Clinical outcomes of total hip arthroplasty for fractured neck of femur in patients over 75 years.

To date, there has been little research into the clinical outcomes of total hip arthroplasty (THA) for intracapsular neck of femur (NOF) fracture in the very elderly. 44 patients over 75years underwent THA for an intracapsular NOF fracture over a two year period. Oxford Hip Scores were obtained from 37 patients with a mean score of 39.7 (range 11-47). Katz Index Scores were collected from 36 patients with a mean pre-operative score of 5.9 and post operative score of 5.7. THA in this population gives patients the best opportunity to return to premorbid function. When complications occur there is a catastrophic effect on independence. Therefore it is important to select these patients' appropriately and to optimise their medical condition peri-operatively.

Lymph node grafting in the treatment of upper limb lymphoedema: a clinical trial.

BACKGROUND: Microvascular lymph node transfer has been shown to improve the severity of lymphoedema. However, microvascular surgery is not suitable for all patients. Simple lymph node grafting does not require general anaesthetic or significant surgical resources and is a technique that has been tested in animal models only until this point. Our hypothesis is that the transplanted lymph nodes integrate into the lymphovascular system and function as a 'pump', directly pumping interstitial fluid back into the venous system. METHODS: We hypothesized that lymph node grafting would improve lymphoedema with a low risk of complications. The procedure was performed in a day surgery setting under local anaesthetic with sedation. Two lymph nodes were harvested from the groin and grafted into subcutaneous tissue on the volar aspect of the affected limb at supratrochlear and wrist levels. RESULTS: We found that nine of 10 patients reported a subjective and/or functional improvement in their lymphoedema, including an improvement in hand function and tissue feel. Truncal cone calculation volumes showed an overall decrease in affected limb volume of 89.7 mL (standard deviation = 136.5). Furthermore, follow-up lymphoscintigram imaging on one patient demonstrated viability and function of the implanted node. CONCLUSIONS: We conclude that this is a safe procedure and should be further investigated as an alternative to a microsurgical procedure as a treatment for upper limb lymphoedema. Further research with a larger sample size is needed to confirm the findings of this pilot study.