Continuous peripheral nerve blocks (cPNBs) have shown good results in pain management after orthopedic surgeries. However, the variation of performance between different subspecialities is unknown. The aim of this study is to describe our experience with cPNBs after lower limb orthopedic surgeries in different subspecialties. This prospective cohort study was performed on collected data from cPNBs after orthopedic surgeries in lower limbs. Catheters were placed by experienced anesthesiologists using sterile technique. After catheterization, the patients were examined daily, by specially educated acute pain service nurses. The characteristics of the patients, duration of catheterization, severity of the post-operative pain, need for additional opioids, and possible complications were registered.Introduction and Objective
Materials and Methods
Although hip arthroplasty has been very successful in relieving pain and optimising function, problems have arisen with wear and osteolysis. Highly cross linked polyethylene has been developed to address this problem. The aim of this study was to compare the in vivo wear of standard versus highly cross linked polyethylene (HXLP) in primary total hip arthroplasty at 5-year follow up. Approval was obtained through the Regional Ethics Committee before commencement of the study. 122 patients were enrolled in a prospective, double blinded, randomised trial and followed annually to assess their progress. Annual radiographs were analysed using previously validated edge detection software to assess for 2 dimensional, 3 dimensional and volumetric wear. To reduce the disproportionate effects of bedding in and creep, the initial x-ray used was that taken at 6 months following surgery.Introduction
Methods
In October 2008, CMS instituted a new “No payment for preventable complications“ programme and has released a list of conditions for which it intends to expand the programme in 2009. Although not reimbursing for preventable complications is justifiable, some of the proposed target conditions are lacking in both adequate diagnostic testing accuracy and preventability. This study examines the effects of imperfect sensitivity and specificity of diagnostic testing, the prevalence of condition, and the rate of surveillance on the ratio of numbers of DVT/PE diagnosed and those that actually occur.Background
Aims
A wide variety of hospital data is reported to and published by national groups intending to compare quality of care between institutions. The rate of deep venous thrombosis and pulmonary embolism (DVT/PE) after orthopaedic surgery is among those reported. In an effort to examine the validity of hospital data reported to these national groups, we looked deeper into the cases of DVT reported by our hospital to the University Health Services Consortium (UHC). The rate of DVT/PE after orthopaedic surgical procedures reported to UHC for 2007 was 2.6% (33 cases). This rate is over twice the UHC mean for this same time period. Review of the 33 reported cases of DVT/PE revealed that only 12 were appropriately coded; if appropriately coded and reported, the DVT/PE rate would have been 0.95%. The rates of DVT/PE reported by this institution to UHC result in that institution being characterised as having comparatively high rates of this complication. However, the validity of this characterisation should be questioned, based on inconsistencies seen in the institution's diagnostic coding. This investigation raises concerns that coding variations between institutions may prohibit accurate quantification of hospital complications and ought not be used for the purpose of benchmarking.
A commonly held belief amongst surgeons and patients is that progression of disease (arthritis) to other compartments is a major cause of early failure of UKRs. We analysed the NJR database records of 17,643 primary UKRs performed between April 2003 and April 2009. Where these had been revised the reason for revision was noted.Background
Methods
Total hip replacements (THRs) are associated with significant blood loss which often requires high transfusion rates of allogeneic blood. Although safer than ever, allogeneic blood transfusion is still associated with risks to the recipients. This meta-analysis aims to investigate the efficacy and safety of tranexamic acid (TXA) in reducing blood loss and allogeneic blood transfusion after THR. A systematic review and meta-analysis of published randomised controlled trials which used TXA to reduce blood loss and transfusion in hip arthroplasty were conducted. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group.Background and aim
Patients and Methods
The transverse skin incision for anterior cervical spine surgery is not extensile, thus it must be made at the accurate level. The use of palpable bony landmarks is unreliable due to anatomical variations and pre-operative fluoroscopy to identify the level takes up operating room time, increases the radiation dose to the patient and increases the overall cost of the operation. To describe a simple, fast and inexpensive method of accurate transverse skin incision placement for anterior cervical spine surgery and to report on its use in 54 consecutive adult patients.Background
Objective
The purpose of this clinical series is to prospectively review the mid-term clinical and radiographic outcomes of the Scandinavian Total Ankle Replacement (STAR) performed at two academic Canadian University centres. Between 1998 and 2005, 111 STAR were implanted into 98 patients at two Canadian centres. Prospective clinical and radiographic follow-up was performed. Validated and non-validated outcome questionnaires consisting of the AAOS foot and ankle questionnaire, AOFAS Hindfoot score, Foot Function Index (FFI), Ankle Osteoarthritis Scale (AOS) were completed. Sixty four patients were followed with these scores prospectively and 50 retrospectively. Both groups had prospective radiographic follow-up using measures described by Hintermann Aim
Methods
Middle-aged female patients with painful hip arthritis often have high expectations, are physically active and are more likely to have underlying anatomical abnormalities such as DDH. Large hard bearing total hip replacement (THR) offer the possibilities of reduced wear and risk of dislocation. The patients in this series all had surgery in the private sector and were operated on by one surgeon. They were selected for a hard bearing THR on the basis of age, health and expectations. Large bearing metal-on-metal (MOM) THR became possible in 2003, with ceramic-on-ceramic (COC) bearings used in patients with allergies to metal. There were 90 patients in the MOM group and 92 patients in the COC group. The mean age was 60 and the commonest diagnosis was osteoarthritis in both groups. In the MOM group there were 8 complications: 2 deep infections, 1 death from PE, and 5 severe soft tissue reactions (pseudotumour). In the COC group there were 2 complications: 1 deep infection and 1 patient with intermittent squeaking. The patients in this study were closely matched in terms of age and lifestyles. All of them were operated on by a single high volume specialist hip surgeon. The results suggest a high risk of failure in female patients who have had MOM THR. Most of the failures had described discomfort in the hip for many months before revision surgery. All of the failures were associated with a cemented CPT stem. The surgeon no longer uses MOM bearings in female patients because of the unacceptably high failure rate compared to COC bearings. COC bearings appear to offer the active middle-aged female patient consistently good results and a low risk of failure at least in the short to medium term.
The purpose of this study was to evaluate the independent contributions of surgeon procedure volume, hospital procedure volume, and standardisation of care on short-term post-operative outcomes and resource utilisation in lower-extremity total joint arthroplasty. An analysis of 182,146 consecutive patients who underwent primary total joint arthroplasty was performed with use of data entered into the Perspective database by 3421 physicians from 312 hospitals over a two-year period. Adherence to evidence-based processes of care was defined by administration of appropriate perioperative antibiotic prophylaxis, beta blockade, and venous thromboembolism prophylaxis. Patient outcomes included mortality, length of hospital stay, discharge disposition, surgical complications, readmissions, and reoperations within the first 30 days after discharge. Hierarchical models were used to estimate effects of hospital and surgeon procedure volume and standardisation on individual and combined surgical outcomes and length of stay.Background
Methods
In degenerative lumbar spine, it seems possible that foraminal stenosis is over-diagnosed as axial scanning is not performed in the plane of the exiting nerve root. We carried out a two-part study to determine the true incidence of foraminal stenosis. Initially we performed a retrospective analysis of radiology reports of conventional Magnetic Resonance Imaging in 100 cases of definite spinal stenosis to determine the incidence of reported ‘foraminal stenosis’. Subsiquently we performed a prospective study of MRI including fine slice T2 and T2 STIR coronal sequences in 100 patients with suspected stenosis. Three surgeons and one radiologist independently compared the diagnoses on conventional axial and sagittal sequences with the coronal scans.Introduction
Patients and Methods
Successful tendon repairs are reliant on the suture material having high tensile strength, no or little tissue response, good handling characteristics and little elastic/plastic deformation. Plastic deformation contributes to gap formation at a tendon repair site. Previous research has shown a gap greater than 4mm is likely to fail. Pre-tensioning is a commonly used method to improve the handling properties of sutures. This study investigates whether the plastic deformation demonstrated by two suture materials used in flexor tendon repair is affected by manual pre-tensioning. Twenty lengths of 3/0 Prolene (Ethicon, UK) and 3/0 Ethibond Excel (Ethicon, UK) were selected. Half of the sutures in each group were manually pre-tensioned (longitudinal stretch of 15N for 3s) prior to knot tying (standard surgical knot with six throws) and half were knotted without pre-tensioning. The suture lengths were measured before and after a standardised cyclical loading regime on a tensile tester. The regime was designed to represent the finger flexion forces produced in an active rehabilitation programme after tendon repair. All sutures were subsequently tested to their ultimate tensile strength.Introduction
Material/Methods
There are different opinions amongst surgeons as to the selection criteria for UKR with regards to age and BMI. Many surgeons perceive higher rates of failure in young or overweight patients or often choose TKR for elderly patients. We analysed the registry records (UK National Joint Registry) of 10,104 patients who had undergone UKR with a minimum of two years follow-up from their primary surgery. BMI data was recorded in 1,831 (18%) and age in all. There were 295 deaths and these patients were excluded from our analysis. Patients' BMI were categorised according to Department of Health and WHO (2004) classification (Normal, Pre-Obese, Obese I, Obese II, Obese III)Background
Methods
