The Royal College of Surgeons of England (RCS) recently issued guidance regarding the use of re-operation rates in the re-validation of UK based orthopaedic surgeons. Currently, little has been published concerning acceptable rates of re-operation following primary surgical management of orthopaedic trauma, particularly with reference to re-validation.

We conducted a retrospective review of patients undergoing a clearly defined re-operation following primary surgical management of trauma between 1^st January 2010 and 31^st December 2011. 3688 patients underwent primary procedures while 83 (2.25%; 99%CI = 1.69 to 2.96%) required an unplanned re-operation. The mean age of patients was 46 years (range 2–98) with 46 (55%) males and a median time to re-operation of 34 days (IQR 12–134). Potentially avoidable re-operations occurred in 47 patients (56.6%; 99%CI = 42.6 to 69.8%) largely due to technical errors (46 patients; 55.4%; 99%CI = 41.4 to 68.7%), representing 1.27% (99%CI = 0.87 to 1.83%) of the total trauma workload. Within RCS guidelines 28 day re-operation rates for hip fractures, wrist fractures and ankle fractures were 1.4% (99%CI = 0.5 to 3.3%), 3.5% (99%CI = 0.8% to 12.1%) and 2.48% (99%CI = 0.7 to 7.6%) respectively.

We present novel work that has established baseline re-operation rates for index procedures required for revalidation of orthopaedic surgeons.

Midline skin incision and medial arthrotomy for knee arthroplasty may be preformed in flexion or extension. Anatomical studies have revealed a risk to the infra patellar branch of the saphenous nerve. This study addresses

whether sensory loss is greater following skin incision in flexion or extension.

Null hypothesis- there is no detectable difference in sensation before and after knee arthroplasty. Pilot study- light touch, sharp touch and two point discrimination were evaluated pre-operatively, at one week, six weeks and six months postoperatively in twelve patients recruited prospectively. Randomization was achieved using an envelope system. Six patients underwent approach and closure in flexion and six in extension. Prospective cohort study – 50 patients underwent sensory mapping for light touch and sharp touch pre-operatively. These control results were compared with the post-operative findings at six months. All measurements were standardised to anatomical landmarks with the knee in 90 degrees flexion.

There is a constant area of sensory loss lateral to the midline scar, which shows some recovery with time. The sensory loss affects both light and sharp touch. Initially, this is in a similar distribution anteriorly and laterally extending from the superior pole of the patella to the tibial tubercle, approximately 2cm lateral to the midline. The loss is most marked immediately after surgery. There is a noticeable recovery in sharp touch by six weeks. The recovery in light touch is slower and less complete at the six month review. There is no demonstratable difference in sensory loss regardless of whether the incision is made in flexion or extension, (p=0.1)

Lateral sensory loss is a constant feature in this series six months following knee arthroplasty. Patients may benefit from pre-operative counselling regarding the likelihood of lateral cutaneous sensory deficit following knee arthroplasty.

We undertook the current study to analyze the factors involved with failed previous stabilization surgery for patients with anterior or anteroinferior glenohumeral instability. Between 1997 and 2003 we treated seventy-four patients with traumatic unidirectional instability. The average age was thirty-two and the average follow up was fifty-eight months. There were sixteen females and fifty-eight males. All patients underwent a primary diagnostic arthroscopy followed by arthroscopic stabilization in forty-seven and open stabilization in twenty-seven cases. Ten had a recurrence of instability. Of these two had significant trauma. Of the remaining, six were in the arthroscopic group and two in the open procedure group.

Analyze the factors involved with failed previous stabilization surgery for patients with anterior or anteroinferior glenohumeral instability.

Between 1997 and 2003 we treated seventy-four patients with traumatic unidirectional instability. The average age was thirty-two years (range nineteen to forty-seven). There were sixteen females and fifty-eight males. The average follow up was fifty-eight months (range seven to eighty-three). All patients underwent a primary diagnostic arthroscopy followed by arthroscopic stabilization in forty-seven and open stabilization in twenty-seven cases. The arthroscopic procedure involved two Suretac II labral reattachment and capsular shrinkage using electrocautery. The open procedure involved a Bristow/Latarjet procedure using a delto-pectoral approach and reattachment of coracoid process using a single malleolar screw.

Ten patients had a recurrence of instability. Of these two had significant trauma, one each group. Of the remaining eight, six were in the arthroscopic group and two in the open procedure group. In the arthroscopic recurrence group, three had a large Hill Sach’s lesion and one a large Bankart Lesion. In the open procedure group, both had a large Hill Sach’s and Bankart’s lesion. This gave a recurrence rate of 12.7% in the arthroscopic group and 7.4% in the open group.

A large Hill-Sach lesion > 2mm is a contra-indication to arthroscopic repair and the optimum stabilisation procedure is an open repair (Bristow/Laterjet). Without a significant Hill-Sach’s lesion an arthroscopic Suretac II labral re-attachment is an effective way of achieving stability. Those who have a large Hill-Sach and significant Bankart’s lesion may need a combination of Bankart’s repair plus an extra-articular procedure like a Bristow/Laterjet procedure.

This report concerns an operative technique using inexpensive pre-polymerised cement discs as a means of addressing the bone loss from the posterior femoral condyles found during revision total knee replacement.

Bone lost from the posterior condyles in the loosened femoral component of a total knee replacement enlarges the flexion gap at revision. Downsizing the femoral component to fit the remaining bone requires a thicker tibial insert and a proximalised new femoral component to maintain balanced gaps in flexion and extension. Patella infera results from this proximalisation of the joint line and interferes with the extensor apparatus.

Some knee systems offer customised components with thickened posterior femoral condyles or provide the surgeon with the option of adding metal augments to the femoral component to manage the posterior femoral bone loss.

This technique has been applied to ten cases (follow- up ranging from 15 to 46 months) in which inexpensive pre-polymerised cement spacers were incorporated into the posterior femoral cement mass. This allowed the use of primary stemmed components with preservation of the original joint line position.

No case has resulted in loosening although two cases have required further revision due to recurrence of their original infection. At revision of these cases the cement discs remained firmly incorporated in the cement mass.

We conclude that this technique is reliable, inexpensive and could be applied to other prosthetic varieties.