Advertisement for orthosearch.org.uk
Results 1 - 16 of 16
Results per page:
Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_2 | Pages 5 - 5
1 Mar 2022
Clutton JM Razii N Chitnis SS Kakar R Morgan-Jones R
Full Access

Introduction

The burden of prosthetic joint infection (PJI) in total knee arthroplasty (TKA) has been rising in line with the number of primary operations performed. Current estimates suggest an infection rate of 1–2.4%. Two-stage revision has traditionally been considered the gold standard of treatment; however, some studies suggest comparable results can be achieved with single-stage procedures. The potential advantages include less time in hospital, a single anaesthetic, reduced costs, and greater patient satisfaction.

Methods

We reviewed data for 72 patients (47 males, 25 females), with a mean age of 71 years (range, 49 to 94), who underwent single-stage revision TKA for confirmed PJI between 2006 and 2016. A standardized debridement protocol was performed with immediate single-stage exchange. All cases were discussed preoperatively at multidisciplinary team (MDT) meetings, which included input from a senior musculoskeletal microbiologist. Patients were not excluded for previous revisions, culture-negative PJI, or the presence of a sinus.


Bone & Joint Open
Vol. 2, Issue 5 | Pages 305 - 313
3 May 2021
Razii N Clutton JM Kakar R Morgan-Jones R

Aims

Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Two-stage revision has traditionally been considered the gold standard of treatment for established infection, but increasing evidence is emerging in support of one-stage exchange for selected patients. The objective of this study was to determine the outcomes of single-stage revision TKA for PJI, with mid-term follow-up.

Methods

A total of 84 patients, with a mean age of 68 years (36 to 92), underwent single-stage revision TKA for confirmed PJI at a single institution between 2006 and 2016. In all, 37 patients (44%) were treated for an infected primary TKA, while the majority presented with infected revisions: 31 had undergone one previous revision (36.9%) and 16 had multiple prior revisions (19.1%). Contraindications to single-stage exchange included systemic sepsis, extensive bone or soft-tissue loss, extensor mechanism failure, or if primary wound closure was unlikely to be achievable. Patients were not excluded for culture-negative PJI or the presence of a sinus.


Bone & Joint Research
Vol. 9, Issue 6 | Pages 311 - 313
1 Jun 2020
Tsang SJ Morgan-Jones R Simpson AHRW


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_16 | Pages 69 - 69
1 Dec 2015
Williams R Kotwal R Roberts-Huntley N Khan W Morgan-Jones R
Full Access

At first-stage revision surgery for infection of total knee arthroplasties, antibiotic-impregnated cement spacers are frequently implanted. Two types of cement spacers are commonly used, “static” and “articulating” cement spacers. Advocates of cement spacers state that they deliver high doses of antibiotics locally, increase patient comfort, allow mobility and provide joint stability. They also minimize contracture of collateral ligaments, thereby facilitating re-implantation of a definitive prosthesis at a later stage. The use of these cement spacers, however, are not without significant complications, including patella tendon injuries.

We describe a series of three patients who sustained patella tendon injuries in infected total knee arthroplasties following the use of a static cement spacer at first-stage knee revision.

The patella tendon injuries resulted in significant compromise to wound healing and knee stability requiring multiple surgeries. The mid-term function was poor with an Oxford score at 24 months ranging from 12–20

Based on our experience, we advise caution in the use of static cement spacer blocks. If they are to be used, we recommend that they should be keyed in the bone to prevent patella tendon injuries.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_15 | Pages 66 - 66
1 Dec 2015
Khan W Williams R Metah A Morgan-Jones R
Full Access

Honey has been used as a topical antiseptic for at least 5,000 years. SurgiHoney is a CE licensed sterile product, which has been proven to be non-toxic and effective when used topically in the treatment of chronically infected wounds. The key difference from other medical grade honey is the broad spectrum antimicrobial characteristics with activity against Gram +ve, Gram –ve and multi-resistant organisms. Its novel role against the bacterial bioburden and biofilm associated with periprosthetic infections around total knee arthroplasties (TKA's) is therefore considered.

SurgiHoney was used as an implant coating immediately prior to wound closure after implantation of salvage endoprosthesis for multiply revised, infected TKA's undergoing staged reconstruction.

We report a consecutive series of multi-revised, infected revision TKA's where SurgiHoney was used as an active antimicrobial coating. We discuss its intra-operative application and early clinical outcomes.

The use of Surgihoney as a novel anti-microbial is established in the management of complex wound infections. This is the first reported use of SurgiHoney as a deep, implant coating in the salvage of prosthetic joint infection.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_16 | Pages 64 - 64
1 Dec 2015
Williams R Khan W Huntley N Morgan-Jones R
Full Access

Joint degeneration may make a total knee arthroplasty (TKA) a requirement for pain relief and function. However, the presence of ipsilateral limb osteomyelitis (OM) makes surgical management extremely challenging.

We report the experience of a high volume revision knee surgeon managing ipsilateral limb multi resistant OM and the outcome of subsequent TKA.

Four consecutive patients were identified who had either ipsilateral femoral or tibial chronic osteomyelitis treated prior to undergoing TKA. Surgery to eradicate the osteomyelitis involved a Lautenbach compartmental debridement, and where necessary, healing by secondary intention. The decision to proceed to a TKA was based on history, clinical examination and radiological findings of advanced osteoarthritic change.

The patients had a mean age of 50 years. They had a background of multi-organism OM and underwent single-stage TKAs at an average of 63 months following eradication of the underlying OM.

Three patients did well but had complications associated with poor skin and soft tissues, and abnormal bone anatomy. One patient developed an infection and following a re-revision had an arthrodesis.

The results for the four cases are summarised in Table 1.

We have highlighted that patients with ipsilateral limb multi resistant OM are a difficult cohort to manage.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_15 | Pages 51 - 51
1 Dec 2015
Williams R Khan W Williams H Abbas A Mehta A Ayre W Morgan-Jones R
Full Access

A common step to revision surgery for infected total knee replacement (TKR) is a thorough debridement. Whilst surgical and mechanical debridement are established as the gold standard, we investigate a novel adjuvant chemical debridement using an Acetic Acid (AA) soak that seeks to create a hostile environment for organisms, further degradation of biofilm and death of the bacteria.

We report the first orthopaedic in vivo series using AA soak as an intra-operative chemical debridement agent for treating infected TKR's. We also investigate the in vitro efficacy of AA against bacteria isolated from infected TKR's.

A prospective single surgeon consecutive series of patients with infected TKR were treated according to a standard debridement protocol. Patients in the series received sequential debridement of surgical, mechanical and finally chemical debridement with a 10 minute 3% AA soak.

In parallel, we isolated, cultured and identified bacteria from infected TKR's and assessed the in vitro efficacy of AA. Susceptibility testing was performed with AA solutions of different concentrations as well as with a control of a gentamicin sulphate disc. The effect of AA on the pH of tryptone soya was also monitored in an attempt to understand its potential mechanism of action.

Physiological responses during the AA soak were unremarkable. Intraoperatively, there were no tachycardic or arrythmic responses, any increase in respiratory rate or changes in blood pressure. This was also the case when the tourniquet was released. In addition, during the post-operative period no increase in analgesic requirements or wound complications was noted. Wound and soft tissue healing was excellent and there have not been any early recurrent infections at mean of 18 months follow up.

In vitro, zones of inhibition were formed on less than 40% of the organisms, demonstrating that AA was not directly bactericidal against the majority of the clinical isolates. However, when cultured in a bacterial suspension, AA completely inhibited the growth of the isolates at concentrations as low as 0.19%v/v.

This study has shown that the use of 3% AA soak, as part of a debridement protocol, is safe. Whilst the exact mechanism of action of acetic acid is yet to be determined, we have demonstrated that concentrations as low as 0.19%v/v in solution in vitro is sufficient to completely inhibit bacterial growth from infected TKR's.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 86 - 86
1 Sep 2012
Azam A Agarwal S Morgan-Jones R
Full Access

Introduction

This study was undertaken to evaluate the early results of a new implant system - the metaphyseal sleeve - in revision total knee replacement. The femoral and tibial metaphyseal sleeves are a modular option designed to deal with metaphyseal bone loss and achieve cementless fixation over a relatively wide area in the metaphysis.

Methods

Over three years, femoral and/or tibial metaphyseal sleeves were implanted in 104 knees in 103 patients (54 male and 49 female). The clinical notes and radiographs of these patients were reviewed retrospectively. Thirty one patients had revision for infection, 42 for aseptic loosening, and 31 for instability, pain or stiffness. Eighty nine knees were revised as a single stage and 15 were done as two stage procedure. Minimum follow up is 12 months (average 18.5 months).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 51 - 51
1 Sep 2012
Edwards G Hall A Morgan-Jones R
Full Access

We describe the results for the management of chronic osteomyelitis in long bones using a new single stage procedure, the Cardiff technique. Fourteen consecutive patients were treated prospectively. The patients had a mean age of 52; all patients had a mean stay in hospital of 5 days with outpatient dressings. All patients had tibial fractures, 2 were infected non unions. The origin of infection was traumatic in 13 cases and haematogenous in 1 case. This one stage procedure or The Cardiff technique, uses techniques described by both Papineau's 3 stage method and Lautenbach's procedure. It involves removal of all avascular and infected tissue via marginal debridement, opening of the medullary cavity proximally and distally, compartmental debridement and copious saline irrigation. The wound is then packed with Jelonet and kaltostat and fresh dressings applied weekly. The wound is left to heal via secondary intention. There is no routine use of antibiotics. Antibiotics were only used when required, i.e. Clinical evidence of cellulitis or infection. 11 patients healed with no further surgery, no skin grafting, no bone grafting and no flap coverage. Mean time to healing was 5 months; both non unions united giving results similar to other accepted techniques. There were 3 residual infections, 2 due to inadequate debridement which required a single further compartmental debridement (Lautenbach method), 1 had an avascular bone edge requiring further local debridement. We feel this procedure confers the following advantages; minimal surgical insult, early discharge, out patient management, good outcomes and most importantly, high patient satisfaction. It also serves as a reminder that simple wounds do well with simple solutions.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 56 - 56
1 Jul 2012
Azam A Agarwal S Morgan-Jones R
Full Access

Purpose of the study

This study was undertaken to evaluate the early results of a new implant system - the metaphyseal sleeve - in revision total knee replacement. The femoral and tibial metaphyseal sleeves are a modular option designed to deal with metaphyseal bone loss and achieve cementless fixation over a relatively wide area in the metaphysis.

Methods

Over three years, femoral and/or tibial metaphyseal sleeves were implanted in 104 knees in 103 patients (54 male and 49 female). The clinical notes and radiographs of these patients were reviewed retrospectively. Thirty one patients had revision for infection, 42 for aseptic loosening, and 31 for instability, pain or stiffness. Eighty nine knees were revised as a single stage and 15 were done as two stage procedure. Minimum follow up is 12 months (average 18.5 months).


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 41 - 41
1 Jan 2011
Caesar B Morgan-Jones R Warren R Wade R Roberts P Richardson J
Full Access

Thirty-five patients were followed prospectively from their referral to the Problem Fracture Service with chronic osteomyelitis of diaphyseal bone between November 1994 and June 1999.

The patients were treated using a closed double-lumen suction irrigation system following reaming and arthroscopic debridement of the intramedullary canal; this is a modified system based on the work of Charles Lautenbach. Results of these procedures were regularly followed up in clinic, and between June and July 2007 the whole cohort was reviewed via postal questionnaire, telephone and case note review.

At a mean follow up of 101 months, 26 were living with no evidence of recurrence, 4 had died of unrelated causes with no evidence of recurrent infection. Four patients had persisting problems with sinus discharge requiring intermittent antibiotic therapy and 1 patient had his limb amputated for recurrent metaplastic change.

These results gave this cohort an 86% clearance of infection, with recurrence in 12%, which is comparable to the Papineau and Belfast techniques with significantly less surgical insult to the patient.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 409 - 410
1 Jul 2010
Kotwal RS Prasad N Morgan-Jones R
Full Access

Purpose of the study: The purpose of this study is to present our initial experience of single stage revision surgery for infected total knee arthroplasty (TKA).

Methods and results: 12 patients underwent single stage revision for infected TKA. The average patient age was 72.5 years and M: F was 2:1. 5 of the 12 patients had frank infection with presence of discharging sinuses pre-operatively. The procedure involved explantation, debridement, subtotal synovectomy, use of high pressure carbon dioxide (Carbojet) and re-implantation using revision prosthesis and antibiotic laden cement. Utmost care was taken to restore the balance and stability of the revised knee. All the patients were given appropriate intravenous and oral antibiotics in the peri-operative period. Oxford knee scores (OKS) were obtained pre-operatively and at the latest follow-up. Patient satisfaction was also assessed.

At the latest follow-up, none of the patients had recurrence of the infection nor did they need any further surgical procedure. There was no radiographic evidence of loosening of the prosthesis. The OKS had improved from a mean of 17 pre-operative to 41 at the latest follow-up. All the patients were extremely satisfied with the outcome.

Conclusion: Knee function and patient satisfaction improved significantly after single stage revision for infected TKA. None of the patients needed further surgery in the short term. Early results are very encouraging and this change in practice may save on costs and patient morbidity associated with the second stage.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 419 - 419
1 Jul 2010
Kotwal RS Fairclough J Morgan-Jones R
Full Access

Purpose of the study: We report an unusual complication of patella tendon rupture that occurred secondary to the use of static cement spacer blocks in a series of three patients undergoing staged revision total knee arthroplasty (TKA) for infection.

Methods and results: 3 male patients developed patella tendon injury secondary to anterior subluxation of static cement spacer blocks used at the first of a two-stage revision procedure for infected TKA. Average patient age was 70 years. The interval between the 1st and the 2nd stages varied between 3.5 to 24 months. At the second stage, it was observed that the patella tendon was completely severed and irreparable in one case, whereas it was partially injured and repairable in the other two cases. In the case with irreparable tendon injury, stable joint reconstruction could not be achieved at the second stage and ultimately resulted in knee arthrodesis. In the other two cases, 2nd stage revision was performed using hinged revision knee components and the tendon injury was repaired and protected with a circlage wire. None of the patients were satisfied with their outcome at the final review.

Conclusion: This is the first report in the literature reporting the complication of patella tendon rupture secondary to the use of static cement spacer blocks in staged revision knee arthroplasty. The injury can either be repairable or irreparable. The functional outcome and satisfaction is not good after the salvage procedures. Therefore, we recommend that these spacer blocks should not be used in revision knee arthroplasty.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 78 - 78
1 Mar 2009
Gudena R Mehta J Morgan-Jones R
Full Access

Introduction: Sequential staged distraction with fixed rate and rhythm, alternative compression and distraction is well described in the literature to treat non-unions. However we looked the union in established non-unions of tibia using one stage distraction without further manipulation at the fracture site maintaining the stability.

Materials and Methods: 12 patients with established tibial non-unions were referred during the period of 2001–2005. 2 cases were infected non unions. All patients were symptomatic and exhibited deformity at the non-union site. Ten males, two females were in the study group with a mean age of 39.2 years. The location of non-union was distal 1/3 of tibia in 8 cases and 2 cases of proximal and middle 1/3. External fixation was used to acutely distract the fracture (one stage) and tension the soft tissues to attain fracture stability. Infection at the fracture site required further operative debridement. Regular followup with radiographs to assess the union.

Results: Osseous union was achieved in all the cases at an average time period of 17.2 weeks. There was no recurrence of osteomyelitis in the infected cases following secondary debridement. All the patients were pain free and fully mobile without aid at review.

Conclusion: We concluded that acute distraction osteogenesis produces fracture union in selected established cases of non union. This method can be used to obtain impressive gains in the lengths of the long bones. Bone is uniformly produced regardless of the location of the non union. This is more patient compliant, effective and relatively easy to perform.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_I | Pages 30 - 30
1 Jan 2003
Morgan-Jones R Joneleit M Solis G Cross MJ
Full Access

To document the incidence of intra-articular pathology resulting from delayed Anterior Cruciate Ligament (ACL) reconstruction

A prospective assessment of meniscal and chondral damage found at the time of primary ACL reconstruction, and the relationship of incidence of intra-articular pathology to time since original ACL injury.

We reviewed 1960 patients who had undergone a primary ACL reconstruction. There were 1443 Males and 517 females, with an average age of 28.3 years. The average age at injury was 25.4 years.

1136 patients (58%) had secondary intra-articular pathology, 621 (54.7%) had a medial meniscal tear, 594 (52.4%) had a lateral meniscal tear and 381 (33.5%) had chondral damage. The average time from injury to reconstruction was 2.9 years (34.8 months) Those with secondary intraarticular pathology presented for reconstruction later, average 3.9 years (46.8 months), compared to those without secondary pathology, average 1.5 years (18 months).

The incidence of secondary intra-articular pathology increased with delay between original ACL injury and reconstruction. 41% of those waiting 12 months; 60% of those waiting 3 years; 79% of those waiting 5 years and 88% of those waiting 10 years had secondary intra-articular pathology.

This study confirms the relationship between an unstable ACL deficient knee and the incidence of secondary intra-articular pathology. Furthermore, our study reveals the increasing incidence of meniscal and chondral pathology the greater the delay from injury to ACL reconstruction. To prevent unnecessary secondary intra-articular pathology we recommend ACL reconstruction is performed with minimal delay.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 269 - 269
1 Nov 2002
Cross M Roger G Morgan-Jones R Machan S Parish E
Full Access

Introduction: The Motus (Osteo) total knee replacement design is an uncemented, stemless, hydroxyapatite-coated prosthesis designed as a low profile resurfacing implant.

Aim: To review the results after five to eight years of the use of this prosthesis by one surgeon and to discuss the perceived advantages of its design.

Methods: Between 1992 and 1996 the Motus (Osteo) prosthesis was used in 606 primary total knee replacements in 409 patients. The evaluation was undertaken using a clinical knee score based on the Knee Society Score and the Hospital for Special Surgery (HSS) score, which produces a maximum score of 200/200.

Results: The mean age was 69 years (range: 31 to 88 years) with 53% of the patients being female. Osteoarthritis was the underlying pathology in the majority of the cases. The minimum time to follow up was 60 months (mean: 79, range: 60 to 104 months). The mean pre-operative knee score was 98/200 with a range of movement from six degrees to 122 degrees. After five years, the mean knee score was 180/200 with a range of movement from one degree to 113 degrees. To date only two patients have required a revision procedure, both for deep infection. Twenty-six patients have died and six have been lost to follow-up as they are overseas.

Conclusion: At a minimum five-year review, the Motus (Osteo) total knee replacement prosthesis produced excellent functional and clinical results with a low rate of complications.