Journal of Perioperative Practice

This paper reports a prospective audit, against an existing baseline standard, for intermittent pneumatic compression (IPC) in the prophylaxis of asymptomatic deep vein thrombosis (DVT). This was done via a structured questionnaire, using the methodology of total population sampling, encapsulating all theatre staff within one NHS trust. With regards to the standard, performance is good, as IPC is DVT prophylaxis of choice in the perioperative area and is used frequently on most patients. The findings of the audit do, however, highlight the need for appropriate local DVT risk assessment guidelines, essential to ensure that prophylaxis is administered to the correct at risk groups, as prevention may be unjustified in low risk groups and possibly inappropriate for the same regimen to be used for all patients.

A super morbidly obese woman with a twin pregnancy presented to our hospital in Perth, Western Australia, for obstetric care. A caesarean section was planned for her, in order to ensure a safe, controlled manner of delivery. This article details the processes and procedures which had to be implemented in order to safely care for the patient during her perioperative experience.

Minimally invasive knee replacement surgery has been developed in an attempt to lessen the impact of operations on the patient's quality of life, in the same way as arthroscopy, the forefather of minimally invasive surgery (MIS), revolutionised cartilage and ligament surgery three decades earlier. The technique is based on minimising soft tissue and muscle trauma, skin incision length, and capsular disruption while trying to maintain the ultimate goal of a well-aligned, well-fixed knee replacement. Short-term advantages including accelerated recovery and reduction in blood loss have been demonstrated, but it remains to be investigated whether MIS is able to provide sustainable benefits and long-term outcome equivalent to conventional surgery. Successful application of MIS techniques have been confirmed in conjunction with unicompartmental knee arthroplasty (UKR) implantation, while its use with total knee arthroplasty remains experimental. Critics have expressed concern that reduced visibility may compromise implant positioning and leg alignment which could have a negative effect on prosthetic long-term survival. MIS clearly represents a unique and more technically demanding procedure, but the learning curve may perhaps overshadow the benefits. Computer navigation may help to avoid such problems but so far scientific evidence regarding definitive outcomes is lacking, and some of the MIS techniques are still in the early phases of development.