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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_11 | Pages 2 - 2
4 Jun 2024
Townshend D Bing A Clough T Sharpe I Blundell C Davenport J Davies H Davis J Dhar S Goldberg A Karski M Hepple S Kakwani R McKinley J Murty A Ragland M Shalaby H Smith R Taylor H
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Introduction

This is a multi-centre, prospective, observational study of 503 INFINITY fixed bearing total ankle arthroplasties. We report the minimum two-year results of this prosthesis which was introduced to the UK Market in 2014 and is now the most used ankle arthroplasty in the National Joint Registry of England and Wales.

Methods

Patients were recruited from 11 centres in the United Kingdom between June 2016 and November 2019. Demographic, radiographic, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Foot Ankle Questionnaire and Euroquol 5D-5L) were collected preoperatively, at 6 months, 1 year and 2 years and 5 years. The average age was 67.8 (range 23.9 to 88.5) and average BMI 29.3 (18.9 to 48.0). The COFAS grading system was used to stratify deformity. There were 261 (51.9%) COFAS Type 1, 122 (24.2%) COFAS Type 2, 31 (6.2%) COFAS 3 and 89 (17.7%) COFAS type 4. 38 patients (7.6%) presented with inflammatory arthritis. 99 (19.7%) implantations utilised patient specific instrumentation. Complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts and/or subsidence.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_7 | Pages 14 - 14
8 May 2024
Morley W Dawe E Boyd R Creasy J Grice J Marsland D Taylor H
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Introduction

Osteoarthritis in the foot and ankle affects approximately 30,000 patients annually in the UK. Evidence has shown that excess weight exacerbates foot pain, with significant increases in joint forces. However, despite the current trend for Clinical Commissioning Groups to ration surgery for obese patients, studies have not yet determined the effect of weight loss in obese patients with foot and ankle arthritis.

Aim

Pilot study to investigate the effect of simulated weight loss on pain scores in obese patients with symptomatic foot and ankle arthritis.


The Bone & Joint Journal
Vol. 98-B, Issue 6 | Pages 840 - 845
1 Jun 2016
Chesser TJS Fox R Harding K Halliday R Barnfield S Willett K Lamb S Yau C Javaid MK Gray AC Young J Taylor H Shah K Greenwood R

Aims

We wished to assess the feasibility of a future randomised controlled trial of parathyroid hormone (PTH) supplements to aid healing of trochanteric fractures of the hip, by an open label prospective feasibility and pilot study with a nested qualitative sub study. This aimed to inform the design of a future powered study comparing the functional recovery after trochanteric hip fracture in patients undergoing standard care, versus those who undergo administration of subcutaneous injection of PTH for six weeks.

Patients and Methods

We undertook a pilot study comparing the functional recovery after trochanteric hip fracture in patients 60 years or older, admitted with a trochanteric hip fracture, and potentially eligible to be randomised to either standard care or the administration of subcutaneous PTH for six weeks. Our desired outcomes were functional testing and measures to assess the feasibility and acceptability of the study.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_17 | Pages 22 - 22
1 Nov 2014
Willmott H Smith J Taylor H
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Introduction:

The cavovarus foot is a complex deformity caused by muscle imbalance, soft-tissue contracture and secondary bony abnormality. It is a combination of hindfoot, midfoot and forefoot deformity and the decision making process for surgical management can be difficult. The process of deciding which combination of procedures is required is often poorly understood. We present an algorithm to assist with this decision making.

Methods:

We have analysed a single surgeon's experience of cavovarus foot correction, from a consecutive series of 50 patients over 5 years, to develop an algorithm to guide operative decision making. Cases included cavovarus deformity secondary to cerebral palsy, Friedreich's ataxia, Charcot Marie Tooth disease, post-traumatic contracture, post-cerebrovascular accident, iatrogenic post-surgery and physiological cavus. We have taken a systematic approach to each component of the deformity in order to generate the algorithm.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_15 | Pages 3 - 3
1 Oct 2014
Clark E Taylor H Hutchinson J Nelson I Wordsworth B Harding I Tobias J
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AIS is present in 3–5% of the general population. Large curves are associated with increased pain and reduced quality of life. However, no information is available on the impact of smaller curves, many of which do not reach secondary care. The objective of this project was to identify whether or not there is any hidden burden of disease associated with smaller spinal curves.

The Avon Longitudinal Study of Parents and Children (ALSPAC) is a population-based birth cohort that recruited over 14,000 pregnant women from the Bristol area between 1991–1992 and has followed up their offspring regularly. At aged 15 presence or absence of spinal curvature ≥6degrees was identified using the validated DXA Scoliosis Measure in 5299 participants. At aged 18 a structured pain questionnaire was administered to 4083 participants. Chi-squared was used to investigate any association between presence of a spinal curve at aged 15 and self-reported pain at aged 18 years. Sensitivity analyses were performed by rerunning analyses after excluding those who were told at aged 13 they had a spinal curve (n=27), and using a higher spinal curve cut-off of ≥10degrees.

Full data was available for 3184 participants. Of these, 56.8% were female, and 4.2% non-white reflecting the local population. 202 (6.3%) had a spinal curve ≥6degrees and 125 (3.9%) had a curve ≥10degrees. The mean curve size was 12degrees. 140/202 (69.3%) had single curves, and 57.4% of these were to the right. In total 46.3% of the 3184 participants reported aches and pains that lasted for a day or longer in the previous month, consistent with previous literature. 16.3% reported back pain. Those with spinal curves ≥6degrees were 42% more likely to report back pain than those without (OR 1.42, 95%CI 1.00 to 2.02, P=0.047). In addition, those with spinal curves had more days off school, were more likely to avoid activities that caused their pain, were more likely to think that something harmful is happening when they get the pain, and were more afraid of the pain than people without spinal curves (P<0.05). Sensitivity analyses did not change results.

We present the first results from a population-based study of the impact of small spinal curves and identify an important hidden burden of disease. Our results highlight that small scoliotic curves that may not present to secondary care are nonetheless associated with increased pain, more days off school and avoidance of activities.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_2 | Pages 19 - 19
1 Jan 2014
Kelsall N Chapman A Sangar A Farrar M Taylor H
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Introduction:

The dorsal closing wedge calcaneal osteotomy has been described for the treatment of insertional pathology of the tendo-achilles. The aim of this study was to evaluate the efficacy of the technique using outcome measures.

Method:

This was a prospective case series. Patients were included if they had tendo-achilles insertional pathology (calcific tendonitis, bursitis or Haglund's deformity). A short extended lateral approach was used and a 1 cm dorsally based closing wedge osteotomy of the calcaneus performed. Fixation was with 2 staples. Patients were scored pre-operatively and at 6 and 12 months post-operatively using the VISA-A and AOFAS ankle-hindfoot scores. Results were analysed with the paired student t-test.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 61 - 61
1 Jan 2013
Rajagopalan S Barbeseclu M Moonot P Sangar A Aarvold A Taylor H
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Background

As hallux valgus (HV) worsens clinical and radiological signs of arthritis develop in metatarsophalangeal joint due to incongruity of joint surfaces. The purpose of this prospective study was to determine if intraoperative mapping of articular erosion of the first metatarsal head, base of the proximal phalanx, and tibial and fibular sesamoids can be correlated to clinical and/or radiographic parameters used during the preoperative assessment of the HV deformity

Materials and methods

We analysed 50 patients prospectively who underwent surgery between Jan 2009-Jan 2010. Patients with a known history of previous first metatarsophalangeal joint surgical intervention, trauma, or systemic arthritis were excluded from analysis. Preoperative demographics and AOFAS score were recorded. Intraoperative evaluation and quantification of the first metatarsal head, base of the proximal phalanx, and sesamoid articular cartilage erosion was performed. Cartilage wear was documented using International Cartilage Research Society grading.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 45 - 45
1 Sep 2012
Moonot P Rajagopalan S Brown J Sangar B Taylor H
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It is recognised that as the severity of hallux valgus (HV) worsens, so do the clinical and radiological signs of arthritis in the first metatarsophalangeal joint.

However, few studies specifically document the degenerate changes. The purpose of this study is to determine if intraoperative mapping of articular erosive lesions of the first MTP joint can be correlated to clinical and/or radiographic parameters used during the preoperative assessment of the HV deformity.

Materials & Methods

We prospectively analysed 50 patients who underwent surgery between Jan 2009 & Jan 2010. Patients with a known history of previous first metatarsophalangeal joint surgical intervention, trauma, or systemic arthritis were excluded from analysis. Preoperative demographics and AOFAS scores were recorded. Radiographic measurements were obtained from weight bearing radiographs. Intraoperative evaluation of the first metatarsal head, base of the proximal phalanx, and sesamoid articular cartilage erosion was performed. Cartilage wear was documented using International Cartilage Research Society grading.

Results

three patients did not have scoring or cartilage wear documentation carried out and were excluded. The mean age was 56 years. The mean hallux valgus angle was 31 degrees. The mean IMA was 15 degrees. The mean AOFAS score was 62. Patients with no inferomedial (IM) and inferolateral (IL) wear had significantly better AOFAS score than patients who had IM & IL wear (p < 0.05). Patients who had IM & IL wear had a significantly higher HVA (p < 0.05). There was a significant positive correlation between hallux valgus angle and AOFAS score. We also found correlation between sesamoid wear and AOFAS score and HV angle.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 62 - 62
1 Sep 2012
Brown J Moonot P Taylor H
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Introduction

The delayed presentation of Achilles tendon rupture is common, and is a difficult problem to manage. A number of surgical techniques have been described to treat this problem. We describe the use of Flexor Hallucis Longus (FHL) transfer to augment the surgical reconstruction of the delayed presentation of achilles tendon rupture.

Materials and Methods

Fourteen patients with chronic tendo-Achilles rupture, presenting between April 2008 and December 2010, underwent surgical reconstruction and FHL transfer. Surgery was performed employing standard operative techniques, with shortening of the Achilles tendon and FHL transfer into the calcaneum with a Biotenodesis screw (Arthrex). VISA-A scores were performed preoperatively and six months postoperatively. Complication data was collected by review of the electronic patient record and direct patient questioning.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 481 - 481
1 Sep 2012
Smith H Manjaly J Yousri T Upadhyay N Nicol S Taylor H Livingstone J
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Informed consent is vital to good surgical practice. Pain, sedative medication and psychological distress resulting from trauma are likely to adversely affect a patient's ability to understand and retain information thus impairing the quality of the consent process. This study aims to assess whether provision of written information improves trauma patient's recall of the risks associated with their surgery.

121 consecutive trauma patients were randomised to receive structured verbal information or structured verbal information with the addition of supplementary written information at the time of obtaining consent for their surgery. Patients were followed up post-operatively (mean 3.2 days) with a questionnaire to assess recall of risks discussed during the consent interview and satisfaction with the consent process.

Recall of risks discussed in the consent interview was found to be significantly improved in the group receiving written and verbal information compared to verbal information alone (mean questionnaire score 41% vs. 64%), p=0.0014 using the Mann-Whitney U test. Patient satisfaction with the consent process was significantly improved in the group receiving written and verbal information, 97.9% of patients reported that they understood the risks of surgery when they signed the consent form compared to 83.2% who received verbal information alone (p=0.01). The majority of patients who received written information reported finding it helpful (93.8%) and most of the patients who did not receive written information reported they would have found it useful had it been offered (66%).

Patients awaiting surgery following trauma can pose a challenge to adequately inform about benefits conferred, the likely post operative course and potential risks. Written information is a simple and cost-effective means to improve the consent process and was popular with patients.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 70 - 70
1 May 2012
Craik J Rajagopalan S Lloyd J Sangar A Taylor H
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Introduction

Syndesmosis injuries are significant injuries and require anatomical reduction. However, stabilisation of these injuries with syndesmosis screws carries specific complications and many surgeons advocate a second operation to remove the screw. Primary Tightrope suture fixation has been shown to be an effective treatment for syndesmotic injuries and avoids the need for a second operation.

Materials and Methods

A retrospective audit identified patients who were treated for syndesmosis injuries over a two year period. Theatre and clinic costs were obtained to compare the cost of syndesmosis fixation using diastasis screws with the estimated cost of primary syndesmosis fixation using a Tightrope suture.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 95 - 95
1 Mar 2012
Sahu A Harshavardena N Maret S Dhir A Taylor H
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Introduction

The aim of the study was to analyze the outcome of AO cannulated screws for fractures neck of femur at our institute.

Methods

412 patients (101 males/311 females) who underwent AO screws for fracture neck of femur over 5 years (2000 -2004) and followed-up for a minimum of 2 yrs formed the study population. A retrospective review of data from electronic patient record (EPR), clinical coding, clinic and GP letters was made. Age, residential placement, Garden's classification, mode of injury, associated comorbidities, pre-admission mobilisation status, allergies, addictions and anticoagulation status details were collected. Reasons for re-admissions, re-operations and comorbidities developing as a result of these interventions were critically analysed. Post-op physiotherapy, proportion of patients sustaining contra-lateral fracture NOF and its management and mortality statistics were reviewed.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 478 - 478
1 Nov 2011
Dunning M Taylor H
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Introduction: The HRG 4 coding system was introduced in April 2009 to allow the calculation of tariffs for all surgical procedures. At our institution we felt surgeon input could improve the accuracy of this coding and optimise trust income.

Method: A retrospective audit of one month’s procedures under the care of a single consultant was performed. The hospitals coding and tariff, as performed by coding clerks, was reviewed and the procedures were re-coded by a foot and ankle fellow using the notes and the HRG 4 grouper. A comparison was made between the coding and income generated in the standard fashion and that achieved after optimisation by surgeon input.

Results: The codes of 51 patients were examined. 86% of major foot procedures were correctly coded. However, 56% of ‘minor’ procedures were recoded as ‘intermediate’, many of these involving hallux valgus surgery. 58% of procedures had a different code after surgeon input and 41% generated a different tariff. The total tariff for the coding clerk group was £79,192. The total tariff in the surgeon assessed group was £97,268 - a difference of £18,076. Extrapolated over the year this could represent a potential gain of over £200,000, for a single Consultant in a single Trust.

Conclusion: We believe surgeon involvement in coding is crucial to improve accuracy and to optimise trust income. We will discuss various issues surrounding the new HRG 4 codes and how best to use them in current practice.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 255 - 255
1 Jul 2011
Upadhyay V Sahu A Mahajan R Taylor H Farrar M
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Purpose: The aim of the study was to analyze the outcome of AO cannulated screws for fractures neck of femur in patients with Diabetes mellitus.

Method: Sixty-two patients aged 50 years or more (17 males & 45 females) who underwent AO screws for fracture neck of femur over seven years (1999–2005) and followed-up for a minimum of two years formed the study population. A retrospective review of data from electronic patient record (EPR), clinical coding, clinic & GP letters was made. Age, residential placement, Garden’s classification of fracture, mode of injury, associated other co morbidities, pre-admission mobilisation status, allergies, addictions and anticoagulation status details were collected.

Results: The mean age of patients was 67 years (range 52–96 yrs). Eleven patients died in two years time. Forty-one patients were less than 75 years of age and 21 patients were more than 75 years of age. All the patients more than 75 years of age had undisplaced intracapsular fractures. Thirteen patients were type I and 49 patients were type II diabetic. Non-union and avascular necrosis occurred in nine (17%) & 13 (26%) patients respectively. Revision surgery in the form of total hip replacement or hemiarthroplasty were performed in 21 (41%) cases. The incidence of avascular necrosis following osteosynthesis at one year was 14%. Age, control of diabetes, postoperative complications, pre-fracture mobilization status etc. Complications like wound infection were more principally in patients who had poorly-controlled diabetes.

Conclusion: Patients with diabetes mellitus have metabolic bone disease due to vasculitis. This increases the risk of complications associated with fracture fixation such as non-union, cut-through and avascular necrosis (AVN). The complications and revision surgery rate was high in patients with displaced fractures and with poorly controlled diabetes. Comorbidities like diabetes and patient’s age were also strong predictors of healing in addition to fracture configuration. Looking at very high complication and re-operation rate, our recommendation in patients with diabetes is primary hemiarthroplasty irrespective of femoral head displacement, if there age is more than 75 years.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 533 - 533
1 Oct 2010
Wylde V Blom A Hewlett S Learmonth I Taylor H
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Background: Because of the changing demographics of the population and improvements in prosthesis design and surgical technique, ever-increasing numbers of younger patients are undergoing joint replacement. Younger patients often receive hip resurfacing rather than conventional THR because of the preservation of bone stock and the lower risk of dislocation. However, pain relief and restoration of function for younger patients is particularly important to continue with a normal, active life. Yet there is little existing research to establish if hip resurfacing results in better patient-reported outcomes than conventional total hip replacement (THR). Therefore, the aim of this study was to compare patient-reported outcomes after hip resurfacing and THR, after controlling for age, gender, general health and length of follow-up.

Methods: A postal survey was sent to all patients who had a hip resurfacing or primary THR between April 2004 - April 2006 at the Avon Orthopaedic Centre. To assess hip pain and function, quality of life, general health and satisfaction with the outcome of surgery, the questionnaire included the WOMAC, HOOS Quality of Life Scale, SF-12 and a validated satisfaction scale. The continuous outcome scores were compared for those who had a THR and those who had hip resurfacing, after adjusting for age, sex, general health and length of follow-up, using Analysis of Variance.

Results: Completed questionnaires were received from 911 THR patients and 157 hip resurfacing patients (response rate of 68% and 71%). Hip resurfacing patients had a mean age of 52 years and 71% were male. THR patients had a mean age of 68 years and 37% were male. After controlling for the effects of age, gender, general health and follow-up length, there was no significant difference in pain (p=0.70), function (0.85), hip-related quality of life (p=0.66) or satisfaction (0.09) between hip resurfacing patients and THR patients at 1–3 years post-operative.

Conclusions: The findings from this study suggest that hip resurfacing has no short-term clinical advantage over conventional THR. A prospective randomised controlled trial is necessary to further compare patient outcomes after hip resurfacing and THR.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 310 - 311
1 May 2010
Sahu A Harshavardhana N Maret S Kolwadkar Y Taylor H
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Introduction: The aim of the study was to analyze the outcome of AO cannulated screws for fractures neck of femur in patients with Diabetes mellitus.

Methods: of study: 62 patients aged 50 years or more (17 males & 45 females) who underwent AO screws for fracture neck of femur over 7 yrs (1999–2005) and followed-up for a minimum of 2 yrs formed the study population. A retrospective review of data from electronic patient record (EPR), clinical coding, clinic & GP letters was made. Age, residential placement, Garden’s classification of fracture, mode of injury, associated other co morbidities, pre-admission mobilisation status, allergies, addictions and anticoagulation status details were collected. An in depth study was conducted to look into delays for surgery, length of stay in hospital, complications and treatment of these complications. Reasons for re-admissions, re-operations and comorbidities developing as a result of these interventions were critically analysed. Post-op physiotherapy, proportion of patients sustaining contra-lateral fracture NOF & its management and mortality statistics were reviewed.

Results: The mean age of patients was 67 yrs (range 52–96 yrs). 11 patients died in 2 years time. 41 patients were less than 75 years of age and 21 patients were more than 75 years of age. All the patients more than 75 years of age had undisplaced intracapsular fractures. 13 patients were type 1 and 49 patients were type 2 diabetic. Non-union & avascular necrosis occurred in 9 (17%) & 13 (26%) patients respectively. Revision surgery in the form of total hip replacement or hemiarthroplasty were performed in 21 (41%) cases. The incidence of avascular necrosis following osteosynthesis at 1 yr was 14%. Age, control of diabetes, post-operative complications, pre-fracture mobilization status and degree of impaction on AP & version on lateral radiographs were of statistical significance in predicting fracture healing and its associated complications. Complications like wound infection etc were more principally in patients who had poorly controlled diabetes.

Conclusion: Patients with diabetes mellitus have metabolic bone disease due to vasculitis. This increases the risk of complications associated with fracture fixation such as non-union, cut-through and avascular necrosis (AVN). The complications and revision surgery rate was high in patients with displaced fractures and with poorly controlled diabetes. Comorbidities like diabetes & patient’s age were also strong predictors of healing in addition to fracture configuration. Looking at very high complication and reoperation rate, our recommendation in patients with diabetes is primary hemiarthroplasty irrespective of femoral head displacement, if there is age more than 75 years.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 333 - 333
1 Jul 2008
Hassouna H Singh D Taylor H Johnson S
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Objective of the Study: To assess the clinical effectiveness of ultrasound guided injection in the management of Morton’s Metatarsalgia.

Patients and Methods: Patients, that were clinically diagnosed to with interdigital Morton’s neuroma were treated with ultrasound guided injection of local anaesthetic and steroid. Fifty three patients were available for follow-up, and all had detailed telephone questionnaires completed. These questionnaires included a pre and post injection symptom score, as well as a Johnson Satisfaction score.

Results: 69% of patients had ultrasound diagnosis of Morton’s neuroma and 31% had an ultrasound diagnosis of intermetatarsal bursa. Mean follow up was11.4 months (Range: 3-23 months).67% of the patients were satisfied with the results of treatment. At follow up 63% of patients had no limitation in activity levels, and had no need to modify their shoe wear. Of all patients included in the study, only 3 patients have gone on to require surgery for ongoing symptoms.

Conclusion: Some studies have suggested that neither injection nor imaging have a role in the treatment of Morton’s neuroma. This study, however, demonstrate that ultrasound guided placement of local anaesthetic and steroid in either an intermetatarsal bursa or Mor-ton’s neuroma gives a good short and medium term symptom relief and in the majority of cases avoids the need for surgery.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_II | Pages 143 - 144
1 Jul 2002
Taylor H Richards S Khan N McGregor A Alaghband-Zadeh J Hughes S
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Aim of Study: The aim of the study was to investigate the effect of muscle retractors on intramuscular pressure in the posterior spinal muscles during posterior spinal surgery.

Methods: Twenty patients undergoing posterior spinal surgery were recruited into this study and recordings of intramuscular pressure during surgery were performed using a Stryker® compartment pressure monitoring system, prior to insertion of retractors, 5, 30 and 60 minutes into surgery and on removal of retractors. Prior to and following use of the retractors, muscle biopsies were taken from the erector spinae muscle for analysis.

Results: A significant increase in intramuscular pressure (p< 0.001) was observed during surgery, with pressure rising from 7.1±4.1 mmHg pre-operatively to 26.4±16.0 mmHg 30 minutes into the operation. On removal of retractors, this pressure returned to or near to the original value. Analysis of muscle biopsies using calcium-activated ATPase birefringence revealed a reduction in muscle function following prolonged use of self-retaining retractors.

Discussion: This study demonstrates a substantial rise in pressure in the erector spinae muscle during posterior spinal surgery. Following retraction, marked changes were noted in the function of the muscles. This could be an important factor in the generation of operative scar tissue and post-operative dysfunction of the spinal muscles, and therefore, may be a cause of persistent back pain frequently observed in post-operative patients. Currently, this work is being extended to investigate the relationship between loss of muscle function and duration of retraction, and to study the long term implications of loss of muscle function with respect to surgical outcome and chronic back pain.