Elective hip and knee arthroplasty and the effect of rivaroxaban and enoxaparin thromboprophylaxis on wound healing.

Introduction: Rivaroxaban is the first licensed oral direct inhibitor of factor Xa. Recent studies from the RECORD trials suggest rivaroxaban has superior efficacy compared to enoxaparin in preventing venous thromboembolism (VTE) with no significant increase in the major bleeding risk. Concerns remain regarding the incidence of minor bleeding, consequent delayed wound healing and subsequent risk of infection.

The effect of the grade of surgeon on blood loss in fractured neck-of-femur surgery.

Significant blood loss in neck-of-femur (NOF) fracture surgery contributes to the high morbidity and mortality. Since the introduction of the European Working Time Directive, trainee surgeons are more junior and inexperienced. We assessed NOF surgical blood loss in relation to the surgeon grade and experience.

Gemella haemolysans Infection in Total Hip Arthroplasty.

Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G.

The outside-in subcutaneous arthroscopically assisted lateral retinacular release: a new technique.

Arthroscopic lateral retinacular release in the knee has been used extensively for the treatment of patellar pain and instability. The release can be performed using a number of techniques, but achieving access to the retinaculum can often be difficult, particularly in obese patients. We describe a simple modification of an arthroscopically assisted method, which utilises electrosurgery through a subcutanous channel to perform an outside-in release.

Cost analysis of managing paediatric femoral shaft fractures: flexible intramedullary nailing versus non-operative management.

This retrospective study aimed at comparing the cost of operative treatment versus non-operative treatment in the management of isolated paediatric femoral shaft fracture, in a single Trauma and Orthopaedic unit in a district general hospital in South East England. Patients were divided into three groups according to their treatment, and the cost was analysed depending on their requirements for hospital stay, theatre, physiotherapy, radiographs and plaster cast. Sixty-two children were admitted to our trauma unit with an isolated femoral shaft fracture from January 2001 to April 2005.

Intraoperative arthrometry in anterior cruciate ligament reconstruction.

Arthrometry has an established role in the measurement of knee laxity in anterior cruciate ligament injury and following reconstruction. The role of routine intraoperative arthrometry in anterior cruciate ligament reconstruction is poorly defined, and this study was designed to test the hypothesis that intraoperative arthrometry provides an objective method of documenting successful knee stabilisation following anterior cruciate ligament reconstruction. A consecutive cohort of 100 patients with unilateral isolated anterior cruciate ligament disruption were prospectively evaluated using a Rolimeter arthrometer.

Cement retrieval in minimally invasive knee surgery: the 90 degrees ball probe.

Minimally invasive knee surgery has many potential advantages as well as disadvantages. One such disadvantage in both unicompartmental and total knee arthroplasty is the inability to visualize or retrieve extruded cement. We describe the use of a new instrument, a 90 degrees ball probe, which we have used in more than 300 minimally invasive unicompartmental knee arthroplasty cases.

Single photon emission computed tomography in planning unicompartmental knee arthroplasty. A prospective study examining the association between scan findings and intraoperative assessment of osteoarthritis.

The aim of this study was to determine the relationship between preoperative single photon emission computed tomography (SPECT) scan findings and intraoperative assessments of knee osteoarthritis (OA) in patients undergoing tibiofemoral unicompartmental knee arthroplasty (UKA). Fifty knees in 46 patients undergoing UKA were investigated preoperatively with a SPECT scan to confirm unicompartmental disease. There were 38 men and 12 women in the cohort with an average age of 63 years (range 44-78).

Haemoglobin levels following unicompartmental knee arthroplasty: influence of transfusion practice and surgical approach.

A retrospective review was undertaken of preoperative and day 3 postoperative haemoglobin (Hb) levels in all unicompartmental knee arthroplasty (UKA) procedures performed by a single surgeon. Sixty-six UKAs were performed using the same prosthesis through an open approach with patella eversion. This group was compared with 212 UKAs performed using a minimally invasive approach without patella eversion, with an implant and instrumentation specifically devised for this approach.

Debridement of wear granulomata in revision total hip arthroplasty: use of a chondrotome shaver blade.

Osteolysis is a common complication following uncemented total hip arthroplasty and is usually secondary to a biological reaction to polyethylene wear debris. The resultant periprosthestic bone resorption and granulomata is frequently not associated with implant loosening. In such circumstances, an option is to leave the well-fixed component, debride the granulomata, and exchange the polyethylene liner.

Unicompartmental knee arthroplasty: an intermediate report of survivorship after the introduction of a new system with analysis of failures.

We describe the outcome of a series of 66 consecutive porous coated low contact stress (LCS) unicompartmental knee arthroplasty (UKA) cases performed in 52 patients for osteoarthritis (OA) by a single surgeon. Both survival, using the endpoint of revision for any cause, and knee function, using the Oxford knee score (OKS) as a validated outcome measure, were established in a retrospective review. At an average postoperative follow-up period of 5.