The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examinedwhether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1) and the last 9 (Cohort 2) hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy.Purpose:
Methods:
To look at the effect of width and tissue at surgical margins, together with the use of adjuvant therapy on locally recurrent disease and disease free survival. The distance (mm) and tissue has been regularly reported for 5 years, prior to this it was reported as wide, marginal or intra-lesional. It is known from previous studies that 90% of locally recurrent disease for osteosarcoma and Ewing's occurs within 2 years from surgery. Therefore all primary bone sarcomas of the pelvis and appendicular skeleton that underwent surgery between 1/1/2005 and 1/1/2008 were entered, giving at least 2 years follow up. The pathology records were reviewed and the margins and percentage tumour necrosis were recorded. Those patients who had suffered local or distal disease relapse or died were highlighted. Analysis was undertaken by Kaplan Meier survival curves with univariate and multivariate analysis.Introduction
Methods
Recently a great deal of interest has emerged in new techniques for resection of bone tumours, such as the use of computer guided surgery, joint sparing prostheses and epiphysiolysis. However, all the techniques may require narrower margins at resection than the traditional Enneking wide margins. The aim of the study was to look at the effect of width and tissue at surgical margins, together with the use of adjuvant therapy on locally recurrent disease and disease free survival. The quality in terms of precise distance (mm) and tissue has been regularly reported by our pathologists for 5 years, prior to this it was reported as wide, marginal or intralesional. It is known from previous studies that 90% of locally recurrent disease for osteosarcoma and Ewings occurs within 2 years from surgery. Therefore all primary bone sarcomas of the pelvis and appendicular skeleton that underwent surgery between 1/1/2005 and 1/1/2008 were entered into the study group, giving at least 2 years follow up. The pathology records were reviewed and the quality of the margins and percentage tumour necrosis were recorded. Those patients who had suffered local or distal disease relapse or died were highlighted. Analysis was undertaken by Kaplan Meier survival curves with univariate and multivariate analysis.Introduction
Methods
To assess if paediatric patients are getting adequate gonadal protection whilst undergoing pelvic X-rays. A retrospective study of 100 AP pelvic X-rays in 62 consecutive paediatric patients was performed. All children 16 years and under (mean = 8 years) who had an AP pelvic X-ray at our institution between 1st April 2004 and 1st July 2005 were included in the study. When reviewing the X-rays, the manufacturer’s guidelines for ideal shield size and position were strictly followed to assess whether adequate gonadal protection was being achieved (the lead shield must be completely covering the true pelvis in girls and the scrotum in boys). A subsequent questionnaire survey involving 20 radiographers was carried out. In 78 cases gonadal protection was inadequate. This was unrelated to the child’s age or sex. In 72 cases shield position and in 11 cases shield size was incorrect. The survey showed that 40% of radiographers believed that the gonadal shield was either difficult to use or had a poor design. Twenty percent felt they had received inadequate training. Gonadal shields reduce radiation exposure of the reproductive organs during pelvic X-rays. Many designs are available on the market but not all designs function adequately. Our study showed that a poor design of gonadal shield can cause unnecessary radiation exposure. We present this audit to make people aware of this poor design and recommend that a detailed market survey prior to buying such equipment and subsequent training of staff in its proper use must be carried out.
The aim of this study was to demonstrate the benefits of a simple blood transfusion protocol in Primary Total Knee Replacement. Patients undergoing TKR in the UK usually have either blood cross matched or have an auto transfusion of drained blood postoperatively. Audit of blood requirements of patients undergoing TKR showed that a large amount of blood was wasted. A CT ratio (Ratio of number of units of blood cross matched to number of units transfused) of 4.86 was obtained. Range recommended by the blood transfusion society is 2: 1 to 3: 1. A protocol was then made to Group and Save and Antibody Screen for all patients having a primary TKR, except patients with haemoglobin less than 12.5 gm/dl pre operatively and those patients with multiple red cell antibodies in their blood. A further study involving 50 patients was carried out using the new protocol. Two units of blood was cross matched for each of 5 patients (3 with Hb <
12 gm/dl and 2 with red cell antibodies). Post operatively the 3 patients with Hb <
12 gm/dl required blood transfusion of 2 units each, reducing the CT ratio to 1.7: 1. The benefits from above protocol are : a). Patient safety as risks of transfusion are avoided and b). Cost saving for trust on haematology technician time and on transfusion sets which cost around £70 each.
