Early detection of Developmental Dysplasia of the Hip (DDH), and treatment, may prevent the need for surgical correction following late presentation. Neonatal examination, and ultrasound screening of at risk groups, does not detect all cases. Most neonates treated in the Intensive Care Unit (NICU) have abdominal radiographs performed during their stay. These include the hips but DDH is not routinely looked for. 50 neonatal abdominal films (five from patients who subsequently were found to have DDH, 45 from patients without this condition) were randomly shown to three paediatric orthopaedic surgeons and three paediatric radiologists on two separate occasions. Each was asked whether they would refer the patient for further investigation. An overall sensitivity of 25.5% (Range 0–60%) and specificity of 93.2% (Range 87–97%) was found with a positive predictive value (PPV) of 14.0% (Range 0–37%) and negative predictive value (NPV)of 96.3% (Range 95–98%). Although the low sensitivity and PPV make interpretation of these films a poor way to diagnose DDH, the high specificity and NPV suggest that they may be used as a prompt to further investigation. Therefore, we propose that DDH should be looked for on these films and, where there is radiological suspicion, ultrasound examination should be advised.
To assess the incidence of fatal pulmonary embolism (PE) following elective total knee replacement (TKR) with a standardised multi-modal prophylaxis regime in a large teaching DGH over a 10 year period. Information was gathered from a prospective audit database, utilising clinical coding for TKR and those that had died within 42 and 90 days. The 10 years from April 2000 were analysed to establish both 42 and 90 day mortality rates. A multi-modal prophylaxis regime for all patients included regional anaesthesia (when possible), mechanical prophylaxis (Flo-tron calf garment per-operatively, AV impulse boots until mobile and anti-embolism stockings for 6 weeks), mobilisation within 24 hours and 75mg aspirin for 4 weeks. A case note review was performed to ascertain the causes of death. Where a patient had been referred to the coroner, the coroner's office was contacted for PM results.Aim
Material and methods
286 patients underwent total hip arthroplasty with a cemented titanium femoral implant (Ultima, Johnson & Johnson) between July 1995 and July 2001. The acetabular component was either a porous coated cup or a cemented all-polyethylene cup. A 28mm cobalt chromium head was used in all patients. Patients were prospectively evaluated with clinical examination, Harris hip scores and radiographic assessment. Analysis of the data was performed. Of the 286 patients, 11 patients were excluded from analysis for reasons including incomplete data (8) and death (3). The remaining 275 patients were comprised of 118 males and 157 females with an average age of 70.8 years (55–89 years). The average follow up was 10.5 years (1.03–14.23). The median follow up was 10 years. 177 cemented all-polyethylene and 98 porous coated acetabular cups were used. The average Harris hip scores were 34.4 and 81.25 for preoperative and last follow up visit respectively. 11 stems were revised (aseptic loosening 9, infection 2). Radiographic assessment showed vertical subsidence in 30 patients (10.9%) (>5mm in 6 and < 5mm in 24 patients). Complete cement-bone radiolucency was noted in 11 stems (4%). Radiolucent lines covering < 50% of cement-bone interface were noted in 18 stems (6.5%). There were no cases of cement fracture. Kaplan-Meier survivorship was 91% at 10 years & 89.8% at 12 years.Method
Results
