Urinary retention in men after total hip arthroplasty.

A prospective study of sixty-four men was conducted before they underwent a total hip arthroplasty to try to identify the factors that are predictive of postoperative urinary retention. Although neither the urological history nor the physical examination provided information that was helpful in accurately identifying the patients who were at risk, those whose peak urinary flow rate was less than seventeen milliliters per second did have a statistically significant likelihood of the development of urinary retention. A system of management that we hope will reduce the incidence of this complication is proposed.

The transverse posterior approach to the neck.

Traditional posterior approaches to the neck use a vertical craniocaudal incision which often leaves an unsightly scar. An incision along Langer's transverse lines of tension divides only the cross-fibres of the dermis and we have found the results of this approach encouraging: wound healing was uncomplicated and the cosmetic appearance excellent.

Low friction arthroplasty for old quiescent infection of the hip.

We report the results of low friction arthroplasty in 72 old tuberculous hips and 42 hips with old quiescent septic arthritis. Follow-up was for a minimum of two years. Recrudescence of tuberculosis was seen in only one patient, but deep infection occurred in four of the hips with previous septic arthritis. The reasons for this are discussed. It is recommended that patients with old tuberculous hips should have a course of anti-tuberculous drugs before operation, that patients with previous septic infection should have prophylactic antibiotics and antibiotic-loaded cement and that the operation should be performed by an experienced surgeon.

Rhys-davies exsanguinator: a haven for bacteria.

Serial swabs were taken from the inner and outer surfaces of a new Rhys-Davies exsanguinator before and after use on the limbs of patients to exsanguinate limbs prior to tourniquet inflation and surgery. Both surfaces of the exsanguinator showed increasing levels of contamination with bacterial colonisation with use starting from the first use. The organisms grown included potentially harmful bacteria such as Pseudomonas sp. The Rhys-Davies exsanguinator can harbour potentially harmful organisms and, thus, may raise the risk of infection transmission between patients when used without cleaning between uses. Methods of effective cleaning of the exsanguinator between uses are discussed.

Clavicular osteotomy in shoulder arthroplasty.

We present an approach to the shoulder which is easily performed, offers unrivalled exposure for the accurate placement of prostheses or reconstruction of complicated fractures and is easily closed. We have used this approach since 1977 and report our results in 128 patients.

The impact of alcohol ingestion on the orthopaedic and accident service.

There is a well recognized association between the ingestion of alcohol and trauma. The incidence of orthopaedic injuries related to alcohol ingestion and requiring admission has not previously been reported. In a pilot study from the Royal Liverpool Hospital we found that in 22.4% of patients requiring admission, alcohol had been consumed prior to the accident. The incidence of spinal and ankle fractures was higher in the inebriated patients and the circumstances of their injuries differed from those who were sober. Injuries following drinking occurred mainly in young and middle aged males. We discuss simple methods of recognising problem drinking among accident and orthopaedic patients.

The aetiology and management of acute epididymitis.

The aetiology of acute epididymitis presenting to a surgical unit in a District General Hospital is presented. Patients over 45 years old frequently have a coliform urinary tract infection which may be associated with bladder neck obstruction. These patients require treatment with a suitable antibiotic (Co-trimoxazole) and further investigation. This condition occurs more commonly in patients under 45 years old in whom it is not associated with urinary tract infection. We have not demonstrated significant chlamydial infection and in a double blind study the antibiotic Co-trimoxazole did not hasten recovery. In this group the aetiology remains obscure.

Low blood manganese levels in Liverpool children with Perthes' disease.

The aetiology of Perthes' disease of the hip, avascular necrosis of the head of the femur, is unknown. Children with the disease have a generalised abnormality of growth. A similar disproportionate growth is found in chicks given a diet deficient in manganese. In Liverpool, which has the highest incidence of Perthes' disease reported anywhere in the world, children with the disease were shown to have lower blood manganese levels than controls. This is evidence that manganese deficiency around the time of birth may be a cause of Perthes' disease, but the results require confirmation.