Five surgeons independently rated clinical photographs of forty patients with AIS. Ratings of shoulder blades, shoulder symmetry, and waist symmetry were related to “overall appearance”, and were also correlated with rib prominence and Cobb angle. Because the components of surgeons’ ratings of appearance differed, this may lead to inconsistent recommendations regarding surgery. To identify patient characteristics associated with surgeons’ ratings of patient physical deformity in Adolescent Idiopathic Scoliosis (AIS). Five surgeons independently rated clinical photographs of forty patients with AIS. Surgeons separately rated the appearance of patients’ shoulder blades, shoulder symmetry, waist symmetry and also rated their “overall appearance Surgeons’ mean rating for “overall appearance” was moderately correlated with rib prominence (r = 0.48), vertebral rotation (r = 0.44) and Cobb angle (r = 0.53). Surgeons’ rating of patients’ “overall appearance” was affected by each of: shoulder blades (p = 0.001), shoulder symmetry (p = 0.01) and waist symmetry (p = 0.001). However, each surgeon weighted components of patients’ appearance differently to arrive at their overall rating of appearance (p<
0.006). Because patients’ physical appearance is an important element of surgical decision making, differences among surgeons could be contributing to inconsistent recommendations. Surgeons’ ratings of physical appearance are based on surgeons’ ratings of patients’ shoulder blades, waist symmetry and shoulder symmetry but surgeons weight those elements differently. Surgeon decision making is complicated. It is based on radiographs and subjective assessment. Patients’ appearance undoubtedly influences surgeon recommendation for surgery. We need to clarify surgeons’ ratings and improve the criteria for surgeon decision making.
This study compared the effect of manipulation with a period of normal activity on the range of intervertebral sidebending. Thirty asymptomatic male volunteers were randomised to treatment or control groups. All were subjected to low-dose X-ray screening through 80° of passive lumbar spine side-bending. Motion sequences were digitised at a 5Hz sampling rate. The treatment group (n=16) had rotary manipulation to each lumbar linkage, followed by normal activity. The control group (n=14) had normal activity only. Both groups were then re-screened. Each vertebral pair was tracked and intervertebral rotation throughout the motion measured. Three subjects were analysed 10 times for reliability and all intervertebral motion was tracked twice. Twenty-one manipulated linkages and 10 controls met the reliability criteria. For non-manipulated segments the mean range at first screening was 14.2° (SD 1.39) and manipulated segments 12.8° (SD 3.81). The range of the non-manipulated segments increased by +0.9o and the manipulated segments by +0.4°. The change in manipulated segments was negligible and similar to controls, although the instrument can be sufficiently reliable to measure a 2° difference. The technique is sufficiently robust to determine if spinal manipulation changes these ranges in selected patients.
We aimed to assess individual differences in complaints in patients just before total hip replacement (THR) and the importance attached to the relief of each of them. In a pilot study, using open-ended interviews, we identified 16 main complaints, four of which (night pain, unequal leg length and discomfort during sexual and recreational activities) were not included in any of the six hip-rating scales in general use. Each of the 16 complaints was then assessed in 72 patients and rated for severity and the relative importance of relief. From this we calculated a severity-importance rating for each complaint and a patient-specific score for all complaints. The 72 patients had a mean age of 64 years (17 to 92) and 51% were men. The most important reasons for wanting a THR were day pain and walking difficulty, but the complaints mentioned above and not included in standard hip scores were also important. Greater attention to the individual requirements of patients might improve evaluation of the outcome of orthopaedic treatments.
Long radiographs are used to measure lower limb axial alignment, to assess the progression of deformity, and to plan corrective surgery. The purpose of this study was to test the belief that jigs are necessary in order to control limb position for radiography. Above-knee amputated limbs were fixed in different positions of rotation and of knee flexion and radiographed to study the effect on the apparent alignment of the limb. If the limb was rotated no more than 10 degrees from the neutral the effect on apparent axial alignment was minimal and radiographic measurement was reliable. This suggests that standardised positioning jigs are not needed in routine clinical practice.
This is a preliminary report of the results of knee joint replacements using the Liverpool Mark II knee joint system which consists of a bicondylar prosthesis and a set of stereotactic instruments. The prosthesis has been developed from Gunston's concept, and the special instruments ensure its accurate insertion through meniscectomy-type incisions placed on either side of the patella. Particular features of the prosthesis are near-normal articulation, and the simplicity of the operation. Sixty-two knee replacements were implanted in forty-two patients between the spring of 1974 and January 1977. After the operation fifty-six knees were painless and four others produced only slight pain. Full extension was obtained in fifty-eight knees, and none showed a valgus or varus deformity. Collateral laxity was absent in all knees. There were two failures. These early results are most encouraging.