[Cement plug embedded in the patella: a rare complication of total knee arthroplasty.

An unusual delayed complication of total knee arthroplasty involving the unresurfaced patella is described. The complication is due to the impaction of a loose cement plug used to seal the defect left by the femoral intramedullary alignment rod. The origin, presentation, and management are discussed.

Rupture of the pectoralis major muscle: surgical treatment in athletes.

Pectoralis major tendon rupture is a relatively rare injury, resulting from violent, eccentric contraction of the muscle. Over 50% of these injuries occur in athletes, classically in weight-lifters during the 'bench press' manoeuvre. We present 13 cases of distal rupture of the pectoralis major muscle in athletes. All patients underwent open surgical repair. Magnetic resonance imaging was used to confirm the diagnosis in all patients. The results were analysed using (1) the visual analogue pain score, (2) functional shoulder evaluation and (3) isokinetic strength measurements. At the final follow-up of 23.6 months (14-34 months), the results were excellent in six patients, good in six and one had a poor result. Eleven patients were able to return to their pre-injury level of sports. The mean time for a return to sports was 8.5 months. The intraoperative findings correlated perfectly with the reported MRI scans in 11 patients and with minor differences in 2 patients. We wish to emphasise the importance of accurate clinical diagnosis, appropriate investigations, early surgical repair and an accelerated rehabilitation protocol for the distal rupture of the pectoralis major muscle as this allows complete functional recovery and restoration of full strength of the muscle, which is essential for the active athlete.

The effect of laminar air-flow on the results of Austin-Moore hemiarthroplasty.

INTRODUCTION: A second cycle audit to evaluate the results after introduction of water impervious surgical gowns and drapes while performing Austin-Moore hemiarthroplasty as recommended by our previously published study. AIM: To assess the difference in the re-operation rate following Austin-Moore hemiarthroplasty between procedures performed under laminar air-flow to those performed in conventional (non-laminar flow) theatres, after the introduction of water impervious gowns and drapes in 2000. MATERIALS AND METHODS: A consecutive cohort of patients who had Austin-Moore hemiarthroplasties performed at our district general hospital between August 2000 and July 2004 were included in the study. The minimum follow-up period was 1 year. Of the total of 435 patients, 223 were operated in non-laminar air-flow theatres and 212 were operated in laminar air-flow theatres. Peri-operative antibiotics and water-impervious surgical gowns and drapes were used in all cases. RESULTS: The overall re-operation rate for all indications was 1.4% (3/212) in the laminar air-flow theatre group and 5.8% (134/223) in the non-laminar air-flow theatre group. CONCLUSION: The rate of re-operation for all indications in the non-laminar air-flow theatre group was four times greater than in the laminar air-flow group. We recommend that Austin-Moore hemiarthroplasty procedures should be performed in laminar air-flow equipped theatres.