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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_2 | Pages 11 - 11
10 Feb 2023
Boyle A George C MacLean S
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A larger radial tuberosity, and therefore a smaller radioulnar space, may cause mechanical impingement of the DBT predisposing to tear. We sought to investigate anatomic factors associated with partial DBT tears by retrospectively reviewing 3-T MRI scans of elbows with partial DBT tears and a normal elbow comparison group

3-T MRI scans of elbows with partial DBT tears and elbows with no known pathology were reviewed retrospectively by two independent observers. Basic demographic data were collected and measurements of radial tuberosity length, radial tuberosity thickness, radio-ulnar space, and radial tuberosity-ulnar space were made using simultaneous tracker lines and a standardised technique. The presence or absence of enthesophytes and the presence of a single or double DBT were noted.

26 3-T MRI scans of 26 elbows with partial DBT tears and 30 3-T MRI scans of 30 elbows without pathology were included. Basic demographic data was comparable between the two groups. The tear group showed statistically significant larger mean measurements for radial tuberosity length (24.3mm vs 21.3mm, p=0.002), and radial tuberosity thickness (5.5mm vs 3.7mm, p=<0.0001. The tear group also showed statistically significant smaller measurements for radio-ulnar space (8.2mm vs 10.0mm, p=0.010), and radial tuberosity-ulnar space (7.2mm vs 9.1mm, p=0.013). There was a statistically significant positive correlation between partial DBT tears and presence of enthesophytes (p=0.007) as well as between partial DBT tears and having two discrete DBTs rather than a single or interdigitating tendon (p=<0.0001).

Larger radial tuberosities, and smaller radio-ulnar and radial tuberosity-ulnar spaces are associated with partial DBT tears. This may be due to chronic impingement, tendon delamination and consequent weakness which ultimately leads to tears. Enthesophytes may be associated with tears for the same reason. Having two discrete DBTs that do not interdigitate prior to insertion is also associated with partial tears.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_2 | Pages 12 - 12
10 Feb 2023
Boyle A Zhu M Frampton C Poutawera V Vane A
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Multiple joint registries have reported better implant survival for patients aged >75 years undergoing total hip arthroplasty (THA) with cemented implant combinations when compared to hybrid or uncemented implant combinations. However, there is considerable variation within these broad implant categories, and it has therefore been suggested that specific implant combinations should be compared. We analysed the most common contemporary uncemented (Corail/Pinnacle), hybrid (Exeter V40/Trident) and cemented (Exeter V40/Exeter X3) implant combinations in the New Zealand Joint Registry (NZJR) for patients aged >75 years.

All THAs performed using the selected implants in the NZJR for patients aged >75 years between 1999 and 2018 were included. Demographic data, implant type, and outcome data including implant survival, reason for revision, and post-operative Oxford Hip Scores were obtained from the NZJR, and detailed survival analyses were performed. Primary outcome was revision for any reason. Reason for revision, including femoral or acetabular failure, and time to revision were recorded.

5427 THAs were included. There were 1105 implantations in the uncemented implant combination group, 3040 in the hybrid implant combination group and 1282 in the cemented implant combination group. Patient reported outcomes were comparable across all groups. Revision rates were comparable between the cemented implant combination (0.31 revisions/100 component years) and the hybrid implant combination (0.40 revisions/100 component years) but were statistically significantly higher in the uncemented implant combination (0.80/100 component years). Femoral-sided revisions were significantly greater in the uncemented implant combination group.

The cemented implant and hybrid implant combinations provide equivalent survival and functional outcomes in patients aged over 75 years. Caution is advised if considering use of the uncemented implant combination in this age group, predominantly due to a higher risk of femoral sided revisions. The authors recommend comparison of individual implants rather than broad categories of implants.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 25 - 25
1 Mar 2008
Chakravarty D Parker M Boyle A
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This study was conducted to find out whether blood transfusion was an independent risk factor for mortality and wound infections after hip fracture surgery.

A retrospective cohort study analysed prospectively collected data for 3571 hip fracture patients undergoing surgery over the last 15 years in one institution. Out of these 1068 patients underwent blood transfusion.

There were no significant differences in the mortality values at 30, 120 and 365 days and in the rates of infection (superficial and deep) in the two groups (transfused and non-transfused).

Conclusion: Blood transfusion does not significantly increase mortality or infection following hip fracture surgery.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 43 - 44
1 Mar 2006
Chakravarty D Parker M Boyle A
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Introduction: This study was conducted to find out whether blood transfusion was an independent risk factor for mortality and wound infection after hip fracture surgery.

Materials and Methods: A retrospective cohort study analysed prospectively collected data for 3571 hip fracture patients undergoing surgery over the last 15 years in one institution. Out of these 1068 patients underwent blood transfusion.

Results: There were no significant differences in the mortality values at 30, 120 and 365 days and in the rates of infection (superficial and deep) in the two groups(transfused and non-transfused).

Conclusion: Blood transfusion does not significantly increase mortality or infection following hip fracture surgery.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 168 - 168
1 Mar 2006
White A Parker M Boyle A
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Conventional treatment for nondisplaced intracapsular hip fractures is with cannulated screws. Some authors have argued that in the older patient a hemiarthroplasty offers a better outcome even in the case of a nondisplaced fracture. We have compared the outcomes of an age, sex & co-morbidity matched cohort of 346 patients who have had their nondisplaced hip fracture treated using cannulated screws with a group of 346 patients who have had a displaced fracture treated with a hemi-arthroplasty. The average age of the patients studied was 80.8 years. All operations were carried out at Peter-borough District Hospital and the follow up data was collected as part of the hip fracture project. Operation time, hospital stay and peroperative complication rate are less for the fixation group. They also have better outcomes in terms of pain, use of walking aids and mobility scores at one year. Mortality is 4% less at one year in the patients treated with screws and this, again, is statistically significant. There is no difference in terms of residential status at one year. In patients where the fracture is initially treated with cannulated screws the reoperation rate is considerably higher (17 % versus 6%) but length of stay is less for secondary procedures. We feel that there is little evidence to justify the use of hemi-arthroplasty in nondisplaced femoral neck fractures in patients of any age.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 311 - 311
1 Sep 2005
Chakravarty D Boyle A Parker M
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Introduction and Aims: Immune suppression induced by blood transfusion may be a determinant in the development of post-operative infectious complications. This study was to determine if blood transfusion was an independent risk factor for mortality and wound infections after hip fracture surgery.

Method: A retrospective cohort study analysing the prospectively collected data for 3571 hip fracture patients undergoing surgery over the last 15 years at one institution. Out of these 1068 patients underwent blood transfusion. Mortality was related to whether the patient was transfused, and adjusted for confounding predictors of mortality (age, sex, pre-operative haemoglobin concentration residential status, ASA grade and mobility).

Results: 3461 cases remained after 290 (7.7%) cases had to be excluded for missing data in the multivariate analysis. The mortality values at 30,120 and 365 days in the transfused group were 95 (8.9%), 247 (23.1%) and 381 (35.7%), whereas corresponding values in the non-transfused group were 181 (7.2%), 374 (14.9%) and 626 (25.0%). This difference at six and 12 months was statistically significant. With adjustment for confounding variables with a Cox regression mode the hazard ratio for mortality at one year was 1.11 (95% CI 0.96–1.29, p value 0.17). Superficial infection occurred in 22 patients (2.0%) in the transfused group and there were 10 deep infections (0.9%). This was not a statistically significant difference from the incidence in the non-transfused group, 48 cases (1.9%) and 15 (0.6%) respectively.

Conclusion: In conclusion, although it appears that blood transfusions are associated with an increased mortality, when this is adjusted for baseline characteristics and confounding variables, the difference is not statistically significant. Neither was there an increased incidence of wound infection in the transfused patients.