The objective of this study was to compare items from musculoskeletal outcome questionnaires with items generated by pre- and post-operative ankle arthrodesis and arthroplasty patients (patient-selected portion of the Patient-Specific Index (PASI-P)) to determine if existing questionnaires address patients' concerns. Patients (n=142) completed the PASI-P. Items from 6 standardised questionnaires (AAOS, patient-reported portion of AOFAS, FFI, LEFS, SMFA, WOMAC) and PASI-P were matched by 3 reviewers to corresponding categories in the International Classification of Functioning, Disability and Health (ICF). The ICF classification hierarchy codes broad first categories and increasingly detailed second, third, and fourth categories. The standardised questionnaires were then compared to the ‘gold standard’ of PASI-P.Purpose
Materials/Methods
The goals of evidence-based clinical practice guidelines in medicine are to promote best practices and reduce variations. Ideally they should improve physician performance and patient outcomes. Although controversy exists about the definition of a high quality guideline and how guidelines will be used in our health care system, there is a call for their use to help improve quality patient care. Guidelines related to musculoskeletal topics should be developed by national orthopaedic organisations and subspecialty societies using the best available clinical evidence. The American Academy of Orthopaedic Surgeons has, since 2007, developed nine evidence-based guidelines in the areas of hand, sports, foot/ankle, shoulder, paediatrics and total joint replacement. The keys to successful guideline development include an expert methodologist, an experienced evidence analysis staff, strict adherence to established rules to minimise bias, and strong communication with relevant subspecialty societies. The AAOS process allows any individual or group to submit a potential topic for consideration. A physician workgroup of 5-8 members is selected after wide advertisement of the topic. Workgroup members must have no relevant financial conflicts of interest to the topic and are required to fill out an enhanced disclosure form. The workgroup is comprised of orthopaedic surgeons and other specialists with expertise in the topic. There are two in-person meetings between which the staff finds and analyses the data to support the specific initial questions. The final document is 300-350 pages. There is a period of peer review by relevant societies as well as a period of public commentary followed by the formal committee and Board approval. The final guideline is disseminated widely via press releases, subspecialty societies, AAOS meetings, webinars, JBJS, JAAOS, and related questions on resident and member national examinations. These guidelines now form the basis for future AAOS quality initiatives.
Few studies have examined the socio-economic impact of complications requiring surgery following initial surgical management of proximal femoral fractures. Our hypothesis was that there would be a significant difference in the cost, mortality rate and ultimate discharge location in patients requiring further surgery after their index procedure for a proximal femoral fracture compared to a matched control group. This was a retrospective matched cohort study of all proximal femoral fractures presenting to the John Radcliffe Hospital over a five year period. Data had been collected prospectively in a standard manner. The total cost of treatment for each patient was calculated by separating the treatment costs into its components. Mortality data was retrieved from the Office of National Statistics and data were analysed using SPSS statistics software, with a There were 2360 proximal femoral fractures in 2257 patients. Of this group, 144 (6.1%) required further surgical intervention due to a complication of the primary procedure. Mean age at time of fracture was 82.59 years; 81.6% women. Mean cost of treatment in those cases with complications was £18,731 compared to £8,575 for uncomplicated cases (p=0.00) with a mean length of stay of 62.8 days and 32.7 days respectively (p=0.00). Mortality probability of cases was significantly higher than the control group with a mean survival of 209 days versus 496 days for controls ( The socio-economic impact of complications following treatment of proximal femoral fractures is important in this current economic climate. Greater awareness and understanding are warranted. Recognition of potential risk factors for complications may allow earlier detection of potential cases and thereby reduce their number and in turn the socioeconomic cost.
The Kotz Modular Femoral Tibial Replacement system has been one of the most widely utilised uncemented modular systems for bone and joint reconstruction after tumour resection. We have identified a significant incidence of mechanical failure and breakage of the prosthesis. The purpose of this investigation is to review the modes of implant failure and the outcomes after prosthetic revision for a broken Kotz prosthesis. Over 20 years there were 121 distal femoral, 55 proximal tibial, 47 proximal femoral and 12 total femoral replacements performed.Background
Methods
Pathologic humerus fractures secondary to metastases are associated with significant pain, morbidity, loss of function, and diminished quality of life. Here we report our experience with stabilisation using intramedullary polymethylmethacrylate (PMMA) cement and non-locking plates. A retrospective review was undertaken of patients treated at a tertiary musculoskeletal oncology centre from 1989 to 2009. Patients who underwent surgery for an impending or completed pathologic humerus fracture with a diagnosis of metastatic disease or myeloma were included. All patients underwent intralesional curettage of the tumour followed by fixation with intramedullary PMMA and plating.Introduction
Methods
Functional Ultrasound Elastography (FUSE) of Tendo Achilles is an ultrasound technique utilising controlled, measurable movement of the foot to non-invasively evaluate TA elastic and load-deformation properties. The study purpose is to assess Achilles tendons, paratenon and bursa mechanical properties in healthy volunteers and establish a clinical outcome tool for TA treatment. We studied 40 Achilles tendons in healthy volunteers using our novel Elastography method, which we developed in the University of Oxford. US scan device (Z.one, Zonare Medical System Inc., USA, 8.5 MHz) with and without the Oxford isometric dynamic foot and ankle mover were used. Tendon insertion, midportion and musculotendinous junction were examined during lateral movement and axial compression/decompression modes. B mode and elasticity images were derived from the raw ultrasound radio frequency data. The anatomical structures mechanical properties were evaluated by a semi-quantitative score of different colours representing stiff tissue (blue) to more soft tissue (green, yellow, red). The Achilles tendons showed mainly a hard structured pattern on sonoelastography. Compression/decompression modes are best used to demonstrate axial softening, while longitudinal displacement is best used to assess load transfer. The average strain along the tendon was 2% (range 0-6%). The overall correlation (?) between real-time sonoelastography and ultrasound findings was < 0.3. However, the correlation (?) between FUSE UEI and US findings was 1.0 Our findings show that FUSE seems to be a sensitive method for assessment of TA mechanical properties. The B mode and elasticity images must be viewed simultaneously. Elasticity and stiffness measurement may offer an invaluable tool to guide TA rupture and tendonopathy treatment and rehabilitation protocol.
