We retrospectively reviewed 35 cemented unicompartmental knee replacements performed for medial unicompartmental osteoarthritis of the knee in 31 patients

THA in young patients is challenging regarding restoration and survival because patients are young, active, and tend to have disturbed anatomy. We asked whether a three-dimensional custom cementless stem could restore hip function, decrease osteolysis and wear, and enhance stem survival in young patients. We retrospectively reviewed 212 patients (233 hips) younger than 50 years (mean, 40 years) at a followup of 5 to 16 years (mean, 10 years). The Merle D'Aubigné-Postel and Harris hip scores improved at last followup. No thigh pain was recorded for any of the patients; 187 of the 212 patients (88%) had full activity recovery, 206 had full range of motion, and 151 had a score greater than 80 points for all five categories of the Hip disability and Osteoarthritis Outcome score. Five patients had femoral osteolysis not associated with pain. With revision for any reason as an end point, the survivorship was 87% (range, 77%-97%) at 15 years, and considering stem revision only, the survivorship was 93% (confidence interval, 90%-97%) at 15 years. Our data compare favorably with those from series using standard cementless stems at the same followup with a high percentage of patients achieving functional restoration and a low rate of complications.

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Distal radius and ulna fractures are the most common fractures seen in England, occurring at a rate of 22/10,000 person years. Kirschner (K)-wire fixation is a well-accepted method of treating these fractures. There is a surprising paucity of evidence on the subject of prophylactic antibiotics and the duration of K wires can be left in, as these relate to infection rates. We therefore present the results of our protocol for distal radius K-wire fixation for which: no antibiotic prophylaxis was given; we used a percutaneous (not buried) technique, where the K wires were removed after 4 weeks, and the patient has a total of 6 weeks in cast (last 2 wk without wires). The results of the last 100 consecutive patients who were treated with manipulation and K wiring of dorsally displaced distal radial fractures in a standard district general hospital over a 2-year period were analyzed retrospectively. A total of 100 patients had 176 K wires inserted. The mean age was 32.5 years. The mean time to pin removal was 29.4 days. The infection rate was 2%. These results illustrate a safe and clinically effective protocol for K-wire fixation in treating distal radius fractures. On the basis of this study, we do not advocate the use of prophylactic antibiotics, postulating that they do not affect infection rate and thereby eliminating potential antibiotic adverse effects. Furthermore, we do not bury the K wires, which allows for their removal in clinic, thus preventing risks of further operative procedures.

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Introduction:Patient length of stay (LOS) for lower limb arthroplasty is a frequently quoted outcome measure. However, the use of mean values in days is prone to being skewed by outliers.Methods:Between January 2013 and December 2015, patient LOS for primary hip and knee replacement was collected in 1,168 patients. There were two groups: pre- and postinstitution of the Rapid Recovery Program. The hypothesis was that reducing LOS would highlight proportionate differences when using hours as the measuring unit.Results:Statistical analysis confirmed a significant reduction in LOS between the Enhanced Recovery Program and Rapid Recovery Program (P < 0.001).Discussion:Use of the median LOS reduces the impact of outliers. Use of hours as the unit of measure of LOS enabled analysis of the time of day of discharge. With decreasing LOS and day-case arthroplasty, a measurement in median hours should become the standard to allow for the detection of subtle changes.

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