This is a prospective study to determine if we could identify patients who may benefit from preoperative catheterisation in lower limb arthroplasty. 211 consecutive patients undergoing total hip and knee arthroplasty were recruited. There were 131 female (62%) and 80 male (32%), the mean age (+−1 S.D.) was 68+−12 years old. Patients’ demographic details and pre-operative urinary symptoms were recorded. Previous urological surgery and past history of urinary catherisation were also documented. The anaesthetist who was blinded from the study selected the type of anaesthesia and the post-operative analgesia regime. All patients were required to produce mid-stream urine sample before surgery and at post-operation. Urine tract infection was confirmed on a positive microbiological culture. Regression analysis was used to assess various co-variables to identify the high-risk groups. 35 female (56%) and 27 male (44%) were catheterised, the mean age (+−1 S.D.) was 72+/−14 years old. The frequency of catheterisation was unrelated to the surgical procedure, the type of anaesthesia or the postoperative pain control regime. Age over 65 years old and nocturia were significant indicators for urinary catheterisation (p<
0.05). Patients with urinary incontinence and nocturia were strong determinant for urinary catheterisation (p<
0.03). Males over the age 65 years with a past history of urinary catheterisation (p=0.037) were more likely to be catheterised than females of the same group (p=0.947). This has become more evidential if patients have coexisting urinary incontinence and nocturia (p=0.005). Females over the age of 65 years with urinary incontinence were also significant (p=0.013). The sensitivity for urinary catheterisation in patients over the age of 65 years with previous history of catheterisation, urinary incontinence or nocturia was 89.7%. This group of patients would benefit from pre-operative urinary catheterisation.
While the early period of distraction osteogenesis has been extensively investigated, there are very few data describing the long-term morphology of the regenerate. We performed magnetic resonance scans in ten adults (men age 35+− 11 yr), seven of whom had bone transport for an iatrogenic osseous defect while further three had tibial lengthening for limb length discrepancy. Follow-up ranged between 14 and 43 months (mean : 28 + − 10 months) following the removal of the external fixator. The perimeter, cross- sectional area, volume and the mean signal intensity was calculated from the obtained T1 weighted axial images. Values were compared with the contralateral tibia that acted as control. All cases that had bone transport increased the volume of the tibia from 15.3% up to 50.8%. The regenerated segment was noted to have expanded significantly (p<
0.0001) in all cases. Mean signal intensity in the regenerate decreased in seven cases significantly (p<
0.0001) suggesting increase content of unhydrated tissue such as bone and collagen. The cross-sectional surface of the transported segment was increased in all cases (p<
0.008). Finally in cases that underwent bone transport, the docking site was noted to be obstructed by unhydrated tissue. Contrary to previous claims, the post-distraction osteogenesis tibia is far from normal, consisting of areas with potentially different biomechanical properties. Recognition of these changes is essential not only for appropriate pre-operative counselling but also for considering treatment modalities in case of a fracture.
We present our technique for arthrodesis of the failed Keller’s excisional arthroplasty and the results of postoperative follow-up in a series of eight patients [nine feet]. Arthrodesis of the first metatarsophalangeal joint was performed with a tricortical interposition bone graft stabilised between the first metatarsal and proximal phalanx with a mini dental plate. In all cases the indication for the procedure was for chronic pain at the first meta-tarsophalangeal joint and transfer metatarsalgia of the lateral rays. Post-operative follow-up ranged from 13– 70 months and patients were evaluated using a custom-made satisfaction questionnaire, clinical examination and evaluation of pre-and post-operative x-rays. All patients were female. The mean age of the patients was 53.2 years [range 32–69]. The post- operative questionnaire revealed that five patients [six cases] were highly satisfied with the surgery. However, we do report complications associated with the procedure including one case of deep infection and four cases in total of radiological non-union of the graft. The majority of patients were highly satisfied with the surgery, but this technique for the revision of failed Keller’s procedures has a significant risk of complications, so patients should receive appropriate counselling pre-operatively. Although the mini dental plate was low profile, its decreased rigidity may have been responsible for the four cases of non-union.
The degree of spinal canal encroachment was determined from coronal sections of the CT scan by measuring the antero- posterior diameter (APD) and the surface area (Area). (APD 18.84% – 80.62%, Area 9.5% – 81.29%). Average period of follow up was 24.8 months. All Frankel Group C improved to Frankel D and six out of the 13 Frankel D patients improved to Frankel E. The other seven Frankel D patients out of the 13 patients also had improvement in motor scores but did not change Frankel grade.
The meniscal repairs were carried out by a single surgeon over a period of 4 years. 30 patients ( 1st set) had isolated meniscal repairs. 9 patients ( 2nd set) had meniscal repairs and ACL reconstruction at the same time. 11 patients (3rd set) had meniscal repair followed by ACL reconstruction few months later. The patients were seen in the clinic at 2, 6, 24 weeks post surgery and then kept under surveillance.
There was only 1 failure in the 2nd set who needed partial menisectomy 19 months post repair. This gives it a failure rate of 11.1%. In the 3rd set, there were 2 failures out of whom one needed partial menisectomy and other needed re-repair using the arrows at 3 and 7 months respectively post repair at the time of ACL reconstruction, a failure rate of 18.8%.
Repair of distal biceps tendon rupture is a subject that has received increasing attention in the past decade. In the active individual who desires as close to normal function as possible, repair of biceps tendon is recommended. The author describes a tehnique with a single anterior incision and fixation with superanchors. This method was successfully used in 25 patients with excellent functional results. There were no failures and no complications of neurological injury. The single anterior incision approach in which superanchors are used is recommended as an alternative to the traditional two-incision method. The Biceps brachii is an important flexor of the elbow and is the main supinator of the forearm. Avulsion of its distal tendon insertion is rare injury that mostly affects middle-aged men. It represents only 3% of all biceps tendon ruptures. There is an average of 1.24 spontaneous complete distal biceps ruptures per 100,000 people per year. The decline in the number of distal biceps tendon ruptures with increasing age correlates with a decrease in at-risk activities after the fourth decade of life. Decreased vascularity, tendon impingement, degenerative changes of the distal biceps tendon and the use of anabolic steroids have been postulated to predispose to tendon rupture. Our study shows that repair of distal biceps tendon ruptures using superanchors is safe and gives clinically objective and functional results similar to bone tunnel fixation. We had no major complications, no suture anchor failures and no occurrence of synostosis and neurological injuries. We recommend the use of superanchors for the treatment of distal biceps tendon ruptures.
Do patients’ recollections of disease severity following joint replacement surgery accurately reflect their pre-operative disability? Oxford Knee score questionnaires were sent to 100 patients who had undergone primary knee replacement surgery between January 1998 and July 2000.They were asked to complete these in a manner reflecting their pre-operative disability. The results were then compared with actual scores completed by the same group of patients prior to their surgery. The response rate was 78%.The mean pre-operative score was 45 compared to the recall score of 46.9. The difference was not significant (p=0.77).We believe that recall of disability using a simple knee score is a reliable method of assessing pre-operative disability.
There is a legal and ethical obligation to gain informed consent before treatment commences. A number of bodies have issued guidelines for obtaining consent and these include the Department of Health, the GMC, The Royal College Surgeons of England, and the B.O.A. For a patient to give their informed consent to surgery they must receive sufficient information about their illness, proposed treatment and its prognosis. There are no specific guidelines regarding joint replacement. With this in mind a retrospective case note study was undertaken involving 100 patients who had undergone a hip replacement. Noting the documented discussion at all stages of patient contact.Fifty percent of patients had been seen and listed in the Outpatients by a Consultant, 25% were discussed with the Consultant responsible and the remainder were listed without Consultant input. In only 33 % of cases were any specific risks recorded. This had fallen to 4% on their visit to pre operative assessment clinic. All the consent forms were completed at the time of admission for surgery. Forty percent of these on the day of surgery. The majority were completed by SHOs (58%), while only 4% were completed by consultants. None of the forms noted the lead surgeon. All the consent forms noted some frequently occurring risks. However there was a large variance in the details recorded. The study highlights that the majority of complications are only documented on the consent form, with little note of the dialogue leading up to it. It is also apparent that there is no agreement as to what represents a significant or frequent complication. This review raises a number of important issues. There needs to be a national standardisation of the process of consent. We propose the introduction of a specific consent form for hip replacements that provide improved documentation of the standardised risks involved. This should also include guidelines regarding prosthesis choice, surgical approach and the extent of trainee involvement. In addition we would also suggest there is a need to improve sequential documented discussion up to the point of surgery and introduce specific training for juniors carrying out consent.
We explored the association of post-operative pyrexia following hip arthroplasty and the development of deep infection
The metabolic response of trauma may mimic infection and the reliability of serological parameters for diagnosing infection may be questionable. We prospectively assessed the changes in the acute inflammatory markers, febrile response and the immune profiles of 101 patients following primary hip arthroplasty and their association with infection.