Abstract

Abstract

Aim

We present the medium-term clinical results of a reverse total shoulder arthroplasty with a trabecular metal glenoid base plate.

Introduction

Optimal orthopaedic implant placement is a major contributing factor to the long term success of all common joint arthroplasty procedures. Devices such as 3D printed bespoke guides and orthopaedic robots are extensively described in the literature and have been shown to enhance prosthesis placement accuracy. These technologies have significant drawbacks such as logistical and temporal inefficiency, high cost, cumbersome nature and difficult theatre integration. A radically new disruptive technology for the rapid intraoperative production of patient specific instrumentation that obviates all disadvantages of current technologies is presented.

Back ground:

The aim of this study is to evaluate the long-term outcome after posterior spinal stabilization surgery for the management of de novo non-tuberculous bacterial spinal infection.

Medium-term results of the Discovery elbow replacement are presented. We reviewed 51 consecutive primary Discovery total elbow replacements (TERs) implanted in 48 patients. The mean age of the patients was 69.2 years (49 to 92), there were 19 males and 32 females (37%:63%) The mean follow-up was 40.6 months (24 to 69). A total of six patients were lost to follow-up. Statistically significant improvements in range movement and Oxford Elbow Score were found (p < 0.001). Radiolucent lines were much more common in, and aseptic loosening was exclusive to, the humeral component. Kaplan–Meier survivorship at five years was 92.2% (95% CI 74.5% to 96.4%) for aseptic loosening. In four TERs, periprosthetic infection occurred resulting in failure. A statistically significant association between infection and increased BMI was found (p = 0.0268). Triceps failure was more frequent after the Mayo surgical approach and TER performed after previous trauma surgery. No failures of the implant were noted.

Our comparison shows that the Discovery has early clinical results that are similar to other semi-constrained TERs. We found continued radiological surveillance with particular focus on humeral lucency is warranted and has not previously been reported. Despite advances in the design of total elbow replacement prostheses, rates of complication remain high.

Cite this article: Bone Joint J 2014;96-B:1359–65

Regional nerve block for upper limb surgery is an established procedure. Our study was undertaken to look at the patient experience of this. We prospectively studied 59 consecutive patients undergoing shoulder arthroscopic surgery under regional anaesthesia in our department. They completed a questionnaire which they brought back at their first follow up appointment. The questionnaire gathered information of their experience of anaesthesia and surgery, adequate postoperative information. We reviewed if intra-operative pain occurred and if the patients would undergo such a procedure again. All surgeons were upper limb specialists.3 out of 59 patients required conversion to general anaesthetic (5%) due to failure of the block. The introduction of the block was mainly painless;with patients giving a mean scoring of 0.59 on the visual analog pain score (VAS, range 0–5). 26 patients (44%) expressed interest and watched their operation. Of those, 7 patients felt anxious after having the proceedings explained.1 patient discontinued to watch due to this. 10 patients experienced intraoperative pain, 2 requiring local anaesthetic, 8 receiving sedation, giving a mean score of 3.2 on the VAS. 81.4% of patients would have surgery with regional anaesthetic again, 85% would recommend to others. 83% of patients received adequate information. Overall satisfaction of the experience was rated out of 10, with a mean score of 8.7 (median 9). Regional blocks are an established technique. Since patients are awake and can watch their surgery, it is important to consider the patients perception of this experience. The majority of viewing patients were reassured by explanations of their pathology. Most patients would undergo another procedure with regional anaesthesia and would recommend it, suggesting that this is an effective and popular choice. The overall experience is positive. This supports our intention of offering regional blocks for all upper limb surgery, facilitating increasing use of day case facilities, reducing inpatient stays

The aim of the study was to assess the validity of the new device [BREVIO] [AEND] [Level 2 evidence] in diagnosing carpal tunnel syndrome in the outpatient setting when used by personnel not trained previously in neurophysiologic methods. We prospectively compared the results from a portable handheld automated electroneurodiagnostic devices (AEND) the BREVIO with those from conventional nerve conduction studies. We calculated specificity and sensitivity. We also studied the limits of agreement and correlation between measured latencies. Patient satisfaction with new device was recorded.

Twenty-seven participants (42 hands) were tested. The average age was 56.43 years (38-79). There were 16 females and 11 males. The sensitivity and specificity of the BREVIO as compared to conventional methods were 80% and 75% using distal motor latencies; using distal sensory latencies the sensitivity and specificity were 90% and 60% respectively. The limits of agreement between the sensory and motor latencies using Bland Altman plots were good. Similarly there was good correlation between values measured with the Pearson's correlation coefficient. The position of the baseline cursor was questionable in 19 hands. Repositioning the cursor reduced the number of false positive results which would increase the specificity of the device. The average pain score, VAS on a scale of 1-10, with the BREVIO was 1.69 (1-4) and 3.11(1-5) with conventional testing. The average satisfaction rating on a scale of 1-5 was 1.39 with the BREVIO and 2.73 with the conventional nerve conduction testing.

The BREVIO is an interesting device. We recommend its use by untrained persons only under the supervision of someone trained in neurophysiology who is aware of potential pitfalls.

Neer type 2 fractures of the distal third of the clavicle have a non union rate of 22-35% after conservative treatment. Open reduction and internal fixation has been recommended by most authors but there is no consensus about the best method of internal fixation. We retrospectively assessed the union and shoulder function following Hook plate fixation in 18 patients with Neer type 2 fractures of lateral end clavicle with more then a six month follow up after surgery.

There were 14 males with a mean follow-up of 25.89 months (6-48 months) and the average age was 40.33 years (22-62 range). Fifteen had acute fractures and the rest were non unions. Complications included two non unions, one following a deep infection. There were no iatrogenic fractures. Acromial osteolysis was seen in five patients who had their plates in situ. The average pain score at rest was 1 (0-4) and the average pain score on abduction was 2.2 (0-5). The average Constant score was 88.5 (63-100). Patients were asked to rate their shoulder function; three said their shoulder was normal, eleven said it was nearly normal and one rated it as not normal.

Hook plate fixation appears to be a valuable method of stabilising Neer type 2 fractures of the clavicle resulting in high union rates and good shoulder function. These plates need to be removed after union to prevent acromial osteolysis.

The purpose of this study is to determine whether the mode of anaesthesia chosen for patients undergoing lumbar microdiscectomy surgery has any significant influence on the immediate outcome in terms of safety, efficacy or patient satisfaction.

This prospective randomised study compared safety, efficacy and satisfaction levels in patients having spinal versus general anaesthesia for single level lumbar microdiscectomy.

Fifty consecutive healthy and cooperative patients were recruited and prospectively randomised into two equal groups; half the patients received a spinal anaesthetic (SA), the remainder a general anaesthetic (GA). Each specific mode of anaesthesia was standardised.

Comprehensive post-operative evaluation concentrated on documenting any complications specific to the particular mode of anaesthesia, recording the pace at which the various milestones of physiological and functional recovery were reached, and the level of patient satisfaction with the type of anaesthesia used.

The results showed no serious complication specific to their particular mode of anaesthesia in either group. Thirteen out of 25 SA patients required temporary urinary catheterisation (9 males, 4 females) while among the GA group 4 patients required urinary catheterisation (4 males and 1 female). Post-operative pain perception was significantly lower in the SA group. The SA patients achieved the milestones of physiological and functional recovery more rapidly. While both groups were satisfied with their procedure, the level of satisfaction was significantly higher in the SA group.

In conclusion, lumbar spinal microdiscectomy can be carried out with equal safety, employing either spinal or general anaesthesia. While they require more temporary urinary catheterisation associated with the previous use of intrathecal morphine, patients undergoing SA suffer less pain in association with their procedure and recover more rapidly. Blinded to an extent by not having experienced the alternative, both groups appeared satisfied with their anaesthetic. However, the level of satisfaction was significantly higher in the SA group.

Introduction: Metastatic spinal disease continues to be a challenge in the management of patients with advanced malignancy. Anterior en bloc spondylectomy and stabilisation, a more extensive procedure, is favoured as it is thought to provide a curative resection and improve the overall outcome (Tomita et al,2002; Wiegel, 1999).

Aim: The aim of this study was to see if there is still a role for extensive posterior decompression (Wide laminectomy and transpedicular decompression) with stabilisation in the treatment of these patients which is the mode of treatment used in our institution and favoured by some others (Bauer, 1997)

Patients and Methods: We retrospectively reviewed a cohort of patients treated in our institute by extensive posterior decompression and stabilisation between 2000 to 2006. We excluded patients having haematological primaries and anterior surgery and those with inadequate data.

Outcome measures used were post operative mortality, Post operative improvement in Frankel score, level of pain perception, level of mobility and ability to perform activities of daily living.

Results: 52 patients had posterior surgery with Colarado instrumentation being used in a majority. There was a slight male preponderance with an average age of 67 years. The mean length of follow up was 12 months.57% patients were dead at last review. 52 % patients showed an improvement in Frankel scores. There was a significant decrease in analgesic requirement post operatively with an improvement in pain scores. Similarly there was an improvement in the ability to perform activities of daily living and the level of mobility. No major surgical complications were noted bar a few superficial wound infections. Revision surgery was done in 6 cases. In 2 it was for a tumour recurrence, for broken rods in 2 and converted to anterior in 2. There were 4 immediate peri operative deaths.

Conclusion: Our results are comparable to Bauer et al, 1997 and other series. Posterior spinal surgery is very much a viable treatment option to treat selected cases with metastatic spinal disease. It avoids all the complications and morbidity of anterior surgery while producing an overall improvement in pain, the quality of life, level of mobility and neurological status.

Introduction: The diagnosis of Achilles tendon rupture must be made promptly and reliably to prevent avoidable morbidity. The calf squeeze test (CST) offers a simple clinical test with high sensitivity. However, in our clinical practice we have noticed a lack of clarity in the medical notes. We believe there is confusion regarding what constitutes a positive CST. Movement of the foot being positive or lack of movement of the foot indicating the test is positive. The purpose of this study was to assess the degree of error and to determine whether this is due to lack of knowledge, an inability to perform or correctly interpret and record the result of the CST. We assessed SHO’s , Registrars and Consultants in the Accident & Emergency and Orthopaedic Departments.

Method: Ninety one doctors completed a supervised questionaire. They were asked four questions 1) What tests they chose to diagnose Achilles tendon rupture. 2) How they would perform a CST. 3) What they considered a positive CST to mean . 4) How they would record the diagnosis of a ruptured Achilles tendon.

Results: 92%(84/91) of doctors overall chose to use a CST. 88%(80/91) performed the CST correctly. The CST was interpreted incorrectly by 41%(15/37) and 26%(14/54) of A + E and Orthopaedic doctors respectively. Also 32%(12/37) of A + E and 19%(10/54) of Orthopaedic department doctors mistakenly thought that the diagnosis of an Achilles tendon rupture was consistent with a negative test.

Conclusion: The results suggest that the recording of AT rupture may be inaccurate in as many as 32%(12/37) when patients present to the A + E department. This error is not a result of lack of knowledge or performance of the CST but of interpretation and recording. We would strongly discourage the recording of the CST in terms of a positive or negative result. The result should be described in words, for example ‘No movement of the foot on squeezing the calf muscle.’ We suggest that all SHOs and Registrars who may be called upon to assess patients with suspected Achilles tendon rupture are informed of this source of error.

Introduction: The incidence of younger people requiring arthroplasty is on the rise. Metal on metal Hybrid hip resurfacing arthroplasty is an exciting alternative to conventional arthroplasty, to Orthopaedic surgeons, in young active patients where preserving bone stock is important.

Materials and Methods: All patients with a hybrid Birmingham hip resurfacing arthroplasty (cemented femoral component and a hydroxyappitie coated press fit acetabulum) from 1997–2001, operated by the senior surgeon were followed up. They had annual AP and lateral x-rays, the pre and post op Harris hip scores were recorded and a patient satisfaction survey was done. Results: There were 36 patients, aver follow up 17.2 months, the aver age was 52.Except for 2 patients with femoral neck fractures which required revision there were no other significant complications. Both these patients had a notched femoral neck intraoperatively. There were no revisions for aseptic loosening .The average preop and post op Harris hip scores were 45.5 and 92.1 respectively. There were no radiological signs of loosening. 93% said they would recommend it to others, 93 % rated the surgery as being excellent to good and 96 % returned to normal or near normal level of activity as

Conclusions: We feel that Conservative Hip arthroplasty with resurfacing of the femoral head is an attractive concept particularly in younger patients.

The advantages are preservation of bone stock, non violation of the proximal femur, reduction of stress shielding in the proximal femur and it is quite physiological.

The one important thing is to avoid notching the neck to prevent disastrous fractures. The implant is less forgiving and the learning curve is steep. The ultimate usefulness can only be gauged once longer follow-ups are available.