Breakage of intramedullary femoral guide rod during total knee arthroplasty: a case report.

We report a rare complication during primary total knee arthroplasty. An intramedullary femoral guide rod was broken during insertion. The broken part jammed into the isthmus of the femur. An initial attempt to push the broken rod via the proximal femur by a guide wire to the distal femur was unsuccessful because the broken rod was lodged in the isthmus. Ultimately, the isthmus was opened using a flexible 9-mm end-cutting reamer, and the broken rod was pushed down to the distal femoral entry site in an antegrade fashion under image intensification. Selecting a more medial entry site on the intercondylar notch with a smaller valgus cutting angle and using a shorter guide rod can avoid such a breakage.

Investigation of the use of drained blood reinfusion after total knee arthroplasty: a prospective randomised controlled study.

PURPOSE: To compare the use of a blood salvage and reinfusion system with standard allogeneic blood transfusion after total knee arthroplasty--a procedure associated with significant postoperative blood loss. METHODS: Between June 2002 and May 2004, 60 patients undergoing total knee arthroplasty were randomly allocated into a reinfusion group (n = 26) or a control group (n = 34). Patients in the reinfusion group had their blood reinfused from drains within 6 hours of surgery. Both groups received allogeneic blood transfusions according to specified transfusion criteria if the haemoglobin level fell below 90 g/l, or in the presence of severe anaemic symptoms. Haemoglobin levels and drain output were recorded daily for 3 consecutive days after surgery. RESULTS: There was no significant difference between the 2 groups in demographic data, drain output, total blood loss, and mean postoperative haemoglobin levels. Significantly more allogeneic blood was required by the control group than by the reinfusion group (p = 0.022). CONCLUSION: Postoperative reinfusion of drained blood reduced the need for blood transfusion after total knee arthroplasty, while having an effect on postoperative haemoglobin level equivalent to standard allogeneic blood transfusion.

Arthroscopic procedures for the treatment of anterior shoulder instability: local experiences.

OBJECTIVE: To review the outcomes of arthroscopic stabilisation procedures for the treatment of recurrent anterior shoulder dislocation. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Patients receiving arthroscopic stabilisation procedures for recurrent anterior shoulder dislocation between 1999 and 2003. MAIN OUTCOME MEASURES: Functional outcomes including pain, range of motion, and activity level were assessed using the Constant score. Intra-operative findings were also discussed. RESULTS: A total of 18 arthroscopic stabilisation procedures were performed for the treatment of recurrent shoulder instability. Two cases converted to open procedures were excluded from this review. The overall outcomes were good and seven patients reported a full recovery. Fourteen out of 16 patients reported minimal or no pain, and the mean Constant score was 80. There were no cases of re-dislocation and no major complication was noted. CONCLUSION: All the reviewed patients had a satisfactory functional recovery. Therefore, we believe that the use of arthroscopic stabilisation procedure can produce a favourable outcome for appropriate shoulder pathologies.

Reliability of Hong Kong Chinese version of the Patient-rated Forearm Evaluation Questionnaire for lateral epicondylitis.

OBJECTIVE: To determine the reliability and validity of a dedicated assessment tool for lateral epicondylitis after translation into Hong Kong Chinese. DESIGN: Cross-sectional study. SETTING: District hospital, Hong Kong. PATIENTS: Seventy-four patients, 12 of whom were bilingual, were recruited (total of 82 elbows). MAIN OUTCOME MEASURES: Translation equivalence and reliability were measured with the test-retest method. Validity was measured against the Roles and Maudsley outcome score and mean maximal grip strength. RESULT: The Patient-rated Forearm Evaluation Questionnaire had high English-Chinese equivalence (Spearman's rho correlation coefficient=0.926; P<0.001). It was also very reliable (intraclass correlation coefficient=0.99; P<0.001). Validity according to the Roles and Maudsley outcome score and mean of maximal grip strength was significant (P<0.01). CONCLUSION: The Hong Kong Chinese version of Patient-rated Forearm Evaluation Questionnaire is a reliable and valid assessment tool for chronic lateral epicondylitis. Its equivalence to the original English version makes outcome assessment across cultural barrier feasible.

The shape and size of femoral components in revision total hip arthroplasty among Chinese patients.

OBJECTIVE: 39 sets of preoperative hip X-rays were studied to find out whether Chinese patients need revision femoral components with a different shape and size from western patients. METHODS: From July 1998 to June 2001, the pre-revision X-rays of 39 revision total hip replacements among 38 Chinese patients (21 men and 17 women) were studied. The component size that produced the best distal canal-filling in the anteroposterior X-ray was determined by using templates of 200-mm femoral components used commonly for Caucasian patients. RESULTS: The diameter of the component needed was 13.5 mm or less in 54% of cases, compared with only 17% for Caucasian patients as reported in the literature (p<0.01). When lateral templates of the corresponding size were put over the lateral X-rays, the anterior cortex of the 200-mm straight stem was shown to have thinned by 2.0 mm or more in 36% of hips; for 200-mm bowed stem, there was thinning of the anterior cortex by 2.0 mm or more in only 5% of hips (p<0.01). CONCLUSION: Chinese patients are likely to need smaller femoral components than Caucasian patients, and may benefit from bowed-stem components in femoral revision.