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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 200 - 200
1 Sep 2012
Queally J Cummins F Brennan S Shelly M O'Byrne J
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Despite the high prevalence of musculoskeletal disorders seen by primary care physicians, numerous studies have demonstrated deficiencies in the adequacy of musculoskeletal education at multiple stages of medical education. The aim of this study was to assess a newly developed undergraduate module in musculoskeletal medicine.

Methods

A two-week module in musculoskeletal medicine was designed to cover common musculoskeletal disorders that are typically seen in primary care. A previously validated examination in musculoskeletal medicine was used to assess the cognitive knowledge of ninety-two students on completion of the module. A historical control group (seventy-two students) from a prior course was used for comparison.

Results

The new module group (2009) performed significantly better than the historical (2006) control group in terms of score (62.3% versus 54.3%, respectively; p < 0.001) and pass rate (38.4% versus 12.5%, respectively; p = 0.0002).

In a subgroup analysis of the new module group, students who enrolled in the graduate entry program (an accelerated four-year curriculum consisting of students who have already completed an undergraduate university degree) were more likely to perform better in terms of average score (72.2% versus 57%, respectively; p < 0.001) and pass rates (70.9% versus 21.4%, respectively; p < 0.001) compared with students who had enrolled via the traditional undergraduate route. In terms of satisfaction rates, the new module group reported a significantly higher satisfaction rate than that reported by the historical control group (63% versus 15%, respectively; p < 0.001).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 210 - 210
1 Sep 2012
Cummins F Kelly D Kenny P
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Background and purpose

The two most common complications of femoral impaction bone grafting are femoral fracture and massive implant subsidence. We investigated fracture forces and implant subsidence rates in embalmed human femurs undergoing impaction grafting. The study consisted of two arms, the first examining the force at which femoral fracture occurs in the embalmed human femur, and the second examining whether significant graft implant/subsidence occurs following impaction at a set force at two different impaction frequencies.

Methods

Using a standardized impaction grafting technique with modifications, an initial group of 17 femurs underwent complete destructive impaction testing, allowing sequentially increased, controlled impaction forces to be applied until femoral fracture occurred. A second group of 8 femurs underwent impaction bone grafting at constant force, at an impaction frequency of 1 Hz or 10 Hz. An Exeter stem was cemented into the neomedullary canals. These constructs underwent subsidence testing simulating the first 2 months of postoperative weight bearing.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 41 - 41
1 May 2012
Cummins F Kenny P Kelly D
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Summary

A laboratory based study investigating fracture forces and implant subsidence rates in embalmed human femurs undergoing impaction grafting.

Methods

Human femurs were harvested from cadavers for destructive impaction testing. An initial group of femurs underwent destructive impaction testing, using the impaction grafting technique as described by Gie et al, modified, allowing increasing, controlled impaction forces to be applied until femoral fracture occurred.

A second group of embalmed human femurs underwent impaction bone grafting at constant force, with varied impaction frequencies. An Exeter stem was cemented into the neo-medullary canals. These constructs underwent subsidence testing simulating the first 2 months post-operative weight-bearing.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 43 - 43
1 Mar 2010
Egan C Cummins F O Connor P Kenny P
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Aim: It is widely accepted that surgical skills improve with experience. Part of this experience comes from operating on patients while honing new skills. Total hip arthroplasty is one such procedure. This paper examines outcomes in relation to the primary surgeon

Methodology: All patients who had an Exeter femoral component implanted and 2 years follow-up in the hospital joint register had their X-Ray, outcome scores and complications reviewed. Complications are routinely recorded as part of the joint register and hospital computer discharge system. Radiological outcome measures were taken as recommended by Johnston et al. Procedures were recorded as either performed by consultant surgeon or registrar supervised by consultant surgeon.

Results: Post operative WOMAC scores at six months and 2 years were similar in both groups (Consultant 19.6, registrar 22.32 at 6 months) SF-36 figures were similar at six months (Consultant performed 78.56, consultant supervised 75.39). There was a difference in SF-36 at 2 years (72.77 vs 63.11) but this was not statistically significant. Average abduction angle was lower in consultant supervised than consultant performed procedure. (36.75 vs 47 deg) Barrack cement grading was similar in both groups. Consultant inserted stems were more likely to be in neutral position compared to consultant supervised stems (84% vs 56%)

Conclusion: In both goups the quality of life indexes do show a difference in outcome which relates to the primary surgeon.. However decreased abduction angle may lead to decreased range of motion post operatively and should be addressed intraoperatively.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 52 - 52
1 Mar 2010
Egan C Cummins F Kenny P
Full Access

Introduction: With the advent of harder wearing metal alloys such as cobalt chrome the technique of hip surface replacement has been resurrected. It is becoming an increasingly popular especially with the younger patient with end-stage hip arthritis. In this study we seek to demonstrate this procedure’s short term success rate for Cappagh and to demonstrate the new Joint Registry in action which has been collating data for the last 2 years.

Methods: The Bluespiers online database was used to identify 200 consecutive primary hip resurfacing performed in Cappagh National Orthopaedic Hospital between January 1st 2006 and January 31st 2008. Patients completed a WOMAC 3.1 Osteoarthritis assessment and SF-36 General Health survey before their operation and at their 1st Joint Registry Clinic Review, typically between five and 9 months post-operatively.

Findings: 200 hip resurfacing procedures by 7 surgeons were identified between January 1st 2006 and January 31st 2008. The mean patient age was 55 years(range, 23 to 81 years). 48 (32%) were female and 152 (68%) were male. Two post-operative femoral neck fractures were recorded which were converted to THR.

We used the SF-36 score as a surrogate marker of overall subjective health and quality of life. The average preoperative SF-36 score was 50.93 (5 to 94.4). The average SF-36 score at 1st Joint Review Clinic visit was 77.55 (23.77–100). This demonstrates an average improvement of 24.44 (−17.69 to 59.75)

As a measure of arthritis severity we will use the WOMAC 3.0 score as a surrogate. The average preoperative WOMAC score was 52.95 (4–92) and the average WOMAC score at 1st Joint Registry Review was 16.11 (0–75). This demonstrates an average decrease in WOMAC score of 34.46 (−29 to 83)

Discussion: Hip surface replacement in Cappagh as recorded by the Joint registry has good success in treating hip arthritis with good improvement of quality of life. We would hope to demonstrate with the joint registry continuing long-term success of this treatment.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 99 - 99
1 Mar 2010
Egan C Cummins F O Connor P Kenny P
Full Access

Aim: It is widely accepted that surgical skills improve with experience. Part of this experience comes from operating on patients while honing new skills. Total hip arthroplasty is one such procedure. This paper examines outcomes in relation to the primary surgeon

Methodology: All patients who had an Exeter femoral component implanted and 2 years follow-up in the hospital joint register had their X-Ray, outcome scores and complications reviewed. Complications are routinely recorded as part of the joint register and hospital computer discharge system. Radiological outcome measures were taken as recommended by Johnston et al. Procedures were recorded as either performed by consultant surgeon or registrar supervised by consultant surgeon.

Results: Post operative WOMAC scores at six months and 2 years were similar in both groups (Consultant 19.6, registrar 22.32 at 6 months) SF-36 figures were similar at six months (Consultant performed 78.56, consultant supervised 75.39). There was a difference in SF-36 at 2 years (72.77 vs 63.11) but this was not statistically significant. Average abduction angle was lower in consultant supervised than consultant performed procedure. (36.75 vs 47 deg) Barrack cement grading was similar in both groups. Consultant inserted stems were more likely to be in neutral position compared to consultant supervised stems (84% vs 56%)

Conclusion: In both goups the quality of life indexes do show a difference in outcome which relates to the primary surgeon. However decreased abduction angle may lead to decreased range of motion post operatively and should be addressed intraoperatively.