Corona mortis injury causing delayed presentation of pelvic pseudoaneurysm.

Pseudoaneurysms are rare complications in urological surgery. Typically, they would present with pain, haematuria or anaemia. We report a 60-year-old patient who was found to have a chronic pseudoaneurysm via a corona mortis vascular variant, 3 months after a robotic-assisted prostatectomy. Unlike other rare reports of delayed vascular complications after minimally invasive urological surgery, the patient was entirely asymptomatic.Apart from careful intraoperative dissection, a high index of suspicion and low threshold for imaging are also required in the follow up period. Percutaneous trans-arterial embolization is safe and effective in dealing with post-surgical pseudoaneurysms.

What Do Scottish Patients Expect of Their Total Knee Arthroplasty?

BACKGROUND: The aim of this study was to carry out an in-depth assessment of patient expectations before surgery in a representative sample of the Scottish population undergoing primary total knee arthroplasty and also assess the influence of demographic factors and preoperative functions on expectations. METHODS: This was a prospective cohort study of 200 patients treated in our institution from November 2011 to July 2013. Patients received standard preoperative preparation including consultation with a surgeon, an information booklet and a DVD. Patients completed the Hospital for Special Surgery Knee Replacement Expectation Survey along with the EuroQol EQ-5D-3L health questionnaire on the day of admission. RESULTS: Fifty-nine percent of the cohort were women, mean age 67.7 years (45-84 years), mean body mass index 32.5 (21-50), mean preoperative Oxford Knee Score 17 (1-44). Relief of pain and improved ability to walk were the most important expectations, followed by the ability to use public transport and/or drive, ability to change position, ability to walk down stairs, and the ability to carry out routine daily activities and/or chores. Some expectations were unrealistic. No relationships between expectations and demographics, including preoperative function, were found. CONCLUSION: This study suggests that patients have very high and sometimes unrealistic expectations regarding their improvements after total knee arthroplasty even after detailed preoperative consultation and education. In addition, these expectations cover a wide range of dimensions. We suggest that to effectively manage patients' expectations, it is important to assess each patient individually and reinforce what expectations can realistically be achieved.