Informed consent is a very important part of surgical treatment. In this paper, we report a number of legal judgements in spinal surgery where there was no criticism of the surgical procedure itself. The fault that was identified was a failure to inform the patient of alternatives to, and material risks of, surgery, or overemphasizing the benefits of surgery. In one case, there was a promise that a specific surgeon was to perform the operation, which did not ensue. All of the faults in these cases were faults purely of the consenting process. In many cases, the surgeon claimed to have explained certain risks to the patient but was unable to provide proof of doing so. We propose a checklist that, if followed, would ensure that the surgeon would take their patients through the relevant matters but also, crucially, would act as strong evidence in any future court proceedings that the appropriate discussions had taken place. Although this article focuses on spinal surgery, the principles and messages are applicable to the whole of orthopaedic surgery. Cite this article:
Little is known about tissue changes underlying bone marrow lesions (BMLs) in non-weight-bearing joints with osteoarthritis (OA). Our aim was to characterize BMLs in OA of the hand using dynamic histomorphometry. We therefore quantified bone turnover and angiogenesis in subchondral bone at the base of the thumb, and compared the findings with control bone from hip OA. Patients with OA at the base of the thumb, or the hip, underwent preoperative MRI to assess BMLs, and tetracycline labelling to determine bone turnover. Three groups were compared: trapezium bones removed by trapeziectomy from patients with thumb base OA (n = 20); femoral heads with (n = 24); and those without (n = 9) BMLs obtained from patients with hip OA who underwent total hip arthroplasty.Objectives
Methods
The purpose of this study was to examine whether leg-length discrepancy (LLD) following unilateral total hip arthroplasty (THA) affects the incidence of contralateral head collapse and subsequent THA in patients with bilateral osteonecrosis, and to determine factors associated with subsequent collapse. We identified 121 patients with bilateral non-traumatic osteonecrosis who underwent THA between 2003 and 2011 to treat a symptomatic hip, and who also exhibited medium-to-large lesions (necrotic area ≥ 30%) in an otherwise asymptomatic non-operated hip. Of the 121 patients, 71 were male (59%) and 50 were female (41%), with a mean age of 51 years (19 to 71) at the time of initial THA. All patients were followed for at least five years and were assessed according to the presence of a LLD (non-LLD Aims
Patients and Methods
Intra-articular 90Yttrium (90Y) is an adjunct
to surgical treatment by synovectomy for patients with diffuse-type tenosynovial
giant-cell tumour (dtTGCT) of the knee, with variable success rates.
Clinical information is, however, sparse and its value remains unclear.
We investigated the long-term outcome of patients who underwent synovectomy
with and without adjuvant treatment with 90Yttrium. All patients with dtTGCT of the knee who underwent synovectomy
between 1991 and 2014 were included in the study. Group A patients
underwent synovectomy and an intra-articular injection of 90Yttrium
between six and eight weeks after surgery. Group B patients underwent
surgery alone.Aims
Patients and Methods
The aims of this study were to evaluate the efficacy of preoperative denosumab in achieving prospectively decided intention of therapy in operable giant cell tumour of bone (GCTB) patients, and to document local recurrence-free survival (LRFS). A total of 44 patients received preoperative denosumab: 22 to facilitate curettage, 16 to facilitate resection, and six with intent of converting resection to curettage. There were 26 male and 18 female patients. The mean age was 27 years (13 to 47).Aims
Patients and Methods
The primary aim of this study was to define and quantify three
new measurements to indicate the position of the greater trochanter.
Secondary aims were to define ‘functional antetorsion’ as it relates
to abductor function in populations both with and without torsional
abnormality. Three new measurements, functional antetorsion, posterior tilt,
and posterior translation of the greater trochanter, were assessed
from 61 CT scans of cadaveric femurs, and their reliability determined.
These measurements and their relationships were also evaluated in
three groups of patients: a control group (n = 22), a ‘high-antetorsion’ group
(n = 22) and a ‘low-antetorsion’ group (n = 10).Aims
Patients and Methods
Aims
Patients and Methods
This multicentre, retrospective study aimed to improve our knowledge
of primary pyogenic spinal infections in children by analyzing a
large consecutive case series. The medical records of children with such an infection, treated
at four tertiary institutions between 2004 and 2014, were analyzed
retrospectively. Epidemiological, clinical, paraclinical, radiological,
and microbiological data were evaluated. There were 103 children,
of whom 79 (76.7%) were aged between six months and four years.Aims
Patients and Methods
In the United Kingdom, lower incidences of intraspinal abnormalities
in patients with early onset idiopathic scoliosis have been observed
than in studies in other countries. We aimed to determine the rates
of these abnormalities in United Kingdom patients diagnosed with idiopathic
scoliosis before the age of 11 years. This retrospective study of patients attending an urban scoliosis
clinic identified 71 patients satisfying a criteria of: clinical
diagnosis of idiopathic scoliosis; age of onset ten years and 11 months
or less; MRI screening for intraspinal abnormalities. United Kingdom
census data combined with patient referral data was used to calculate
incidence.Aims
Patients and Methods
The aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation. A cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12).Aims
Patients and Methods
