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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_10 | Pages 37 - 37
1 Jun 2023
Elsheikh A Elazazy M Elkaramany M
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Introduction. Osteomyelitis is a challenge in diagnosis and treatment. 18F-FDG PET-CT provides a non-invasive tool for diagnosing and localizing osteomyelitis with a sensitivity reaching 94% and specificity reaching 100%. We aimed to assess the agreement in identifying the geographic area of infected bone and planned resection on plain X-ray versus 18F-FDG PET-CT. Materials & Methods. Clinical photos and X-rays of ten osteomyelitis patients were shown to ten consultant surgeons; they were asked to draw the area of infection and extent of planned surgical debridement; data will be compared to 18F-FDG PET-CT results. Results. We tested the agreement between the surgeons in every parameter. Regarding height, there was poor agreement between surgeons. Regarding perimeter, the ten surgeons showed low-moderate agreement. The ten surgeons showed a low-moderate agreement for circularity. Results document the variability of assessment and judgement based on plain X-rays. In comparison to PET-CT, All parameters were significantly different in favour of 18F-FDG PET-CT over X-ray (P < 0.001). Conclusions. 18F FDG PET-CT provides a three-dimensional tool for localizing the exact location of the infected bone and differentiating it from the normal bone. Thus, it could be beneficial in precise pre-operative planning and surgical debridement of chronic osteomyelitis


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_3 | Pages 44 - 44
23 Feb 2023
Kruger P Lynskey S Sutherland A
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The attitudes of orthopaedic surgeons regarding radiology reporting is not well-described in the literature. We surveyed Orthopaedic Surgeons in Australia and New Zealand to assess if they routinely review formal radiology reports. An anonymized, 14 question online survey was distributed to consultant surgeons of the Australian and New Zealand Orthopaedic Associations (AOA, NZOA). Two hundred respondents completed the survey (Total number of Fellows: 283 NZOA, 1185 AOA). 18.5% of respondents always reviewed the formal Radiology report, 44.5% most of the time, 35% sometimes and 2% never. By imaging modality, MRI reports were the most frequently reviewed (92%), followed by ultrasound (74%) and nuclear medicine (63%). Only 10% of surgeons consulted formal reports for plain radiography. 55% of surgeons were still likely to disagree with the MRI report, followed by 46% for plain radiography. In cases of disagreement, only 21% of surgeons would always contact the reporting radiologist. The majority of Surgeons (85.5%) think there should be more collaboration between the disciplines, although only 50.5% had regular attendance of a Radiologist at their departmental audit. This survey reveals that the majority of orthopaedic surgeons are not routinely reading radiology reports. This points towards a need for further interdisciplinary collaboration. To our knowledge, this is the first survey directly assessing attitudes of orthopaedic surgeons towards radiology reports


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_9 | Pages 11 - 11
1 Jun 2021
Munford M Jeffers J
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OSSTEC is a pre-spin-out venture at Imperial College London seeking industry feedback on our orthopaedic implants which maintain bone quality in the long term. Existing orthopaedic implants provide successful treatment for knee osteoarthritis, however, they cause loss of bone quality over time, leading to more dangerous and expensive revision surgeries and high implant failure rates in young patients. OSSTEC tibial implants stimulate healthy bone growth allowing simple primary revision surgery which will provide value for all stakeholders. This could allow existing orthopaedics manufacturers to capture high growth in existing and emerging markets while offering hospitals and surgeons a safer revision treatment for patients and a 35% annual saving on lifetime costs. For patients, our implant technology could mean additional years of quality life by revising patients to a primary TKA before full revision surgery. Our implants use patent-filed additive manufacturing technology to restore a healthy mechanical environment in the proximal tibia; stimulating long term bone growth. Proven benefits of this technology include increased bone formation and osseointegration, shown in an animal model, and restoration of native load transfer, shown in a human cadaveric model. This technology could help capture the large annual growth (24%) currently seen in the cementless knee reconstruction market, worth $1.2B. Furthermore, analysis suggests an additional market of currently untreated younger patients exists, worth £0.8B and growing by 18% annually. Making revision surgery and therefore treatment of younger patients easier would enable access to this market. We aim to offer improved patient treatment via B2B sales of implants to existing orthopaedic manufacturer partners, who would then provide them with instrumentation to hospitals and surgeons. Existing implant materials provide good options for patient treatments, however OSSTEC's porous titanium structures offer unique competitive advantages; combining options for modular design, cementless fixation, initial bone fixation and crucially long term bone maintenance. Speaking to surgeons across global markets shows that many surgeons are keen to pursue bone preserving surgeries and the use of porous implants. Furthermore, there is a growing demand to treat young patients (with 25% growth in patients younger than 65 over the past 10 years) and to use cementless knee treatments, where patient volume has doubled in the past 4 years and is following trends in hip treatments. Our team includes engineers and consultant surgeons who have experience developing multiple orthopaedic implants which have treated over 200,000 patients. To date we have raised £175,000 for the research and development of these implants and we hope to gain insight from industry professionals before further development towards our aim to begin trials for regulatory approval in 2026. OSSTEC implants provide a way to stimulate bone growth after surgery to reduce revision risk. We hope this could allow orthopaedic manufactures to explore high growth markets while meaning surgeons can treat younger patients in a cost effective way and add quality years to patients' lives


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_3 | Pages 18 - 18
1 Apr 2019
Lee P Chandratreya AP
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Background of study. Following the Montgomery ruling, consent is now a matter of law. The medical professionals have to show proof that risks and implications and material risks are explained to the patient and that they have accepted to go ahead with surgery. Materials and Methods. We devised a free web based programme (. www.consentplus.com. ) which introduces a documented checkpoint to the consent process in hip and knee replacement surgery. It enables reproducible high-quality bite-sized information delivery to patients and their families in an optimal environment. It utilises the flip classroom principle to facilitate dialogue between doctors and patients. It generates physical documentation to show patients’ knowledge and understanding of the risks; to produce a truly informed consent. Results. 1567 users completed the Consent PLUS process over 28 hospitals across the UK. 98.1% of users were satisfied with Consent PLUS in terms of quality of service and information delivered. Users’ self-rated knowledge increased by 29%, independent of age group, prior knowledge or check-point scores. Supportive documentation for 100% of the users, which facilitated the consent process but did not replace the consultation. 60% of users accessed the system via desktop computers, 23% via tablet and 17% via mobile phone. 55 consultant surgeons and 28 hospitals have been registered into the system by the users. 96.9% of users found Consent PLUS useful and 96.3% would recommend it to their friends. 92.6% would use it again. Conclusion. Consent PLUS can facilitate information delivery and improve patients’ understanding of the risks of surgery and its implications subjectively and objectively. Consent PLUS is a tool designed to enhance and facilitate the consent process, not to replace the current consent forms


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_2 | Pages 18 - 18
1 Feb 2020
Rivière C Jain A Harman C Maillot C Parsons T
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Introduction. The alternative kinematic alignment (KA) technique for total knee arthroplasty (TKA) aims at restoring the native joint line orientation and laxity of the knee. The goal is to generate a more physiological prosthetic knee enabling higher functional performance and satisfaction for the patient. KA TKA have only been reported so far with cruciate retaining and posterior-stabilised designs. Similarly, medial pivot design for TKA has been recently developed to enable more natural knee kinematics and antero-posterior stability. The superiority of KA technique and medial pivot implant design is still controversial when compared to current practice. Our study aims to assess the value of KA TKA when performed with medial pivot implants. Methods. We conducted a retrospectively matched case-control study. Clinical data was prospectively collected on patients as part of an ongoing ODEP study. Thirty-three non-selected consecutive KA TKAs performed by the lead author were matched to a control group of 33 measured resection with mechanically aligned (MA) TKAs performed by other consultant surgeons. Patients were matched for sex, age, BMI and pre-operative Oxford Knee Score (OKS). Pre-operative median OKS was 21 points (max 48), mean age was 69, mean BMI 31, and there were 21 female patients in both arms. The medial pivot GMK Sphere implant (Medacta, Switzerland) was used in all cases. OKS and EQ-5D scores were measured pre-operatively and at 1-year post-op. Patient outcome satisfaction scores were assessed at 1-year follow-up using a visual analogic scale (VAS). Pre- and post-operative knee radiographs were analysed using TraumaCad software. Results. No reoperation or revision was recorded in either group. KA patients were found to have higher OKS (median 44 Vs 42, p=0.78), satisfaction (median 99/100 Vs 90/100, p=0.28), and EQ-5D improvement (mean 0.34 Vs 0.28, p=0.21) compared to MA patients; however, none of the differences discovered were statistically significant. In addition, KA patients had a femoral component that was on average, 3.5° more valgus orientated (aLDFA 84° Vs 80°, p<0.05) and 2.1° more flexed (4.4° Vs 2.3°, p=NS), and a tibial component with 3.6° (aMPTA 86° Vs 89.6°, p<0.05) and 3.9° (5.5° Vs 1.6°, p<0.05) increased varus orientation and posterior slope, respectively. Conclusion/Discussion. KA TKA performed with medial pivot implant design has shown good safety and efficacy at early-term. The physiological implantation provided by the KA technique seems to be clinically beneficial compared to MA implantation, although, the measured differences did not show statistical significance. Having a low study power and high ceiling effect of outcome measure tools may partly explain our results. Early results for KA TKA are encouraging and longer follow-up is warranted to assess longevity of results. For any figures or tables, please contact authors directly


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_10 | Pages 12 - 12
1 Oct 2015
Kumar KHS Barbur S Twohig E Sandhu H
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Proximal Femoral Nail Antirotation (PFNA) I one of the implants commonly used to stabilise subtrochanteric fractures or communited inter/pertrochanteric fractures. The aim of this project was to assess the outcome of PFNA in a busy District General Hospital. Between November 2009 to November 2012, 76 patients underwent PFNA. These patients were identified from the local hip fracture database, which is prospectively collected. The mean age of the patients was 80.11 years (range of 26.83 to 98.53). 27 were male and 49 female. Right hip was involved in 36 cases and left hip in 40. 9 patients required revision surgery due to failure of the primary surgery. 2 patients died due to other causes. 5 out of the 9 patients who underwent revision surgery had their primary surgery performed by a trainee under consultant supervision and a consultant surgeon performed the other 4 cases. In our series failure rate was 11.8%. We conclude that although PFNA is an excellent device to fix subtrochanteric or communited intertrochanteric fractures of the proximal femur one needs to be cautious and follow the correct operative technique to avoid failures


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_5 | Pages 4 - 4
1 Mar 2014
Jonas S Shah R Al-Hadithy N Mitra A Deo S
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A number of studies suggest revision of unicompartmental knee replacement (UKR) to total knee replacement (TKR) is straightforward. We hypothesise that this is not always the case in terms of complexity, cost and clinical outcome. We identified 23 consecutive patients revised from UKR to TKR by 2 consultant surgeons (2005–2008). These were matched by age, sex and comorbidity to a cohort of primary TKRs (42 patients) performed during the same period. Data were collected regarding demographics, cost (surgical time & implants) and 1 & 5-year follow-up of clinical outcome (OKS) and outpatients attended. There was no statistically significant difference in cost of implants for revision UKR to TKR vs. primary TKR (p=0.08), however operative time was significantly higher in the revision group. One year mean OKS was significantly higher in the primary TKR group (mean 30 vs. 23 p=0.03), but 5-year follow up showed no significant difference (mean OKS 27 vs. 32 p=0.20). The revision group had statistically significantly greater number of follow-up appointments (mean 6 Vs. 2 p<0.0001). Revision of UKR to TKR is not a universally straightforward procedure, carrying significant overall cost implications. Clinical outcomes, although significantly different at 1 year are almost the same at 5 years


Bone & Joint Open
Vol. 5, Issue 8 | Pages 697 - 707
22 Aug 2024
Raj S Grover S Spazzapan M Russell B Jaffry Z Malde S Vig S Fleming S

Aims

The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O).

Methods

Data collected by the UK Medical Education Database (UKMED) between 1 January 2014 and 31 December 2019 were used in this retrospective longitudinal cohort study comprising 1,960 CSTs eligible for ST3. The primary outcome measures were whether CSTs applied for a T&O ST3 post and if they were subsequently offered a post. A directed acyclic graph was used for detecting confounders and adjusting logistic regression models to calculate odds ratios (ORs), which assessed the association between the primary outcomes and relevant exposures of interest, including: age, sex, ethnicity, parental socioeconomic status (SES), domiciliary status, category of medical school, Situational Judgement Test (SJT) scores at medical school, and success in postgraduate examinations. This study followed STROBE guidelines.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 159 - 159
1 Jan 2013
Karunathilaka C Chan F Pinto N Rathnayake K Chandrasiri J
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In acute orthopedic trauma care rapid communication between the resident and consultant surgeon is important. Teleradiology and internet facilities have been explained for transferring the x-ray images. Advanced technology found to be impractical for many countries like Sri Lanka. Objective. To determine the applicability of mobile phone multimedia message system (MMS) in acute trauma care to transfer the X-ray images and identify the practical issues related to it. Methodology. A cross sectional survey was done for a period of 01 yr. Digital photos of X-ray images were taken by using a phone camera and communicated between the senior resident and the consultant. MMS images were analyzed in relevant to the, adequacy of MMS images, quality of the MMS image and relevant area of visualization to reach a radiological diagnosis to decide the acute management plan of the patient. Analyzed the issues related to the processing and transmission of MMS Images. Results. 220 X-rays were evaluated. In 93.4 percent times was able to achieve a radiological diagnosis and decide an acute management plan. In 95% of images area of visualization is adequate. Reasons for poor quality images were analyzed. The external factors that determine the quality of the MMS images were identified. The poor quality of MMS images due to illuminator, blurring and cross bars in the MMS image increases the relative risk of achieving radiological diagnosis by factor 1.09, 3.07 and 1.32 respectively. Conclusion. The results suggest that MMS images are useful tool to communicate between consultant and the resident to decide the management plan for the patient in acute trauma care. But still the clinical assessment and on site assessment is the gold standard. Multimedia messages can be used to speed up the management process and helpful when there is time distance between the consultant and the resident


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_II | Pages 29 - 29
1 Feb 2012
Branfoot T Harwood P Britten S Giannoudis P
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Guidelines on the care of the seriously injured have led to widespread changes in clinical practice. The ‘hub and spoke’ model of trauma care means increasing numbers of patients with complex problems are concentrated into regional centres. Though providing the highest standards of treatment, this has cost implications for the receiving unit, particularly given the Department of Health's move towards a ‘Payment by Results’ model of health provision. We undertook an economic evaluation of complex limb reconstruction within our tertiary referral unit. Patients referred to the complex trauma service were identified. Patients were assigned to either a ‘complicated’ or ‘straightforward’ group by two consultant surgeons, based on the nature of their treatment. 5 cases from each group were randomly selected for further analysis. Data pertaining to the direct healthcare costs for these patients was analysed. Costs per investigation/intervention were obtained relating to hospital stay, outpatient care, operative interventions and investigations. Overall 26 patients were referred to our complex trauma service from other units over 6 months. A mean of £8,375 (6,163) per patient was recouped using current Service Level Agreements. This amounts to a £26,587 deficit per patient, or £1,394,905 per year assuming current referral rates. Those planning a service treating complex trauma must allow for the considerable costs involved and make provisions to recoup this from the referring Primary Care Trust


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXV | Pages 115 - 115
1 Jun 2012
Konan S Hossain FS Haddad FS
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Introduction. There have been concerns regarding the quality of training received by Orthopaedic trainees. There has been a reduction in working hours according to the European working times directive. National targets to reduce surgical waiting lists has increased the workload of consultants, further reducing the trainees' surgical experience. Navigation assisted procedures are successfully used in orthopaedics and provides useful feedback to the surgeon regarding precision of implant placement. We investigated the use of navigation aids as an alternative source of training surgical trainees. Methods. We choose a navigation assisted knee replacement (TKR) model for this study. A first year Orthopaedic registrar level trainee was taught the TKR procedure by a scrubbed consultant in 5 cases. He was then trained in use of non-CT based navigation surgery. The Trainee then performed navigation assisted non-complex primary TKR surgery. A consultant Orthopaedic surgeon was available throughout for advice and support. Data collected included pre and post procedure valgus and varus alignment of the knee, total operative time and WOMAC scores pre and post operatively. Results. A total of 42 TKRs were performed. Intra-operative review by the consultant surgeon was necessary on 3 occasions in the first 10 cases and two occasions in the remaining cases. The average operative time reduced from 184.25 minutes in the first 10 cases to 163.11 minutes in the next 20 cases and 150.33 minutes in the next 12 cases. The varus/valgus alignment was corrected to within 8 degrees in all cases. A significant improvement in WOMAC scores was recorded for all patients (p< 0.05). Conclusion. We believe that this model can be used as a training aid in various orthopaedic surgical procedures


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 55 - 55
1 Mar 2012
Edwards M Hartwright D Scott W
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Parallel operating lists are a contentious subject. Many people feel that supervision, training and quality of patient care is negatively affected and consider this an outdated model in modern practice. Dual and parallel lists have been largely abandoned due to training committees' opinions that standards of orthopaedic training were being negatively affected. A new model of dual lists was implemented in a district general hospital as part of an arthroplasty service. The training impact was evaluated. Adjacent theatres were utilised for a single session. Two joint replacement surgeries were undertaken in each theatre. The sequential timing of the lists allowed the consultant to perform or supervise all of the operations in a consecutive manor. Staggering the start times allowed the consultant to approach and implant the first joint replacement, leaving the junior doctor or nurse practitioner to close the first operation and get the patient off the table while the consultant transferred to the adjoining theatre where the registrar had positioned, painted and draped the second patient, allowing the consultant to perform or supervise the second surgery. The process was then repeated until all four cases were performed. Evaluation of two registrar's elogbooks was undertaken and compared to the national average. During a twelve month period the trainees was involved in a mean of 72 joint replacement surgeries compared to a national average of 49. The trainees were the primary surgeon in a significantly higher number of operations compared to the national average. This model of sequential operating lists facilitated a service of high volume arthroplasty surgeries and significantly increased the exposure of the training registrar to joint replacements. Supervision of trainees was not significantly impacted. The model requires effective support services and a dedicated team of theatre staff, but can be very rewarding for consultant surgeon and trainee alike


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_13 | Pages 1 - 1
1 Jun 2016
Prasad VR Fung M Borowsky K Tolat A Singh B
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We wished to assess the usefulness of Inspace balloon arthroplasty (IBA), in our Upper limb unit by regular patient reviews prospectively. This prospective study was started adhering to local approval process. Patients were identified in routine clinical practice by three upper limb consultants presenting with pain and disability and diagnosis of cuff tear was established clinically and on MRI. The patients were explained of ‘available’ treatment options and an information leaflet about balloon arthroplasty provided. Patients were seen in 4 weeks, in a dedicated clinic to find out their willingness to participate. Consultant shoulder surgeons carried out all Balloon arthroplasties and where the cuff was reparable or contraindications identified were excluded from study. All the patients were reviewed by an independent clinician pre-operatively and post operatively using the assessment tools of Oxford Shoulder Scores (OSS), SF12 and VAS at 6 weeks, followed by 3, 6, 12 months and annually after. We performed a total of 32 IBA procedures. At the latest follow-up we identified that 24 patients have completed 2 years post procedure. Of these patients 1 deceased after 6 months, 3 were lost to follow up one each at 6, 12 and 24 months. Three were revised to reverse TSA. The OSS reflects that the positive difference of 10 in the average scores (24 pre-operative versus 34 at 2 years) noted at one year follow up were maintained at 2 years. Similar observations made analysing at 12 months and 2 years scores for the VAS pain scores of 3 at 2 years compared to pre-operative score of 6 and so were improvements in both physical & mental components of SF12. Our study observes that the IBA provides a sustainable pain relief and functional improvements over 2 years and may be a suitable alternative in physiologically compromised patients with irreparable RCT


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_10 | Pages 2 - 2
1 Oct 2015
Prasad V Singh B Borowsky K Tolat A Kurta I
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Aim. To determine the benefit of dissolvable Balloon Arthroplasy in managing patients with massive irreparable rotator cuff tears (RCT). Methods. This is prospective pilot study carried out adhering to the local approval process. Patients having massive cuff tear with pain or functional limitation were seen by consultants and MRI confirmed the diagnosis. The patients were explained of ‘all available’ treatment options and information leaflet about the new procedure balloon arthroplasty, provided. Patients were seen after 4 weeks in a dedicated clinic to find out if they were willing to participate. Patients were seen by a physiotherapist pre and post-operatively at 6 weeks then at 3, 6 and 12months in addition to medical follow-ups, using VAS, Oxford Shoulder, Constant and SF36 scores. All procedures were carried out by consultant shoulder surgeons and where the cuff was reparable or contraindications identified were excluded. Results. Of the 25 recruited 4 were lost for follow up. 17 of the remaining 21 completed 12 month follow up, and the remaining completed their 6 month follow up. Male to female ratio was 2:1 and no surgical complications were noted. Two patients required an inverse shoulder arthroplasty. Improvements were noted in the SF36, VAS and OSS. Conclusion. The balloon arthroplasty seems to offer benefit for a group of patients who are unfit or not keen on major surgery to offer pain relief possibly function. Recommendations cannot be made due to the study but suggest a multicentre study


Bone & Joint Open
Vol. 2, Issue 3 | Pages 181 - 190
1 Mar 2021
James HK Gregory RJH

The imminent introduction of the new Trauma & Orthopaedic (T&O) curriculum, and the implementation of the Improving Surgical Training initiative, reflect yet another paradigm shift in the recent history of trauma and orthopaedic training. The move to outcome-based training without time constraints is a radical departure from the traditional time-based structure and represents an exciting new training frontier. This paper summarizes the history of T&O training reform, explains the rationale for change, and reflects on lessons learnt from the past.

Cite this article: Bone Jt Open 2021;2-3:181–190.


Bone & Joint Open
Vol. 1, Issue 5 | Pages 98 - 102
6 May 2020
Das De S Puhaindran ME Sechachalam S Wong KJH Chong CW Chin AYH

The COVID-19 pandemic has disrupted all segments of daily life, with the healthcare sector being at the forefront of this upheaval. Unprecedented efforts have been taken worldwide to curb this ongoing global catastrophe that has already resulted in many fatalities. One of the areas that has received little attention amid this turmoil is the disruption to trainee education, particularly in specialties that involve acquisition of procedural skills. Hand surgery in Singapore is a standalone combined programme that relies heavily on dedicated cross-hospital rotations, an extensive didactic curriculum and supervised hands-on training of increasing complexity. All aspects of this training programme have been affected because of the cancellation of elective surgical procedures, suspension of cross-hospital rotations, redeployment of residents, and an unsustainable duty roster. There is a real concern that trainees will not be able to meet their training requirements and suffer serious issues like burnout and depression. The long-term impact of suspending training indefinitely is a severe disruption of essential medical services. This article examines the impact of a global pandemic on trainee education in a demanding surgical speciality. We have outlined strategies to maintain trainee competencies based on the following considerations: 1) the safety and wellbeing of trainees is paramount; 2) resource utilization must be thoroughly rationalized; 3) technology and innovative learning methods must supplant traditional teaching methods; and 4) the changes implemented must be sustainable. We hope that these lessons will be valuable to other training programs struggling to deliver quality education to their trainees, even as we work together to battle this global catastrophe.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_II | Pages 26 - 26
1 Feb 2012
Macleod A Kurdy N
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Podiatrists have an important role in providing care in a Foot and Ankle clinic. Most Foot and Ankle Surgeons welcome the assistance they can provide – in a supervised role. Most Trusts should have one Foot and Ankle Surgeon but there are a limited number of trained specialists. Some Trusts have been appointing ‘Consultant Podiatric Surgeons’ – perhaps as a way of addressing this shortfall. There are potentially a number of concerns amongst Foot and Ankle Surgeons: the public perception of title ‘consultant’; a Non supervised role; Potential to be used as a more cost effective option. We therefore undertook a Questionnaire assessment of patients attending a Foot and Ankle Clinic. Over a six week period 148 patients attended the specialist clinic. Of those 76% responded. 64% were females. The average age range was 45-64. Most patients assumed the Consultant in charge of their care was a qualified medical practitioner (93%) and regulated by the GMC (92%) and who had completed a recognised higher surgical training scheme (93%). Irrespective of suitable experience 2 out of 3 patients stated they would object if the Consultant in charge of their care did not meet the above criteria. If the patient required surgery 80% stated they would object if the supervising Consultant was not a medically qualified doctor (this was more important in female patients) Interestingly 78% stated they would refuse surgery unless they were under the care of a medically qualified doctor. Very few patients understood the title Consultant Podiatric Surgeon (with those responding assuming they were medical doctors). This potentially has significant implications in those Trusts employing Consultant Podiatric Surgeons as opposed to Foot and Ankle (Orthopaedic) Surgeons. Unless this differential is clearly explained to the patients there is an issue with informed consent and the potential for litigation


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXII | Pages 11 - 11
1 Jul 2012
Edwards D Millington J Dunlop D Higgs D Latham J
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With an increasing ageing population and a rise in the number of primary hip arthroplasty, peri-prosthetic fracture (PPF) reconstructive surgery is becoming more commonplace. The Swedish National Hip Registry reported that, in 2002, 5.1% of primary total hip replacements required revision due to PPF. Laboratory studies have indicated that age, bone quality and BMI all contribute to an increased risk of PPF. Osteolysis and aseptic loosening contribute to the formation of loosening zones as described by Gruen, with subsequent increased risk of fracture. The aim of the study was to identify significant risk factors for PPF in patients who have undergone primary total hip replacement (THR). Logbooks of three Consultant hip surgeons were filtered for patients who had THR-PPF fixation subsequent to trauma. Risk factors evaluated included sex, age, bone density (Singhs index), loosening zones, Vancouver classification, prosthesis stem angle relative to the axis of the femur, and length of time from THR to fracture. A control group of uncomplicated primary THR patients was also scrutinised. Forty-six PPF were identified representing 2.59% of THR workload. The male: female ratios in both groups were not significantly different (1:1.27 and 1:1.14 respectively). Average age of PPF was 72.1, which was significantly older than the control group (54.7, p>0.05). The commonest type of PPF was Vancouver type B. Whilst stem position in the AP plane was similar in both groups, in lateral views the PPF stem angle demonstrated significant antero-grade leg position compared to the non-PPF group (p.0.05). The PPF group demonstrated a greater number of loosening zones in pre-fracture radiographs compared to the control group (2.59 and 1.39 respectively, p>0.05). Our workload from PPF reflects that seen in Europe. Age, stem position and the degree of stem loosening appear to contribute to the risk of a peri-prosthetic fracture


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_III | Pages 82 - 82
1 Feb 2012
Barker S Cox Q
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Late presentation and rapid progression of Dupuytren's contracture significantly increases operating time, complications and likelihood of incomplete correction; however, surgical timing is usually more a function of waiting list length than of clinical criteria. We sought to measure the rate of progress of Dupuytren's contracture. All patients with Dupuytren's contracture referred to the sole Consultant Hand Surgeon for Highland Region between June 1997 and February 2003 were prospectively included. Fixed flexion deformities at each finger joint and thumb-index angle to the point of firm resistance to extension were recorded by a single observer (QGNC) at presentation and immediately pre-operatively. Of 151 participants 37% had a family history. There was a male predominance of 5:1, with bilaterality in 77% at presentation. Five percent had diabetes, 3% had epilepsy, 52% acknowledged tobacco habits and 24% regular alcohol in excess of recommended limits. Angular deterioration was observed in 52% of digits, over one quarter of this occurred at the small finger joints, where 58% of PIPJs progressed. Mean delay from presentation to surgery was 11 months (2-55.5). Mean age at presentation of 62 (16-86) years did not correlate with angular deformity at presentation or with velocity of deterioration or with manual/non-manual employment. Mean severity of deformity at presentation for manual (34°) was double non-manual workers (17°) although angular deterioration was faster in the non-manual group (3.8 cf 0.7°/month respectively). Similar speeds of deterioration were seen at MCPJ and PIPJ, speed of deterioration was 2.2°/month for each of the three ulnar digits. Speed of deterioration correlated (r=0.7) with severity of deformity at presentation for ring and small fingers. This study offers the first quantification of rate of deterioration in Dupuytren's contracture. This could be used as a waiting list tool to predict the delay before a digit is likely to pose increased surgical risk


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 14 - 14
1 May 2012
Gheiti AC Kegan C Boran S Kenny P
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Introduction. Surgical experience has been shown to improve the clinical outcomes in Total hip arthroplasty. The objective of this study was to compare clinical and radiological outcomes between Consultants and NCHDs grade surgeons for the Exeter total hip replacement taken from the Cappagh National Orthopaedic Hospital Joint Register. Methods & Materials. Between 2005 and 2008, 2749 primary total hip replacements were done, 433(15.78%) were Exeter total hip system. 380(86%) out of 433 were included in the study, 227(59%) were females and 154(41%) were males. A consultant was the primary surgeon for 193(51%) patients and an NCHD was the primary surgeon for 187(49%) patients. Mean age, at time of operation was 68 years. Clinical outcome was assessed with WOMAC and SF36 scoring system. Patients were invited to fill in the WOMAC and SF36 questionnaire, pre-operatively, at 6 months and at 2 years after the operation. Radiographs were evaluated for radiolucency with a standardized technique. Results. Mean WOMAC scores for consultant grade surgeons were: 61(pre op), 23.34(6 months post op) and 22.96(at 2 years post op) with standard deviations of 15.61(pre-op), 17.9(at 6 months) and 17.19(at 2 years). Average SF36 scores were 42.40(pre-op), 70.15(at 6 months) and 71.30(at 2 years) with standard deviations of 17.94(pre op), 18.02(6 months) and 22.59(2 years). NCHD grade surgeons had average WOMAC scores: 62.55(pre op), 22.36(6 months) and 25.35(2 years). Average SF36 scores were: 41.1(pre-op), 67.47(6 months) and 66.63(2 years). The difference in the mean WOMAC scores between consultants grade and NCHD grade surgeons were 1.55(pre-op), 0.98(6months) and 2.39(2 years), while the difference between the mean SF36 were 1.3(pre-op), 2.68(6 months) and 4.67(2 years). Student T Test was used to correlate differences between the 2 groups. The difference in outcomes between the 2 groups was not significant (P<0.05). Conclusion. We found out that both groups had similar outcome and survival, with no significant difference when using an Exeter Total Hip Arthroplasty