Reduced Blood Loss and Transfusion Rates: Additional Benefits of Local Infiltration Anaesthesia in Knee Arthroplasty Patients.

We hypothesised that local infiltration of anaesthesia (LIA) containing adrenaline may reduce peri-operative blood loss and transfusion requirements in primary total knee arthroplasty patients (TKA) when compared to simple patient control analgesia (PCA). In this retrospective cohort study there were 22 TKAs in the PCA group and 27 TKAs in the LIA group. There were no drains used or significant differences in demographics between groups. There was a statistically significant difference in blood loss (P = 0.003), between the LIA group (M = 942 ml, CI 829-1055), and the PCA group (M = 1314 ml, CI 1099-1527). Patients receiving PCA were 4.3 times more likely to require blood transfusion. Using the LIA technique reduces blood loss and risk of blood transfusion.

Fracture of the femoral alignment stem of a hip resurfacing arthroplasty. A case report.

Metal-on-metal hip resurfacing arthroplasty has become increasingly popular for the treatment of osteoarthritis in a younger patient population. While the initial complication of femoral neck fracture is being addressed, we describe a fracture of the femoral alignment stem in a component two years from the primary procedure.

Second metatarsophalangeal joint instability and second metatarsal length association depends on the method of measurement.

INTRODUCTION: Second metatarsophalangeal joint (MTPJ) instability is an important cause of forefoot pain and its causation multi-factorial. There is debate over an association with a relatively increased second metatarsal length and numerous measurement techniques. It is not known which, if any correlate with second MTPJ instability or their accuracy. We hypothesized that the method of measurement would affect the apparent relationship between second metatarsal length and second MTP instability. MATERIALS AND METHODS: We analyzed standardized radiographs of 81 feet with second MTPJ instability using methods described by Coughlin, Maestro, and Hardy/Clapham. A control group of 11 feet were assessed from patients with a clinical diagnosis of Morton's neuroma (no instability) and successfully treated with a single steroid injection. The hallux valgus angle was also recorded. Patients mean age was 56 (range, 25 to 84) years, with female to male ratio of 4:1 and equal laterality. RESULTS: Second metatarsal length measurements were not significantly different between grades of instability using any method, although Kruskal-Wallis analysis revealed a significant association between instability grades and increasing age (p<0.05). Analysis of relative metatarsal lengths and second MTPJ instability revealed Coughlins method approached statistical significance (p < 0.055), but upon standardizing for age it became statistically significantly associated (r = 0.21, n83: p < 0.05). Spearman's rho correlation identified increasing hallux valgus was associated with decreased the second metatarsal length for Maestro and Hardy & Clapham methods (r = -0.29, n92: p < 0.005) and (r = -0.36, n86: p < 0.001), respectively. CONCLUSION: A positive correlation of second metatarsal length to second MTPJ instability existed using Coughlins method controlling for age. Maestro and Hardy & Clapham methods were possibly influenced by co-existing hallux valgus. The association of a clinical finding with a possible causative factor is likely influenced by its method of radiographic measurement.

Tibial nerve impingement secondary to posterior cement extrusion after unicompartmental knee arthroplasty.

Unicompartmental knee replacements have become increasingly popular with improved survivorship and clinical results. This has been combined with minimally invasive surgery to further improve patient recovery and rehabilitation. Despite improved instrumentation, it remains a technically demanding procedure. We present a previously unreported case of tibial nerve impingement as a consequence of posterior cement extrusion after a unicompartmental knee replacement.

Management of a tibial periprosthetic fracture following revision knee arthroplasty using a pulsed electromagnetic field stimulation device: a case report.

Periprosthetic fractures associated with total knee arthroplasty are rare but present a challenging problem particularly when associated with revision arthroplasty. Fractures around tibial stems are particularly difficult with no accepted technique in their management. This case describes a tibial periprosthetic fracture following a revision knee arthroplasty which was successfully managed with a Pulsed ElectroMagnetic Field bone stimulation device. We believe this to be first reported use of a bone stimulation device in this clinical environment.

A stab in the back with a screwdriver: a case report.

BACKGROUND: Stabbings infrequently produce spinal injury. However, the use weapons other than blades can overcome this natural defence barrier. CASE PRESENTATION: We present a spinal injury produced by a screwdriver, its management and a review of the literature. CONCLUSION: This case highlights the need for clinical vigilance, including in those who appear stable and a senior multidisciplinary approach to each individual case.