Background

Dissociation of the polyethylene liner is a known failure mechanism of the Harris Galante I and II uncemented acetabular components. The outcomes of revision surgery for this indication and the influence of time to diagnosis are not well described.

Introduction

An educated public are becoming increasingly aware of percutaneous needle fasciotomy (PNF) for the treatment of Dupuytren's contracture. We believe that it has an important place in the management of this condition and have set up a dedicated one-stop clinic to perform this procedure.

Introduction

Haemodynamically compromised patients with biomechanically unstable pelvic fractures need reduction of the pelvic volume to effect tamponade of bleeding bone and vessels. Knee binding, to help achieve this, is advocated in standard Advanced Trauma and Life Support teaching but is rarely used. There are no reports in the literature as to the benefits derived from this simple manoeuvre. The aim of this study was to investigate whether there was an effect on symphysis pubis closure by binding the knees together and to quantify this.

Background: Local blocks, as the sole means of anaesthesia, in forefoot surgery have previously been described. This technique is not widely practised in the UK but we have routinely used such blocks for many years. Our aim was to assess how well patients tolerated this technique.

Methods: 64 consecutive day cases of fore-foot surgery were recruited prospectively for local anaesthetic block. A range of operations were performed including basal osteotomy of 1st metatarsal and MTPJ arthrodesis. No patients declined to be included. Peripheral nerve blockade was performed by the orthopaedic surgeon or his registrar. Efficacy of block was assessed intra-operatively with a visual analogue score (VAS) of 0 to 10 (10 being worst pain imaginable and 0 being no pain). Overall satisfaction with the anaesthetic procedure was assessed on a 5 point scale (from 1 = very unsatisfied to 5 = very satisfied) at 2 weeks.

Results: Average time to perform the block was 6 minutes (range 3 to 12 mins). Mean VAS for knife to skin was 0.38 (95% confidence ± 0.31) and for ankle tourniquet was 1.44 (95% confidence ± 0.51). At follow up mean satisfaction at 2 weeks was 4.2 out of 5 (95% confidence ± 0.30) with only 9 patients lost to follow up (86% of patients followed up). No complications were reported.

Conclusion: Our experience is that these blocks are quick and easy to perform in the hands of orthopaedic surgeons. They are well tolerated and effective. They result in a considerable cost saving in terms of theatre efficiency and anaesthetist and ODP resources. These savings are still being evaluated.

We present a retrospective study of a consecutive cohort of 109 patients, under the age of 60, who had either a patello-femoral replacement (PFR), uni-compartmental replacement (UKR) or a total knee replacement (TKR). They were operated on by 2 senior surgeons between 2002 and 2006 at the Avon Orthopaedic Centre in Bristol. The aim of this study was to look at the effect of knee replacement on the employment status of this group of patients.

Data were collected from patient’s hospital records and a questionnaire regarding occupational status sent postoperatively to patients. Statistical analysis showed that our groups were similar which meant that further comparison between them was valid.

Eighty two percent of patients who were working prior to surgery and who had either a TKR or UKR were able to return to work postoperatively. Only 54% of those who had a PFR were able to return to work and this was statistically significant when compared with patients in the other two groups p=0.047. The median time for return to work postoperatively for the study population was 12 weeks. Those in the PFR group took significantly longer to do so (20 weeks) compared to those who had either a UKR (11 weeks) or TKR (12 weeks) p=0.01. Patient’s subjective opinion as to their ability to work following knee arthroplasty was worse in the PFR group p=0.049.

This is the first study to compare employment status following patello-femoral, uni-compartmental knee and Total Knee Replacement. TKR and UKR are effective in returning patients to active employment and that this is typically 3 months following surgery. Patients who had a PFR did not experience the same benefits in terms of numbers returning to work, time to do so and their subjective opinion as to their ability to cope with normal duties.

We performed a retrospective study of a consecutive cohort of 109 patients, under the age of 60 years, who had either a Patellofemoral replacement (PFR), Uni-compartmental replacement (UKR) or a Total knee replacement (TKR). They were operated on by 2 senior surgeons between 2002 and 2006 at the Avon Orthopaedic Centre in Bristol. The aim of this study was to examine and compare the effect of knee replacement on the employment status of this group of patients.

Demographic and diagnostic data were collected from patient’s hospital records and a detailed questionnaire regarding occupational status sent postoperatively. Of the 109 patients, 37 underwent PFR, 31 UKR and 41 TKR. The study population included 38 men and 71 women and the mean age for both sexes was 53 years (range 40–60 years).

82% of patients who were working prior to surgery and who had either a TKR or UKR were able to return to work postoperatively. Only 54% of those who had a PFR were able to return to work and this was statistically significant when compared with patients in the other two groups p=0.47. The median time for return to work postoperatively for the study population was 12 months. Those in the PFR group took significantly longer to do so (20 months) compared to those who had either a UKR (11 months) or TKR (12 months) p=0.01. Patient’s subjective opinion as to their ability to work following knee arthroplasty was worse in the PFR group p=0.049.

This is the first study to compare employment status following Patellofemoral, Unicompartmental knee and Total Knee Replacement. TKR and UKR are effective in returning patients to active employment and this is typically one year following operation. Those patients who had a PFR did not experience the same benefits in terms of numbers returning to work, time to do so and their subjective opinion as to their ability to cope with normal duties.

We examined the effect of age, gender, body mass index (BMI), medical co-morbidity as represented by the American Society of Anaesthesiologists (ASA) grade, social deprivation, nursing practice, surgical approach, length of incision, type of prosthesis and duration of surgery on length of stay after primary total hip arthroplasty (THA).

Data was collected on 675 consecutive patients in a regional orthopaedic centre in South West England. The length of stay varied from 2 to 196 days and was heavily skewed. Data were therefore analysed by non parametric methods.

To permit comparison of short with protracted length of stay, data were arbitrarily reduced to 2 groups comprising 2 to 14 days for short stays and 15 to 196 for long. These data were analysed by Chi-squared and Fisher’s exact test in univariate and by Logistic regression for multivariate analysis

The mean length of stay was 11.4 days, an over-estimate compared to the median length of stay of 8 days which more correctly reflects the skewed nature of the distribution. 81.5% of patients left hospital within 2 weeks, 13.6% within 2 and 4 and 4.9% after 4.

On univariate analysis age above 80 years, age between 70 and 79 years, Body Mass Index > 35, ASA grades 3 and 4, transgluteal approaches, long incisions, cemented cups and prolonged operations were associated with longer stays.

On multivariate analysis, age above 80, age between 70 and 80, ASA grades 3 and 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2 weeks.

This is the first study to record all the published variables associated with length of stay prospectively and to subject the data to multivariate analysis. Prolonged stay after THA is pre-determined by case mix but slick surgery through limited incisions may reduce the length of admission.

Introduction: Restoration of hip biomechanics is an important part of successful total hip replacement. Preoperative templating acts as a guide to selection of size and positioning of prostheses to enable this. We aimed to Establish how closely natural femoral offset could be reproduced using the manufacturers templates for 10 femoral stems in common use in the U.K.

Method: The10 most frequently used femoral components from the U.K. national joint registry (cemented and un-cemented) were identified. Sets of templates for these designs were used to template a series of 47 consecutive pre-operative radiographs from patients who had undergone unilateral total hip replacement for unilateral osteoarthritis of the hip. The non-operated on side of the pelvic radiographs were templated using the 10 sets of templates according to the technique of Schmalzreid. This demonstrated how much the offset of the hip would be changed if that prosthesis were selected and implanted in the templated position. 3 different surgeons performed the complete process. The standard deviation of change in offset between the templated centre of rotation and the normal centre of rotation of the set of radiographs for each prosthesis was then calculated allowing us to rank the templates and hence implants according to their ability to reproduce the normal anatomical offset.

Results: The most accurate template was the CPS with a Root Mean Square Error of 2.0mm followed in rank order by: C stem 2.16, CPT 2.40, Exeter 3.23, Stanmore 3.28, Charnley 3.65, Corail 3.72, ABG II 4.30, Furlong HAC 5.08, Furlong modular 7.14.

Discussion: There is fairly wide variation in the ability of the femoral prosthesis templates to reproduce normal femoral offset in a series of standard pre-operative hip radiographs. The more modern polished tapered stems with high modularity were best able to reproduce femoral offset. There is however no correlation between the prostheses ability to restore offset and clinical results. Some of the older less modular stems, which were unable to get close to normal offset, have some of the best longterm clinical results. With the increasing digitalisation of radiographs a change in the method of templating is required. This may allow manufactures to re-examine their templates and improve the accuracy of this process.

Restoration of hip biomechanics is an important determinant of outcome in hip replacement. Pre-operative templating is considered important in preoperative planning, and this trend is likely to develop further to satisfy consumer demand and to facilitate navigated surgery, particularly as digitisation of radiographs becomes established.

We aimed to establish how closely natural femoral offset could be reproduced using the manufacturers’ templates for 10 femoral stems in common use in the U.K.

The most frequently used femoral components from the U.K. national joint registry and uncemented) were identified, and the CPS-Plus stem was added, as this is in use in our unit. A series of 24 consecutive pre-operative radiographs from patients who had undergone unilateral total hip replacement for unilateral osteoarthritis of the hip were reviewed.

The non-operated on side of the pelvic radiographs was templated as described by Schmalzreid. 3 surgeons of variable experience (junior trainee, senior trainee, consultant) performed the assessment. The standard deviation of change in offset between the templated centre of rotation and the normal centre of rotation of the set of radiographs for each prosthesis was then calculated allowing a ranking.

The most accurate template was the CPS with a mean standard deviation of 1.92mm followed in rank order by: CPT 2.21mm, C Stem 2.42mm, Stanmore 3.02 mm Exeter 3.06 mm, ABG II 3.54mm, Charnley 3.54 mm, Corail 3.63 mm, Furlong HAC 4.2 mm and Furlong modular 4.86mm.

There is wide variation in the ability of the femoral templates to reproduce normal femoral anatomy in a series of standard pre-operative hip radiographs. The more modern cemented polished tapered stems with high modularity appear best able to reproduce femoral offset. Nevertheless, some older monoblock stems, despite poor templating characteristics, are known to be associated with acceptable clinical results. The coming years are likely to be witness to changes in patient expectations and radiograph storage. Implant design and digital templates will need to improve apace with these changes, to ensure accurate preoperative planning.

We examined the effect of age, gender, body mass index (BMI), medical comorbidity as represented by the American Society of Anaesthesiologists (ASA) grade, social deprivation, nursing practice, surgical approach, length of incision, type of prosthesis and duration of surgery on length of stay after primary total hip arthroplasty (THA).

Data was collected on 675 consecutive patients in a regional orthopaedic centre in South West England. The length of stay varied from 2 to 196 days and was heavily skewed. Data were therefore analysed by non parametric methods.

To permit comparison of short with protracted length of stay, data were arbitrarily reduced to 2 groups comprising 2 to 14 days for short stays and 15 to 196 for long. These data were analysed by Chi-squared and Fisher’s exact test in univarate and by Logistic regression for multivariate analysis.

The mean length of stay was 11.4 days, an over-estimate compared to the median length of stay of 8 days which more correctly reflects the skewed nature of the distribution. 81.5% of patients left hospital within 2 weeks, 13.6% within 2 and 4 and 4.9% after 4.

On univarate analysis age above 80 years, age between 70 and 79 years, Body Mass Index > 35, ASA grades 3 and 4, transgluteal approaches, long incisions, cemented cups and prolonged operations were associated with longer stays.

On multivariate analysis, age above 80, age between 70 and 80, ASA grades 3 and 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2 weeks.

This is the first study to record all the published variables associated with length of stay prospectively and to subject the data to multivariate analysis. Prolonged stay after THA is pre-determined by case mix but slick surgery through limited incisions may reduce the length of admission.