Hip precautions are currently practiced in three-quarters of trauma hospitals in the UK, despite national recommendations from the ‘Blue Book’ not stating it as a requirement. Valuable therapist time is utilised alongside the need for specialised equipment, which can potentially delay discharge whilst it is being arranged.
Objective of this study was to explore the current practice of the use of hip precautions on discharge following hemiarthroplasty for hip fractures. To also explore whether they are necessary and to identify areas for improvement to benefit patient care overall. Online survey distributed to various Trauma and Orthopaedic Departments across the UK. Survey was available over a 4-month period, collecting 55 responses overall. Majority of responses were from trauma and orthopaedic consultants who were aware of the ‘Blue Book’ recommendations. The majority of trusts who responded did not practice hip precautions and did not feel this increased the risk of dislocations on discharge. Recommendations included integration of hip precautions in the post-op advice in coordination with the physiotherapist and information leaflets on discharge regarding hip precautions.
Hip precautions were not commonly practiced, for reasons including patient compliance and the inherently stable procedure of a hemiarthroplasty compared to a THR, reducing the need for hip precautions. Hip precautions are not widely regarded as a useful practice for post-hip hemiarthroplasty, viewed as utilising more resources and increasing costs and risk due to increased hospital stay. Thus, this potentially delays discharge overall. A consistent approach should be implemented in treating patients post-hip hemiarthroplasty.
To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach. Hospital records of 27 patients with isolated congenital thoracolumbar kyphosis undergoing surgery at a single centre were retrospectively analyzed. All patients underwent deformity correction which involved a three-column osteotomy by single-stage posterior-only approach. Radiological parameters (local kyphosis angle (KA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), C7 sagittal vertical axis (C7 SVA), T1 slope, and pelvic incidence minus lumbar lordosis (PI-LL)), functional scores, and clinical details of complications were recorded.Aims
Methods
Calcium sulphate has traditionally been used as a filler of dead space arising during surgery. Various complications have been described following the use of Stimulan bio-absorbable calcium sulphate beads. This study is a prospective observational study to assess the safety profile of these beads when used in revision arthroplasty, comparing the complication rates with those reported in the literature. A total of 755 patients who underwent 456 revision total knee arthroplasties (TKA) and 299 revision total hip arthroplasties (THA), with a mean follow-up of 35 months (0 to 78) were included in the study.Aims
Methods
In order to prevent dislocation of the hip after total hip arthroplasty
(THA), patients have to adhere to precautions in the early post-operative
period. The hypothesis of this study was that a protocol with minimal
precautions after primary THA using the posterolateral approach
would not increase the short-term (less than three months) risk
of dislocation. We prospectively monitored a group of unselected patients undergoing
primary THA managed with standard precautions (n = 109, median age
68.9 years; interquartile range (IQR) 61.2 to 77.3) and a group
who were managed with fewer precautions (n = 108, median age 67.2
years; IQR 59.8 to 73.2). There were no significant differences between
the groups in relation to predisposing risk factors. The diameter
of the femoral head ranged from 28 mm to 36 mm; meticulous soft-tissue
repair was undertaken in all patients. The medical records were
reviewed and all patients were contacted three months post-operatively
to confirm whether they had experienced a dislocation. Aims
Patients and Methods
The routine use of posterior hip dislocation precautions is typically utilized postoperatively following total hip arthroplasty via a posterior surgical approach. This has included use of an abduction pillow and limiting adduction, internal rotation and flexion more than 90 degrees for a minimum of 6 weeks postoperatively. This may slow the course of rehabilitation, increase the length of hospital stay and the total cost of the procedure, and add additional anxiety to the patient. We conducted this study to see if posterior hip precautions are necessary after total hip arthroplasty via a posterior approach when the hip meets certain intraoperative criteria for stability. All patients in our institute undergo routine hip stability testing during primary total hip arthroplasty via a posterior approach. Before October 2010, all of our primary total hip arthroplasty patients were placed on routine hip precautions. We stopped hip precautions in October 2010 for all the patients who were noted to meet hip stability criteria intraoperatively. We prospectively compared the consecutive patients who underwent this procedure without hip precautions with a retrospective control group of patients who had hip precautions.Introduction:
Methods and Materials:
Hip arthrodesis remains a viable surgical technique
in well selected patients, typically the young manual labourer with
isolated unilateral hip disease. Despite this, its popularity with
patients and surgeons has decreased due to the evolution of hip
replacement, and is seldom chosen by young adult patients today.
The surgeon is more likely to encounter a patient who requests conversion
to total hip replacement (THR). The most common indications are
a painful pseudarthrosis, back pain, ipsilateral knee pain or contralateral
hip pain. Occasionally the patient will request conversion because
of difficulty with activities of daily living, body image and perceived
cosmesis. The technique of conversion and a discussion of the results
are presented. Cite this article:
The purpose of this study was to examine if Sugioka's transtrochanteric rotational osteotomy (TRO) of the femoral head could be a valid option in treating idiopathic osteonecrosis of the femoral head. Thirty-two TROs performed in 29 patients between 1985 and 2006 were studied. Patient age at operation ranged from 16 to 56 years (average, 36 years). Thirteen hips were in women and 19 hips in men. Height was 165 cm and weight 63 kg (Body Mass Index 23) on average. Risk factors were corticosteroid use in 18 hips and excessive alcohol consumption in 15 hips (2 of them had both backgrounds), while neither of them was found with 1 hip. Bilateral hips were affected in 19 patients and 3 of them underwent bilateral TROs sequentially. The femoral head was rotated anteriorly in 26 hips and posteriorly in 6 hips. For fixation of the osteotomy site, large femoral screws had been used till 1995 (Group 1, 9 hips), and since 1996 an AO angle plate or a compression hip screw has been used (Group 2, 13 hips). Since 2003, pre-operative planning was performed more meticulously and the distal part of the joint capsule was cut after osteotomy as described by Atsumi (Group 3, 10 hips). The average follow-up period was 6.5 years (range, 2 to 21 years).Introduction
Methods
The results of primary total knee replacement performed on a group of haemophiliac patients in a single institution by the same surgeon using the same surgical technique and prosthesis are reported. A total of 35 primary replacements in 30 patients were carried out between 1996 and 2005 and were reviewed retrospectively. The mean age of the patients was 31 years (24 to 42) and the mean follow-up was for 7.5 years (1 to 10). There were 25 patients with haemophilia A and five with haemophilia B. The HIV status and CD4 count were recorded, and Knee Society scores determined. Two patients had inhibitors to the deficient coagulation factor. There were no early wound infections and only one late deep infection which required a two-stage revision arthroplasty, with a good final result. The incidence of infection in HIV-positive and negative patients was thus similar. One knee in a patient with inhibitor had excessive bleeding due to a pseudoaneurysm which required embolisation. The results were excellent in 27 knees (77%), good in six (17%) and fair in two (6%). The survival rate at 7.5 years taking removal of the prosthesis for loosening or infection as the end-point was 97%. The mechanical survival of total knee replacements in haemophiliacs is very good. Our results confirm that this is a reproducible procedure in haemophilia, even in HIV-positive patients with a CD4 count >
200 mm3 and those with inhibitors. Our rate of infection was lower than previously reported. This could be due to better control of the HIV status with highly active anti-retroviral therapy and the use of antibiotic-loaded cement.
This study examined the effect of completely disregarding dislocation precautions on the incidence of dislocation, as well as the speed of patient rehabilitation after THJR Since 1st March 2005, all uncomplicated primary THJR’s performed by one of the senior authors for OA have been told by their physiotherapist to do what they like, when they like, during the post-operative period. All patients were operated on through a modified direct lateral approach A representative sample of 30 patients were administered a questionnaire at their 6 week postoperative visit. There were no dislocations. Of those patients in full-time employment, the majority had returned to work by 6 weeks. Most were able to drive between 3 and 4 weeks. Nearly all had regained their pre-operative range of movement and could put on their own shoes and socks. All claimed that being told to disregard dislocation precautions gave them more confidence in their THJR and helped with their achieving a speedy recovery from surgery. Patients who are judged at the time of surgery to have a stable THJR articulation, benefit form being told to disregard the usual dislocation precautions, and are able to return to work and driving in a more timely manner.
Aim: The purpose of this study was to evaluate the prevalence of methicillinresistant Staphylococcus aureus (MRSA) isolates in the Orthopaedic Department of a new University Hospital, two years from its opening. Methods: Forty-three consecutive S. aureus isolates, collected from cultures (pus 90%) from consecutive orthopaedic inpatients were included in the study. Resistance to antimicrobial agents was assessed by the disk diffusion method. The mecA-gene was detected by PCR assay, whereas molecular typing of the isolates was performed by PFGE. Results: Only 5 of the 43 strains (11.6%) expressed high level resistance to oxacillin (MIC ≥ 64mg/L). All these isolates possessed mecA-gene and exhibited resistance, except oxacillin, to more than four classes antimicrobial groups. The remaining 38 isolates (34 beta-lactamase positive) were susceptible to oxacillin (MIC ≤ 2mg/L), and expressed a less resistant type than that of MRSA. Molecular typing by PFGE showed apparent heterogeneity among isolates and the absence of predominant clones. Conclusions: The 11.6% prevalence of MRSA is well below the reported average in the literature. Apparently the isolates originated from different sources of contamination. All patients had previous hospitalizations, where they acquired the infections and subsequently transferred the MRSAs to our department.
Purpose: The purpose of this study was to evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the Orthopaedic Department of a new University Hospital, two years from its opening. Material and Methods: Forty-three consecutive S. aureus isolates, collected from cultures (pus 90%) from consecutive orthopaedic inpatients were included in the study. Resistance to antimicrobial agents was assessed by the disk diffusion method. The mecA-gene was detected by PCR assay, whereas molecular typing of the isolates was performed by PFGE. Results: Only 5 of the 43 strains (11.6%) expressed high level resistance to oxacillin (MIC ≥ 64mg/L). All these isolates possessed mecA-gene and exhibited resistance, except oxacillin, to more than four classes antimicrobial groups. The remaining 38 isolates (34 beta-lactamase positive) were susceptible to oxacillin (MIC ≤ 2mg/D, and expressed a less resistant type than that of MRSA. Molecular typing by PFGE showed apparent heterogeneity among isolates and the absence of predominant clones. Conclusions: The 11.6% prevalence of MRSA is well below the reported average in the literature. Apparently the isolates originated from different sources of contamination. All patients had previous hospitalizations, where they acquired the infections and subsequently transferred the MRSAs to our department.
