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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 29 - 29
1 Jul 2022
Bishi H Afzal I Wang C Stammers J Mitchell P Field R Alazzawi S
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Abstract

Introduction

In revision knee arthroplasty, rotating hinge implants (RHK) have been considered to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). The aims of this study were to compare patient reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high volume elective orthopaedic centre with previously validated bespoke database.

Methodology

One hundred and eight patients who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EQ5D, Health State and Oxford Knee Scores were collected pre-operatively and at 1 year post-operatively. Complication data was collected at 6 weeks, 6 months, 1 year and 2 years post-operatively. NJR data was interrogated, in addition to our own database, to investigate implant survival.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 67 - 67
1 Mar 2013
Alazzawi S Haddad F
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Introduction

Acute infection following Total Hip Arthroplasty (THA) is a serious complication. It is commonly treated by irrigation and debridement (I&D) with component retention (exchange only the mobile parts of the joint - head and liner). However, the reported re-infection rate with the use of this approach remains high. We are reporting our experience in using single - stage revision arthroplasty in treating acute infection of THA. We hypothesized that the infection control rate after immediate early revision for acute infection of cementless implants is better than has been reported for I&D with exchange of mobile parts.

Methods

From our infection arthroplasty database, we reviewed the outcome of 19 patients who had an acute infection (within 6 weeks) of cementless THA. Our management strategy includes I&D and single-stage (direct-exchange) revision arthroplasty followed by 6 weeks course of culture specific oral antibiotics.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 190 - 190
1 Jan 2013
Alazzawi S Bardakos N Hadfield G Butt U Beer Z Field R
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Using general practitioner records, hospital medical notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with an overall mean age of 71.8 years (34.3–93.2). A total of 319 (79.4%; 95% confidence interval, 75.4%–83.3%) reported complications were confirmed to be correct. Very high rates of correct reporting were demonstrated for infection (94.5%) and further surgery (100%), whereas the rates of reporting deep venous thrombosis (DVT), pulmonary embolism, myocardial infarct and stroke were lower (75%–84.2%). Dislocation, periprosthetic fractures and nerve palsy were associated with modest rates of correct reporting (36%–57.1%). More patients who had had knee surgery delivered incorrect reports of dislocation (p = 0.001) and DVT (p = 0.013). Despite these variations in accuracy, it appears that post-operative complications may form part of a larger patient-reported outcome programme for monitoring outcome after elective joint replacement surgery.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 441 - 441
1 Sep 2012
Alazzawi S Mayahi R Musonda P Parker M
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Objective

The aim of this study was to determine the correlation between body weight and fracture union for displaced intracapsular fracture neck of femur treated by closed reduction and internal fixation.

Patients and methods

A total of 197 patients with displaced intracapsular fracture of neck of femur, all of whom have been treated with closed reduction and internal fixation, were studied. The mean age was 71 years and 79% were female. Patients were followed up until fracture endpoint (union or non-union) with minimum follow up of 200 days.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 262 - 262
1 Sep 2012
Alazzawi S Hadfield S Bardakos N Field R
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Introduction

The outcomes programme of our institution has been developed from a system first used at Epsom and St Helier NHS Trust 15 years ago. The system was implemented at our institution when it opened in 2004, and has been used to collect data on over 17,000 joint replacement operations so far. A bespoke database is used to collect, analyse and report outcome data.

Methods

An integrated system allows the collection of patient-reported outcome measures (PROMS), patient satisfaction scores, radiological assessment, and medical or surgical complications. Functionality allows the transfer of data from existing clinical management programmes, and the generation of customised letters and questionnaires to send to patients. Analysis of data and report production is fully automated. Data is collected pre-operatively, during the inpatient stay, and post-operatively at 6 weeks, 6, 12 and 24 months. Results are disseminated to the surgeons, the senior management team and the Clinical Governance Committee.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 442 - 442
1 Sep 2012
Field R Alazzawi S Field M Bardakos N Pinskerova V Freeman M
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Introduction

Femorotibial malalignment exceeding ±3° is a recognised contributor of early mechanical failure after total knee replacement (TKR). The angle between the mechanical and anatomical axes of the femur remains the best guide to restore alignment. We investigated where the femoral head lies relative to the pelvis and how its position varies with respect to recognised demographic and anatomic parameters. We have tested the hypothesis of the senior author that the position of the centre of the femoral head varies very little, and if its location can be identified, it could serve to outline the mechanical axis of the femur without the need for sophisticated imaging.

Patients & Methods

The anteroposterior standing, plain pelvic radiographs of 150 patients with unilateral total hip replacements were retrospectively reviewed. All patients had Tönnis grade 0 or 1 arthritis on the non-operated hip joint. All radiographs were obtained according to a standardised protocol. Using the known diameter of the prosthetic head for calibration, the perpendicular distance from the centre of the femoral head of the non-operated hip to the centre of pubic symphysis was measured with use of TraumaCad software. Anatomic parameters, including, but not limited to, the diameter of the intact femoral head, were also measured. Demographic data (gender, age, height, weight) were retrieved from our database.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 130 - 131
1 May 2011
De Rover WS Kang S Alazzawi S Smith T Walton N
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Materials and Methods: The institution’s prospective database of unicompartmental knee replacements was reviewed for all Oxford Phase III Unicompartmental Knee Replacement (Biomet, UK) undertaken from January 2004 to July 2007. This identified a total of 645 procedures undertaken. We included all cases where there was pre-operative skyline radiographs and American Knee Scores, Oxford Knee Score and SF-12 data, in addition to skyline radiographs, OKS and SF-12 data with a minimum of 2 years follow-up. All patients without this baseline and follow-up data were excluded. This provided a total of 196 knees (162 patients)

Using Altman’s nomogram, the sample size was calculated to be 85 for a power of 90%, with an α significance level of 0.05.

Using this database, digital radiographs were assessed using the institution’s PACS system. Pre-operative and follow-up skyline radiographs following Jones et al’s (1993) patellofemoral scoring system were examined by four assessors utilising Jones’ patellofemoral scoring system. In addition, in cases where patellofemoral joint changes were evident, each assessor acknowledged whether this involved the medial, lateral or bilateral aspects of the patellofemoral joint.

Intra-observer reliability was made comparing the four assessors.

Statistical analysis was performed, using the Statistical Package for the Social Sciences (SPSS) 16.0 for Windows (SPSS Inc, Chicago, Illinois).

In order to determine whether changes in patellofemoral joint status related to patients function or quality of life, the difference in OKS and SF-12 from pre-operative to the follow-up period was assessed.

Results: There was a statistically significant progression of patellofemoral osteoarthritis as found on the preoperative and postoperative radiographs (p< 0.01, Mann Whitney), there was a correlation between a low OKS and Jones patellofemoral score (P< 0.05, Mann-Whitney). However, there was no correlation between the site of patellofemoral involvement and outcome scores.

Conclusion: Due consideration should be taken when offering medial unicompartmental knee replacement to patients with patellofemoral involvement and this is independent of the site of patellofemoral involvement.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 37 - 37
1 Mar 2009
Nazir A Roy S Mathur K Alazzawi S
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Background: goal of our study was to predict the size of intramedullary nail using forearm as reference. Intra-medullary nailing has become favoured treatment for femoral shaft fractures. An implant of the correct size is needed to achieve the desired results. Preoperative templating is useful and well established for trauma and elective surgery to ensure availablity of a suitable implant of correct size preoperatively. Various ways have been described to estimate the nail length. Most commonly used is to x-ray the other limb or directly measure the reamer under x-ray. However these methods involve use of x-rays and information is not well-timed. We describe a simple technique, which can be used to predict the length of femur and therefore have the intra medullary nail of appropriate length available.

METHOD: measurements were taken on 100 volunteers from the tip of olecranon to the tip of little finger and tip of greater trochanter to palpable joint line on the lateral side of the knee. Two observers took the measurements on both sides. We used an ordinary plastic tape measure for ease of use and reproducibility.

RESULTS: statistical analysis revealed a very strong correlation (with pearson correlation factor of 1) between the two lengths. Difference between the two means was 0.16 Mm.

CONCLUSION: forearm reference represents maximum nail length required. It provides a useful method of estimation of femoral length. It can be easily applied in clinical practice with a tape measure alone without resort to x-rays and other expensive and possibly harmful means.