The aim of this study was a quantitative analysis of a surgeon’s
learning curve for scoliosis surgery and the relationship between
the surgeon’s experience and post-operative outcomes, which has
not been previously well described. We have investigated the operating time as a function of the
number of patients to determine a specific pattern; we analysed
factors affecting the operating time and compared intra- and post-operative
outcomes. We analysed 47 consecutive patients undergoing scoliosis
surgery performed by a single, non-trained scoliosis surgeon. Operating time
was recorded for each of the four parts of the procedures: dissection,
placement of pedicle screws, reduction of the deformity and wound
closure.Aims
Patients and Methods
In order to prevent dislocation of the hip after total hip arthroplasty
(THA), patients have to adhere to precautions in the early post-operative
period. The hypothesis of this study was that a protocol with minimal
precautions after primary THA using the posterolateral approach
would not increase the short-term (less than three months) risk
of dislocation. We prospectively monitored a group of unselected patients undergoing
primary THA managed with standard precautions (n = 109, median age
68.9 years; interquartile range (IQR) 61.2 to 77.3) and a group
who were managed with fewer precautions (n = 108, median age 67.2
years; IQR 59.8 to 73.2). There were no significant differences between
the groups in relation to predisposing risk factors. The diameter
of the femoral head ranged from 28 mm to 36 mm; meticulous soft-tissue
repair was undertaken in all patients. The medical records were
reviewed and all patients were contacted three months post-operatively
to confirm whether they had experienced a dislocation. Aims
Patients and Methods
Few reports compare the contribution of the talonavicular articulation
to overall range of movement in the sagittal plane after total ankle
arthroplasty (TAA) and tibiotalar arthrodesis. The purpose of this
study was to assess changes in ROM and functional outcomes following
tibiotalar arthrodesis and TAA. Patients who underwent isolated tibiotalar arthrodesis or TAA
with greater than two-year follow-up were enrolled in the study.
Overall arc of movement and talonavicular movement in the sagittal
plane were assessed with weight-bearing lateral maximum dorsiflexion
and plantarflexion radiographs. All patients completed Short Form-12
version 2.0 questionnaires, visual analogue scale for pain (VAS)
scores, and the Foot and Ankle Ability Measure (FAAM).Aims
Patients and Methods
The purpose of this study was to refine an accepted contaminated
rat femur defect model to result in an infection rate of approximately
50%. This threshold will allow examination of treatments aimed at
reducing infection in open fractures with less risk of type II error. Defects were created in the stablised femurs of anaethetised
rats, contaminated with Objectives
Methods
This short contribution aims to explain how intervertebral disc ‘degeneration’ differs from normal ageing, and to suggest how mechanical loading and constitutional factors interact to cause disc degeneration and prolapse. We suggest that disagreement on these matters in medico-legal practice often arises from a misunderstanding of the nature of ‘soft-tissue injuries’.
Drug therapy forms an integral part of the management
of many orthopaedic conditions. However, many medicines can produce
serious adverse reactions if prescribed inappropriately, either
alone or in combination with other drugs. Often these hazards are
not appreciated. In response to this, the European Union recently
issued legislation regarding safety measures which member states
must adopt to minimise the risk of errors of medication. In March 2014 the Medicines and Healthcare products Regulatory
Agency and NHS England released a Patient Safety Alert initiative
focussed on errors of medication. There have been similar initiatives
in the United States under the auspices of The National Coordinating
Council for Medication Error and The Joint Commission on the Accreditation
of Healthcare Organizations. These initiatives have highlighted
the importance of informing and educating clinicians. Here, we discuss common drug interactions and contra-indications
in orthopaedic practice. This is germane to safe and effective clinical
care. Cite this article:
Wound complications are reported in up to 10% hip and knee arthroplasties and there is a proven association between wound complications and deep prosthetic infections. In this randomised controlled trial (RCT) we explore the potential benefits of a portable, single use, incisional negative pressure wound therapy dressing (iNPWTd) on wound exudate, length of stay (LOS), wound complications, dressing changes and cost-effectiveness following total hip and knee arthroplasties. A total of 220 patients undergoing elective primary total hip and knee arthroplasties were recruited into in a non-blinded RCT. For the final analysis there were 102 patients in the study group and 107 in the control group.Objectives
Methods
The purpose of the study was to investigate whether closed intramedullary
(IM) nailing with percutaneous cement augmentation is better than
conventional closed nailing at relieving pain and suppressing tumours
in patients with metastases of the femur and humerus. A total of 43 patients (27 men, 16 women, mean age 63.7 years,
standard deviation (Aims
Patients and Methods
Nylon sutures and skin staples are used commonly in total knee arthroplasty (TKA) surgical wound closure. However, there is no study that compares the wound healing efficacy and patient satisfaction scores of both techniques in the same knee. We randomised 70 patients who underwent primary TKA into two groups. In one group of 34 patients, the skin at the upper half of the wound was closed with skin staples and the lower half of the wound was closed with simple interrupted nylon sutures. In the other group of 36 patients, the skin at the upper half of the wound was closed with nylon stitches and the lower half of the wound was closed with skin staples. We recorded the wound closure time, pain score at the time of stitch removal, wound complication rate, patient satisfaction score, and the Hollander wound evaluation score at the post-operative periods of five days, 14 days, six weeks, three months, and six months. Each half wound was analysed separately.Objectives
Methods
We review our experience of Coonrad-Morrey total elbow arthroplasty
(TEA) for fractures of the distal humerus in non-rheumatoid patients
with a minimum of ten years follow-up. TEA through a triceps splitting approach was peformed in 37 non-rheumatoid
patients for a fracture of the distal humerus between 1996 and 2004.
One patient could not be traced and 17 had died before the tenth
anniversary of their surgery. This left 19 patients with a minimum
follow-up of ten years to form the study group. Of these, 13 patients
were alive at the time of final review. The other six had died,
but after the tenth anniversary of their elbow arthroplasty. Their
clinical and radiological data were included in the study. Aims
Patients and Methods
A soft-tissue defect over an infected total knee
replacement (TKR) presents a difficult technical problem that can
be treated with a gastrocnemius flap, which is rotated over the
defect during the first-stage of a revision procedure. This facilitates
wound healing and the safe introduction of a prosthesis at the second
stage. We describe the outcome at a mean follow-up of 4.5 years
(1 to 10) in 24 patients with an infected TKR who underwent this procedure.
A total of 22 (92%) eventually obtained a satisfactory result. The
mean Knee Society score improved from 53 pre-operatively to 103
at the latest follow-up (p <
0.001). The mean Western Ontario
and McMaster Universities osteoarthritis index and Short-Form 12
score also improved significantly (p <
0.001). This form of treatment can be used reliably and safely to treat
many of these complex cases where control of infection, retention
of the components and acceptable functional recovery are the primary
goals. Cite this article:
Dual mobility cups have two points of articulation,
one between the shell and the polyethylene (external bearing) and
one between the polyethylene and the femoral head (internal bearing).
Movement occurs at the inner bearing; the outer bearing only moves
at extremes of movement. Dislocation after total hip arthroplasty (THA) is a cause of
much morbidity and its treatment has significant cost implications.
Dual mobility cups provide an increased range of movement and a
may reduce the risk of dislocation. This paper reviews the use of these cups in THA, particularly
where stability is an issue. Dual mobility cups may be of benefit
in primary THA in patients at a high risk of dislocation, such as
those who are older with increased comorbidities and a higher American
Association of Anesthesiology grade and those with a neuromuscular
disease. They may be used at revision surgery where the risk of
dislocation is high, such as in patients with many prior dislocations,
or those with abductor deficiency. They may also be used in THA
for displaced fractures of the femoral neck, which has a notoriously
high rate of dislocation. Cite this article:
During the last ten years, greater attention
has been given to the management of peri-operative blood loss after
total knee arthroplasty (TKA), as it is a modifiable outcome that has
a significant effect on the rate of complications, the recovery,
and the economic burden. Blood loss after TKA has been greatly reduced
during this time, thereby dramatically reducing the rates of allogeneic
transfusion. This has significantly reduced the complications associated
with transfusion, such as fluid overload, infection, and increased length
of stay. The greatest advent in lowering peri-operative blood loss after
TKA has been the introduction of tranexamic acid, which reduces
blood loss without increasing the risk of thromboembolic events. This paper discusses the ways of reducing blood loss after TKA,
for which a multimodal algorithm, with pre-, intra- and post-operative
measures, has been adopted at our institution. Cite this article:
The cause of dissatisfaction following total
knee arthroplasty (TKA) remains elusive. Much attention has been
focused on static mechanical alignment as a basis for surgical success and
optimising outcomes. More recently, research on both normal and
osteoarthritic knees, as well as kinematically aligned TKAs, has
suggested that other specific and dynamic factors may be more important
than a generic target of 0 ± 3º of a neutral axis. Consideration
of these other variables is necessary to understand ideal targets
and move beyond generic results. Cite this article:
It has recently been reported that the transverse
acetabular ligament (TAL) is helpful in determining the position
of the acetabular component in total hip replacement (THR). In this
study we used a computer-assisted navigation system to determine
whether the TAL is useful as a landmark in THR. The study was carried
out in 121 consecutive patients undergoing primary THR (134 hips),
including 67 dysplastic hips (50%). There were 26 men (29 hips)
and 95 women (105 hips) with a mean age of 60.2 years (17 to 82)
at the time of operation. After identification of the TAL, its anteversion
was measured intra-operatively by aligning the inferomedial rim
of the trial acetabular component with the TAL using computer-assisted
navigation. The TAL was identified in 112 hips (83.6%). Intra-observer reproducibility
in the measurement of anteversion of the TAL was high, but inter-observer
reproducibility was moderate. Each surgeon was able to align the trial component according
to the target value of the angle of anteversion of the TAL, but
it was clear that methods may differ among surgeons. Of the measurements
of the angle of anteversion of the TAL, 5.4% (6 of 112 hips) were
outliers from the safe zone. In summary, we found that the TAL is useful as a landmark when
implanting the acetabular component within the safe zone in almost
all hips, and to prevent it being implanted in retroversion in all
hips, including dysplastic hips. However, as anteversion of the
TAL may be excessive in a few hips, it is advisable to pay attention
to individual variations, particularly in those with severe posterior
pelvic tilt. Cite this article:
To compare radiographic failure and re-operation rates of anatomical
coracoclavicular (CC) ligament reconstructional techniques with
non-anatomical techniques after chronic high grade acromioclavicular
(AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide
healthcare system to identify surgical technique, complications,
radiographic failure and re-operations. Procedures fell into four
categories: Aims
Patients and Methods
Instability in flexion after total knee replacement
(TKR) typically occurs as a result of mismatched flexion and extension
gaps. The goals of this study were to identify factors leading to
instability in flexion, the degree of correction, determined radiologically,
required at revision surgery, and the subsequent clinical outcomes.
Between 2000 and 2010, 60 TKRs in 60 patients underwent revision
for instability in flexion associated with well-fixed components.
There were 33 women (55%) and 27 men (45%); their mean age was 65
years (43 to 82). Radiological measurements and the Knee Society
score (KSS) were used to assess outcome after revision surgery.
The mean follow-up was 3.6 years (2 to 9.8). Decreased condylar
offset (p <
0.001), distalisation of the joint line (p <
0.001)
and increased posterior tibial slope (p <
0.001) contributed
to instability in flexion and required correction at revision to regain
stability. The combined mean correction of posterior condylar offset
and joint line resection was 9.5 mm, and a mean of 5° of posterior
tibial slope was removed. At the most recent follow-up, there was
a significant improvement in the mean KSS for the knee and function
(both p <
0.001), no patient reported instability and no patient
underwent further surgery for instability. The following step-wise approach is recommended: reduction of
tibial slope, correction of malalignment, and improvement of condylar
offset. Additional joint line elevation is needed if the above steps
do not equalise the flexion and extension gaps. Cite this article:
We hypothesised that the use of computer navigation-assisted
surgery for pelvic and sacral tumours would reduce the risk of an
intralesional margin. We reviewed 31 patients (18 men and 13 women)
with a mean age of 52.9 years (13.5 to 77.2) in whom computer navigation-assisted
surgery had been carried out for a bone tumour of the pelvis or
sacrum. There were 23 primary malignant bone tumours, four metastatic
tumours and four locally advanced primary tumours of the rectum.
The registration error when using computer navigation was <
1 mm
in each case. There were no complications related to the navigation,
which allowed the preservation of sacral nerve roots (n = 13), resection
of otherwise inoperable disease (n = 4) and the avoidance of hindquarter
amputation (n = 3). The intralesional resection rate for primary
tumours of the pelvis and sacrum was 8.7% (n = 2): clear bone resection
margins were achieved in all cases. At a mean follow-up of 13.1
months (3 to 34) three patients (13%) had developed a local recurrence.
The mean time alive from diagnosis was 16.8 months (4 to 48). Computer navigation-assisted surgery is safe and has reduced
our intralesional resection rate for primary tumours of the pelvis
and sacrum. We recommend this technique as being worthy of further
consideration for this group of patients. Cite this article:
