This study examined the effect of completely disregarding dislocation precautions on the incidence of dislocation, as well as the speed of patient rehabilitation after THJR Since 1st March 2005, all uncomplicated primary THJR’s performed by one of the senior authors for OA have been told by their physiotherapist to do what they like, when they like, during the post-operative period. All patients were operated on through a modified direct lateral approach A representative sample of 30 patients were administered a questionnaire at their 6 week postoperative visit. There were no dislocations. Of those patients in full-time employment, the majority had returned to work by 6 weeks. Most were able to drive between 3 and 4 weeks. Nearly all had regained their pre-operative range of movement and could put on their own shoes and socks. All claimed that being told to disregard dislocation precautions gave them more confidence in their THJR and helped with their achieving a speedy recovery from surgery. Patients who are judged at the time of surgery to have a stable THJR articulation, benefit form being told to disregard the usual dislocation precautions, and are able to return to work and driving in a more timely manner.
To review local experience using the Avon patellofemoral arthroplasty All patients were retrospectively reviewed with respect to function, radiology and satisfaction Fourteen patients were followed up. There were no revisions and very good functional outcome. Patient satisfaction was high. The Avon patellofemoral arthroplasty is an effective implant in selected patients.
INTRODUCTION: Posterolateral intertransverse lumbar fusion is a commonly performed procedure for stabilisation of the degenerated lumbar spine. A typical clinical scenario for which such fusions are used is the stabilisation of a degenerative spondylolisthesis after decompression. In a recent large series reported in the literature, this type of fusion was noted to have a pseudarthrosis rate of up to 45% (Fischgrund, METHODS: A pilot study was designed to evaluate the safety and efficacy of osteoinductive protein-1 (OP-1, also known as recombinant human BMP-7) in lumbar posterolateral fusion. Thirty-six patients with the diagnosis of symptomatic spinal stenosis and single level degenerative spondylolisthesis in the lower lumbar spine (L3–S1) were enrolled. The patients were randomised to either the OP-1 group or the control group. The OP-1 group received 3.5 mg of OP-1 per side in a putty carrier. The control group received iliac crest autograft alone. Outcomes were measured clinically using the Oswestry score and radiographically using dynamic radiographs evaluated independently by two blinded radiologists using digital calipers. Patients were deemed a clinical success if they showed a >
20% improvement in Oswestry score and were deemed a radiographic success if they showed bridging bone and spinal stability on flexion/ extension films. RESULTS: At twelve months, 18/21 (85.7%) patients in the OP-1 group and 8/11 (72.7%) patients in the autograft group were considered clinical successes, while 13/18 (72.2%) of patients in the OP-1 group and 6/10 (60%) patients in the autograft group were considered radiographic successes. No adverse events related to the use of OP-1 were noted. DISCUSSION: Despite the non-statistical number of patients enrolled in this pilot study, these preliminary results suggest that OP-1 appears to be a safe and effective replacement for iliac crest autograft in human pos-terolateral lumbar fusion. The OP-1 group had a higher radiographic fusion rate than the autograft group. This correlated well with the greater clinical success experienced by the OP-1 group, as measured by improvement in the Oswestry score. None of the previously reported device related complications related to the use of BMPs in animal studies, such as exuberant bone growth with subsequent neural impingement, ectopic ossification, or spinal stenosis, was seen in the treatment group. CONCLUSION: OP-1 appears to be a safe and effective replacement for iliac crest autograft in human posterolateral lumbar fusion. The dose, 3.5 mg per side, and the carrier, a biodegradable putty, appear to provide a safe and effective means of delivering the bone morphogenetic protein OP-1 to the human lumbar spine.
Sixty-three prostheses were implanted in 54 patients. Follow-up was from 55 to 144 months. Eighteen patients had died. Eight prostheses had been revised between four to 82months after the initial surgery. Of the patients who were reviewed, the average Oxford Knee score was 20. Two patients were not satisfied with the prosthesis.
Deep vein thrombosis is uncommon in children but can occur given certain circumstances. Protein C deficiency has recently been described in a child with deep vein thrombosis complicating septic arthritis. We present four case reports of children who developed deep vein thrombosis in association with musculoskeletal sepsis. All had evidence of musculoskeletal sepsis and thrombosis. One child died. Prothrombotic screens were performed demonstrating normal haematological parameters in the three surviving children. The high mortality of deep vein thrombosis complicating musculoskeletal sepsis is emphasised, particularly the potential for septic embolic complications. Deep vein thrombosis should be considered in any child with musculoskeletal sepsis and generalised limb swelling. Early recognition and treatment can lead to favourable outcomes.
