Compartment syndrome is a rare complication of total knee arthroplasty that requires early recognition and prompt decompression in order to prevent long-term disability. We have found only one previous case report in the literature. We present a series of seven cases from four hospitals and five surgeons. Six of the cases resulted in the loss of at least one compartment, and one resulted in amputation. Four of the cases resulted in legal action. We suggest that important risk factors contributing to the development of this condition include complex surgery, soft-tissue compromise, previous surgery, and possibly vascular disease. Delay in the diagnosis and hence delay in decompression was common in our series, and in five cases appeared to be related to the use of a postoperative epidural infusion for pain relief. The presence of associated neurological compromise may have also been a significant factor in the delay to diagnosis in two cases.

Objectives: In COPD, disturbed sleep is related to exacerbation frequency, poor quality of life and early mortality. We developed the Manchester Sleep Symptoms Index (MSSI) to assess night-time symptoms and disturbed sleep in COPD. MethOds: Identification of potential items was guided by interviews and focus groups involving COPD patients and age-matched controls. Hierarchical methods and Rasch analysis informed item deletion and development of a unidimensional scale. Internal consistency and test-retest reliability were assessed. Concurrent validity was examined using Pearson's correlation with the St George's Respiratory Questionnaire (SGRQ), modified MRC Dyspnoea Scale, FACIT fatigue scale, MOS Sleep Scale, HADS Anxiety and Depression scores. Results: Qualitative data from 36 patients with COPD and 10 age-matched controls informed an initial list of 22 items. The cross-sectional study included 203 COPD patients (GOLD: I: 14% II: 41% III: 25% IV: 7%; male: 63%, mean age: 64.7; SD: 7.5 years) and 50 non-COPD controls. 12 items were removed during hierarchical methods and a further two following Rasch analysis. The final MSSI contains 8 sleep-related items that are specific to COPD patients: breathlessness, chest tightness, cough and sputum production. The index has good internal consistency (Cronbach's alpha 0.87), test-retest repeatability (intra-class coefficient 0.77) and validity. Total MSSI scores significantly correlated with the SGRQ (r= 0.64); MRC Dyspnoea scale (r= 0.46), FACIT-F (r= -0.61); MOS problems index 2: (r= 0.62); MOS Sleep adequacy (r= 0.40); MOS Sleep disturbance (r= 0.53) HADS anxiety (r= 0.54) and depression (0.48). There was good overall fit to the Rasch model (Chi-squared: 29.2 df: 16 p= 003.) and distribution of item scores. cOnclusiOns: The MSSI is a reliable, valid, uni-dimensional self-reported outcome measure of sleep and night-time symptoms for people with COPD. It is simple and quick to use making it suitable for research and practice. Further work is needed to determine the minimal clinical important difference and cross cultural validity.

Background: Total knee replacement (TKR) is a surgical procedure for intractable degenerative disease of the knee joint. Despite continued evolution in prosthesis design and surgical procedures, restricted range of motion and functional performance is still common in patients undergoing TKR. Posterior stabilized TKR aims to maintain a more reproducible roll back than cruciate retaining and mobile bearing knees, possibly leading to better flexion and function.The aim of this study was to compare the performance of De-Puy posterior-stabilized rotating platform TKR prosthesis (PS-RP) with the newer Hi-Flex PS-RPF system. In particular, the two prostheses were compared for patient satisfaction and functional outcome.Methods: Seventy physically active patients with unilateral knee osteoarthritis, allocated for primary TKR were recruited into the study. Patients were randomly allocated to one of the two treatment groups. The pre and post-operative data (functional outcome and patient satisfaction) was statistically analysed between the two groups.Results: There were no statistical subjective differences between the 2 groups at 6 weeks and 12 months post-operative. There was a significant difference between knee flexion of patients in the Hi-Flex TKR group at 12 months post-operative, achieving higher mean flexion (123.8 ± 7.8 deg compared to 116.4 ± 14.1 deg; p < 0.013). However, this group also had better preoperative flexion suggesting direct correlation between the preoperative and postoperative knee flexion angles, in keeping with current literature. Conclusion:Therefore, we concluded that there are no significant subjective or objective differences between hiflex and standard knee replacements after 12 months of follow-up.