Identification and treatment of anaemia in patients awaiting hip replacement.

INTRODUCTION: The correction of anaemia prior to total hip arthroplasty reduces surgical risk, hospital stay and cost. This study considers the benefits of implementing a protocol of identifying and treating pre-operative anaemia whilst the patient is on the waiting list for surgery. PATIENTS AND METHODS: From a prospective series of 322 patients undergoing elective total hip arthroplasty (THA), patients identified as anaemic (haemoglobin (Hb) < 12 g/dl) when initially placed upon the waiting list were appropriately investigated and treated. Pre- and postoperative Hb levels, need for transfusion, and length of hospital stay were collated for the entire patient cohort. RESULTS: Of the cohort, 8.8% of patients were anaemic when initially placed upon the waiting list for THA and had a higher transfusion rate (23% versus 3%; P < 0.05) and longer hospital stay (7.5 days versus 6.6 days; P < 0.05). Over 40% of these patients responded to investigation and treatment whilst on the waiting list, showing a significant improvement in Hb level (10.1 g/dl to 12.7 g/dl) and improved transfusion rate. CONCLUSIONS: Quantifying the haemoglobin level of patients when initially placed on the waiting list helps highlight those at risk of requiring a postoperative blood transfusion. Further, the early identification of anaemia allows for the utilisation of the waiting-list time to investigate and treat these patients. For patients who respond to treatment, there is a significant reduction in the need for blood transfusion with its inherent hazards.

The effect of total hip replacement on the employment status of patients under the age of 60 years.

INTRODUCTION: A retrospective study was undertaken of a consecutive cohort of 86 patients (101 hips) under the age of 60 years operated on by a single orthopaedic team between 1993 and 2003 at a district general hospital. PATIENTS AND METHODS: Demographic and diagnostic data were collected from patients' hospital records, and a detailed questionnaire regarding occupational status was used at follow-up. RESULTS: Nearly all of the patients working prior to surgery returned to employment following surgery. Nearly half of those not working pre-operatively regained employment postoperatively; among those that did not return to work, this was for reasons unrelated to their hip. Those patients who had been out of work prior to their surgery took significantly longer to return to work. CONCLUSIONS: Our study demonstrates that total hip replacement is effective in keeping patients under the age of 60 years employed. It is also effective in allowing those already off work due to hip pain to return to work, although there is a much greater delay.

MRSA in patients presenting with femoral fractures.

AIM: To assess MRSA carrier status in patients from different residences presenting with femoral fractures and to assess the incidence of MRSA deep wound infections post-operatively with regard to MRSA status on presentation. METHOD: One hundred and five patients were screened for MRSA on arrival over a 20-week period. They were then followed up post-operatively to determine the number of patients developing MRSA deep wound infection. RESULTS: One out of three patients came from an institution (nursing, residential home or hospital). Nearly one in four of these patients were MRSA carriers, compared with a carrier rate of less than 1 in 20 in patients admitted from home. Of the 11 cases presenting as MRSA carriers, two developed a MRSA deep wound infection, compared with 2 out of the 94 patients not colonised with MRSA (X2 p < 0.01).

The influence of biomaterial on patterns of failure after cemented total hip replacement.

We examined aseptic loosening and osteolysis in 77 revised McKee-Arden total hip arthroplasties (THAs) using polyethylene cups and identical femoral stems made from either cobalt chrome alloy or titanium alloy. Time to failure was significantly shorter in the titanium group. Loosening and peri-prosthetic osteolysis occurred with significantly higher frequency in the titanium group compared to the cobalt chrome group.

Prophylactic plating of the donor site of osteocutaneous radial forearm flaps.

We carried out a retrospective study of fracture morbidity of radial forearm osteocutaneous donor sites. During a period of three-and-a-half years, 12 patients had had composite flaps taken, and 5 of them had subsequently fractured the radius. We then elected to plate the radius prophylactically and found that over a period of just over two years, none of the 8 patients who had had prophylactic plating at the original harvesting operation had subsequently fractured the radius.

Radiographic appearance and structural properties of proximal femoral bone in total hip arthroplasty patients.

The relationship between the morphology of the proximal femur and the physical properties of intertrochanteric trabecular bone was assessed in 26 patients undergoing total hip arthroplasty. Significant correlations were found between ash density and (1) Singh index, (2) "calcar-to-canal isthmus ratio," and (3) a modified "morphologic cortical index." Despite this, these radiographic indices accounted for only 30% of the variability in bone density and are therefore of limited predictive value in this context. Two indices of cortical morphology were at least as effective as the Singh index in predicting cancellous bone density. Surgeons using these indices to quantify the morphology and structure of proximal femoral bone should be aware of their limitations when selecting patients for cementless arthroplasty.

Locked nailing for nonunion of the tibia.

We treated 24 patients with nonunion of tibial shaft fractures by locked intramedullary nailing, 18 by open and six by closed techniques. Union was achieved in 22 patients, failing only in two patients with active infection. Locked nailing prevented recurrence of deformity and allowed the patients to mobilise without external support. Supplementary bone grafting was essential only for major defects.

Refracture after the removal of plates from the forearm. An avoidable complication.

The incidence of refracture following the removal of screws and plates from the diaphyses of 115 forearm bones in 80 patients has been studied. Refracture occurred in four adult patients as a result of minimal trauma, in two patients at the original fracture site after premature plate removal, at the site of a countersunk interfragmentary screw in one and at the original fracture site in another who had required three operative procedures to achieve 'union'. It is suggested that refracture could have been avoided in at least two of these patients. If the 3.5 mm plating system has been used, the incidence of refracture should be minimal.

Bone structure after removal of internal fixation plates.

We used single-photon absorptiometry to assess the forearm bones after the removal of internal fixation plates in 14 patients. We found convincing evidence of cortical atrophy in only one patient, in whom the plates had been removed prematurely after only 16 months. It is suggested that such plates should be retained for at least 21 months, to allow bone density to return to its prefracture level. The recommendations of the AO/ASIF group are supported.

Closed traction lesions of the brachial plexus--an epidemic among young motorcyclists.

One-hundred-and-sixty patients with closed traction lesions of the brachial plexus sustained in motorcycle accidents were asked about their accident. One-hundred-and-six responded. Most were young men with limited experience of riding motorcycles. Riders with less than one year's experience were more likely to be injured in the absence of another vehicle than were more experienced riders. Two-thirds of those responding felt the present training requirements for motorcyclists to be inadequate.

Disability following closed traction lesions of the brachial plexus sustained in motor cycle accidents.

102 patients with closed traction lesion of the brachial plexus resulting from motor cycle accidents have been studied. The majority were young men, with the dominant arm involved in 64%. 74% of the patients underwent early operative exploration and 54% of these were amenable to at least partial repair. 65% of the patients had sustained irreparable pre-ganglionic injury to at least three roots of the plexus. 74% of the patients had sustained additional injuries in the accident. Subsequent reconstructive procedures were performed in 26% of patients. 60% of the patients regained employment, but 76% complained of persistent pain in the limb.

Hair chromium concentrations in adult insulin-treated diabetics.

Hair chromium concentrations have been measured in age- and sex-matched groups of insulin-treated diabetics and normal controls. Average concentration (+/- S.E.M.) was reduced in female (2.9 +/- 0.5 compared with 5.1 +/- 0.7 nmol/g) but not in male diabetics.