Aims

The aim of this study was to gain a consensus for best practice of the assessment and management of children with idiopathic toe walking (ITW) in order to provide a benchmark for practitioners and guide the best consistent care.

As Total Hip Replacement (THR) rates increase healthcare providers have sought to reduce costs, while at the same time improving patient safety and satisfaction. Up to 50% of patients may be appropriate for Day Case THR, and in appropriately selected patients’ studies show no increase in complication rate while affording a significant cost saving and maintaining a high rate of patient satisfaction.

Despite the potential benefits, levels of adoption of Day Case THR vary. A common cause for this is the perception that doing so would require the adoption of new surgical techniques, implants, or theatre equipment. We report on a Day-Case THR pathway in centres with an established and well-functioning Enhanced Recovery pathway, utilising the posterior approach and standard implants and positioning.

We prospectively collected the data on consecutive THRs performed by a single surgeon between June 2018 and July 2021. A standardised anaesthetic regimen using short acting spinal was used. Surgical data included approach, implants, operative time, and estimated blood loss. Outcome data included time of discharge from hospital, post operative complications, readmissions, and unscheduled health service attendance.

Data was gathered on 120 consecutive DCTHRs in 114 patients. 93% of patients were successfully discharged on the day of surgery. Four patients required re-admission: one infection treated with DAIR, one dislocation, one wound ooze admitted for a day of monitoring, one gastric ulcer. One patient had a short ED attendance for hypertension.

Our incidence of infection, dislocation and wound problems were similar to those seen in inpatient THR. Out data show that the widely used posterior approach using standard positioning and implants can be used effectively in a Day Case THR pathway, with no increase in failure of same-day discharge or re-admission to hospital.

We present our experience of treating 57 cases of bone defects associated with chronic osteomyelitis (COM) and an algorithm for their treatment.

A retrospective analysis of our operation database revealed 377 patients treated for COM (2002–2010). 76 (20%) had bone defects, of these 57 had notes and x-rays available. The tibia was most commonly affected (63%), followed by the femur (21%). Infection control procedures included debridement, drilling and sequestrectomy. Long-term antibiotics were seldom used. Prerequisites to reconstruction surgery were; fully healed skin, absence of sequestrae on x-ray and no antibiotics for 2-months. Decision on the method of treatment of defect was made depending on; age, defect size, viability of periosteum and physes, condition of soft tissues and coexisting deformity.

Initial treatment was; plaster stabilisation (15), frame stabilisation (6), free fibula structural bone grafts (9), ipsilateral vascularised fibula graft (7), non-structural cancellous bone graft (8), bone transport (8) and amputation (4). Forty three (75%) patients were successfully treated with initial strategy. Initial treatment therefore failed in 14 (25%) patients. Successful treatment subsequently used was; structural bone grafting (6), non-structural bone grafting (4), bone transport (3) and Rush Rod stabilisation (1).

Little is known about osteomyelitis-induced bone defects, which cause massive morbidity in developing countries. Our novel research shows that these can be treated successfully, often by relatively simple methods. In the absence of ongoing infection, non-vascularised bone grafting techniques are often successful. Bone transport or vascularised grafting are more reliable but more complex solutions.

We present our experience of treating 57 cases of bone defects associated with chronic osteomyelitis (COM) and a new algorithm for their treatment.

A retrospective analysis of our operation database revealed 377 patients treated for COM (2002–2010). 76 (20%) had bone defects, of these 57 had notes and x-rays available.

Data was collected on: age, sex, type/extent of bone involved, number/type of procedures, and length of stay. The tibia was most commonly affected (63%), followed by the femur (21%). Infection control procedures included debridement, drilling and sequestrectomy. Long-term antibiotics were seldom used. Prerequisites to reconstruction surgery were; fully healed skin, absence of sequestrae on x-ray and no antibiotics for 2-months. Decision on the method of treatment of defect was made depending on; age, defect size, viability of periosteum and physes, condition of soft tissues and coexisting deformity.

Initial treatment was; plaster stabilisation (15), frame stabilisation (6), free fibula structural bone grafts (9), ipsilateral vascularised fibula graft (7), non-structural cancellous bone graft (8), bone transport (8) and amputation (4).

43 (75%) patients were successfully treated with initial strategy. Initial treatment therefore failed in 14 (25%) patients. Successful treatment subsequently used was; structural bone grafting (6), non-structural bone grafting (4), bone transport (3) and Rush Rod stabilisation (1).

Little is known about osteomyelitis-induced bone defects, which cause massive morbidity in developing countries. Our novel research shows that these can be treated successfully, often by relatively simple methods. In the absence of ongoing infection, non-vascularised bone grafting techniques are often successful. Bone transport or vascularised grafting are more reliable but more complex solutions.

Background

The diagnosis of Periprosthetic Joint Infection (PJI) is a considerable challenge in total joint arthroplasty. The mainstay for diagnosis of PJI is a combination of serological markers, including C-reactive protein (CRP), along with joint aspirate for white cell count, differential and culture. The aim of this study was to examine the use of synovial fluid CRP in the diagnosis of PJI.

Study Design: Retrospective review of patients treated with mineralized collagen matrix hydrated with bone marrow in Anterior Cervical Decompression and Fusion (ACDF).

Background: Autologous iliac crest bone is regarded as the gold standard graft material for ACDF. Postoperative donor site pain and morbidity made us seek for an alternative while still providing a high rate of fusion as attained with autologous bone.

Methods: All patients who underwent ACDF between August 2005 and May 2007 by the senior author for cervical myelopathy or radiculopathy secondary to degenerative changes or trauma were included. Patients with an additional posterior fusion were excluded. A total of 80 patients were observed for 16 months (range, 6–27 months). In all patient we used a mineralized collagen matrix hydrated with bone marrow aspirate from the left iliac crest as our cage graft material. All patients had PEEK interbody cages and anterior cervical plating. Clinical and radiographic follow-up data were obtained. X-rays were reviewed by both the senior author and an independent radiologist. Clinical outcomes were measured as described by Robinson and with the Nurick scale.

Results: 31 single-level fusions, 35 two-level, 13 three-level and 1 four-level fusion were performed. No revision surgery was needed. One patient had a subsequent laminectomy for residual cord compression. All patients achieved a solid fusion. No symptomatic pseudoarthrosis was noted. No donor site morbidities were noted.

With a successful clinical result defined as an excellent or good outcome accompanied by significant pain relief, 73 patients had a successful clinical result.

Conclusion: The use of a mineralized collagen matrix in combination with bone marrow aspirate in ACDF eliminates iliac crest donor site morbidities while still providing high rates of fusion.

Background: The Wrightington Frusto-Conical 2 (FC2) hip is a tapered stem with derotation flutes designed to withstand physiological loads in normal gait. There is a paucity of literature with regard to the outcome of this stem. This study was designed to determine the medium term outcome of the FC2 hip

Methods: We identified 217 consecutive patients who underwent total hip arthroplasty using the FC2 stem in one institution. Patients were recalled for clinical review. Pain, function and movement were assessed using the Harris Hip Score (HHS) and the D’Aubigne Postel Score. General quality of life and hip specific assessed were made using the WOMAC and SF-36 self directed questionnaires. Statistical analysis was performed.

Results: 86 patients were assessed with a mean follow-up of 7.3 years. Objective clinical outcomes were judged to be good or excellent according to the HHS and the D’Aubigne Postel scores. WOMAC assessment of disease specific outcome demonstrated excellent results particularly in relation to pain and stiffness. SF-36 demonstrated a quality of life score in keeping with an aging study population. There was a 95% survival at 7.3 years.

Conclusions: The FC2 hip has demonstrated a good outcome in the medium term. It shows outcomes that are similar to the Exeter and Charnley hips at this length of followup. Longitudinal follow-up studies are necessary to determine the results of hip implants

Background; We investigated, as a neoadjuvant to surgical therapy, the effect of a gene therapy of the primary tumour on the progression of minimal residual disease to overt liver metastases. The gene construct coding for the immunostimulatory molecules GM-CSF and B7-1 was delivered to the growing tumour by electroporation in Balb/C mice.

Methods; JBS fibrosarcomas were induced subcutaneously and were randomised at 80mm3 to control and treatment groups. One day prior to treatment, the portal circulation was seeded with tumour cells. Gene delivery was assessed by in vivo imaging, cytokine measurement and anti–tumour cytotoxicity (in vitro and in vivo). Responses were determined by liver examination.

Results; Gene expression and cytokine production was evident in treated tumours. Development of liver metastases was inhibited by neoadjuvant therapy in all 8 animals, in comparison to none of the control animals (n = 6) (average liver weight=0.99 g vs. 1.748 g. p< 0.03.) Metastases were confirmed histologically. Cytotoxicity studies and rechallenge confirmed development of specific T cell antitumour responses after gene therapy.

Conclusions; Immunogene therapy of the primary tumour induces effective anti–tumoural responses and inhibits the development of liver metastases. This strategy could be developed for neoadjuvant therapy of some human cancers.

Introduction. Total hip arthroplasty is one of the most successful operations performed by an orthopaedic surgeon. There are three surgical approaches in use since Charnley popularised the trans-trochanteric approach. Opinion has been divided as to which approach is superior.

Aim. This study was designed to examine the difference in morbidity between the classical Charnley trans-tro-chanteric approach and the antero-lateral trans-gluteal (Hardinge) approach in primary hip arthroplasty.

Methods. Information on 891 patients, who underwent primary total hip arthroplasty performed by a single surgeon, was collected prospectively between 1998–2003 using a modified SF-36 form, pre-operatively, intra-operatively, and at three months. Information collected includes patient demographics, diagnosis, intra-operative blood-loss, and post-operative satisfaction and range of motion. Information was collected on the Excel database and analysed using Minitab statistical package.

Results. The two groups were statistically similar for gender and side of pathology. There was no statistical difference in blood-loss between the groups. There was higher morbidity in the TT group. More patients were doubtful or dissatisfied with the THR in the TT group. There was a greater range of motion in the Hardinge group.

Conclusion. In this study population, the trans-trochanteric approach was associated with higher morbidity, a lower patient satisfaction rating and a lower range of motion.