Survivorship of the Charnley Elite Plus cemented femoral stem

We report the results of the Charnley Elite Plus femoral stem in multiple surgeons' hands at a minimum of 3 years after implantation. Over a 4-year period, 244 patients underwent 268 primary hip arthroplasty procedures using this particular stem. Patients underwent postal and radiographic review at a mean of 4.5 (3.0--6.8) years following their arthroplasty. There were five revision procedures for aseptic loosening (5/268; 1.9%). Radiological assessment revealed gross radiological failure in a further 12 femoral stems (12/208; 5.8%). In the best case scenario, using revision for aseptic loosening as the endpoint, the survivorship for this period was 98.1%. If radiographic failures are incorporated into this endpoint, survivorship is 93.1%. This failure rate at an early stage raises concerns as to the long-term survivorship of this prosthesis.

Body-exhaust suit versus occlusive clothing. A randomised, prospective trial using air and wound bacterial counts

We randomly allocated 50 total knee replacements to scrub teams wearing body-exhaust suits (BES) or Rotecno occlusive clothing. The effectiveness of the clothing was assessed using air andwound bacterial counts. Bacteria were recovered from 62% of wounds (64% BES, 60% Rotecno). The mean air count was 0.5 CFU/ m3 with BES and 1.0 CFU/m3 with Rotecno (p = 0.014). The mean wound counts were 14 bacteria/wound with BES and eight bacteria/wound with Rotecno (p = 0.171). There was no correlation between the air and wound counts (r = -0.011, Spearman's). The higher air counts suggest that Rotecno occlusive clothing is less effective than BES, but wounds were equally contaminated with both types of clothing suggesting that at very low levels of air contamination the contribution of bacteria to the wound from the air is irrelevant. Even doubling the air counts from 0.5 to 1.0 CFU/m3 had no detectable effect on the wound. This allows a reassessment to be made of other sources of contamination the effect of which would previously have been overwhelmed by contamination from air.

Clavicular fracture non-union surgical outcome and complications

Symptomatic clavicular fracture non-union is rare. When it does occur, however, it may pose a difficult problem causing pain and functional impairment. The emphasis of this paper is on preopertive disabilities and the postoperative outcome and complications. Twenty patients with clavicular non-union treated operatively from 1989 to 1997 were reviewed, the average follow up was thirty-four months. Eleven fractures were midshaft, eight were lateral third and one medial third. A detailed proforma was completed with the patients documenting preoperative symptoms, outcome after surgery and complications. A literature search was carried out to find out the incidence of complications related to operating on post-traumatic clavicular non-union. All of the twenty fractures non-unions duly united after surgical intervention although three required early adjustment or change of metal work. The subjective and objective outcomes were good in 19 cases and poor in one. The postoperative complications included three implant failures, one stiff shoulder, two patients with numbness below the scar and one patient with an infected donor site wound. The literature search revealed that from 24 publications and 301 patients who had operations for clavicular non-union ther were 18 (6%) reported complications related to metal work, 45 (15%) reported complications related to soft tissues, seven (2%) complications related to the scar and 24 (8%) failures of union. Symptomatic clavicular non-union can cause severe disabilities. Good outcome, at low risk, can be expected from internal fixation and bone grafting of midshaft non-unions. Although there are only eight cases of lateral third clavicular non-unions, this is the largest series in the literature. Furthermore, the study clearly demonstrates both the difficulties treating this fracture surgically and a procedure to be avoided (acromio-clavicular bridging), which, again has not been previously addressed.