The recruitment drive, investment and collaboration within Betsi Cadwaladr University Health Board (BCUHB) sites providing specialist lower limb arthroplasty and trauma service has evolved over last few years with aims to improve patient care and reduce reliance on tertiary referral centres. Through our service-evaluation project, we reviewed the results of treatment provided for periprosthetic femur fractures (PPFFs) presenting to BCUHB sites over last 4 years. We retrospectively reviewed consecutive PPFFs admitted at three BCUHB sites from January’20 to June’23 with mean follow-up of 20.8 ± 13.2 (8–49) months [n=161; Mean age: 82.2 ± 8.5 (59–101) years, Females:107]. Over the review period we noted a 23% increase in service demand for care of PPFFs. Majority were managed surgically [132/161] [38 revision arthroplasties; 94 ORIFs] at BCUHB sites and two patients were referred to tertiary centre. Average time to surgery was 3.5 days. 90% of the PPFFs were managed successfully with 10% (16/159) having orthopaedic complications needing further intervention. 6.3 (10/159) had medical complications and did not need orthopaedic re-intervention. In our series, 12-month re-operation rate was 6.1% (8/132) and 1-month, 3-month and 1-year mortality rate was 6.3%, 11.3% and 21.4% respectively. These results are comparable to the published results of PPFF management at tertiary centres. Potential cost savings compared to transfer to tertiary centre for PPFF management was £2.31 million. Thus, it is possible to successfully provide adequate care for PPFFs at DGHs and efforts should be made to appropriately equip and adequately staff DGHs, to provide service for local PPFF care.
Accurate analysis of the patellar resurfacing is essential to better understand the etiology of patella-femoral problems and dissatisfaction following total knee arthroplasty (TKA). In the current published literature patellar resurfacing is analysed using 2D radiographs. With use of radiographs there is potential for error due to differences in limb positioning, projection, anatomic variability and difficulties in appreciating the cement-bone interface. So, we have developed a CT Scan based 3D modelled technique for accurate evaluation of patellar resurfacing. This technique for analyses of patellar resurfacing is based on the pre-operative and pos-operative CT Scan data of the patients who underwent TKA with patellar resurfacing. In the first step, accurately landmarked 3D models of pre-op patellae were created from pre-operative CT Scan data in ScanIP software. This model was imported in Geomagic design software and computational model of post-op patella was created. This was further analysed to determine the inclination of the patellar resection plane, patellar button positioning and articular volumetric restoration of the patella. Reliability and reproducibility of the technique was tested by comparing 3 sets of 10 measurements done by 2 independent investigators on 30 computational models of patellae derived from the data of randomly chosen 30 TKA patients.Abstract
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