Glass-ceramics were developed initially for the immobilization of miscellaneous Pu-residues at the UK’s Sellafield site from which it was uneconomic to recover Pu for reuse. Renewed interest in the immobilization of a portion of the UK PuO2 stockpile has led to glass-ceramics being evaluated for bulk Pu immobilization. The Nuclear Decommissioning Authority (NDA) in the UK have proposed hot isostatic pressing (HIP) as a potential consolidation technique for the processing of these wasteforms. In this study, zirconolite based glass-ceramics were investigated to determine an optimum formulation. The yield of zirconolite is shown to vary with glass composition and glass fraction, such that a higher Al content favours zirconolite formation. The sample preparation process is discussed to highlight the importance of a high temperature heat-treatment during sample preparation to achieve high quality HIPed wasteforms.

En dépit des progrès enregistrés en Arthroplastie Totale de Hanche (ATH), sous certainesconditions, les contraintes prothétiques peuvent être amplifiées et transmises auxancrages osseux avec un risque accru de descellement (B. The et al., J. Biomech. 41 (2008)100–105). Les pics de chargement sont identifiés parmi les facteurs qui conduisent auxéchecs des ATH (A. Boulila, Optimisation et aide à la conception d’implants orthopédiques– Étude de l’usure d’implants articulaires de hanche, Travaux non publiés et Rapportd’avancement, INO MT Kassab, décembre 2006, Tunis, 82 p.). Cette étude porte sur unesimulation numérique des prothèses de hanche hybrides, de géométrie et de couple dematériaux différents. On montre que certaines géométries (∅28 × 56 mm) et certains couplesde matériaux (alumine/polyéthylène), peuvent atténuer les contraintes induites après chocet protéger la prothèse contre l’usure ou les ruptures prématurées. Devant une panoplied’une cinquantaine de modèles de prothèses de hanche existant sur le marché (M.R. Urist,Curr. Prob. Surge. 12 (1975) 1–54), certaines PTH de diamètre (interne et externe)incompatible avec un niveau de contraintes admissible doivent être éliminées. Unecombinaison judicieuse des matériaux de contact pour favoriser l’amortissement (cas ducouple polyéthylène/céramique) peut être une solution pour absorber les chocs et remédierau problème de descellement.

Objectives: Registers have proven to be a valuable instrument in the evaluation of arthroplasty procedures and the performance of implants. The aim of this study was to describe the structure, functioning, and content of arthroplasty registers in Europe and other parts of the world.

Methods: A search of technical reports was carried out through the Internet and in Medline/PubMed. The exhaustiveness of the information was confirmed using the links to Web pages of other registers and contacts with key people. Aims, methods in data collection and evaluation, internal structure and organization, participants, validity of the data, and other variables were assessed for each arthroplasty register using a qualitative content analysis of the texts.

Results: Fifteen arthroplasty registers were identified which published sufficient information to conduct a comparative analysis. Eight additional registers were identified but no information was available on the Internet or in English. Most registers were initiatives of an orthopaedic society receiving governmental funding. Data were collected using standardized clinical forms and additional information from clinical-administrative datasets or other registers (mortality, implant costs, hip fractures). The main outcome measure of these registers is survival of the prostheses. Registers use the Internet and their annual reports as the main strategy for the dissemination and feed-back of their results.

Conclusions: Scientific or professional societies and the public health administration should collaborate in the development of arthroplasty registers. To adequately assess the results of observational data information on the structure, the process of arthroplasty interventions and patients characteristics should be collected.

There are several clinically useful techniques for delivering radical radiotherapy to the prostate. One such beam arrangement is a conformal four-field box technique. Patients who have undergone a total hip replacement have in place a metallic prosthesis, which presents challenges in achieving a homogenous dose distribution. This is due to the increased density of the metal in comparison to bone and soft tissue. The resultant effect is additional attenuation of the X-ray beam as it passes through the prosthesis. The interaction of the photons with the metal also causes increased scatter. Thus, the dose delivered to the tumour is reduced if it is not corrected for. Due to the uncertainty in the amount of attenuation, it is recommended to avoid irradiating through the hip concerned. This means that the four-field box technique cannot be used. Instead, different field arrangements are used such as three or four oblique fields. This is a retrospective investigation into which field arrangement would be the most appropriate for early stage prostate cancer patients. Ten previously treated prostate patients were planned with different beam arrangements avoiding the prosthesis. The results were analysed and are presented with reference to the doses to the organs at risk and the planning target volume. The results indicate that the beam arrangement of choice should be three fields (anterior, posterior and lateral) or a three-field oblique beam arrangement. It has been proved that these plans are acceptable as a solution in this scenario.

Background and objective: To determine whether prior exposure of non-steroidal anti-inflammatory drugs increases perioperative blood loss associated with major orthopaedic surgery.

Methods: Fifty patients scheduled for total hip replacement were allocated to two groups (double blind, randomized manner). All patients were pretreated for 2 weeks before surgery: Group 1 with placebo drug, Group 2 with ibuprofen. All patients were injected intrathecally with bupivacaine 20 mg plus morphine 0.1 mg, in a total volume of 4 mL, to provide surgical anaesthesia.

Results: The presence of severe adverse effects caused eight patients in the ibuprofen group and six in the placebo group to terminate their participation in the trial. The perioperative blood loss increased by 45% in the ibuprofen group compared with placebo. The total (±SD) blood loss in the ibuprofen group was 1161 (±472) mL versus 796 (±337) mL in the placebo group.

Conclusions: Pretreatment with ibuprofen before elective total hip surgery increases the perioperative blood loss significantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.

We studied a number of factors that may be associated with urinary retention, in particular the method of postoperative analgesia delivery, in 47 men and 69 women undergoing lower limb joint replacements. The following factors were studied: age, gender, height, weight, previous history of urinary retention, presence of symptoms suggestive of urinary tract obstruction, type of anaesthetic (general anaesthetic or spinal anaesthetic), type of postoperative analgesia (intramuscular or patient-controlled analgesia with morphine) and the total dose of morphine given. Urinary retention developed in 18.1% of patients. Stepwise logistic regression analysis was used to identify independent explanators of an increased probability of developing urinary retention. Three factors emerged – male gender, increasing age and the use of patient-controlled analgesia.

The efficacy of an integrated autotransfusion regimen, including pre-donation and perioperative salvage of autologous blood, was prospectively evaluated in 2884 patients undergoing total hip (n=2016) or knee arthroplasty (n = 480), and hip revision (n = 388) with either balanced general, regional, or integrated epidural/general anaesthesia. Allogenic concentrated red blood cells were transfused in the presence of symptomatic anaemia or when haemoglobin concentration was < 6gdL−1 (10gdL−1 in patients affected by cerebrovascular or coronary artery disease) after all salvaged and pre-donated autologous blood had been transfused. A total of 278 patients (9.6%) received allogenic blood. Risk factors for allogenic blood transfusion were: preoperative haemoglobin concentration < 10gdL−1 (after autologous blood pre-donations) (Odds ratio: 8.7; 95% CI: 6.5–16.8; P=0.004), hip revision versus hip or knee arthroplasty (Odds ratio: 5.8; 95% CI: 3.9–8.5; P=0.0001) and inability in obtaining the number of predonations required by the Maximum Surgery Blood Order on Schedule (Odds ratio: 3.4; 95% CI: 2.7–4.1; P=0.0001). The incidence of perioperative complications, including wound infection and haematoma, as well as myocardial ischaemia, respiratory failure and thromboembolic complications, was higher in those patients requiring allogenic blood transfusion (29.8%) than that observed in patients receiving only autologous blood (6.6%) (P=0.0005); while the mean time duration from surgical procedure to patient discharge from the orthopaedic ward was shorter in those patients not receiving allogenic blood transfusion (12 days; 25–75th percentiles: 8–14 days) than in those patients who required perioperative transfusion with allogenic blood (15 days; 25–75th percentiles: 10–17 days) (P=0.0005). In conclusion, this prospective study highlighted the clinical relevance of applying an extensive and integrated autotransfusion regimen in order to reduce allogenic blood transfusion and associated complications in patients undergoing major joint replacement.

Objectives: To examine the influence of a picture archiving and communication system (PACS) on the length of stay (LOS) for patients receiving total hip replacement (THR) or total knee replacement (TKR) procedures.

Methods: A before-and-after design was used. Data were collected on all THR and TKR procedures at Hammersmith Hospital from 1993–96. A regression approach was used to examine the influence of PACS on LOS. Factors such as patient age, sex, and physician were controlled for.

Results: Type of admission and discharge, month of procedure, complications, and number of procedures all significantly influenced LOS for patients undergoing THR. For patients receiving TKR, age, sex, admission, prosthetic complications, number of procedures, and PACS significantly influenced LOS.

Conclusions: While this study shows an apparent reduction of 25% in the average LOS for TKR patients at the time PACS was introduced, this is unlikely to be a true PACS effect and no similar reduction in LOS was shown for THR patients.

Bone injury while undergoing electro-convulsive therapy is thought to be rare. We report a case of hip fracture during treatment which was associated with osteoporosis. Patients at increased risk could be identified.