Foot and ankle surgery is a rapidly evolving specialty. As the number and complexity of cases increases, the number of complaints,
Definitions and perceptions of good and poor outcome vary between patients and surgeons, and perceived inadequate outcome can lead to
Background. In the UK 70,000 knee arthroplasties are performed each year. Although outcomes from knee arthroplasties are usually excellent, they can nevertheless lead to negligence claims. The aim of this study was to establish the incidence, cost and cause of negligence claims arising from knee arthroplasties. Method. All claims made to the NHS
Claims for clinical negligence are increasing annually. Limb reconstructive surgery recognises ‘problems, obstacles, and complications’ as part of the treatment process, but this does not prevent a claim for an alleged poor result or a complication. We analysed claims for clinical negligence in the National Health Service in England and Wales for issues following limb reconstructive surgery. A database of all 10,456 claims related to Trauma and Orthopaedic Surgery from 1995–2010 was obtained from the NHS
Introduction. While THA is associated with positive results and long-term improvement in patient quality of life, outcomes are nonetheless associated with adverse events and post-procedural deficits related to discrepancies in leg length (LLD), offset and cup placement. Post-THA errors in these parameters are associated with gait alteration, low back pain and patient dissatisfaction. Such discrepancies often necessitate revision and increasingly lead to medical malpractice
Introduction. Limb length discrepancy after THA can result in medicolegal
The undergraduate curricula in the UK have no designated modules on sarcomas. Lumps and bumps are commonly presented to surgeons, hence awareness of sarcoma is important. The aim of this study was to identify the awareness and knowledge of orthopaedic and surgical trainees relating to the presentation, referral and management of sarcomas. Participants were invited to take part and complete an online questionnaire. Sarcoma knowledge was assessed using a variety of questions. Key resources were provided to improve knowledge at the end of the questionnaire. There were 250 respondents, which included medical students (n=49), foundation doctors (n=37), core surgical trainees (n=58), registrars (n=73), post-CCT surgeons (n=9) and academic fellows (n=4). Both UK and international trainees were included. 45% did not recall receiving sarcoma teaching at undergraduate level, with 61% stating they did not have adequate training to identify sarcoma “red flags”. 58% did not have sufficient background knowledge of sarcomas whilst 38% were unable to identify sarcoma red flags. 64% and 25% of trainees had insufficient knowledge of the correct referral process and management for sarcomas respectively. There appears to be a deficiency in training regarding sarcoma identification and management within trainees. “Red flags” for lumps are not widely known who may be asked to review these patients. Many trainees are not aware of the national guidelines for referral and management. The large sample of respondents is likely to be representative of the larger trend and may lead to inappropriate management, poor outcomes and
My involvement in the DEFENSE side of MoM hip
Introduction. Restoration of anatomy is essential in total hip arthroplasty (THA) to optimize function and stability. Leg-length discrepancy of ≥10mm is poorly tolerated and can be the subject of
The current standard of care in the United States for the treatment of an infected arthroplasty, whether it be a TKA, THA or TSA remains two stage revision. We performed a systematic review of the English literature to answer the question of whether one-stage or two-stage revision of infected shoulder arthroplasty was better in terms of re-infection rate, patient satisfaction and patient function. There were no prospective, randomised studies comparing these two approaches. We found 19 studies with a minimum one year follow up which described 99 patients with two-stage revision, 38 with one-stage revision and 36 with spacers. There were no significant differences between the groups for recurrent infection rate or complication rate. The spacer only group had higher satisfaction than the one-stage group, but the satisfaction rate between the one- and two-stage groups was not statistically different. Unfortunately, the numbers in our study were small and based upon level IV evidence. It is interesting that currently the data do not support two-stage over one-stage revision of an infected TSA. So why do we continue to use two-stage revision? I believe it is the fear of
Introduction. ‘VTE disease is the new MRSA’, with much attention received in the media and the political world. Following the 2010 NICE guidelines all patients admitted to hospital should have VTE prophylaxis considered and a formal VTE risk assessment done with documentation and review in a 24 hour period. We carried out a completed audit cycle to identify our adherence to these guidelines and introduced a novel method to ensure compliance. Materials/Methods. An audit of 400 patients admitted to the orthopaedic department was carried out with review of case notes. Three key parameters were investigated: Firstly the compliance of carrying out a risk assessment for VTE disease with correct documentation, secondly investigating how many patients got re-assessed in 24 hours and finally if patients received appropriate VTE prophylaxis. The data was re-audited following the introduction of a new drug chart with a box section for VTE risk assessment and prophylaxis on the chart itself. Results. In the first cycle VTE risk assessments were carried out in 2.5% with 0% having a re-assessment in 24 hours and 93.5% of patients having correctly prescribed VTE prophylaxis. Following the new drug charts, the risk assessments were carried out in 79%, re-assessment in 50% and correct prescribed prophylaxis in 99% of the patients. Conclusions. We recommend all hospitals should have a section in the drug chart itself for VTE risk assessment and prophylaxis as this greatly improves compliance to the NICE guidelines. This ensures optimal patient care and protects the trust from
INTRODUCTION. Leg length discrepancy following total hip arthroplasty (THA) can be functionally disabling for affected patients and can lead on to
Introduction. Following the publication of our original survey in 2000 (Eur. Sp. J. 11(6):515-8 2002) we have sought to re-evaluate the perceptions and attitudes towards spinal surgery of the current UK orthopaedic Specialist Registrars (SpRs), and to identify factors influencing an interest in spinal surgery. At that time 175 orthopaedic spinal surgeons in the UK needed to increase by 25% to satisfy parity with other European countries. Methods. A postal questionnaire was sent to all 917 SpRs. The questionnaire sought to identify perceptions in spinal surgery, levels of current training and practice, and intentions to pursue a career in spinal surgery. Results. A 61% response rate has confirmed that 74% of trainees intend to avoid spinal surgery (69% in 2000). However 10% are committed to become a Specialist Spinal Surgeon (6.5% in 2000). Their perceptions were wide ranging but most concluded that the intellectual challenge and opportunities for research are widely recognised. However enthusiasm is dampened by poor perceptions of outcomes from surgery, negative somatisation and depression associations, complications and the fear of
Background. Leg length discrepancy (LLD) after intramedullary nailing of femoral shaft fractures is a common problem reported in up to 43% of cases. Comminuted fractures with radiographic loss of bony landmarks have an increased possibility of being fixed with unequal leg lengths. Aims. The purpose of this report is to evaluate the efficacy of routinely obtaining a CT scanogram post-operatively on patients of comminuted femoral shaft fractures treated with intramedullary nailing and immediate correction of limb length inequality if indicated. Results. Twenty one patients with comminuted femoral shaft fractures that were treated with intramedullary nailing and underwent a CT scannogram for evaluation of LLD were included in the study. There were 12 patients with Winquist III and 9 with a Winquist IV fracture pattern. Following surgery leg lengths were measured from the CT scanograms using a computerised measuring ruler. The largest leg length discrepancy noted on scannogram was 4 cm. The average limb length discrepancy was 0.67 cm. Eight patients had a discrepancy of 1cm or greater. We also measured the tibial length in all patients and found only 3 patients with exactly equal tibial lengths. A tibial length discrepancy less than 5mm was observed in 11 patients. In 7 patients it was between 5-9mm and in 3 patients it was 10mm or greater. Four patients underwent leg length correction during the same admission. Conclusion. The decision to undertake correction of the LLD is primarily dependant on the degree of discrepancy. The degree of LLD that requires correction remains undefined. In this study LLD of greater than 15mm was considered for equalisation. Immediate equalisation saves cost, morbidity, delayed sequelae and
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
Background:. Total hip arthroplasty (THA) has been proven to be successful in achieving adequate pain relief and favorable outcomes in patients suffering from hip osteoarthritis (OA). However, leg length discrepancy (LLD) is still a significant cause of morbidities such as nerve damage, low back pain and abnormal gait. Despite most of the reported values of LLD in the literature being within the acceptable threshold of < 10 mm, some patients still report dissatisfaction, leading to