Orthopaedic departments are increasingly put under pressure to improve services, cut waiting lists, increase efficiency and save money. It is in the interests of patients and NHS organisations to ensure that operating theatre resources are used to best effect to ensure they are cost effective, support the achievement of waiting time targets and contribute to a more positive patient experience. Patients in the UK are expected to have undergone surgery once decided within 18 weeks. A good system of planning and scheduling in theatre enables more work, however is largely delegated to non-clinical managerial and administrative staff. After numerous cancellations of elective cases due to incomplete pre-operative work-up, unavailable equipment and patient DNAs, we decided to introduce a surgeon-led scheduling system. The surgeon-led scheduling diary involved surgeons offering patients a date for surgery in clinic. This allowed for appropriate organisation of theatre lists and surgical equipment, and pre-operative assessment.Introduction
Intervention
We evaluated the quality of guidelines on thromboprophylaxis
in orthopaedic surgery by examining how they adhere to validated
methodological standards in their development. A structured review
was performed for guidelines that were published between January
2005 and April 2013 in medical journals or on the Internet. A pre-defined
computerised search was used in MEDLINE, Scopus and Google to identify
the guidelines. The AGREE II assessment tool was used to evaluate
the quality of the guidelines in the study. Seven international and national guidelines were identified.
The overall methodological quality of the individual guidelines
was good. ‘Scope and Purpose’ (median score 98% interquartile range
(IQR)) 86% to 98%) and ‘Clarity of Presentation’ (median score 90%,
IQR 90% to 95%) were the two domains that received the highest scores. ‘Applicability’
(median score 68%, IQR 45% to 75%) and ‘Editorial Independence’
(median score 71%, IQR 68% to 75%) had the lowest scores. These findings reveal that although the overall methodological
quality of guidelines on thromboprophylaxis in orthopaedic surgery
is good, domains within their development, such as ‘Applicability’
and ‘Editorial Independence’, need to be improved. Application of
the AGREE II instrument by the authors of guidelines may improve
the quality of future guidelines and provide increased focus on
aspects of methodology used in their development that are not robust. Cite this article: Bone Joint J 2014;96-B:19–23.
Reconstructing acetabular defects in revision hip arthroplasty can be challenging. Small, contained defects can be successfully reconstructed with porous-coated cups without bone grafts. With larger uncontained defects, a cementless cup even with screws, will not engage with sufficient host bone to provide enough stability. Porous titanium augments were originally designed to be used with cementless porous titanium cups, and there is a scarcity of literature on their usage in cemented cups with bone grafting. We retrospectively reviewed five hips (four patients – 3 women, 1 man; mean age 65 years) in which we reconstructed the acetabulum with a titanium augment (Biomet, IN, USA) as a support for impaction bone grafting and cemented acetabular cups (Figure 1). All defects were classified according to Paprosky classification. Radiographic signs of osseointegration were graded according to Moore grading. Quality of life was measured with the Oxford Hip Score.Introduction
Methods
A 58 year old man underwent TKR with computer navigation using our standard technique. His post operative course was characterized by thigh swelling and pain. He was discharged on postoperative day 3 with a range of movement of 0–30°. 3 days later he was readmitted with increasing thigh pain and swelling. A quadriceps haematoma was suspected and a computerized tomography scan with intravenous contrast was performed. This showed active bleeding into the femoral canal at the site of the pin tract from a branch of the profunda femoris artery as it entered the linea aspera and a large haematoma within the quadriceps muscle centred over the pin tract anteriorly. There was no extraosseous posterior haematoma. An 800ml haematoma was drained and two small fragment cortical screws were inserted into the pin tracts. Unicortical screws were used to minimize the risk of causing posterior bleeding. Arterial injury has not been reported before in this setting. The previously reported complications are: pin breakage, superficial wound infection, interference with line of sight, broken pelvic drill, prolonged operation time and prolonged tourniquet time.
Neuromuscular scoliosis is a difficult condition to treat. Curve severity, secondary pelvic obliquity and poor respiratory function can make operative treatment and post operative care challenging. The benefits to the child in terms of improved sitting position and trunk posture can be considerable. We present a large consecutive series of patients with neuromuscular scoliosis treated surgically at our institution. The aim of this work was to study the clinical and radiographic impact of surgery for neuromuscular scoliosis. Data was gathered from patient records and radiographs for all cases of neuromuscular scoliosis treated surgically between April 2002 and Feb 2005. 52 cases were identified. They fell into 2 surgical groups: single stage posterior correction and two stage anterior and posterior correction. All posterior instrumentation was transpedicular. Complications, length of stay, and change in severity of sagittal and coronal plane deformity were recorded. Average pre-operative Cobb angle was 85°. There were 16 patients with additional sagittal plane deformity. Average percentage improvement of Cobb angle was 59%. The correction was better in two stage procedures. Pelvic obliquity was improved in those who were obligatory sitters. Fusion rate was 83% for those followed up more than 1 year. ITU stay was longer in single stage procedures. Complication rate was 58%. We have shown that with appropriate patient selection the correction of neuromuscular scoliosis can achieve good results with high fusion rates. Two stage correction confers correctional advantage on those who have sufficient respiratory reserve to tolerate it.
