The St. Leger total knee replacement: a 10-year clinical and radiological assessment.

The St. Leger total knee replacement (Zynergy Orthopaedics Ltd, Rotherham, UK) was developed as a cheaper alternative to similar implants of its time. Between October 1993 and June 1999, 144 St. Leger total knee replacements were implanted into 114 patients. Seventy-three patients (99 knees) were recalled for assessment (mean follow-up of 10.2 years). Eighteen patients had had their prostheses revised, 11 had died and 12 were lost to follow-up. Functional Score showed 90% poor results and the Objective Knee Score showed 31% poor results. Radiological assessment identified 12 arthroplasties that had failed and 58 that required close follow. Kaplan-Meier cumulative survivorship was 87% at 10 years. The St. Leger knee replacement did not perform as well as others of the same generation and was not worth the initial financial savings.

Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study.

The radiographs of a sample of patients who had canulated hip screw fixation for intracapsular femoral neck fractures were reviewed in our region. There were six different types of configurations used in these fixations which are divided into two groups: (I) triangular configurations, consisting of two parallel screws with a third screw placed either superiorly, inferiorly, anteriorly or posteriorly; and (II) linear configurations with two or three screws in a vertical line. In our study, we tested the relative strength of each configuration in a laboratory setting using synthetic bone models. Statistical analysis, at 5% significance level, using two-way ANOVA and post-hoc test was carried out to test the differences of the results between the configurations.Our results clearly show that the triangular configurations had a higher peak load, higher ultimate load, less displacement and more energy absorption before failure than other configurations.

Subvastus approach for total knee arthroplasty: a prospective, randomized, and observer-blinded trial.

A prospective, randomized, and blinded trial was conducted with 89 consecutive primary knee arthroplasties comparing standard medial parapatellar arthrotomy with the subvastus approach. All patients received the same prosthesis (Insall-Burstein II) inserted by one surgeon using an identical technique with the only difference being the approach. The parapatellar approach (group I) was used in 43 knees, and in the remaining 46 knees the subvastus approach (group II) was used. Assessment revealed significantly earlier return of straight-leg raise (3.2 days vs 5.8 days, P <.001), lower consumption of opiates in the first week (78 mg vs 102 mg, P <.001), less blood loss (527 mL vs 748 mL, P <.001), and greater knee flexion at 1 week (78 degrees vs 55 degrees, P <.001) in group II (subvastus approach). The subvastus approach offers early advantages over the standard parapatellar arthrotomy. It preserves the integrity of the vastus medialis and peripatellar plexus of vessels. We advise its wider use in primary total knee arthroplasty.

Randomized placebo-controlled trial of local anaesthetic infusion in day-case inguinal hernia repair.

BACKGROUND: This study investigated the efficacy of local anaesthetic wound perfusion following day-case inguinal hernia repair. METHODS: Seventy-two patients entered a randomized controlled trial with three patient groups: group 1, pump containing bupivacaine; group 2, pump containing normal saline; and group 3, control group without a pump. All patients had a Lichtenstein hernia repair together with ilioinguinal and iliohypogastric nerve blocks and were prescribed oral analgesia. Postoperative pain was assessed over 5 days using a visual analogue scale. RESULTS: Patients who had a local anaesthetic infusion had significantly less pain than either the placebo or control groups. This was greatest during the first 48 h (day 1, P = 0.028 and 0.011 respectively; day 2, P = 0.012 and 0.037 respectively). CONCLUSION: A portable infusion pump for the delivery of local anaesthetic reduced pain after day-case inguinal hernia repair.