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Introduction: There is controversy as to whether continuous passive motion (CPM) after total knee arthroplasty (TKA), which is the standard treatment, confers significant benefit with respect to outcome. The primary purpose of this study was to determine if CPM or slider-board (SB) therapy, used as adjuncts to standardized exercises (SEs) during the acute-care hospital stay, resulted in a reduced total length of hospitalization and post-discharge rehabilitation in patients who underwent primary TKA., Methods: We carried out a randomized, clinical trial on 120 patients who received a TKA at the University of Alberta Hospital, Edmonton, a tertiary care institution. The study horizon began at the point of discharge from the hospital and continued up to 6 months after operation. Postoperatively, patients (40 in each group) received CPM and SEs, SB therapy and SEs or SEs alone while in the tertiary Health service use was compared using transfer institution length of stay(LOS), post-discharge rehabilitation, readmission and complication rates and their associated costs., Results: There were no differences in health service use or costs among the 3 groups over the 6-month study. The rates of postoperative complications and readmissions also were similar among the groups. Increased health service use associated with knee flexion that was less than 60 degrees at discharge, but similar proportions of patients with poor knee range of movement (ROM) at discharge were found in each group., Conclusions: This finding suggests that adjunctive ROM therapy, as used in this study, does not reduce health service use. Further research is required to determine if adjunctive ROM therapy after discharge from the surgical hospital decreases health service utilization in those patients who have poor knee ROM at the time of discharge.

Objectives: To compare the preliminary rate and amount of bony ingrowth and calcar resorption between patients receiving either a standard anatomical medullary locking (AML) or a tricalcium phosphate (TCP)-coated AML femoral prosthesis and to compare preliminary clinical results., Design: A prospective, randomized, double-blind clinical trial., Setting: An acute care tertiary institution., Patients: Between January 1993 and March 1995, 92 patients underwent primary total hip arthroplasty (THA). They were randomized to 2 groups of 46--a control group or a treatment group. Of the 46 subjects enrolled in each group, no significant differences were seen preoperatively with respect to age, sex, diagnosis, clinical and radiographic assessment. Seventy-one patients were followed up for 24 months., Interventions: Insertion of either a standard AML femoral implant (control group) or a TCP-coated AML femoral implant (treatment group)., Outcome Measures: The degree of hypertrophy, calcar atrophy and the number of spot welds on standard postoperative radiographs at 6, 12 and 24 months. Clinically, assessment according to the Société internationale de chirurgie orthopédique et de traumatologie (SICOT) scale and a 100-point visual analogue scale (VAS) for pain., Results: There were no prosthetic stem revisions in either group at the 24-month follow-up. Radiographically, bony ingrowth was not significantly different in the TCP-coated stem, by chi2 analysis of the degree of hypertrophy and number of spot welds present. Also by chi2 analysis, the degree of calcar atrophy was not significantly different between groups. The mean VAS score for pain at 24 months was 12.5 for the control and 12.1 for the treatment group. No significant differences were seen in any of the clinical categories of the SICOT Scale over the 24-month interval., Conclusion: The objective of TCP-coating--to increase the rate and amount of bony ingrowth while reducing the rate of calcar resorption in non-cemented THA--was not achieved by 24 months postoperatively in our study.

Objective: To describe a method of reducing the costs of implants in hip and knee arthroplasty., Design: Implant costs were compared before and after the implementation of a 2-year contract with implant vendors, providing increased volume for decreased implant cost. An additional 20% of arthroplasties could be done outside the contract for research or special purposes., Setting: A regional health authority involving 2 acute care hospitals., Method: Costs were obtained for 942 hip and knee arthroplasties performed in 1993/94 and compared with costs of 1656 hip and knee arthroplasties performed in 1996/97., Outcome Measures: Implant cost and number of joint arthroplasty procedures performed., Results: A 40% decrease in the cost per implant for primary knee arthroplasty and an 18% decrease in the cost per implant for primary hip arthroplasty were achieved. A rebate, calculated as a percentage of volume used, was received from the vendor to support general orthopedic research and education. A new contract for 3 years has recently been signed with 3 vendors designated as primary vendors for 80% of the volume., Conclusion: The vendor-contract economic strategy effectively reduced the cost of hip and knee arthroplasty and may be useful at other centres looking for cost reduction methods that maintain adequate patient care and support clinical research and education.

Restoration of continuity of the gastrointestinal tract following resection has always presented a challenge to the general abdominal surgeon. Restoration of the left colon has been especially dangerous. In the early days the mortality approached 90% due mainly to breakdown of the anastomosis. Recently, with a better understanding of the blood supply to the colon and more careful preparation of the colon, the mortality and morbidity have been reduced. In a small group of cases, in which previous surgery has interfered with the blood supply to the colon or a secondary pathologic condition exists, continuity cannot be restored by end-to-end anastomosis. In this group the interposition of the ileum between the transverse colon proximally and the rectum distally has resulted in functional continuity of the colon with no adverse metabolic effects.

The incidence of postoperative wound infection was studied in relation to 146 surgical wounds in patients who received cephaloridine as prophylactic antibacterial therapy, and in relation to 120 wounds in another group of patients who did not receive cephaloridine. In the first group, 5 of 146 (3.4%) of wounds became infected; in the second, 25 of 120 (20.8%) of wounds became infected. The difference between the two groups is significant. Use of cephaloridine in this series of patients therefore decreased the incidence of postoperative wound infection.

The Madreporic hip arthroplasty has provided encouraging clinical results. The surface of the prosthesis is unlike other uncemented prostheses since the rough surface is formed by multiple 1-mm diameter beads that are cast as an integral part of the prosthesis and increase its surface area four times. Seven Madreporic hip arthroplasties were implanted in adult male mongrel dogs. Specimens were harvested 5, 6, 9, 12, 20 and 52 weeks after insertion. One specimen became septic and loosened. The prosthesis was stabilized initially by friction fit between the prosthesis and the endosteal cortex of the proximal femur. Dense, uniformly organized, fibrous tissue surrounded the prosthesis at 5 weeks. The fibrous tissue appeared similar to Sharpey's fibres. Circumferential bone contact increased from 26% at 5 weeks to 60% at 52 weeks. Fluorescent labelling revealed active new bone formation within the interstices of the prosthesis without evidence of an intervening soft-tissue membrane. Firm mechanical anchorage of the Madreporic femoral prosthesis was demonstrated in this study.

The authors have tried to determine which patients were at risk of venous thrombosis. They chose 10 tests for hemostasis that might be of value in predicting those patients who were at risk. The tests were used in two groups of patients: one group in a respiratory intensive care unit and another group of patients about to undergo a major spinal operation. The tests were those for measuring: platelet count, prothrombin time, activated partial thromboplastin time, platelet thromboplastic activity (platelet factor 3), plasma clotting time, and concentrations of fibrinogen, plasminogen, antithrombin-III, alpha-1-antitrypsin and platelet fibrin degradation products (FDP). A diagnosis of thrombosis was made by three techniques: radioactive fibrinogen accumulation in the developing thrombus, impedance plethysmograhpy and ascending venography. The only test for hemostasis that discriminated between patients with and without thrombosis was the level of circulatory FDP. Several of the tests showed pronounced changes within the normal range following development of thrombosis and even before its detection. Therefore, none of the tests was truly predictive. A detailed discussion of the performance and interpretation of impedance plethysmography is presented.

An unselected study of 87 inguinal herniorrhapies was carried out over a 2-year period using polyglycolic acid (Dexon) sutures in 46 procedures and conventional sutures in the remaining 41. Tissue reaction was the same with both types of suture; however, the incidence of recurrence was lower with the use of conventional sutures. This study has not confirmed the superiority of Dexon sutures reported in other studies.

Seven cases of annular pancreas are described. In all the diagnosis was confirmed at autopsy or at operation. This study provides a new, original classification for annular pancreas. Two distinct subtypes are described: type 1, extramural and type 2, intramural. In type 1 the presenting symptoms are those of high gastrointestinal obstruction. In type 2 the symptoms are those of duodenal ulceration. For extramural obstructing annuli surgical intervention, if indicated, should be a bypass procedure; for intramural types with duodenal ulcer, subtotal gastrectomy with or without vagotomy is the procedure of choice.