Advertisement for orthosearch.org.uk
Results 1 - 4 of 4
Results per page:
Applied filters
Content I can access

Include Proceedings
Dates
Year From

Year To
Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_4 | Pages 50 - 50
1 Apr 2018
Hafez M Cameron R Rice R
Full Access

Background

Surgical wound closure is not the surgeon”s favorite part of the total knee arthroplasty (TKA) surgery however it has vital rule in the success of surgery. Knee arthoplasty wounds are known to be more prone to infection, breakdown or delayed healing compared to hip arthroplasty wounds, and this might be explained by the increased tensile force applied on the wound with knee movement. This effect is magnified by the enhanced recovery protocols which aim to obtain high early range of movement. Most of the literature concluded that there is no difference between different closure methods

Objectives

We conducted an independent study comparing the complication rate associated with using barbed suture (Quill-Ethicon), Vicryl Rapide (polyglactins910-Ethicon) and skin staples for wound closure following TKA


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_3 | Pages 7 - 7
1 Apr 2018
Hafez M Cameron R Rice R
Full Access

Keywords

Complete Abductor Detachament, Direct Lateral Approach, Abductor Insuffenciency, Hip Arthroplasty

Backgroung

Approach of Total hip replacement (THR) is a very important part of the surgery, the approach dictates the postoperative complications. Lateral approach is one of the most commonly used approaches. The initial lateral approach relied on bony (trochanteric) osteotomy which was later modified to tendon detachment, there are many versions of the lateral approach but the main goal is to detach the hip abductors mechanism to gain access to the underlying joint. One of the modifications is to completely detach the abductors tendon, this offers superior exposure compared to the traditional partial detachment (Hardinge) approach.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_12 | Pages 20 - 20
1 Mar 2013
Ghaffar A Hickey B Rice R Davies H
Full Access

Approximately 20% of patients with ankle fracture sustain syndesmosis injury. This is most common in trans-syndesmotic (type B) and supra-syndesmotic (type C) fibula fractures. Intra-operative assessment of syndesmosis integrity is important because failure to treat these injuries can result in ankle instability and pain.

Our aim was to audit the documentation of intra-operative testing of syndesmosis during ankle fracture open reduction and internal fixation (ORIF). All patients who had ankle fracture ORIF between 1/1/2010 and 21/11/2011 were included. Pre-operative radiographs were reviewed and fractures were classified according to AO classification. Operation notes were reviewed for documentation of assessment of syndesmosis integrity.

153 patients, of mean age 50 years (15–93) were included. 60% (n=92) were female. In 78% of cases (n=119), an assessment of syndesmosis integrity was documented in the operation note. Of the patients with no documented syndesmosis assessment (n=35), the majority had type B fractures (n=34). One patient had a type C fracture.

We have shown that 22% of patients undergoing ankle ORIF for fracture do not have documented assessment of syndesmosis integrity. We suggest that all patients who have ankle ORIF should have intra-operative assessment and documentation of syndesmosis integrity so these injuries are identified and treated accordingly.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 222 - 222
1 May 2011
Hamelynck K Woodnutt D Rice R Bongaerts G
Full Access

Introduction: The articulating surfaces of a new metal-on-metal (MoM) hip prosthesis system were engineered with the ceramic Titanium-Niobium-Nitride (TiNbN) by Physical Vapor Deposition (PVD). The value of PVD technology rests in its ability to modify the surface properties of a device without changing the underlying material properties and biomechanical functionality. In addition to enhancing wear resistance, PVD coatings reduce friction and improve corrosion resistance and thus minimize metal ion release.

Purpose of the study: to investigate whether the elevation of the ion levels of chromium and cobalt, which is normally seen in the blood of patients after MoM hip arthroplasty, could be prevented by the use of the new MoM hip prosthesis with ceramic engineered articulating surfaces.

Materials and Methods: The ACCIS components are manufactured from casted hi-carbon Co-Cr-Mo alloy. Heat treatment reduces the block-carbides in number and size. The surfaces are polished and are micro-finished. Then the surfaces undergo TiNbN-ceramic surface engineering by PVD. The ACCIS prostheses for total hip- and resurfacing arthroplasty are manufactured by implantcast, Buxtehude, Germany.

200 ACCIS resurfacing hip prostheses were implanted in three centers: Morriston Hospital, Swansea, UK, Neville Hall Hospital, Abergavenny, UK and Arthro Clinic, Hamburg, Germany. Blood samples of 60 randomly selected patients were analyzed before surgery and at intervals of 3, 6, 12 and 24 months after surgery. Independent trace metal measurements were performed at the Universitätsklinikum Carl Gustav Carus Dresden, Germany.

Results: The Chromium concentrations were median 0,8215 (0,25–4,6) and the cobalt concentrations were median 1,34 (0,72–4,24)μ gr/L. None of the patients at any moment after operation showed significant increase of Cr and Co ions in the blood and ion levels above the normal limits as described in the Hand book for environmental medicine (1) were exceptional.

Discussion: The median concentrations of chromium and cobalt are significantly lower than levels published in the literature for other MoM metal prostheses. Because the ion level is believed to be a diagnostic tool to identify problems, the absence of an increase of the metal ion levels most probably demonstrates that wear of the metal surfaces can be only minimal (2).

Conclusion:

Surface engineering of metal articular surfaces effectively minimizes corrosion and metal ion release.

The absence of increase of metal ion levels indicates that metal wear is minimal.