Aim. To investigate self-reported quality of life (QoL) in patients with osteomyelitis referred to a specialist centre in the UK and investigate the relationship between QoL and BACH classification. Method. All patients newly referred to a specialist bone infection clinic at a single tertiary centre within the UK between January 2019 and February 2020 were prospectively included. Diagnosis of osteomyelitis was made according to the presence of clinical and radiological criteria for ≥6 months. An EQ-5D-5L questionnaire and visual analogue score (VAS) were completed during the initial clinic appointment. Long-bone osteomyelitis was classified by the attending orthopaedic surgeon using the BACH classification system as either uncomplicated, complex or with limited options available.1 Patients managed non-operatively were subclassified into those who were (i) unfit to receive an operation or (ii) fit and well with stable disease. EQ-5D index scores were compared to a published UK value set of 41 chronic health conditions within the UK.2. Results. 201 patients were referred during the study period, with 159 (79.1%) patients diagnosed with long-bone osteomyelitis and 16 (8.0%) with osteomyelitis of the pelvic bones. Patients with pelvic osteomyelitis reported lower EQ-5D index scores compared to long-bone osteomyelitis (EQ-5D: 0.097 vs. 0.435, p<0.001) but similar VAS (60.2 vs. 54.6, p=0.37). Long-bone and pelvic osteomyelitis gave the 40th and 41st lowest EQ-5D scores respectively when compared to 41 other chronic health conditions including stroke, chronic obstructive pulmonary disease, kidney disease, liver disease and malignancy. Patients classified as having uncomplicated long-bone osteomyelitis reported significantly higher QoL compared to those classified as complex osteomyelitis (EQ-5D: 0.527 vs. 0.401, p<0.05; VAS: 66.9 vs. 58.4, p<0.05). Patients who were not fit for surgery due to co-morbidity reported similar QoL scores compared to those patients with complex osteomyelitis (EQ-5D: 0.293, p=0.07; VAS: 46.6, p=0.06). Patients with stable disease who did not require surgery, gave significantly better QoL scores when compared to the other classifications of osteomyelitis (EQ-5D: 0.746, p<0.01; VAS: 81.9, p<0.01). Conclusions. Patient reported QoL in osteomyelitis correlates with disease complexity as classified according to the BACH classification system. Patients with pelvic and long-bone osteomyelitis rate their QoL lower than patients with other chronic diseases

Introduction. This study assesses self-reported quality of life (QoL) in patients with osteomyelitis referred to a specialist centre in the UK. Materials and Methods. All patients newly referred to a specialist tertiary bone infection clinic within the UK between January 2019 and February 2020 were prospectively included. Diagnosis of osteomyelitis was made according to the presence of clinical and radiological criteria for ≥6 months. An EQ-5D-5L questionnaire and visual analogue score (VAS) were completed during the initial clinic appointment. Long-bone osteomyelitis was classified by the attending orthopaedic surgeon using the BACH classification system as either uncomplicated, complex or with limited options available. Patients managed non-operatively were subclassified into those who were (i) unfit to receive an operation or (ii) fit and well with stable disease. EQ-5D index scores were compared to a published UK value-set of 41 chronic health conditions within the UK. Results. 201 new patients were referred during the study period. 159 (79.1%) met the criteria for long-bone osteomyelitis and 16 (8.0%) for osteomyelitis of the pelvic bones. Patients with pelvic osteomyelitis reported lower EQ-5D index scores compared to long-bone osteomyelitis (EQ-5D:0.097 vs. 0.435, p<0.001) but similar VAS (60.2 vs. 54.6, p=0.37). Long-bone and pelvic osteomyelitis gave the lowest EQ-5D scores respectively when compared to 41 other chronic health conditions including stroke, chronic obstructive pulmonary disease, kidney disease, liver disease and malignancy. Patients classified as having uncomplicated long-bone osteomyelitis reported significantly higher QoL compared to those classified as complex osteomyelitis (EQ-5D:0.527 vs. 0.401, p<0.05; VAS: 66.9 vs. 58.4, p<0.05). Patients not fit for surgery due to co-morbidity reported similar QoL scores compared to those patients with complex osteomyelitis (EQ-5D: 0.293, p=0.07; VAS: 46.6, p=0.06). Patients with stable disease who did not require surgery, gave significantly better QoL scores when compared to the other classifications of osteomyelitis (EQ-5D: 0.746, p<0.01; VAS: 81.9, p<0.01). Conclusions. Patient reported QoL in osteomyelitis correlates with disease complexity as classified according to the BACH classification system. Patients with pelvic and long-bone osteomyelitis rate their QoL lower than patients with other major chronic diseases

Background. In young patients with femoral neck non-union it is desirable to preserve the femoral head. The objective of this study was to assess the outcome results of revision internal fixation and nonvascular fibular bone grafting. Patients and Methods:. Ten patients with non united fracture neck femur were included in this prospective study. Fixation was done with two cancellous screws leaving behind a space between two screws for fibular strut graft. Assessment of union was done by both clinical and radiological criteria. Results:. union was achieved in 8 cases in an average time of 16 weeks (range 12–20 weeks). There was no infection, thromboembolic complications, donor site morbidity or implant failure in our series. Conclusion:. Nonvascularized fibular strut graft along with cancellous screws provides a biological and mechanically sound method of treatment. Fibula being cortical provides mechanical strength besides stimulating union and getting incorporated as biological graft

We describe the association between post-operative femoral stem radiological appearances and aseptic failure of THA (total hip arthroplasty) following a retrospective review of records and radiographs of all patients attending for follow-up between August 2002 and August 2003 who had a cemented Charnley femoral stem and either a cemented polyethylene acetabular cup inserted. Femoral stem aseptic loosening was defined either by findings at revision surgery, the definite radiographic loosening criteria of Harris or progressive endosteal cavitation across zones as described by Gruen. Well-fixed control THAs were defined as those that demonstrated none of the radiographic features of aseptic loosening or ‘at risk’ signs as described by Wroblewski. Parameters measured were: Alignment, Barrack grade of cementation, cement mantle width of the cement mantle and the presence and width of any radiolucent lines. Sixty-three hips were entered into the aseptic failure group and 138 into the control group. The alignment of the femoral stem was not associated with failure (p=0.283). Thickness of the cement mantle was statistically associated with failure in Gruen zones 6 (p=0.040) and Gruen zone 7 (p=0.003). A significant association for the presence of radiolucent lines was found for Gruen zones 3 (p=0.0001) and 5 (p=0.0001). The grade of cementation as measured by the Barrack grade was strongly associated with failure for grades C (p=0.001) and D (p=0.001). This study has demonstrated that easily applied radiological criteria can be used to identify ‘at risk’ Charnley THAs from the immediate post-operative AP radiograph