Introduction and Objective. Dislocation of a hip hemiarthroplasty is a significant complication with a high mortality rate in elderly patients. Previous studies have shown a higher risk of dislocation in patients with neuromuscular conditions. In this study, we reviewed our larger cohort of patients to identify if there is a link between neuromuscular disorders and dislocation of hip hemiarthroplasty in patients with neuromuscular conditions. Materials and Methods. We have retrospectively analysed a single-centre data that was collected over 34 years for patients with intracapsular neck of femur fracture who underwent hip hemiarthroplasty. The study population was composed of four groups: patients with no neuromuscular disorders, patients with Parkinson's disease, patients with previous
Revision knee arthroplasty is a complex procedure with the number and cost of knee revision procedures performed per year expected to rise. Few studies have examined adverse events following revision arthroplasty. The objective of this study was to determine rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision (urgent versus elective indications) and to compare these with primary arthroplasty and re-revision arthroplasty. Patients undergoing primary knee arthroplasty were identified in the UK Hospital Episode Statistics. Subsequent revision and re-revision arthroplasty procedures in the same patients and same knee were identified. The primary outcome was 90-day mortality and a logistic regression model was used to investigate factors associated with 90-day mortality and secondary adverse outcomes including infection (undergoing surgery), pulmonary embolism, myocardial infarction,
Based on Ilizarov's law of tension-stress principle, distraction histogenesis technique has been widely applied in orthopaedic surgery for decades. Derived from this technique, cranial bone transport technique was mainly used for treating cranial deformities and calvarial defects. Recent studies reported that there are dense short vascular connections between skull marrow and meninges for immune cells trafficking, highlighting complex and tight association between skull and brain. Alzheimer's disease (AD) is a progressive neurodegenerative disease and the most common cause of dementia without effective therapy. Meningeal lymphatics have been recognized as an important mediator in neurological diseases. The augmentation of meningeal lymphatic drainage might be a promising therapeutic target for AD. Our proof-of-concept study has indicated that cranial bone transport can promote ischemic
Abstract. Objectives. Our study evaluates financial impact to the Best Practice Tariff (BPT) of hip fracture patients on Novel Oral Anti-Coagulant (NOAC) medication. Since their approval by NICE for the prevention of
INTRODUCTION. Preoperative optimization and protocols for joint replacement care pathways have led to decreased length of stay (LOS), decreased narcotic use and are increasingly important in delivering quality, cost savings and shifting appropriate cases to an outpatient setting. The intraoperative use of vasopressors is independently associated with increased length of stay, risk of adverse postoperative events including death and in total hip arthroplasty there is an increased risk for ICU admission. Our aim is to characterize the patient characteristics associated with vasopressor use specifically in total knee arthroplasty (TKA). METHODS. We retrospectively reviewed 748 patients undergoing inpatient primary total knee arthroplasty at a single academic institution by two surgeons from 1/1/17 to 12/21/18. Demographics, comorbidities, perioperative factors and intraoperative medication administration were compared with multivariate regression to identify patients who may require intraoperative vasopressors. RESULTS. Seven hundred-forty eight patients underwent total knee arthroplasty and 439 patients required intraoperative vasopressors while 307 did not require vasopressors. Significant predictors of vasopressor use were male sex (p=0.035), history of prior cerebrovascular event (p=0.041) and older age (p=0.048). NPO time, anesthesia provider level of training, operative time, and intraoperative mean arterial pressure and heart rate were not significant predictors of vasopressor use intra-operatively during total knee arthroplasty. CONCLUSION. In this study, nearly fifty-nine percent of patients undergoing TKA received intraoperative vasopressor support. Male gender, history of
Objectives. We have increased the dose of tranexamic acid (TXA) in our enhanced total joint recovery protocol at our institution from 15 mg/kg to 30 mg/kg (maximum 2.5 g) as a single, intravenous (IV) dose. We report the clinical effect of this dosage change. Methods. We retrospectively compared two cohorts of consecutive patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery in our unit between 2008 and 2013. One group received IV TXA 15 mg/kg, maximum 1.2 g, and the other 30 mg/kg, maximum 2.5 g as a single pre-operative dose. The primary outcome for this study was the requirement for blood transfusion within 30 days of surgery. Secondary measures included length of hospital stay, critical care requirements, re-admission rate, medical complications and mortality rates. Results. A total of 1914 THA and 2537 TKA procedures were evaluated. In THA, the higher dose of TXA was associated with a significant reduction in transfusion (p = 0.02, risk ratio (RR) 0.74, 95% confidence interval (CI) 0.58 to 0.96) and rate of re-admission (p < 0.001, RR 0.50, 95% CI 0.35 to 0.71). There were reductions in the requirement for critical care (p = 0.06, RR 0.55, 95% CI 0.31 to 1.00), and in the length of stay from 4.7 to 4.3 days (p = 0.02). In TKA, transfusion requirements (p = 0.049, RR 0.64, 95% CI 0.41 to 0.99), re-admission rate (p = 0.001, RR 0.56, 95% CI 0.39 to 0.80) and critical care requirements (p < 0.003, RR 0.34, 95% CI 0.16 to 0.72) were reduced with the higher dose. Mean length of stay reduced from 4.6 days to 3.6 days (p < 0.01). There was no difference in the incidence of deep vein thrombosis, pulmonary embolism, gastrointestinal bleed, myocardial infarction,
Background. Hip arthroplasties are associated with high postoperative pain scores. In some reports, moderate to severe pain was 58% on the first day postoperatively in total hip replacements (THRs). Several techniques are currently used at our institution to tackle acute pain following THRs. These include: 1) Spinal anaesthetic (SA) with Diamorphine only; 2) General anaesthetic (GA) only; 3) SA with local infiltration anaesthetic mixture 1 (LIA1,). Mixture 1 consisted of ropivacaine, adrenaline, and ketorolac; 4) SA with LIA mixture 2 (LIA2). Mixture 2 consisted of bupivacaine and adrenaline; 5) SA with LIA1 and PainKwell pump system. In this study we report on the techniques of acute pain control following THR at our regional centre for elective primary THRs. Methods. Between June 2011 and July 2014, 173 consecutive patients undergoing primary THR using the posterior approach were prospectively followed up. Group 1. GA only. 31 patients, Group 2. SA only. 37 patients, Group 3. SA plus LIA1 only. 38 patients, Group 4. SA plus LIA2 only, 34 patients, Group 5. SA plus LIA1 plus PainKwell Pump System for 48 hours. 33 patients. Results. Fewer patients required opiate analgesia when LIA plus PainKwell pump system was used compared to the other groups. The highest significance was at 0–12 hrs for patients requiring up to 20mg morphine usage (χ2(2) = 46.713, p = 0.000); and 0–12hrs for patients requiring 30mg morphine usage (χ2(2) = 46.310, p = 0.000). There were no infections, DVTs or PEs in any group. One patient in group 3 suffered a
Background. Stress shielding and wear induced aseptic loosening cause failure in arthroplasty surgery. To improve survivorship, the use of a low modulus, low wearing biomaterial may be a suitable alternative to hard bearing prostheses, such as cobalt chromium (CoCr). There has been considerable research interest in the use of polyetheretherketone (PEEK) based on observed clinical success especially in spinal surgery. This study investigated the wear performance of PEEK, carbon reinforced PEEK (CFR-PEEK) and acetal as bearing materials in an all polymer total knee arthroplasty (TKA) using a unidirectional pin on plate test. Methods. The following material combinations were tested: PEEK vs. UHMWPE, CFR-PEEK vs. UHMWPE, PEEK vs. PEEK, CFR-PEEK vs. PEEK, CoCr vs. UHMWPE, PEEK vs. XLPE, CFR-PEEK vs. CFR-PEEK, PEEK vs. Acetal, Acetal vs. XLPE and CoCr vs. XLPE.Tribological couples tested (Pin vs. Plate) Using a previously validated modification of ASTM F732, 20mm diameter spherically ended pins with a radius of 25mm were articulated against 40mm diameter plates. A load of 1000N was applied to generate a contact stress of about 70MPa similar to contact stresses previously reported in the knee. The lubricant used was 25% newborn calf serum containing 0.3% sodium azide to retard bacteria growth and 20mM EDTA to prevent calcium deposition. Three repeats of pin on plate combinations (including 2 passive soak controls) were tested for 2 million cycles at a cycle frequency of 1Hz and a
Newer irreversible oral anticoagulants such as rivaroxaban, a direct factor 10a inhibitor, are increasingly employed to prevent thromboembolic events in atrial fibrillation (AF) patients, and to manage venous thromboembolism (VTE). Unlike warfarin, these agents require no monitoring and involve infrequent dose adjustment. We report the case of a patient treated with rivaroxaban for AF. Patient presented with unprovoked sudden onset right shoulder pain which clinically resembled shoulder haemarthrosis. A single case was anonymised and retrospectively reviewed through examination of clinical and radiographic data. A 70 year old female with known AF presented to Accident and Emergency with sudden onset of right shoulder pain and limited movement, which developed over one hour. The pain was constant, localised to the shoulder and without trauma. Past medical history included severe aortic regurgitation and associated thoracic aortic aneurysm, heart failure, atrial fibrillation and hypertension. Observations were normal upon admission with no haemodynamic compromise or pyrexia. Examining the right shoulder demonstrated distension of shoulder joint capsule, tenderness and a reduced range of movement. Temperature and neurovascular status in the right arm were normal. Investigations upon admission included an INR of 1.2. An anteroposterior right shoulder radiograph showed no evidence of fracture. Patient was managed conservatively with simple oral analgesia. Importantly, rivaroxaban was withheld for 5 days and symptoms resolved. Warfarin therapy was subsequently commenced instead as treatment for AF. Patient was discharged one week later and seen in clinic two weeks post-discharge. A full recovery occurred and with a full range of movement in the right shoulder. In the UK, current National Institute for Health and Care Excellence (NICE) guidelines recommend the use of factor 10a inhibitors, for prevention of
Cardiovascular disease is now the leading cause of morbidity and mortality worldwide. Raised blood pressures (BP) are associated with increased cardiovascular risks such as myocardial infarction,
Background and purpose. There is on-going debate about a possible link between manipulation and
Summary. The significance of matching radius of curvature of the radial head implant and the capitellum in implant selection is evaluated. A mismatch of radius of curvature could lead to point loading, reducing contact area, creating large contact stresses, resulting in arthritis, pain, and other complications. Introduction. Radial head (RH) implant size is chosen by reconstruction outside of the radiocapitellar joint capsule measuring the RH diameter and length, which is replicated for implant selection. RH radius of curvature (RC) is rarely part of the decision although important in determining contact area. Methods. Eleven fresh-frozen cadaver humeri were denuded, with articular cartilage intact. These were held horizontally in an MTS machine; capitellum faced up, and covered with a Tekscan transducer. RH implants were attached by vice to the MTS driving piston. Four different RH implant models were compared: Ascension, Integra Katalyst, Stryker Small and Medium, all CoCr. All implants were 21mm in outer diameter, except the Stryker small implant (18mm). Cyclic axial loading was applied through the RH implant to the capitellum. Contact area and stress concentrations were captured by the transducer. Loading was applied with