The treatment of septic arthritis of the shoulder is challenging.
The infection frequently recurs and the clinical outcome can be
very poor. We aimed to review the outcomes following the use of
continuous negative pressure after open debridement with a large
diameter drain in patients with septic arthritis of the shoulder. A total of 68 consecutive patients with septic arthritis of the
shoulder underwent arthrotomy, irrigation and debridement. A small
diameter suction drain was placed in the glenohumeral joint and
a large diameter drain was placed in the subacromial space with
continuous negative pressure of 15 cm H2O. All patients
received a standardised protocol of antibiotics for a mean of 5.1
weeks (two to 11.1).Aims
Patients and Methods
Using a systematic review, we investigated whether there is an
increased risk of post-operative infection in patients who have
received an intra-articular corticosteroid injection to the hip
for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection
to the hip and infection following subsequent THA were identified
from databases for the period between 1990 to 2013. Retrieved articles
were independently assessed for their methodological quality.Aims
Methods
We compared the accuracy, operating time and radiation exposure
of the introduction of iliosacral screws using O-arm/Stealth Navigation
and standard fluoroscopy. Iliosacral screws were introduced percutaneously into the first
sacral body (S1) of ten human cadavers, four men and six women.
The mean age was 77 years (58 to 85). Screws were introduced using
a standard technique into the left side of S1 using C-Arm fluoroscopy
and then into the right side using O-Arm/Stealth Navigation. The
radiation was measured on the surgeon by dosimeters placed under
a lead thyroid shield and apron, on a finger, a hat and on the cadavers.Aims
Materials and Methods
Whether patients with asymptomatic bacteriuria
should be investigated and treated before elective hip and knee replacement
is controversial, although it is a widespread practice. We conducted
a prospective observational cohort study with urine analyses before
surgery and three days post-operatively. Patients with symptomatic
urinary infections or an indwelling catheter were excluded. Post-discharge
surveillance included questionnaires to patients and general practitioners
at three months. Among 510 patients (309 women and 201 men), with
a median age of 69 years (16 to 97) undergoing lower limb joint
replacements (290 hips and 220 knees), 182 (36%) had pre-operative asymptomatic
bacteriuria, mostly due to We conclude that testing and treating asymptomatic urinary tract
colonisation before joint replacement is unnecessary. Cite this article:
The revised Tokuhashi, Tomita and modified Bauer
scores are commonly used to make difficult decisions in the management
of patients presenting with spinal metastases. A prospective cohort
study of 199 consecutive patients presenting with spinal metastases,
treated with either surgery and/or radiotherapy, was used to compare
the three systems. Cox regression, Nagelkerke’s R2 and
Harrell’s concordance were used to compare the systems and find their
best predictive items. The three systems were equally good in terms
of overall prognostic performance. Their most predictive items were
used to develop the Oswestry Spinal Risk Index (OSRI), which has
a similar concordance, but a larger coefficient of determination
than any of these three scores. A bootstrap procedure was used to
internally validate this score and determine its prediction optimism. The OSRI is a simple summation of two elements: primary tumour
pathology (PTP) and general condition (GC): OSRI = PTP + (2 – GC). This simple score can predict life expectancy accurately in patients
presenting with spinal metastases. It will be helpful in making
difficult clinical decisions without the delay of extensive investigations. Cite this article:
To assess the responsiveness and ceiling/floor effects of the Forgotten Joint Score -12 and to compare these with that of the more widely used Oxford Hip Score (OHS) in patients six and 12 months after primary total hip arthroplasty. We prospectively collected data at six and 12 months following total hip arthroplasty from 193 patients undergoing surgery at a single centre. Ceiling effects are outlined with frequencies for patients obtaining the lowest or highest possible score. Change over time from six months to 12 months post-surgery is reported as effect size (Cohen’s d).Objectives
Methods
The April 2014 Oncology Roundup360 looks at: Eyeball as good as microscope for tumour margins; when is best to stabilise femoral metastases?; fluorine does not cause bone tumours; whether giant cell tumour of the proximal femur ever successfully managed; extraskeletal osteosarcoma; modular lower limb tumour reconstruction; and observational studies the basis for most bone tumour treatment.
Osteosarcoma of the pelvis is a particularly difficult tumour
to treat as it often presents late, may be of considerable size
and/or associated with metastases when it presents, and is frequently
chondroid in origin and resistant to chemotherapy. The aim of this study was to review our experience of managing
this group of patients and to identify features predictive of a
poor outcome. Between 1983 and 2014, 121 patients, (74 females and 47 males)
were treated at a single hospital: 74 (61.2%) patients had a primary
osteosarcoma and 47 (38.8%) had an osteosarcoma which was secondary
either to Paget’s disease (22; 18.2%) or to previous pelvic irradiation
(25; 20.7%). The mean age of those with a primary osteosarcoma was 29.3 years
(nine to 76) and their mean follow-up 2.9 years (0 to 29). The mean
age of those with a secondary sarcoma was 61.9 years (15 to 85)
and their mean follow-up was one year (0 to 14). A total of 22 patients with a primary sarcoma (52.4%) and 20
of those with a secondary sarcoma (47.6%) had metastases at the
time of presentation. Aims
Patients and Methods
The December 2015 Oncology Roundup360 looks at: Amputation may not be the best option; Growing golf balls bad news!; How close is safe? Radiotherapy and surgery; Lymphocyte: monocyte ratio in osteosarcoma; Are borderline cartilage tumours really borderline?; Boosting algorithms improves survival estimates; CT better than Mirels?
Metal-on-metal resurfacing of the hip (MoMHR)
has enjoyed a resurgence in the last decade, but is now again in question
as a routine option for osteoarthritis of the hip. Proponents of
hip resurfacing suggest that its survival is superior to that of
conventional hip replacement (THR), and that hip resurfacing is
less invasive, is easier to revise than THR, and provides superior
functional outcomes. Our argument serves to illustrate that none
of these proposed advantages have been realised and new and unanticipated
serious complications, such as pseudotumors, have been associated
with the procedure. As such, we feel that the routine use of MoMHR
is not justified. Cite this article:
The December 2015 Trauma Roundup360 looks at: Delay to surgery in hip fracture; Hexapod fixators in the management of hypertrophic tibial nonunions; Thromboembolism after nailing pathological fractures; Tibial plateau fracture patterns under the spotlight; The health economic effects of long bone nonunion; Adverse outcomes in trauma; The sacral screw in children; Treating the contralateral SUFE
This study investigated whether the use of tranexamic acid (TXA)
decreased blood loss and transfusion related cost following surface
replacement arthroplasty (SRA). A retrospective review of patients treated with TXA during a
SRA, who did not receive autologous blood (TXA group) was performed.
Two comparison groups were established; the first group comprised
of patients who donated their own blood pre-operatively (auto group)
and the second of patients who did not donate blood pre-operatively
(control). Outcomes included transfusions, post-operative haemoglobin
(Hgb), complications, and length of post-operative stay. Aims
Methods
It is important to be able to identify patients
with an increased risk of venous thromboembolism (VTE) in order
to minimise the risk of an event. We investigated the incidence
and risk factors for post-operative VTE in 168 consecutive patients
with a malignancy of the lower limb. The period of study included
ten months before and 12 months after the introduction of chemical
thromboprophylaxis. All data about the potential risk factors were identified
and classified into three groups (patient-, surgery- and tumour-related).
The outcome measure was a thromboembolic event within 90 days of
surgery. Of the 168 patients, eight (4.8%) had a confirmed symptomatic
deep-vein thrombosis and one (0.6%) a fatal pulmonary embolism.
Of the 28 variables tested, age >
60 years, higher American Society
of Anesthesiologists grade and metastatic tumour were independent
risk factors for VTE. The overall rate of symptomatic VTE was not significantly
different between patients who received chemical thromboprophylaxis
and those who did not. Knowledge of these risk factors may be of
value in improving the surgical outcome of patients with a malignancy
of the lower limb. Cite this article:
The global economy has been facing a financial crisis. Healthcare costs are spiraling, and there is a projected £30 billion health funding gap by 2020 in the UK. What is happening in the UK is a reflection of a global problem. Rationing of healthcare is a topic of much discussion; as unless spending is capped, providing healthcare will become unsustainable. Who decides how money is spent, and which services should be rationed? In this article we aim to discuss the impact that rationing may have on orthopaedic surgery, and we will discuss our own experiences of attempts to ration local services.
The August 2012 Spine Roundup360 looks at: neural tissue and polymerising bone cement; a new prognostic score for spinal metastases from prostatic tumours; recovery after spinal decompression; spinal tuberculosis; unintended durotomy at spinal surgery; how carrying a load on your head can damage the cervical spine; and how age changes your lumbar spine.
Between 2005 and 2012, 50 patients (23 female, 27 male) with
nonunion of the humeral shaft were included in this retrospective
study. The mean age was 51.3 years (14 to 88). The patients had
a mean of 1.5 prior operations ( All patients were assessed according to a specific risk score
in order to devise an optimal and individual therapy plan consistent
with the Diamond Concept. In 32 cases (64%), a change in the osteosynthesis
to an angular stable locking compression plate was performed. According
to the individual risk an additional bone graft and/or bone morphogenetic
protein-7 (BMP-7) were applied. A successful consolidation of the nonunion was observed in 37
cases (80.4%) with a median healing time of six months (IQR 6).
Younger patients showed significantly better consolidation. Four
patients were lost to follow-up. Revision was necessary in a total
of eight (16%) cases. In the initial treatment, intramedullary nailing
was most common. Methods
Results
The October 2015 Foot &
Ankle Roundup360 looks at: TightRope in Weber C fractures; A second look at the TightRope; Incisional VAC comes of age?; Platelet-derived growth factor and ankle fusions; Achilles tendon rehab in the longer term following surgery; Telemedicine for diabetic foot ulcer
The December 2013 Oncology Roundup360 looks at: Peri-articular resection fraught with complications; Navigated margins; Skeletal tumours and thromboembolism; Conditional survival in Ewing’s sarcoma; Reverse shoulders and tumour; For how long should we follow up sarcoma patients?; and already metastasised?
