Urinary catheterization in the postoperative period is known to increase the risk of deep joint infection following arthroplasty. A number of studies have attempted to elucidate the individual patient factors and surgical procedural factors which predispose patients to postoperative urinary retention. We conducted a retrospective observational study of three hundred patients to specifically determine the effect of the anaesthetic technique on the incidence of urinary retention following elective lower limb arthroplasty. One hundred consecutive patients were surveyed in each of three groups differing by the type of the anaesthetic technique and the drug administered; 1) general anaesthesia with femoral nerve block, 2) spinal anaesthesia with intrathecal fentanyl, and 3) spinal anaesthesia with intrathecal morphine. The incidence of urinary retention requiring catheterisation in male patients receiving intrathecal morphine was 58% compared with 10% and 6% for those who had general anaesthesia with femoral nerve block and intrathecal fentanyl, respectively. This difference was statistically significant (p<0.01). The incidence of urinary retention in females across all groups was =2%. The average residual volume of urine following catheterisation was 750ml (460-1500ml). Our findings show that the use of intrathecal morphine greatly increases the risk of postoperative urinary retention in male patients, whereas no significant increase was found amongst female patients. This risk should be carefully considered when choosing the type of intraoperative anaesthetic/analgesic combination employed in male patients and be rationalised against the intended benefits to the patient.
Cam-type femoro-acetabular impingement (FAI) is increasingly recognised as a cause of mechanical hip symptoms in young adults. It is likely that it is a cause of early hip degeneration. Ganz et al have developed a therapeutic procedure involving trochanteric flip osteotomy and dislocation of the hip, and have reported good results. We have developed an arthroscopic osteochondroplasty to reshape the proximal femur and relieve impingement. Fifty patients who presented with mechanical hip symptoms and had demonstrable cam-type FAI on radially-reconstructed MR arthrography, were treated by arthroscopic osteochondroplasty. Ten patients had a post-operative CT; from these images flexion and internal rotation range was tested in a virtual reality (VR) model to determine adequacy of resection. All patients were followed up for a minimum of one year, and post-operative Non-Arthritic Hip Scores (NAHS, maximum possible score 100) compared with pre-operative NAHS.Background
Methods
Femoro-acetabular impingement (FAI) is increasingly recognised as a cause of mechanical hip symptoms in sportspersons. In femoro-acetabular impingement abnormal contact occurs between the proximal femur and the acetabular rim during terminal motion of the hip as a result of abnormal morphologic features involving the proximal femur (CAM) or the acetabulum (Pincer) or both (Mixed) leading to lesions of acetabular labrum and the adjacent acetabular cartilage. It is likely that it is a cause of early hip degeneration. Ganz developed a therapeutic procedure involving trochanteric flip osteotomy and dislocation of the hip, and have reported good results. We have developed an arthroscopic technique to reshape the proximal femur and remove prominent antero-superior acetabular rim thereby relieving impingement. Twelve patients presented with mechanical hip symptoms and had demonstrable cam-type (eight patients) or mixed (four patients) FAI on radially-reconstructed MR arthrography, were treated by arthroscopic femoral osteochondroplasty and acetabular rim resection if indicated. All patients were competing at the highest level in their respective sport (football, rugby and athletics). All patients were followed up and post-operative Non-Arthritic Hip Scores (NAHS, maximum possible score 100) compared with pre-operative NAHS.Background
Methods
In patients with shoulder pain one of the important initial determinations is to assess the integrity of the rotator cuff. Clinical examination is often inconclusive. Compared with MRI and arthrography, ultrasound allows dynamic evaluation, is non-invasive, less expensive, less time-consuming and more acceptable to patients. The aim of the present study was to evaluate the accuracy of high resolution shoulder ultrasonography compared with arthroscopy in a series of consecutive patients with clinically suspected rotator cuff disease. 100 shoulders in 99 consecutive patients with shoulder pain who had undergone standardised pre-operative ultrasonography and subsequent arthroscopy between May 2004 and March 2006 were included in the study. There were 53 males and 46 females with a mean age of 59 years. The mean time interval between the ultrasonographic and the arthroscopic examinations was 227 days. For full thickness tears ultrasonography showed a sensitivity of 100%, specificity 83%, positive predictive value 80%, negative predictive value 100% and accuracy 90%. Ultrasonography showed a sensitivity of 83% in detecting partial thickness tears, specificity 94%, positive predictive value 86%, negative predictive value 93% and accuracy 91%.Introduction
Materials and methods
Management of periprosthetic femoral fractures above a Total Knee Arthroplasty remains a challenge. The different treatment options available include casting for undisplaced fractures, ORIF for a displaced fracture with a well-fixed implant or revision arthroplasty for a very distal fracture and for a fracture with a loose implant. We describe our experience in treating a very distal displaced supracondylar fracture above a well-fixed femoral component in a 68-year-old woman who was recently diagnosed with breast carcinoma and awaiting mastectomy. There was no evidence of metastatic disease. The knee replacement was done 4 years before and the patient did not have any symptoms in the knee prior to the fall. Conventional ORIF with IM nailing or plate osteosynthesis was not possible due to the very distal site of the fracture. We used a custom modified 95 degree angled blade plate in which a slot was cut in the middle of the blade halfway along its length to accommodate the pegs of the femoral component in the distal fragment. The fracture was reduced and fixed with the angled blade plate restoring length, alignment, and providing coronal stability. The patient had a satisfactory union at 3 months without deformity giving a good range of pain free movement in the knee. DCS and 95 degree angled blade plate have been used in the past with mixed results. The lag screw or the blade has to be inserted more proximally to avoid the femoral component and so the distal fixation is often sub optimal. In our case modification of the blade allowed more distal placement providing optimal fixation and avoiding complex revision surgery.
