Clinical outcomes of bilateral single-stage unicompartmental knee arthroplasty.

BACKGROUND: Deciding whether to treat patients with bilateral arthritis with two-stage or bilateral single-stage arthroplasties is a cause of considerable debate in orthopaedic surgery. METHODS: A total of 394 cemented Unicompartmental Knee Arthroplasties (UKA) were performed in this unit between 2006 and 2010. A retrospective review identified 38 patients (76 knees) who underwent bilateral Single-Stage Sequential UKA, performed by a single surgeon. RESULTS: The mean BMI was 29.8 and the majority of patients were ASA grade 2. The mean duration of follow-up was 30 months. The mean total tourniquet time was 83 min. The mean post-operative haemoglobin was 11.8 and no patient required blood transfusion. The mean time to mobilisation was 18 h and the average length of stay was 3.5 days. This compares favourably with an institutional average length of stay of two days for a single UKA. There was a significant improvement in the mean pre- to post-operative OKS (from 14 to 34, p<0.0001). One patient required operative fixation of a tibial plateau fracture after sustaining a mechanical fall two months following surgery. There were no other major complications, including thrombo-embolic events or deep infections. Two patients required excision of a superficial suture granuloma. CONCLUSIONS: Bilateral Single-Stage Sequential UKAs provide significant improvement in patient function and can be performed safely with a low complication rate. Patients can benefit from a single hospital admission and anaesthetic whilst the shorter total in-patient stay reduces costs incurred by the hospital. LEVEL OF EVIDENCE: IV.

Effects of 'bare below the elbows' policy on hand contamination of 92 hospital doctors in a district general hospital.

Despite a lack of evidence the UK's Department of Health introduced a policy of 'bare below the elbows' attire in order to try to reduce the incidence of nosocomial infection. This study investigates the link between this state of dress and hand contamination. A prospective observational study of doctors working in a district general hospital was carried out. The fingertips of each hand were imprinted onto culture medium, and resultant growth assessed for number of colony-forming units and presence of clinically significant pathogens or multiply resistant organisms. These findings were correlated with attire, grade, sex and specialty. Ninety-two doctors were recruited of whom 49 were 'bare below the elbows' compliant and 43 were not. There was no statistically significant difference between those doctors who were 'bare below the elbows' and those that were not, either for the number of colony-forming units or for the presence of clinically significant organisms. No multiply resistant organisms were cultured from doctors' hands. 'Bare below the elbows' attire is not related to the degree of contamination on doctors' fingertips or the presence of clinically significant pathogens. Further studies are required to establish whether investment in doctors' uniforms and patient education campaigns are worthwhile.

Magnesium ions reduce motoneuron death following nerve injury or exposure to N-methyl-D-aspartate in the developing rat.

Developing motoneurons can be induced to die by target deprivation and there is evidence that this cell death involves the excitotoxic effects of N-methyl-D-aspartate. Treatment with dizocilpine maleate, an antagonist of this receptor, has been shown to rescue a proportion of those motoneurons destined to die following nerve injury at birth. However, this is a relatively toxic compound. In this study we examined whether systemic treatment with magnesium sulphate, a non-competitive antagonist of the N-methyl-D-aspartate receptor which is better tolerated than dizocilpine maleate, could prevent motoneuron death. Motoneurons were induced to die either by sciatic nerve injury at birth or by nerve injury at five days followed by exposure to N-methyl-D-aspartate. The number of surviving motoneurons reinnervating the tibialis anterior and extensor digitorum longus muscles were counted using retrograde labelling. Following nerve injury at birth and treatment with magnesium sulphate, there was a small increase in the survival of injured motoneurons, although this improvement was not significant. Nerve injury at five days does not result in motoneuron death, but when followed by treatment with N-methyl-D-aspartate, only 42 +/- 2.9% of motoneurons to these flexor muscles survived. Treatment with magnesium sulphate prior to injection of N-methyl-D-aspartate significantly increased motoneuron survival, so that 67 +/- 5.8% of motoneurons survived. Thus, systemic treatment with magnesium can prevent the death of motoneurons rendered susceptible to the excitotoxic effects of N-methyl-D-aspartate by nerve injury.(ABSTRACT TRUNCATED AT 250 WORDS)