Knee skin temperature following uncomplicated total knee replacement.

This prospective study aimed to establish the pattern of knee skin temperature following uncomplicated primary total knee replacement. Thirty-two patients were included. The skin temperature of operated and contralateral knees was measured preoperatively and daily during the first 6 weeks postoperatively. Measurements were also taken at 3, 6, 12 and 24 months following surgery. The difference in temperature between the two knees had a mean value of (+)2.9 degrees C at 7 days. This mean value decreased to (+)1.6 degrees C at 6 weeks, (+)1.3 degrees C at 3 months, (+)0.9 degrees C at 6 months (+)0.3 degrees C at 12 months and (+)0.0 degrees C at 24 months. Following uncomplicated total knee replacement, the operated knee skin temperature increases compared to the contralateral knee. The difference decreases gradually but remains statistically significant up to at least 6 months following surgery. In the absence of other features of infection, local knee warmth should not cause concern.

Vascular endothelial growth factor expression in osteosarcoma.

UNLABELLED: Vascular endothelial growth factor expression by osteosarcomas at biopsy has been shown to have a negative influence on survival. Whether it continues to be expressed and influence outcome in tumors after neoadjuvant chemotherapy has not been determined. To determine if a high-degree of vascular endothelial growth factor expression by the surviving osteosarcoma cells in the resected tumor has a negative influence on prognosis, we retrospectively reviewed 52 patients with Stage IIB osteosarcoma around the knee, 48 of whom received neoadjuvant chemotherapy. Vascular endothelial growth factor expression by the surviving tumor cells in the surgically resected specimens was determined by immunohistochemical staining. Followup was for a minimum of 92 months. The presence of vascular endothelial growth factor expression in greater than 25% of tumor cells was independently associated with a reduced overall and disease-free survival rate. LEVEL OF EVIDENCE: Prognostic study, Level II (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Fixation failure of the clavicular hook plate: a report of three cases.

Open reduction and internal fixation for unstable fractures of the lateral end of the clavicle (Neer type II) is not complication-free. Most clavicle fractures can be successfully treated by conservative methods. Neer type II fractures have a reportedly high rate of nonunion, therefore internal fixation is recommended. However, the need for surgical treatment remains controversial as nonunion seldom produces a poor functional outcome. We report 3 cases of fixation failure following treatment with a clavicular hook plate. None of the patients required re-fixation surgery and all achieved bony union with a good functional result.

Osteomyelitis and secondary septic arthritis caused by Sphingomonas paucimobilis.

We describe a case of osteomyelitis and secondary septic arthritis caused by Sphingomonas paucimobilis in an immunosupressed adolescent which did not present typically, leading to a delay in diagnosis. This case highlights the need to thoroughly investigate musculoskeletal pain in the immunocompromised patient in order to exclude an infection as a cause.