Severe varus and valgus deformities treated by total knee arthroplasty.

We report a prospective case-controlled study which compared the outcome of knee replacement in seriously deformed and slightly deformed knees. There were 51 knees with varus or valgus deformity greater than 20 degrees matched for age, gender, disease, type of prosthesis and time of operation with a control group in which the alignment of the leg was within 5 degrees of normal. The clinical outcome at a mean 5.

Revision total knee arthroplasty. Comparison of outcome following primary proximal tibial osteotomy or unicompartmental arthroplasty.

Forty-three patients who had undergone revision total knee arthroplasty following either primary, medial unicondylar arthroplasty (23 patients) or valgus tibial osteotomy (20 patients) for medial compartment osteoarthritis were reviewed. Although the two groups had similar knee scores and range of motion at review, six patients (30%) who had undergone prior tibial osteotomy suffered serious postoperative complications. Of these, four patients had a deep infection.

Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee. A comparative study with a 12- to 17-year follow-up period.

Comparable groups of patients with osteoarthritic knees who had either a St. Georg sledge unicompartmental arthroplasty or an upper tibial osteotomy were reviewed in 1985, five to ten years after operation. The results of unicompartmental arthroplasty were better, but it was uncertain whether the superior results would endure.

Cemented total hip arthroplasty in patients younger than 50 years of age. Ten- to 18-year results.

In ten- to 18-year clinical and roentgenographic results of 46 cemented total hip arthroplasties (THAs) in 34 patients younger than 50 years of age, surviving primary implants achieved a mean Harris hip score of 93 points. Survivorship analysis revealed failure rates of 2% at seven years, 10% at ten years, and 12.7% at 12 years.

Postoperative collection and reinfusion of autologous blood in total knee arthroplasty.

A series of 40 patients undergoing primary unilateral total knee arthroplasty were entered into a randomised controlled trial to assess the safety and efficacy of postoperative autologous blood salvage and reinfusion. The mean volume of autologous blood reinfused was 520 ml per patient (51% of the mean total drainage). Homologous blood transfusion was required in only 35% of patients in the study group compared with 95% of patients in the control group (P less than 0.

Efficacy of fixed minidose warfarin prophylaxis in total hip replacement.

Objective: To determine whether a small fixed perioperative dose of warfarin would prevent deep vein thrombosis after total hip replacement.

Design: Prospective, randomised, double blind placebo controlled trial.

Setting: Winford Orthopaedic Hospital, Bristol.

Can knee replacements be assessed by post?

The audit of knee replacement surgery requires long-term follow-up. The aim of this Bristol study was to examine whether an accurate assessment of knee replacement surgery could be undertaken by post, thus obviating the need for patients to visit hospital. A patient's questionnaire was designed to complement the clinic therapist's assessment form currently in use, and this was completed by 73 patients without supervision prior to the therapist's assessment.

Perioperative wound infection in elective orthopaedic surgery.

Between 1981 and 1987, 12,907 [corrected] consecutive open elective orthopaedic procedures were performed. The in-patient infection rate was 1.43%.

Primary total hip replacement in patients over 80 years of age.

We have reviewed 107 patients of 80 years or over who underwent primary total hip replacement. They had many more complications than younger patients. Thus, acute dislocation occurred in 15%, and became chronic in 9%; there were femoral shaft fractures in 4.

Control of bleeding in cemented arthroplasty.

Bleeding from cancellous bone causes lamination within bone cement and at its prosthetic interfaces, and weakens the fixation of joint replacements. We examined the effects of anaesthesia and blood pressure on bleeding in human cancellous bone, and investigated the local response to freezing saline, 1:200,000 adrenaline and hydrogen peroxide. Spinal anaesthesia reduced cancellous bleeding by an average of 44%, local freezing saline by 24%.

Keller's arthroplasty and Mitchell osteotomy: a comparison with first metatarsal osteotomy of the long-term results for hallux valgus deformity in the younger female.

We have made a retrospective comparison between the results of 37 Keller's arthroplasties and 36 distal transverse first metatarsal osteotomies performed in female patients between the ages of 25 and 50 years, for the treatment of hallux valgus. The choice of operation depended on the policy of the consultant responsible for treatment, but analysis of the preoperative findings showed that the two groups were similar, allowing comparative assessment of Keller's procedure in the younger middle-aged patient. All patients were assessed 3 to 5 years after operation using an objective scoring system of symptoms, clinical examination, anteroposterior standing radiographs and walking footprints from a Harris Beath mat.

The fate of cemented total hip arthroplasty in young patients.

Forty-four cemented hip replacements in patients under 45 years of age were assessed clinically and radiologically five to ten years after implantation. Four of five hips were pain-free and provided excellent function, and one in seven hips required revision but have since fared well. The results for osteoarthritic hips were superior to those with rheumatoid disease.

The timing of tourniquet application in relation to prophylactic antibiotic administration.

Antibiotic levels in bone and fat were measured in patients undergoing knee replacement to determine the time that should elapse between intravenous injection and tourniquet inflation. The tissue levels increased progressively with time, and there was wide variation in absorption rate between patients and between the two cephalosporins assessed. Five minutes should probably be left between systemic injection and inflation of the tourniquet, though two minutes may be long enough for drugs which are rapidly absorbed.