Aims

Periprosthetic hip and knee infection remains one of the most severe complications following arthroplasty, with an incidence between 0.5% to 1%. This study compares the outcomes of revision surgery for periprosthetic joint infection (PJI) following hip and knee arthroplasty prior to and after implementation of a specialist PJI multidisciplinary team (MDT).

Objectives

Tranexamic acid (TXA) is an anti-fibrinolytic medication commonly used to reduce perioperative bleeding. Increasingly, topical administration as an intra-articular injection or perioperative wash is being administered during surgery. Adult soft tissues have a poor regenerative capacity and therefore damage to these tissues can be harmful to the patient. This study investigated the effects of TXA on human periarticular tissues and primary cell cultures using clinically relevant concentrations.

The number of revision knee arthroplasties performed is projected to rise dramatically in the coming years. Primary knee arthroplasties are also being performed in younger patients increasing the likelihood of multiple revision procedures. Reconstruction can be challenging with bone stock deficiencies and ligament incompetence. The aim of this study was to present our results of revision total knee arthroplasty using metaphyseal sleeve components to aid reconstruction.

Sixty seven patients underwent revision total knee arthroplasty between September 2005 and November 2010 using metaphyseal sleeves. There were thirty one male and thirty six female patients. The indication for revision was aseptic loosening in thirty nine, sepsis in fifteen, malalignment in eight and instability in five patients. Thirty four patients had tibial sleeves, thirty patients had both tibial and femoral sleeves and three patients had femoral sleeves during revision.

The patients were followed up for a mean of 32 months (Range 12–60) with outcome data collected prospectively. The mean revised oxford knee scores for the patients improved from 15 (Range 2 to 29) preoperatively to 33 (Range 20 to 45) postoperatively. Mean arc of flexion following revision was 87 degrees (Range 55 to 120). Seventy six percent of patients were satisfied or very satisfied with the result of the revision surgery. There have been no radiographic complications specific to the sleeves and no re-operations. There has been one recurrence of infection in a patient revised for sepsis. This has been managed with suppressive antibiotics due to patient co-morbidities.

Metaphyseal sleeves are an effective adjunct in revision knee arthroplasty. We have had good results with their use. To our knowledge no larger series has been presented or published.

The aim of this work was to compare the oxygen saturations in patients in the early period following total knee joint replacement surgery performed using either computer navigation or conventional intramedullary mechanical jigs.

Between August and November 2007 twelve consecutive patients who had computer navigated total knee joint replacements were prospectively reviewed. A comparison group from the same period was made of twenty patients who had knee replacements performed with conventional jigs in this same period. Non-invasive oxygen saturations were measured and recorded as a percentage. Preoperative oxygen saturations measured at the assessment clinic were used a baseline. For the duration of the patients postoperative hospital stay oxygen saturations were measured five times a day as well as their oxygen requirements.

We found that the patients in the computer navigation group on average reached oxygen saturation levels on air equal to those measured in the assessment earlier than the intramedullary jig group (2.2 days versus 2.8 days). There was also a lower need for oxygen and shorter length of stay in the computer navigated group during this early post operative period (4.6 versus 6.0 days).

Previous studies using transcranial Doppler and transoesophageal echocardiograms have shown a reduction of systemic emboli with computer navigated total knee joint replacements. Using oxygen saturation monitoring we have shown there may be a considerable clinical advantage using computer navigated surgery over conventional intramedullary jigs in knee replacement surgery.

The aim of this work was to compare the oxygen saturations in patients in the early period following total knee joint replacement surgery performed using either computer navigation or conventional intramedullary mechanical jigs.

Between August and November 2007 twelve consecutive patients who had computer navigated total knee joint replacements were prospectively reviewed. A comparison group from the same period was made of twenty patients who had knee replacements performed using conventional jigs. Non-invasive oxygen saturations were measured and recorded as a percentage. Preoperative oxygen saturations measured at the assessment clinic were used a baseline. For the duration of the patients postoperative hospital stay oxygen saturations were measured five times a day as well as their oxygen requirements.

We found that the patients in the computer navigation group on average reached oxygen saturation levels on air equal to those measured in the assessment earlier than the intramedullary jig group. There was also a lower need for oxygen in the computer navigated group during this early post operative period.

Previous studies using transcranial Doppler and transoesophageal echocardiograms have shown a reduction of systemic emboli with computer navigated total knee joint replacements. Using oxygen saturation monitoring we have shown there may be a considerable clinical advantage using computer navigated surgery over conventional intra-medullary rod jigs in knee replacement surgery.

Introduction: To determine whether there is a correlation between severity of the slip and duration of symptoms in patients presenting with slipped capital femoral epiphysis.

Methods: 50 patients with slipped capital femoral epiphysis were identified from the Royal Hospital for Sick Children database from 1998 to 2003. Of these, 47 patients had casenotes and radiographs available. 12 patients had bilateral slips resulting in a total of 59 slipped capital femoral epiphyses studied. On the basis of their history, 16 of these hips were unstable and were excluded leaving 43 stable slips in 35 patients. Case-notes were reviewed and the exact age, weight, symptom duration and treatment were recorded. X-rays were assessed and the slip angle was measured by the technique described by Southwick.

Results: The mean age of the patients was 11years 9months (7yrs 5 mths – 16 yrs 5mths). There were 19 males and 16 females. Weights were plotted against age on a centile chart with 85% of patients weighing > 75th centile for age.The mean duration of symptoms was 12.1weeks (2days – 52weeks)The mean slip angle was 22° (5° – 65°)There were 34 mild slips (< 30°), 8 moderate slips (30° – 60°) and 1 severe slip (> 65°). There was no statistical difference in duration of symptoms between these groups.

Statistical analysis by ordinal regression analysis showed there was no correlation between slip severity and duration of symptoms. In addition, there was no correlation between slip severity and age or weight.

Conclusion: There appears to be no relationship between slip severity and duration of symptoms in patients presenting with stable slipped capital femoral epiphysis.