Tennis and Golfers elbows (TE, GE) are difficult conditions to treat. Ultrasound guided steroid injection (UGSI) is one of the treatment modalities in treating refractory TE and GE. We present our clinical experience and short to mid-term results of patients with TE and GE treated with UGSI. Patients with persistent TE and GE treated with UGSI (Marcaine and kenalog) at a tertiary centre between 2007 and 2010 were retrospectively reviewed. Mean follow up was 4 months (Range 2–21 months). Patients were assessed for pain relief, recurrence of symptoms and surgical release.Introduction
Methods
We randomly allocated 50 total knee replacements to scrub teams wearing body-exhaust suits (BES) or Rotecno occlusive clothing. The effectiveness of the clothing was assessed using air and wound bacterial counts. Bacteria were recovered from 62% of wounds (64% BES, 60% Rotecno). The mean air count was 0.5 CFU/ m3 with BES and 1.0 CFU/m3 with Rotecno (p = 0.014). The mean wound counts were 14 bacteria/wound with BES and eight bacteria/wound with Rotecno (p = 0.171). There was no correlation between the air and wound counts (r = −0.011, Spearman’s). The higher air counts suggest that Rotecno occlusive clothing is less effective than BES, but wounds were equally contaminated with both types of clothing suggesting that at very low levels of air contamination the contribution of bacteria to the wound from the air is irrelevant. Even doubling the air counts from 0.5 to 1.0 CFU/m3 had no detectable effect on the wound. This allows a reassessment to be made of other sources of contamination the effect of which would previously have been overwhelmed by contamination from air.
We report the results of the Charnley Elite Plus femoral stem (Ortron 90; Depuy, Leeds, United Kingdom) in multiple surgeon’s hands at a minimum of three years post implantation. The long term results of the Charnley femoral stem have been widely documented . There have been numerous changes to the design and instrumentation of this original stem since its introduction in 1962, and the Charnley Elite Plus represents the fifth generation of this highly successful implant. Between March 1994 and March 1998, 244 patients underwent 268 primary hip arthroplasty procedures using this particular stem. Patients were reviewed at a mean of 4.5 years (3.0 – 6.8 years) following their arthroplasty using the Oxford Hip Score and plain radiographs. There were five revision procedures for aseptic loosening (5/268; 1.9%). Radiological assessment revealed gross radiological failure in a further 12 femoral stems (12/208; 5.8%). There was evidence of focal osteolysis with an apparently stable implant in 36 hips (17.3%). In the best case scenario, using revision for aseptic loosening as the endpoint, the survivorship for this period is 98.1%. If radiographic failures are incorporated into this endpoint, survivorship is 93.1%. Of potential concern however, is the number of adverse features noted on the radiographs, with only 76.9% being categorised as ‘normal.’ The Charnley Elite Plus stem has undergone some fundamental design changes from the original Charnley stem and therefore clinical success should not be automatically assumed. In such circumstances we recommend regular clinical and radiographic follow-up of patients who have have undergone total hip arthroplasty with this particular femoral stem.
