthroplasty was Primary and Traumatic Osteoarthris. Brain Lab Implant dedicated Navigation was used.

Results: Outliers were significantly reduced. Complications including superficial infection, late rehabilitation, and stiffness are reported. No revision was undertaken. Tips and pearls regarding navigated Arthroplasty with reference to learning curve are discussed.

Discussion: Each navigation system type has its advantages and disadvantages and can be used with minimally invasive surgery (MIS) total knee arthroplasty (TKA). In addition, concerns for computer glitches, training of personnel, extra time requirements, cost and ability to demonstrate improvements in technique and results are discussed.

Conclusions: Navigated Knee Arthroplasty using AGC-Biomet implant is recommended. Early experience is reported. Salient features of early learning curve are discussed. The current paper shows how the anatomic approach can influence soft tissue tension and support the surgeon during release of soft tissues in leg axis deformities.

Background: As many as 175,000 anterior cruciate ligament (ACL) reconstructions are performed annually in the United States at a cost > 1 billion dollars. Estimates of the rate of revision surgery are as high as 10%–20%, potentially resulting in as many as 35,000 revisions a year. In addition, errors that are not obvious at short-term or mid-term follow-up may have significant long--term effects in young patients. Studies have demonstrated that the majority of visions are related to technical errors, primarily tunnel placement. Computer-aided navigation systems provide enhanced precision in tunnel placement and may reduce the rate of revision surgery. Computer-aided systems can provide valuable data on rotational and translational laxity of the knee.

Aim: To assess the accuracy of tibial and femoral tunnel placement comparing the Acuflex and Arthrex guides with navigated technique.

Methods: Five formalin preserved cadavers were divided into two groups. An experienced Surgeon comfortable with the jigs and the navigation technique performed all the reconstructions. Group A knees had ACL reconstructions using the Arthrex guide (4 knees) and Group B using the computer navigated technique (5 knees). Quadrupled Hamstring tendon grafts were used for reconstruction. All 9 knees were examined following ligament reconstruction with plain radiography and CT scans to assess the accuracy of the tunnel placement. Computer navigation was performed using the Brain Lab software. Implants used for fixation were Ezlock (Arthrotek, UK) for the femur and interference screw for the tibia.

Results: The findings suggest variability of accuracy in tunnels placement using the two techniques. ACL reconstruction should be carried out with accurate tunnel placement. Care should be taken in placing the tunnel as errors will lead to failure of the reconstructed ligament. Computer aided navigation is recommended in performing ACL reconstructions.

Background: A common problem following total joint arthroplasty is urinary retention, which often necessitates catheterisation in the postoperative period. Most of these catheterisations are done as an emergency in the ward where the sterility is less than optimal.

Methods : A retrospective study of the incidence of emergency urinary catheterisation in 300 male patients who underwent total joint Arthroplasty under spinal anaesthesia over an eighteen-month period is presented. The patients were divided into three groups according to their age Group 1 (50 to 65 yrs), Group 2 (65 to 70 yrs) and Group 3 (70 + yrs).

Results: The incidence of catheterisation for acute urinary retention in Group 1 was 20%, Group 2 – 65% and Group 3 –69%.

Discussion: Urinary stasis predisposes to infection. The direct relationship between urinary catheterisation and infections in total joint Arthroplasty is already well documented. The potential for infection is compounded if the procedure is carried out in the unsterile ward environment. This study shows that the incidence of emergency catheterisation in patients aged 65 or above was high (average 67%) .

Conclusion: We conclude that these patients in groups 2 and 3 should be catheterised electively in the optimal sterile environment of the operating theatre. Catheterization should be performed after the patient has had the anaesthetic and the prophylactic intravenous antibiotic has been administered. The potential occurrence of joint and urinary tract infection is reduced and consequently patient morbidity is lessened.

Aim: We studied the effect of filling the femoral entrance hole in relation to the total blood loss during and after the procedure of Total knee arthroplasty in 72 patients performed between 1997 and 1999 performed in our unit.

Materials and methods: This was a retrospective review and the patients were be broadly classified into three groups, the first (Group A) who had the entrance holes left unblocked (n= 21), the second (Group B) had the holes filled with bone cement (n= 21) and the third (Group C) with the holes filled with bone (n= 26).

Results: The average Blood loss for group A was 1019, group B was 11077 and group C was 1162. The Average Blood transfusion for group A was 0.70 units, group B was 0.40 units and group C was 0.30 units.

Conclusions: We found no significant difference in the Total Blood loss between the three groups and conclude that filling the entrance holes does not effectively reduce the Total Blood Loss in Total Knee arthroplasty and that there is no advantage to be gained in respect of the total transfusion needed for these patients.

This paper outlines and defines a research, which was conducted in order to gauge the efficiency of the Elective Orthopaedic Assessment Clinic in the Department of Orthopaedics, Kilcreene Orthopaedic Hospital, Kilkenny, Ireland. The study was conducted in the year 1999. During this year, 380 patients were seen in the clinic. Of these, 328 patients were on the waiting list for joint replacement and 52 were on the waiting list for other elective procedure. In the process of the study it was observed that 204 patients were found fit on their first preassesment visit. Of all the 328 patients on the waiting list, 48 of those who were awaiting joint replacement were found to have dental caries or infected gums and 28 were diagnosed with some minor infective foci elsewhere in the body. However as according to procedure the patients that did not meet the preassessment criteria due to infection, but were pronounced fit for an operation had to wait for the infection to settle before they could be rescheduled for surgery.

The study in question has proved that the clinic acts as an intermediary between the patients and the operation theatre, by determining patient’s fitness for surgery and appropriately placing them on the corresponding waiting lists. This fact is of primary importance as it aids in preventing possible and sometimes last minute cancellations, thereby attesting to the effectives and efficiency of the clinic. The clinics efficiency can also be measured by the fact that it has initiated a number of improvements, such as the introduction of a checklist card for patients on the waiting list for joint replacements. This checklist includes dental health, and also arranges for patients to be examined by their general practioners and dentists before the preassesment checkup.