We hypothesised whether MIS techniques confer any benefit when treating thoracolumbar burst fractures.

This was a prospective, non-randomised study over the past seven years comparing conservative (bracing:n=27), conventional surgery (open techniques:n=23) and MIS techniques (n=21) for stabilisation and correction of all thoracolumbar spinal fractures with kyphosis of >20⁰, using Camlok S-RAD 90 system (Stryker Spine). All patients previously had normal spines, sustained only a single level burst fracture (T12, L1 or L2) as their only injury. Age range 18–65 years.

All patients in both operatively treated groups were corrected to under 10⁰ of kyphosis, posteriorly only. All pedicle screws/rods were removed between 6 months and 1 year post surgery to remobilise the stabilised segments once the spinal fracture had healed, using the original incisions and muscle splitting/sparing techniques. Patients were assessed via Oswestry Disability Index (ODI) and work/leisure activity status 1 year post fracture.

The conservatively treated group fared worst overall, with highest length of stay, poorest return to work/activity, and with a proportion (5/27) requiring later intervention to deal with post-traumatic deformity. 19/27 returned to original occupation, at average 9 months. ODI 32%.

Conventional open techniques fared better, with length of stay 5 days, most (19/23) returning to original work/activity, and none requiring later intervention. Average return to work was at 4 months. ODI 14%.

MIS group fared best, with shorter length of stay (48 hours), all returning to original work/activity at average 2 months, and none requiring later intervention. ODI negligible.

There was no loss of correction in either operatively treated groups.

The Camlok S-RAD 90 system is a powerful tool for correction of thoracolumbar burst fractures, and maintains an excellent correction.

MIS techniques provide the best outcomes in treating this group of spinal fractures, and offer patients the best chance of restoration to pre-fracture levels of activity.

Objectives. Minimally invasive surgery (MIS) has gained popularity for hallux valgus, compared to the traditional scarf osteotomy (OS). Though evidence suggests similar clinical outcomes, there is paucity of randomised controlled studies. This study aimed to assess the feasibility of conducting a randomised controlled trial comparing the patient recorded and clinical outcomes for the surgical management of Hallux Valgus between OS and MIS Chevron Akin (MICA). Methods. Patients suitable for surgical correction were invited to participate. Post-op rehabilitation was standardised for both groups. Patients completed a validated questionnaire (Manchester Oxford Foot questionnaire and EQ-5D-5L) pre-operatively and post-operatively at 6 months and 1 year. Radiological parameters and range of motion were measured pre-and post-operatively. Results. 31 patients were recruited between Dec 2017 and June 2022. 17 patients were randomised to MICA (15 female, mean age 51) and 15 to OS (14 female, mean age 51). Both groups had a significant improvement in all MOXFQ parameters at 6m and 12m, as well as radiological parameters. VAS improved for OS (p=0.048) and for MICA (p=0.059) at 6m. There was no significant improvement in EQ-5D in either group at 12 months and no significant difference in operative time (p=0.53). There was a higher number of complications in the MICA group with 5 removal of metalwork (29.4%) and 2 superficial infections (11.8%) versus none in the OS group. The dorsiflexion significantly improved in the OS group at 6months (p=0.04). Recruitment rate dipped during COVID. No patients were lost at follow up. Conclusion. Both surgical options show similar clinical results, but higher complication rates were seen with MICA. This study illustrates the feasibility to conduct a randomised control trial for the comparison between the two techniques. Challenges to recruitment included surgeon equipoise, patient preference, training requirement and the pandemic which could be mitigated in a larger study

Background:. Morbidity of any surgical procedure is undefined. Major surgeries and minor surgeries have different morbidities but the morbidity after any surgical procedure is neither quantified nor defined in literature. Minimally invasive surgeries have evolved in all surgical branches and are known to have less morbidity after the surgery. There is no score or index to assess early recovery after any surgical procedure. Aim:. The objective of the study was to develop a scoring method to assess early post operative recovery of TKR patients. Materials and methods:. 50 consecutive total knee replacement patients were evaluated and scored at day 0, day 1, day2 and day3 post operatively. All the patients were operated upon by a single senior surgeon using minimally invasive approach. The scoring of the index consist of a questionnaire with 10 different questions regarding the general well being of the patient, wound condition, physical abilities and few other important parameters. The scores were judged from 0 to 3. Total score ranges from 0 to 30. The higher the score, the higher is the morbidity of the patient. Results:. The patients showed that the general morbidity decreases in great values from postoperative period to 24 h and 48 h after the surgery. Conclusion:. The morbidity index is a very reliable and precious way of assessing post operative condition of the patient in both surgeon's aspect and patient's aspect of view. Since there is no scoring method for early post operative assessment, this morbidity index may be important to measure the early surgical outcome of different surgeries

Aims. To determine whether there is any benefit using a minimally invasive trans-sartorial approach as described by Professor Søballe compared to the ilio-femoral for peri-acetabular osteotomy. Methods. 30 consecutive patients were operated on by a single surgeon. The first 15 underwent an ilio-femoral (I-F) approach whilst the following 15 had a trans-sartorial (T-S) approach. Fixation was achieved with 3 or 4 screws. All other aspects of surgery and rehabilitation were the same. Data was collected prospectively and included operation time, intra-operative blood loss and length of stay. Acetabular correction was measured using the sourcil and centre edge angle (CEA) on pre and post-operative radiographs. Results. Both groups had acceptable radiographic corrections with CEA improving from mean 14.5 to 38.7 degrees (T-S) and 14 to 39 degrees (I-F). The sourcil angle improved from mean 17.8 to 2 degrees (T-S) and 19.5 to −1.5 (I-F). Minimally invasive surgery reduced anaesthetic time by 62 minutes. Haemoglobin loss was reduced by 1 gram/L and there was no requirement for transfusion. Hospital stay reduced by 0.8 days. There were no major adverse complications although two partial femoral neurapraxias were noted early in the series. These fully resolved. Conclusion. We have found significant benefit from changing to minimally invasive PAO. Our patients have smaller wounds, a shorter operative time, reduced bleeding and a shorter length of stay. We found no adverse effects. The time savings have also corresponded to a cost saving for our institution. We recommend this technique although recognise that it has a learning curve and should be initiated by surgeons with previous PAO experience

Recent interest has focused on minimally invasive hip surgery, with less attention being directed to maximising the potential benefits of this type of surgery. We have developed a new multidisciplinary programme for patients undergoing total hip replacement in order to facilitate an overnight hip replacement service. The programme involves a pre-operative regimen of education and physiotherapy, a modified anaesthetic technique, a minimally invasive surgical approach and a portable local anaesthetic pump infusion for post-operative pain control. Strict inclusion and exclusion criteria were developed based on age, medical status and social circumstances. Patients were mobilised on the day of their operation and discharged home with an ‘outreach team’ support network. No patient complained that their discharge was early. Independent evaluation was performed using the Oxford Hip Questionnaire, the Merle d'Aubigné clinical rating system and Visual Analogue Pain Scores. Thirty seven patients underwent total hip replacement using the new protocol. The average length of stay was 1.2 days. The mean pain score on discharge was 1.3/10. The Oxford Hip Questionnaire and Merle d'Aubigné scores were comparable to patients who underwent surgery prior to the introduction of the new protocol. Minimising in-patient stay for total hip replacement benefits the patient by reducing exposure to nosocomial infection and expediting the return to a normal environment for faster rehabilitation. This new programme allows patients undergoing total hip replacement to be discharged after 1 night post-operatively without compromising safety or quality of care. Minimally invasive surgery with a suitable infrastructure can be used to dramatically reduce the length of stay in suitable patients. This can be achieved reliably, safely and with high patient satisfaction. In order to gain the benefit of Minimally Invasive Surgery we recommend introducing this type of comprehensive programme

Background. Minimally invasive surgery is being widely used in the field of total hip arthroplasty (THA). The advantages of the direct anterior approach (DAA), which is used in minimally invasive surgery, include low dislocation rate, quick recovery with less pain, and accuracy of prosthesis placement. However, minimally invasive surgery can result in more complications related to the learning curve. The aim of this study was to evaluate the learning curve of DAA-THA performed by a senior resident. Methods. Thirty-three consecutive patients (33 hips) who underwent primary THA were enrolled in this study. All operations were performed by a senior resident using DAA in the supine position without the traction table. The surgeon started using DAA exclusively for all cases of primary THA after being trained in this approach for 6 months. Operative time, intraoperative blood loss, complications, and accuracy of prosthesis placement were investigated. Results. The mean intraoperative blood loss was 524 mL (range, 130–1650 m L). The mean operative time was 60 min (range, 41–80 min). Radiographic analysis showed an average acetabular anteversion angle of 17.0±3.3°, abduction angle of 37.8±4.3°, and stem alignment of 0±0.8°. Thirty-two (97%) of 33 cups were placed within the Lewinnek's safe zone. The overall complication rate was 12% (4 of 33 hips), including 1 proximal femoral fracture (salvaged with circumferential wiring), 1 temporary femoral nerve palsy (completely recovered in 2 weeks), 1 stem subsidence (5 mm), and 1 cup migration. Three of these complications were occurred in the first 10 cases. No revision surgery was required, No postoperative dislocation occurred. Conclusion. We investigated the learning curve of DAA-THA performed by a senior resident. We considered the first 10 cases as the learning curve, but concluded that with adequate training this procedure can be performed safely and effectively without increasing the risk of complications