The purpose of this study was to compare the clinical and radiographic
outcomes of total ankle arthroplasty (TAA) in patients with pre-operatively
moderate and severe arthritic varus ankles to those achieved for
patients with neutral ankles. A total of 105 patients (105 ankles), matched for age, gender,
body mass index, and follow-up duration, were divided into three
groups by pre-operative coronal plane tibiotalar angle; neutral
(<
5°), moderate (5° to 15°) and severe (>
15°) varus deformity.
American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot
score, a visual analogue scale (VAS), and Short Form (SF)-36 score
were used to compare the clinical outcomes after a mean follow-up period
of 51 months (24 to 147).Aims
Patients and Methods
The aims of this study were to analyse the long-term outcome
of vascularised fibular graft (VFG) reconstruction after tumour
resection and to evaluate the usefulness of the method. We retrospectively reviewed 49 patients who had undergone resection
of a sarcoma and reconstruction using a VFG between 1988 and 2015.
Their mean follow-up was 98 months (5 to 317). Reconstruction was
with an osteochondral graft (n = 13), intercalary graft (n = 12),
inlay graft (n = 4), or resection arthrodesis (n = 20). We analysed
the oncological and functional outcome, and the rate of bony union
and complications.Aims
Patients and Methods
The aim of the study was to compare measures of the quality of
life (QOL) after resection of a chordoma of the mobile spine with
the national averages in the United States and to assess which factors
influenced the QOL, symptoms of anxiety and depression, and coping
with pain post-operatively in these patients. A total of 48 consecutive patients who underwent resection of
a primary or recurrent chordoma of the mobile spine between 2000
and 2015 were included. A total of 34 patients completed a survey
at least 12 months post-operatively. The primary outcome was the
EuroQol-5 Dimensions (EQ-5D-3L) questionnaire. Secondary outcomes were
the Patient-Reported Outcome Measurement Information System (PROMIS)
anxiety, depression and pain interference questionnaires. Data which
were recorded included the indication for surgery, the region of
the tumour, the number of levels resected, the status of the surgical
margins, re-operations, complications, neurological deficit, length
of stay in hospital and rate of re-admission.Aims
Patients and Methods
The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. Data from 94 hospitals on patients aged 60 to 110 who had hip fracture surgery between May 2013 and July 2013 were analysed. Data were linked to the Office for National Statistics (ONS) death register to calculate the 30-day mortality rate. Risk of death was predicted for each patient using the NHFD and Nottingham models in a development dataset using logistic regression to define the models’ coefficients. This was followed by testing the performance of these refined models in a second validation dataset.Objectives
Methods
The aim of this prospective randomised controlled trial was to
compare non-operative and operative management for acute isolated
displaced fractures of the olecranon in patients aged ≥ 75 years. Patients were randomised to either non-operative management or
operative management with either tension-band wiring or fixation
with a plate. They were reviewed at six weeks, three and six months
and one year after the injury. The primary outcome measure was the
Disabilities of the Arm, Shoulder and Hand (DASH) score at one year.Aims
Patients and Methods
The aim of the study was to investigate the controversial issue
of whether the pelvic ring should be reconstructed following resection
of the sarcomas of the ilium. From our database, we identified 64 patients who underwent excision
of a tumour involving the ilium between 1976 and 2015. A total of
35 underwent complete resection, of whom 24 were reconstructed with
a non-vascularised fibula graft, and four with extracorporeal irradiation
and reimplantation. A total of 29 patients had a partial resection.
The mean follow-up was 9.2 years (1.1 to 25.6). Functional outcomes
were assessed using the Toronto Extremity Salvation Score (TESS)
at final follow-up. In all, 32 patients (50%) had a chondrosarcoma.Aims
Patients and Methods
Periacetabular osteotomy is an effective way of treating symptomatic
hip dysplasia. We describe a new minimally invasive technique using
a modification of the Smith-Peterson approach. We performed a prospective, longitudinal cohort study to assess
for any compromise in acetabular correction when using this approach,
and to see if the procedure would have a higher complication rate
than that quoted in the literature for other approaches. We also
assessed for any improvement in functional outcome. From 168 consecutive patients (189 hips) who underwent acetabular
correction between March 2010 and March 2013 we excluded those who
had undergone previous pelvic surgery for DDH and those being treated
for acetabular retroversion. The remaining 151 patients (15 men,
136 women) (166 hips) had a mean age of 32 years (15 to 56) and the
mean duration of follow-up was 2.8 years (1.2 to 4.5). In all 90%
of cases were Tönnis grade 0 or 1. Functional outcomes were assessed
using the Non Arthritic Hip Score (NAHS), University of California,
Los Angeles (UCLA) and Tegner activity scores.Aims
Patients and Methods
Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed.Objective
Methods
Many hospitals do not have a structured process
of consent, the attainment of which can often be rather ‘last-minute’
and somewhat chaotic. This is a surprising state of affairs as spinal
surgery is a high-risk surgical specialty with potential for expensive
litigation claims. More recently, the Montgomery ruling by the United
Kingdom Supreme Court has placed the subject of informed consent
into the spotlight. There is a paucity of practical guidance on how a consent process
can be achieved in a busy clinical setting. The British Association
of Spinal Surgeons (BASS) has convened a working party to address
this need. To our knowledge this is the first example of a national
professional body, representing a single surgical specialty, taking such
a fundamental initiative. In a hard-pressed clinical environment, the ability to achieve
admission reliably on the day of surgery, in patients at ease with
their situation and with little likelihood of late cancellation,
will be of great benefit. It will reduce litigation and improve
the patient experience. Cite this article:
This is the first prospective study to report the pre- and post-operative
patient reported outcomes and satisfaction scores following excision
of interdigital Morton’s neuroma. Between May 2006 and April 2013, we prospectively studied 99
consecutive patients (111 feet) who were to undergo excision of
a Morton’s neuroma. There were 78 women and 21 men with a mean age
at the time of surgery of 56 years (22 to 78). Patients completed
the Manchester-Oxford Foot Questionnaire (MOXFQ), Short Form-12
(SF-12) and a supplementary patient satisfaction survey three months
pre-operatively and six months post-operatively.Aims
Patients and Methods
Smoking is associated with post-operative complications but smokers
often under-report the amount they smoke. Our objective was to determine
whether a urine dipstick test could be used as a substitute for
quantitative cotinine assays to determine smoking status in patients. Between September 2013 and July 2014 we conducted a prospective
cohort study in which 127 consecutive patients undergoing a planned
foot and ankle arthrodesis or osteotomy were included. Patients
self-reported their smoking status and were classified as: ‘never
smoked’ (61 patients), ‘ex-smoker’ (46 patients), or ‘current smoker’ (20
patients). Urine samples were analysed with cotinine assays and
cotinine dipstick tests.Aims
Patients and Methods
Patients with diabetes are at increased risk of wound complications
after open reduction and internal fixation of unstable ankle fractures.
A fibular nail avoids large surgical incisions and allows anatomical
reduction of the mortise. We retrospectively reviewed the results of fluoroscopy-guided
reduction and percutaneous fibular nail fixation for unstable Weber
type B or C fractures in 24 adult patients with type 1 or type 2
diabetes. The re-operation rate for wound dehiscence or other indications
such as amputation, mortality and functional outcomes was determined.Aims
Patients and Methods
Total joint arthroplasty (TJA) is commonly performed in elderly
patients. Frailty, an aggregate expression of vulnerability, becomes
increasingly common with advanced age, and independently predicts
adverse outcomes and the use of resources after a variety of non-cardiac
surgical procedures. Our aim was to assess the impact of frailty
on outcomes after TJA. We analysed the impact of pre-operative frailty on death and
the use of resources after elective TJA in a population-based cohort
study using linked administrative data from Ontario, Canada.Aims
Patients and Methods
Lumbar disc herniation (LDH) is uncommon in youth
and few cases are treated surgically. Very few outcome studies exist
for LDH surgery in this age group. Our aim was to explore differences
in gender in pre-operative level of disability and outcome of surgery
for LDH in patients aged ≤ 20 years using prospectively collected
data. From the national Swedish SweSpine register we identified 180
patients with one-year and 108 with two-year follow-up data ≤ 20
years of age, who between the years 2000 and 2010 had a primary
operation for LDH. Both male and female patients reported pronounced impairment
before the operation in all patient reported outcome measures, with
female patients experiencing significantly greater back pain, having
greater analgesic requirements and reporting significantly inferior
scores in EuroQol (EQ-5D-index), EQ-visual analogue scale, most aspects
of Short Form-36 and Oswestry Disabilities Index, when compared
with male patients. Surgery conferred a statistically significant
improvement in all registered parameters, with few gender discrepancies.
Quality of life at one year following surgery normalised in both
males and females and only eight patients (4.5%) were dissatisfied with
the outcome. Virtually all parameters were stable between the one-
and two-year follow-up examination. LDH surgery leads to normal health and a favourable outcome in
both male and female patients aged 20 years or younger, who failed
to recover after non-operative management. Cite this article:
