We reviewed the records of 431 patients who had open reduction and internal fixation of the scaphoid performed by one surgeon (TJH) over a 13-year period. The Herbert bone screw provided adequate internal fixation without the use of plaster immobilisation, promoting a rapid functional recovery. On average, patients returned to work 4.7 weeks after surgery and wrist function was significantly improved, even when the fracture failed to unite. Healing rates for acute fractures were better than those reported for plaster immobilisation and were independent of fracture location. In the case of established nonunions, healing depended on the stage and location of the fracture, but the progress of
We developed a 12-item questionnaire for completion by patients having total hip replacement (THR). A prospective study of 220 patients was undertaken before operation and at follow-up six months later. Each completed the new questionnaire as well as the SF36, and some the
Over a nine-year period, 20 feet with persistently symptomatic talocalcaneal coalition were treated by resection of the bar. The 17 patients were all under 16 years of age. Excellent or good long-term results were achieved in the ten feet in which preoperative coronal CT had shown that the area of coalition measured 50% or less of the area of the posterior facet of the calcaneum. In these feet heel valgus was less than 16 degrees and there were no radiographic signs of
Socket migration and rotation in the Charnley total hip replacement were evaluated by roentgen stereophotogrammetric analysis in 23 patients with rheumatoid arthritis and 23 patients with osteoarthritis. The two groups were matched with regard to age and sex. The follow-up time was two years. In the rheumatoid patients socket migration was most prominent in the proximal direction and averaged 0.6 mm at 24 months as compared with 0.1 mm in the osteoarthritic group (p = 0.0003). Within the rheumatoid group a preoperative acetabular protrusion in five patients was associated with increased migration and rotation in all directions. The increased proximal migration in rheumatoid arthritis was consistent (p = 0.0009) even after the exclusion of the five protrusion cases. In the rheumatoid patients there was a correlation between low body-weight and proximal migration, but there was no such correlation in the osteoarthritic group. Our results suggest that socket fixation is less secure in patients with advanced inflammatory
Total hip arthroplasty was performed in 45 hips of 44 patients who had pyogenic
Custom flange acetabular components (CFACs) are a patient-specific option for addressing large acetabular defects at revision total hip arthroplasty (THA), but patient and implant characteristics that affect survivorship remain unknown. This study aimed to identify patient and design factors related to survivorship. A retrospective review of 91 patients who underwent revision THA using 96 CFACs was undertaken, comparing features between radiologically failed and successful cases. Patient characteristics (demographic, clinical, and radiological) and implant features (design characteristics and intraoperative features) were collected. There were 74 women and 22 men; their mean age was 62 years (31 to 85). The mean follow-up was 24.9 months (Aims
Patients and Methods
Ferrography is a technique for analysing wear by means of the magnetic separation of wear particles. To evaluate its application in human joints, the results of the ferrographic analysis of saline washings of symptomatic human knees were compared with the results of the arthroscopic examination of the same knees. Ferrography was found to be an extremely sensitive monitor of articular erosion, with a resolution far greater than that of arthroscopy. This was particularly apparent with knees suffering from a torn anterior cruciate ligament: arthroscopy detected no damage to the cartilaginous surfaces whereas ferrography detected a substantial level of "microdamage". The spectrum of wear particles showed qualitative and quantitative alterations depending upon the condition of the knee. Ferrography thus holds much promise as a potential differential diagnostic technique of great sensitivity, with particular relevance to the very early changes which precede clinical symptoms. Study of wear particles is also justified by evidence indicating an active role in the pathophysiological progression of
The results of conventional hip replacement in young patients with osteoarthritis have not been encouraging even with improvements in the techniques of fixation and in the bearing surfaces. Modern metal-on-metal hip resurfacing was introduced as a less invasive method of joint reconstruction for this particular group. This is a series of 446 hip resurfacings (384 patients) performed by one of the authors (DJWM) using cemented femoral components and hydroxyapatite-coated uncemented acetabular components with a maximum follow-up of 8.2 years (mean 3.3). Their survival rate, Oxford hip scores and activity levels are reviewed. Six patients died due to unrelated causes. There was one revision (0.02%) out of 440 hips. The mean Oxford score of the surviving 439 hips is 13.5. None of the patients were told to change their activities at work or leisure; 31% of the men with unilateral resurfacings and 28% with bilateral resurfacings were involved in jobs that they considered heavy or moderately heavy; 92% of men with unilateral hip resurfacings and 87% of the whole group participate in leisure-time sporting activity. The extremely low rate of failure in spite of the resumption of high level occupational and leisure activities provides early evidence of the suitability of this procedure for young and active patients with
The practice of alternating operating theatres has long been used to reduce surgeon idle time between cases. However, concerns have been raised as to the safety of this practice. We assessed the payments and outcomes of total knee arthroplasty (TKA) performed during overlapping and nonoverlapping days, also comparing the total number of the surgeon’s cases and the total time spent in the operating theatre per day. A retrospective analysis was performed on the Centers for Medicare & Medicaid Services (CMS) Limited Data Set (LDS) on all primary elective TKAs performed at the New England Baptist Hospital between January 2013 and June 2016. Using theatre records, episodes were categorized into days where a surgeon performed overlapping and nonoverlapping lists. Clinical outcomes, economic outcomes, and demographic factors were calculated. A regression model controlling for the patient-specific factors was used to compare groups. Total orthopaedic cases and aggregate time spent operating (time between skin incision and closure) were also compared.Aims
Materials and Methods
Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and reverse shoulder arthroplasty (RSA). A total of 100 shoulder arthroplasties (35 TSA and 65 RSA) were evaluated at a mean of 3.8 years (3 to 8.3). The mean age at the time of surgery was 68 years (31 to 90). The mean body mass index was 32.7 kg/m2 (17.3 to 66.4).Aims
Patients and Methods
The aim of this study was to evaluate the differences in revision and complication rates, functional outcomes, and radiological outcomes between cemented and press-fit humeral stems in primary anatomical total shoulder arthroplasty (TSA). A comprehensive systematic review and meta-analysis was conducted searching for studies that included patients who underwent primary anatomical TSA for primary osteoarthritis or rheumatoid arthritis.Aims
Materials and Methods
Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients. Data from the National Joint Registry (NJR) of England and Wales were obtained for all primary cemented TKAs between March 2003 and July 2016. Patient, implant, and surgical variables were analyzed. Cox proportional hazards models were used to assess the influence of ALBC on risk of revision. Body mass index (BMI) data were available in a subset of patients.Aims
Materials and Methods
The Oxford Knee, a resurfacing prosthesis with a meniscal bearing, can be used for either bicompartmental or unicompartmental
The management of displaced subcapital fracture of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age. A total of 163 cases, operated on over four years, have been reviewed. There were relatively more dislocations after operation for fracture than after total replacement for
1. The electric potentials in undeformed rabbit tibiae were measured in vivo and in vitro. 2. Surgically traumatised soft-tissues, particularly muscle, constituted the major source of voltage in vivo (up to 22 millivolts). 3. Electrical insulation of the tibia from attached soft parts abolished the high potentials on the bone. 4. Similarly high voltages could be reproduced in an excised tibia by substituting a battery for the injured muscle. 5. Changes in voltage also could be induced by altering blood flow rates or by rapid infusion of saline into the medullary space. 6. Death of the cellular elements in bone did not alter the voltage significantly. 7. The electrical contributions of the nervous system, and of dipole components of the extracellular matrix (such as collagen), either were inconsequential or of such low magnitude as to be "masked" by the larger "injury" voltages. Supported by grants from the United States Public Health Service (AM-07822) and the National Institute of
We reviewed 25 children who presented consecutively with voluntary (habitual) subluxation of the shoulder. Thirty-six shoulders were involved and symptoms had been present for an average period of 12 years. Eighteen children were managed by 'skillful neglect': all these had become fully active in the profession of their choice and were satisfied with the outcome. Two of them had required shoulder surgery in adult life but only after trauma. Seven children (ten shoulders) had undergone stabilising operations during childhood with the aim of preventing later degenerative
Long-term regular haemodialysis for chronic renal failure is associated with amyloidosis. In this condition excess amounts of the unexcretable plasma protein beta-microglobulin are laid down in tendons, joints and bones. Amyloidosis presents with various musculoskeletal disorders only after several years of dialysis. We reviewed 83 patients who had been dialysed for at least 10 years. The commonest complaint was severe joint pain in the absence of radiological changes of
1. After limb injuries with loss of skin and subcutaneous tissue, full-thickness skin flaps afford the most satisfactory cover. It is particularly important to replace unstable and scarred skin before attempting bone reconstruction and similar operations. 2. In the leg and foot, full-thickness skin cover is conveniently obtained by the cross-leg flap technique. The blood supply of such flaps is considered and the technique of operation is described. Free excision of avascular scar tissue is essential. 3. "Delayed transfer" of the flap is advisable unless conditions are favourable; two methods are considered. 4. Immobilisation in plaster is the most satisfactory method of fixation of the limbs after attachment of the flap. Muscle exercises are performed throughout the period of treatment in order to minimise joint stiffness and shorten convalescence. 5. The cross-leg flap technique should not usually be used in children, young women, or the aged and mentally infirm. Contra-indications include
The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients. A retrospective review of prospectively collected data was undertaken of a consecutive series of 107 femoral lengthening operations in 92 patients. In total, 73 antegrade nails and 34 retrograde nails were inserted. Outcome was assessed by the regenerate healing index (HI), hip and knee range of movement (ROM), and the presence of any complications.Aims
Patients and Methods