To determine the long-term survival outcomes of Copeland Resurfacing Hemiarthroplasty (CRHA) performed by a single surgeon series. A retrospective cohort study which looked at patients who underwent CRHA over 6 years. Re-operations including revisions with component exchange taking place in our hospital and at local centres were reviewed. Oxford Shoulder Score (OSS) was used to assess their functional outcomes pre- and post-CRHA.Abstract
Background
Methods
The literature shows that interscalene anaesthesia (ISA) offers many advantages over general anaesthesia(GA) for arthroscopic surgery. There are benefits intra-operatively, a decrease in post-operative complications and a decrease in hospital stay. However patient satisfaction and acceptance of interscalene anaesthesia has not been fully assessed. We wanted to prospectively assess patient choice and satisfaction with interscalene anaesthesia compared to general anesthesia. Fifty patients undergoing subacromial arthroscopic decompression and suitable for either anaesthetic technique, were prospectively identified between August and December 2006. The anaesthetic team discussed the pros and cons of general anaesthesia versus interscalene anaesthesia and the patient choose the type of anaesthesia. The same anaesthetic team and senior author managed and operated on all the patients in the study. Post-operatively patients filled out a questionnaire, which assessed patient choice, experience and satisfaction with type of anaesthesia undertaken. Forty-sic patients successfully completed the questionnaire (27 female, 19 male, average age 59). Seventy-six percent of patients felt that they really understood the pros and cons of each anaesthetic type. Seventy-eight percent of patients felt that they really had the choice in determining their anaesthesia. Twenty-six choose ISA and twenty choose GA. Post-operative complications were less in the ISA group versus the GA group; pain(5.23ISA, 5.75GA), nausea(11%ISA, 35%GA), vomiting(0 ISA, 1GA), and drowsiness(19% ISA, 70%GA). Hospital stay was shorter in ISA patients compared to GA patients. All patients claimed to be satisfied with their choice and none would in retrospect change it. Patients who choose interscalene anaesthesia had less post-operative pain, nausea, vomiting, drowsiness and shorter hospital stays then those patients who choose general anaesthesia for their shoulder surgery. This is consistent with the literature. All patients claimed to be fully satisfied with their hospital experience irrespective of the type of anaesthesia undertaken and none would have chosen differently.
To review the results of periprosthetic femoral fractures treated using Dall-Miles cable and plates. Periprosthetic femoral fractures are increasingly common and their treatment is challanging for Orthopaedic surgeons. Dall-Miles cable and palte system is the current impalnt of choice for periprosthetic femoral fractures following hip arthroplasty. Between January 1999 and December 2001, twenty-two patients with periprosthetic femoral fracture around hip arthroplasty were treated with Dall-Miles system. Thirteen patients required bone grafting (allograft) at time of surgery. The average age of the group was 82 with eighteen females and four men. Thirteen were Vancouver type B2, two type B1, six type C and one type A fracture. All patients were followed up to fracture union. Two patients had fracture of the plate and required further surgery. Two patients had symptomatic loosening even though the fracture had united and underwent revision hip replacement. These four patients were Vancouver type B2. Nine Vancouver B2 patients had fracture union with no need for revision. All other patients had fracture union with no major complications. The Dall-Miles cable and plate system provides an easy to use implant with satisfactory outcome. The simplicity of the system allows widespread acceptance in these increasingly common fractures. It is particularly useful to obtain bony union in elderly patients not fit enough for a major revision surgery.
