Introduction: Infection following TKR is a catastrophic complication. Few authors have highlighted the need for screening of patients (nose, axilla and groin) before TKR. Despite the fact that some of the centers in UK now routinely perform preoperative screening for TKR patients the overall incidence of surgical site infection in the year 2004 was 2.9%.

Methods and Materials: We introduced a new admission policy and SSI surveillance protocol for TKR patients in the year 2004 at our center. According to the new admission policy all TKR patients who were preoperatively screened were admitted into a clean elective ward. Care was taken not to admit anybody with positive infection screening in that ward, irrespective of the diagnosis. Further we also introduced a new policy of SSI surveillance according toNINSS protocol carried out by dedicated trained nurses.

Results and conclusions: Following the introduction of these policies our surgical site infection has come down to 0% in the year 2004–5 in contrast to 1.7% in the year 2002–3. These results showed that simple measures like having dedicated infection free clean wards and dedicated trained surveillance nurses can significantly reduce the infection rate following TKR

Introduction: Infection following THR is a catastrophic complication. Few authors have highlighted the need for screening of patients (nose, axilla and groin) before THR. Despite the fact that some of the centres in UK now routinely perform preoperative screening for THR patients the overall incidence of surgical site infection in the year 2004 was 2.9%.

Methods and Materials: We introduced a new admission policy and SSI surveillance protocol for THR patients in the year 2004 at our centre. According to the new admission policy all THR patients who were preoperatively screened were admitted into a clean elective ward. Care was taken not to admit anybody with positive infection screening in that ward, irrespective of the diagnosis. Further we also introduced a new policy of SSI surveillance according to NINSS protocol carried out by dedicated trained nurses.

Results and conclusions: Following the introduction of these policies our surgical site infection has come down to 0% in the year 2004–5 in contrast to 1.7% in the year 2002–3. These results showed that simple measures like having dedicated infection free clean wards and dedicated trained surveillance nurses can significantly reduce the infection rate following THR.

Introduction: Surgeries in elderly individuals should be less invasive and less time consuming to reduce immediate postoperative morbidity and mortality. Nevertheless it should also give optimal long-term outcome thereby avoiding subsequent procedures in these high risk individuals. Bipolar hemiarthroplasty is a commonly performed orthopaedic surgery in elderly patients with fracture neck of femur. It is commonly believed that the type of implant and the nature of fixation (cemented or uncemented) influences both the short term and the long term outcome of this procedure. In this retrospective study we compared uncemented and cemented JRI furlong prosthesis.

Method and materials: We had cohort of 60 patients who underwent cemented JRI bipolar hemiarthroplasty in the year of 2003 and 2004. We compared this cohort with the matched sample of 60 patients who underwent uncemented JRI bipolar hemiarthroplasty. We matched variables like age, ASA grade and the experience of surgeon.

Results and Discussion: The perioperative variables like duration of surgery, amount of blood loss, length of hospital stay and postoperative complications (DVT, chest infection, mortality) were found to be less in the uncemented JRI group. However there are concerns about the long-term outcome of uncemented JRI hemi-arthroplasty in the form of peri prosthetic fractures. Out of 60 patients of uncemented JRI group 3 had peri prosthetic fracture as compared to none in the cemented JRI group. We believe this complication more likely could be due to excessive canal preparation and the press fit necessary for the primary stability of the implant. This warrants further prospective controlled trials to provide more evidence on this finding.

Introduction: Outcome reporting following THR constitute a significant proportion of orthopaedic publications. Publication bias in the form of underreporting of studies showing non satisfactory or negative results is a well recognised problem in other specialities. We tried to find out the magnitude of this problem in orthopaedics publications dealing with THR.

Method and materials: We reviewed all publications on THR in the year 2004 in three general orthopaedic journals namely JBJS (BR), JBJS (Am), CORR. Of the 1034 original articles published in these three journals more than 400 articles were concerned with total hip replacement.

Results and Discussion: In this study we found only 6% of the published articles were showing non significant or negative results. This raises concerns about evidence based approach in THR and the need for preventive measures like registering all clinical trials and change in the attitude of editorial board.

Patients and Methods: We conducted a retrospective study of neck of femur fractures over a period of two years. Variables analysed were the perioperative haemoglobin levels, type of fracture and surgery, age, gender and blood transfusion in the perioperative period.

Results: Out of a total of 310 patients 49 required a postoperative blood transfusion.

The mean preoperative Hb of patients who required blood transfusion was 11; S.D. 1.49 while those who did not require a transfusion it was 12.5; S.D.1.42. Transfusion was required in 23% of patients having extra-capsular neck of femur fractures fixed with a DHS and in 9.5% of patients having intracapsular neck of femur fractures undergoing a hemiarthroplasty.

The univariate analysis showed a significant relationship between post-operative transfusion and the pre-operative Hb level (p=0.0001) and the type of fracture (p=0.001). However no relationship was found between transfusion and age (p=0.423) and the gender of the patient (p=0.611).

Discussion: The results of our study indicate that the most important factor in the prediction for blood transfusion in fracture neck of femur is the preoperative level of Hb as well as the type of fracture. Predicting a priori, the target population at a higher risk of requiring blood transfusion would enable us to establish appropriate prophylactic measures.