Judicious surgical intervention has revolutionized the management of the chronic rheumatic diseases in the last decade (Shiers, 1960;MacIntosh and Hunter, 1972;Wilson, 1972). Both reconstructive and palliative surgery have proved to be of great value in the management of patients with these disorders and these operations are today becoming commonplace. Both the indications for and the untoward effects of these operative procedures are becoming more clearly defined, and such complications as infection, loss of joint mobility, loosening of a prosthesis, and the local calcification are well recognized (Roles, 1971;Anderson, Freeman, and Swanson, 1972;Dupont and Charnley, 1972;Miller, 1972). Clearly, also, these operations carry with them the potential hazard of any anaesthetic and of the usual kind of postoperative problems such as deep venous thrombosis, pulmonary infection, or fat embolus.It is the purpose of this present short report to describe a further complication which would appear to be particularly common in certain orthopaedic procedures, namely a sudden postoperative reduction in haemoglobin concentration. To our knowledge little attention has been focused upon this problem, and, since many ofthe patients concerned are suffering from chronic diseases such as rheumatoid arthritis in which the pre-operative haemoglobin concentration itself may be low, this finding has profound clinical significance. The initial observation by one of the authors (E.P.) was that after a Shiers arthroplasty there seemed to be a marked reduction in postoperative as compared with preoperative haemoglobin concentration. Accordingly a small survey was conducted in which the pre-and postoperative haemoglobin concentrations in groups of patients undergoing different orthopaedic operations were recorded and the results are presented in this paper.Material and methods 85 patients suffering from classical or definite rheumatoid arthritis (A.R.A. criteria), all of whom had undergone operations at the Centre for Rheumatic Diseases in the previous year, were studied. Of these patients, 24 had received a Shiers arthroplasty (4 males, 20 females; mean age 54 yrs ± 3-2 S.E.M.; mean duration of arthritis 13-8 ± 19 yrs); twenty had received a McIntosh prosthesis (6 males, 14 females, mean age 51-6 yrs ± 2-8 S.E.M.; mean duration of arthritis 9-2 ± 1-4 yrs), and 21 had received anterior knee joint synovectomy (6 males, 15 females; mean age 49-8 yrs ± 2-4 S.E.M.; mean duration of arthritis 11-3 ± 2-3 yrs). These patients were selected consecutively in a retrograde fashion dating from the original observation and were not further selected in any way.In Table I the clinical details of the groups of patients studied are shown. It can be seen that these patients had severe rheumatoid arthritis denoted by the high articular indices and high erythrocyte sedimentation rate. The reduction in haemoglobin concentration (Cynamet Haemoglobin method) after operation in these groups of patients was compared with a group of 20 patients who had undergone sup...

1. Four cases of sural nerve entrapment lesions in the ankle and foot are reported. 2. All the patients gained complete relief of symptoms following neurolysis. 3. The presence of a ganglion in relation to the sural nerve in the ankle and foot is a helpful sign in the diagnosis of this condition.

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The British Orthopaedic Association assessment questionnaire for knee replacements was adapted to allow comparison of the severity of underlying polyarthritis with the benefits of geometric knee replacement in a retrospective study of 150 knees between six months and six years after operation. Total or partial relief of pain was achieved in 81 per cent of the operation, and changes in mobility occurred in fewer patients. Late sepsis remained a serious complication of nine per cent of the operations and one patient died from septicaemia. Late sepsis was associated with previous synovectomy or osteotomy. Retropatellar pain rarely interfered with the mobility of the patient. There was no association of operations that failed with a high erythrocyte sedimentation rate, a high platelet count, a low haemoglobin level or with a strongly positive rheumatoid factor but pain in the contralateral knee was associated with a diminished functional capacity.