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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 29 - 29
1 Jul 2022
Bishi H Afzal I Wang C Stammers J Mitchell P Field R Alazzawi S
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Abstract

Introduction

In revision knee arthroplasty, rotating hinge implants (RHK) have been considered to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). The aims of this study were to compare patient reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high volume elective orthopaedic centre with previously validated bespoke database.

Methodology

One hundred and eight patients who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EQ5D, Health State and Oxford Knee Scores were collected pre-operatively and at 1 year post-operatively. Complication data was collected at 6 weeks, 6 months, 1 year and 2 years post-operatively. NJR data was interrogated, in addition to our own database, to investigate implant survival.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 134 - 134
1 Jan 2013
Britton E Stammers J Arghandawi S Culpan P Bates P
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Certain acetabular fractures involve impaction of the weight-bearing dome and medialisation of the femoral head. Intra-operative fracture reduction is made easier by traction on the limb, ideally in line with the femoral neck (lateral traction). However, holding this lateral traction throughout surgery is very difficult for a tiring assistant.

We detail a previously undescribed technique of providing intra-operative lateral femoral head traction via a pelvic reduction frame, to aid fixation of difficult acetabular fractures. The first 10 consecutive cases are reviewed (Group 1) and compared with a retrospective control (Group 2, n=18) of case-matched patients, treated prior to introducing the technique. The post-operative X-rays and CT scans were assessed to identify quality of fracture reduction according to the criteria of Tornetta and Matta. Operative time, blood loss and early complication rates were also compared.

All cases in both groups were acute injuries with medial and/or superior migration of the femoral head. The majority were either associated both column or anterior column posterior hemi-transverse. There was no statistical difference between the groups in age, time to surgery, BMI or ASA grade.

Fracture reduction was assessed as excellent in seven, good in three and poor in one. This was not significantly different from the control group (p=0.093). The mean operative time was 232 minutes in Group 1 and 332.78 minutes in Group 2 (p = 0.0015). There was no difference between the groups for blood loss or complication rates.

We conclude that this new technique is at least equivalent to using manual traction and early results suggest it reduces operative time and technical difficulty in treating these complex acetabular fractures.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 85 - 85
1 Sep 2012
Stammers J Kahane S Malek S Aston W Miles J Pollock R Carrington R Briggs T Skinner J
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Infection after knee arthroplasty is a devastating complication. Our aim is to present our outcomes of treating infected knee replacements at a tertiary referral centre.

We performed a consecutive, retrospective case series of all revision knee arthroplasty for infection between January 2006 and December 2008. Case notes were reviewed and data collated on the date and institution of primary arthroplasty, procedures undertaken at our institution, microbiology and bone loss post first stage, serological markers (C-reactive protein, ESR) prior to second stage and outcome.

During this three year period we performed 430 knee revision operations. 51 were in the presence of deep chronic infection. 90% were referred from other hospitals. Overall infection was successfully eradicated in 69%.

Nineteen patients underwent repeat two-stage and overall eleven (58%) patients had successful eradication of infection with multiple two-stages. Of these 47% had F3/T3, the highest grading of Anderson Orthopaedic Research Institute bone loss indicating no metaphyseal bone. A further 12% had bicondylar deficiency on the tibia and no femoral metaphyseal bone (F3/T2b).

Multidrug resistance present in 69% and 47% were infected with multiple organisms. All members of the unsuccessful outcome group had at least one multidrug resistant organism compared to 43% in the successful cohort (P=0.0002). Multiple organisms are associated with an unsuccessful outcome (P=0.056).

Serological markers were not significantly different between the successful and unsuccessful outcome groups.

Where the referring hospital had attempted revision and failed, the chance of eradicating infection dropped from 75% to 58% and the rate of above knee amputation was twelve times higher (3% vs. 36%).

Custom constrained, rotating hinge prostheses enable aggressive soft tissue debridement including ligaments. Successful two-stage requires a multidisciplinary approach including tissue viability nurses, microbiologists and plastic surgeons. Where units lack revision expertise this series suggests early referral increases the chance of limb salvage.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 258 - 258
1 Sep 2012
Stammers J Williams D Berber O Abidin SZ Hunter J Leckenby J Vesely M Nielsen D
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Aims

The BOA/BAPRAS guidelines for the management of open tibial fractures (2009) recommend early senior combined orthoplastics input and appropriate facilities to manage a high caseload. St Georges Hospital is one of four London Trauma Centres fulfilling these criteria. Our aim is to determine whether becoming a trauma centre has affected the management of patients with open tibial fractures.

Methods

Data were obtained prospectively on consecutive open tibial fractures during two 8 month periods: before and after becoming a Major Trauma Centre (May 2009–Dec 2009 and April 2010–Oct 2010 respectively). Data on patient pathway including, admitting hospital, length of stay, timing and number of operations were recorded.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIV | Pages 26 - 26
1 Jul 2012
Kahane S Abbassian A Gillott E Stammers J Aston W
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Skeletal Cryptococcosis although rare has been reported in immunodeficient individuals and in particular those with HIV. We present a case in a HIV- negative patient who presented to the London Sarcoma service masquerading as a primary bone tumour and review the relevant literature.

A 71 year old lady presented with a three month history of right submammary pain associated with a new lump. Chest radiographs showed an osteolytic lesion in the right 6th rib. CT scans demonstrated mediastinal lymphadenopathy and numerous lung nodules. Differential diagnosis of the lesion included TB abscess, myeloma, lymphoma or as a primary lung tumour presenting with hilar lymphadenopathy and necrotic skeletal metastasis. CT guided biopsy was performed with histology showing necrotising granulomatous inflammation with numerous yeast like organisms in keeping with Cryptococcus fungal infection. She was treated successfully with a six week course of voriconazole.

Cryptococcal skeletal infections can cause significant morbidity and mortality and should be considered as a rare cause of lytic osseous lesions.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 95 - 95
1 Mar 2012
Wilding CP Maruthainar K Malikian R Stammers J Blunn GW
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Purpose

To determine the effect that Titanium Nitride (TiN) coatings have on wear rates of ultra high molecular weight polyethylene (UHMWPE)

Background

Ceramic coatings have been shown to confer advantageous countersurface scratch resistance in knee arthroplasty. This may reduce UHMWPE wear rates and revision rates. Dermal hypersensitivity is a common problem with metals; TiN, a ceramic surface, has been used to prevent it. There is little data in the literature regarding the effect of TiN on UHMWPE.


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 6 | Pages 830 - 834
1 Jun 2009
Pinskerova V Samuelson KM Stammers J Maruthainar K Sosna A Freeman MAR

There has been only one limited report dating from 1941 using dissection which has described the tibiofemoral joint between 120° and 160° of flexion despite the relevance of this arc to total knee replacement. We now provide a full description having examined one living and eight cadaver knees using MRI, dissection and previously published cryosections in one knee.

In the range of flexion from 120° to 160° the flexion facet centre of the medial femoral condyle moves back 5 mm and rises up on to the posterior horn of the medial meniscus. At 160° the posterior horn is compressed in a synovial recess between the femoral cortex and the tibia. This limits flexion. The lateral femoral condyle also rolls back with the posterior horn of the lateral meniscus moving with the condyle. Both move down over the posterior tibia at 160° of flexion.

Neither the events between 120° and 160° nor the anatomy at 160° could result from a continuation of the kinematics up to 120°. Therefore hyperflexion is a separate arc. The anatomical and functional features of this arc suggest that it would be difficult to design an implant for total knee replacement giving physiological movement from 0° to 160°.