Background: Postoperative pain following hindfoot surgery can be difficult to control with opioid analgesics. Popliteal nerve blocks have been shown in the literature to be effective in both delaying the onset of postoperative pain and reducing the intensity of the pain, with a variable duration of effect. In 2007 we established a ‘block team’ of anaesthetists available to administer popliteal blocks preoperatively.

Methods: Forty-nine consecutive patients undergoing hindfoot surgery were selected. Data was collected: The proportion of patients having a block; opiate requirement during surgery, in the recovery room and on the ward; pain score; time to mobilize after surgery; and length of stay.

We compared two techniques used for popliteal block and also compared post-operative pain control with and without a popliteal block.

Results: There was a considerable increase in the percentage of patients who had a popliteal block after the block team was established (40% to 91%). Six of 23 (23%) patients needed opiates in the recovery room in the nerve block group; compared to12 of 20 (60%) patients who did not have a block. Comparing the two techniques used for the nerve block, ultrasound guidance reduced postoperative intravenous opiate usage compared to blocks given with the aid of a nerve stimulator (p< 0.05). Fifteen of 16 (94%) patients mobilized on the first post operative day in the ultrasound group compared to 16 of 23 (64%) in the patients who had no block. There were no complications recorded as a result of popliteal nerve blocks.

Conclusions: Establishing a block team has improved the proportion of patients receiving a popliteal block in hindfoot surgery in our hospital. The ultrasound guided technique gives superior results in terms of pain relief and earlier mobilization, when compared blocks administered using a nerve stimulator.

Introduction To evaluate the Fast-Fix meniscal repair system, which is a disposable, pre knotted ‘all-inside’ suture with similar pull out strength to vertical mattress suture.

Materials and Methods Between September 2001 and May 2002, we performed 39 meniscal repairs in 38 patients, 1 patient had bilateral injury. The average age was 24(16–37). The cause of the meniscal injury was sports related in 70%, unrelated to sports in 16% and with no history of trauma in 14%. The average time from injury to repair was 2–3 weeks. The majority had associated Anterior Cruciate Ligament Rupture 73% (28 patients). 23 patients had medial meniscal and 16 had lateral meniscal repair. All cases were done as a day case by the senior author. The meniscus was repaired, if the tear was vertically oriented and in the periphery. Two Fast-Fix sutures were used for each repair. Concomitant ACL injury was reconstructed 6 weeks post meniscal repair.

Meniscus was considered to have healed if a) confirmed at arthroscopy or b) No mechanical symptoms after repair. 31 patients had repeat arthroscopy, 28 for ACL reconstruction, 2 for persistent mechanical symptoms and 1 following re-injury.

Results The range of clinical follow up was between 3 to 20 months. In 26 patients healing of the meniscus was confirmed during arthroscopy. 7 patients had no mechanical symptoms following repair. The healing rate was 86% (33 patients). 5 repairs were considered as failures and were excised subsequently. The healing rate was higher in patients with associated ACL injury (92%) compared to isolated meniscal tear healing rate of 70%.

Discussion We feel early results show the Fast-Fix to be safe, simple to use all- inside meniscal repair technique and has the advantage of vertical mattress sutures and no separate incision. Healing rates with combined ACL injuries are better than isolated meniscal tears.

Aseptic loosening of orthopaedic implants is usually attributed to the action of wear debris from the prosthesis. Recent studies, however, have also implicated physical pressures in the joint as a further cause of loosening. We have examined the role of both wear debris and pressure on the secretion of two chemokines, MIP-1α and MCP-1, together with M-CSF and PGE2, by human macrophages in vitro.

The results show that pressure alone stimulated the secretion of more M-CSF and PGE₂ when compared with control cultures. Particles alone stimulated the secretion of M-CSF and PGE₂, when compared with unstimulated control cultures, but did not stimulate the secretion of the two chemokines. Exposure of macrophages to both stimuli simultaneously had no synergistic effect on the secretion of the chemokines, but both M-CSF and PGE₂ were increased in a synergistic manner. Our findings suggest that pressure may be an initiating factor for the recruitment of cells into the periprosthetic tissue.

The best follow up strategy after hip replacement (THR) is unclear. There are conflicting demands to obtain early diagnosis of loosening, and to minimise clinic visits. It would be desirable to achieve follow up with a validated symptom questionnaire alone, but it is unclear how frequently THRs are asymptomatic during early loosening.

This study examined the relationship between patient reported symptoms after THR using two measures (Oxford Hip Questionnaire (OHQ) and Visual Analogue Scale (VAS)), and the classification of the patients AP x ray of the hip as having definite loosening, possible loosening, or a sound implant. We examined data from 325 patients who had undergone a standard Charnley THR for osteoarthritis. Patients had a mean follow-up of 85 months (range 24–144). X rays were examined by a single Consultant Orthopaedic surgeon, and classified as satisfactory, possible loosening or definite loosening.

As expected, the large majority of patients had a satisfactory appearance on x-ray at all-time points. 12 patients were classified as having definite loosening on the basis of the available x-rays. 8 of these were subsequently listed for revision surgery at review. 20 patients were noted to have evidence of possible loosening. Examination of the Oxford hip questionnaire and VAS data demonstrated a strong relationship between OHQ value and the VAS result for pain (r = 0.78, p < 0.001, Spearman rank correlation). Data were analysed separately (using ROC curves) to determine whether the OHQ or VAS was a satisfactory method of selecting patients who fell into “definite loosening” or “definite or possible loosening” groups. Neither OHQ or VAS were sensitive or specific for definite or possible loosening.

We conclude that x rays are required for early detection of loosening, and that follow up by OHQ or VAS alone is insufficient for this purpose.