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We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue. This was a randomized control trial of 169 patients who required surgery for closed isolated distal radius fractures. The study was performed between March 2016 and April 2019 at a public sector level 1 trauma centre. General anaesthesia was used in 56 patients, Bier’s block in 58 patients, and WALANT in 55 patients. Data were collected on pre-, peri-, and postoperative parameters, clinical outcome, hospital costs, and patient satisfaction. One-way analysis of variance (ANOVA) was used with a p-value of 0.05 being significant.Aims
Methods
We investigated the reliability of the cobalt-chromium (CoCr) synovial joint fluid ratio (JFR) in identifying the presence of a severe aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) response and/or suboptimal taper performance (SOTP) following metal-on-metal (MoM) hip arthroplasty. We then examined the possibility that the CoCr JFR may influence the serum partitioning of Co and Cr. For part A, we included all revision surgeries carried out at our unit with the relevant data, including volumetric wear analysis, joint fluid (JF) Co and Cr concentrations, and ALVAL grade (n = 315). Receiver operating characteristic curves were constructed to assess the reliability of the CoCr JFR in identifying severe ALVAL and/or SOTP. For part B, we included only patients with unilateral prostheses who had given matched serum and whole blood samples for Co and Cr analysis (n = 155). Multiple regression was used to examine the influence of JF concentrations on the serum partitioning of Co and Cr in the blood.Objectives
Methods
Objectives. Intra-articular injections of
We have encountered patients who developed large joint fluid collections with massive elevations in chromium (Cr) and cobalt (Co) concentrations following metal-on-metal (MoM) hip arthroplasties. In some cases, retrieval analysis determined that these ion concentrations could not be explained simply by the wear rates of the components. We hypothesized that these effects may be associated with aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). We examined the influence of the ALVAL grade on synovial fluid Co and Cr concentrations following adjustment for patient and device variables, including volumetric wear rates. Initially restricting the analysis to include only patients with one MoM hip resurfacing device, we performed multiple regression analyses of prospectively collected data. We then repeated the same statistical approach using results from a larger cohort with different MoM designs, including total hip arthroplasties.Objectives
Patients and Methods
We have increased the dose of tranexamic acid (TXA) in our enhanced total joint recovery protocol at our institution from 15 mg/kg to 30 mg/kg (maximum 2.5 g) as a single, intravenous (IV) dose. We report the clinical effect of this dosage change. We retrospectively compared two cohorts of consecutive patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery in our unit between 2008 and 2013. One group received IV TXA 15 mg/kg, maximum 1.2 g, and the other 30 mg/kg, maximum 2.5 g as a single pre-operative dose. The primary outcome for this study was the requirement for blood transfusion within 30 days of surgery. Secondary measures included length of hospital stay, critical care requirements, re-admission rate, medical complications and mortality rates.Objectives
Methods
The purpose of this study was to compare the joint space width between one-leg and both-legs standing radiographs in order to diagnose a primary osteoarthritis of the knee. Digital radiographs of 100 medial osteoarthritic knees in 50 patients were performed. The patients had undergone one-leg standing anteroposterior (AP) views by standing on the affected leg while a both-legs standing AP view was undertaken while standing on both legs. The severity of the osteoarthritis was evaluated using the joint space width and Kellgren-Lawrence (KL) radiographic classification. The Objectives
Methods
To explore the therapeutic potential of combining bone marrow-derived mesenchymal stem cells (BM-MSCs) and hydroxyapatite (HA) granules to treat nonunion of the long bone. Ten patients with an atrophic nonunion of a long bone fracture were selectively divided into two groups. Five subjects in the treatment group were treated with the combination of 15 million autologous BM-MSCs, 5g/cm3 (HA) granules and internal fixation. Control subjects were treated with iliac crest autograft, 5g/cm3 HA granules and internal fixation. The outcomes measured were post-operative pain (visual analogue scale), level of functionality (LEFS and DASH), and radiograph assessment.Objectives
Methods
Effective analgesia after total knee arthroplasty (TKA) improves
patient satisfaction, mobility and expedites discharge. This study
assessed whether continuous femoral nerve infusion (CFNI) was superior
to a single-shot femoral nerve block in primary TKA surgery completed
under subarachnoid blockade including morphine. We performed an adequately powered, prospective, randomised,
placebo-controlled trial comparing CFNI of 0.125% bupivacaine Objectives
Methods
The effects of disease progression and common tendinopathy treatments
on the tissue characteristics of human rotator cuff tendons have
not previously been evaluated in detail owing to a lack of suitable
sampling techniques. This study evaluated the structural characteristics
of torn human supraspinatus tendons across the full disease spectrum,
and the short-term effects of subacromial corticosteroid injections
(SCIs) and subacromial decompression (SAD) surgery on these structural
characteristics. Samples were collected inter-operatively from supraspinatus tendons
containing small, medium, large and massive full thickness tears
(n = 33). Using a novel minimally invasive biopsy technique, paired
samples were also collected from supraspinatus tendons containing
partial thickness tears either before and seven weeks after subacromial
SCI (n = 11), or before and seven weeks after SAD surgery (n = 14).
Macroscopically normal subscapularis tendons of older patients (n
= 5, mean age = 74.6 years) and supraspinatus tendons of younger
patients (n = 16, mean age = 23.3) served as controls. Ultra- and
micro-structural characteristics were assessed using atomic force
microscopy and polarised light microscopy respectively. Objectives
Methods
To study the effect of hyaluronic acid (HA) on local anaesthetic
chondrotoxicity Chondrocytes were harvested from bovine femoral condyle cartilage
and isolated using collagenase-containing media. At 24 hours after
seeding 15 000 cells per well onto a 96-well plate, chondrocytes
were treated with media (DMEM/F12 + ITS), PBS, 1:1 lidocaine (2%):PBS,
1:1 bupivacaine (0.5%):PBS, 1:1 lidocaine (2%):HA, 1:1 bupivacaine (0.
5%):HA, or 1:1 HA:PBS for one hour. Following treatment, groups
had conditions removed and 24-hour incubation. Cell viability was
assessed using PrestoBlue and confirmed visually using fluorescence
microscopy.Objective
Methods
One commonly used rat fracture model for bone and mineral research
is a closed mid-shaft femur fracture as described by Bonnarens in
1984. Initially, this model was believed to create very reproducible
fractures. However, there have been frequent reports of comminution
and varying rates of complication. Given the importance of precise
anticipation of those characteristics in laboratory research, we
aimed to precisely estimate the rate of comminution, its importance and
its effect on the amount of soft callus created. Furthermore, we
aimed to precisely report the rate of complications such as death
and infection. We tested a rat model of femoral fracture on 84 rats based on
Bonnarens’ original description. We used a proximal approach with
trochanterotomy to insert the pin, a drop tower to create the fracture
and a high-resolution fluoroscopic imager to detect the comminution.
We weighed the soft callus on day seven and compared the soft callus
parameters with the comminution status.Objectives
Methods
