It is well established that there is a strong association between
Perthes’ disease and worsening socioeconomic deprivation. It has
been suggested that the primary determinant driving this association
is exposure to tobacco smoke. This study aimed to examine this hypothesis. A hospital case-control study (n = 149/146) examined the association
between tobacco smoke exposure and Perthes’ disease, adjusting for
area-level socioeconomic deprivation. Tobacco smoke exposure was
assessed by parental questionnaire of smoking habits during pregnancy,
and by quantitative assay of current exposure using the urinary
cotinine-creatinine ratio, which is a widely used and validated
measure of tobacco smoke exposure.Aims
Patients and Methods
We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis. The MEDLINE, EMBASE and Cochrane Library databases were searched using defined search terms. The primary outcome measure was spinal fusion, assessed as success or failure in accordance with radiograph, MRI or CT scan review at 24-month follow-up. The secondary outcome measure was time to fusion.Objectives
Methods
There is no consensus about the best method of achieving equal
leg lengths at total hip arthroplasty (THA) in patients with Crowe
type-IV developmental dysplasia of the hip (DDH). We reviewed our
experience of a consecutive series of patients who underwent THA
for this indication. We retrospectively reviewed 78 patients (86 THAs) with Crowe
type-IV DDH, including 64 women and 14 men, with a minimum follow-up
of two years. The mean age at the time of surgery was 52.2 years
(34 to 82). We subdivided Crowe type-IV DDH into two major types
according to the number of dislocated hips, and further categorised
them into three groups according to the occurrence of pelvic obliquity
or spinal curvature. Leg length discrepancy (LLD) and functional
scores were analysed.Aims
Patients and Methods
The aim of this study was to compare the effectiveness of a femoral
nerve block and a periarticular infiltration in the management of
early post-operative pain after total knee arthroplasty (TKA). A pragmatic, single centre, two arm parallel group, patient blinded,
randomised controlled trial was undertaken. All patients due for
TKA were eligible. Exclusion criteria included contraindications
to the medications involved in the study and patients with a neurological
abnormality of the lower limb. Patients received either a femoral
nerve block with 75 mg of 0.25% levobupivacaine hydrochloride around
the nerve, or periarticular infiltration with 150 mg of 0.25% levobupivacaine
hydrochloride, 10 mg morphine sulphate, 30 mg ketorolac trometamol
and 0.25 mg of adrenaline all diluted with 0.9% saline to make a
volume of 150 ml.Aims
Patients and Methods
Little is known about employment following total knee arthroplasty
(TKA). This study aims to identify factors which predict return
to work following TKA in patients of working age in the United Kingdom. We prospectively assessed 289 patients (289 TKAs) aged ≤ 65 years
who underwent TKA between 2010 and 2013. There were 148 women. The
following were recorded pre-operatively: age, gender, body mass
index, social deprivation, comorbidities, indication for surgery,
work status and nature of employment, activity level as assessed by
the University of California, Los Angeles (UCLA) activity score
and Oxford Knee Score (OKS). The intention of patients to return
to work or to retire was not assessed pre-operatively. At a mean
of 3.4 years (2 to 4) post-operatively, the return to work status,
OKS, the EuroQol-5 dimensions (EQ-5D) score, UCLA activity score
and Work, Osteoarthritis and joint-Replacement (WORQ) score were
obtained. Univariate and multivariate analyses were performed.Aims
Patients &
Methods
We performed a retrospective, comparative study of elderly patients
with an increased risk from anaesthesia who had undergone either
anterior screw fixation (ASF) or halo vest immobilisation (HVI)
for a type II odontoid fracture. A total of 80 patients aged 65 years or more who had undergone
either ASF or HVI for a type II odontoid fracture between 1988 and
2013 were reviewed. There were 47 women and 33 men with a mean age
of 73 (65 to 96; standard deviation 7). All had an American Society
of Anesthesiologists score of 2 or more.Aims
Patients and Methods
Osteoarthritis (OA) is the most common form of arthritis, affecting approximately 15% of the human population. Recently, increased concentration of nitric oxide in serum and synovial fluid in patients with OA has been observed. However, the exact role of nitric oxide in the initiation of OA has not been elucidated. The aim of the present study was to investigate the role of nitric oxide in innate immune regulation during OA initiation in rats. Rat OA was induced by performing meniscectomy surgery while cartilage samples were collected 0, 7, and 14 days after surgery. Cartilage cytokine levels were determined by using enzyme-linked immunosorbent assay, while other proteins were assessed by using Western blotObjectives
Methods
The aim of this study was to assess the current available evidence
about when patients might resume driving after elective, primary
total hip (THA) or total knee arthroplasty (TKA) undertaken for
osteoarthritis (OA). In February 2016, EMBASE, MEDLINE, Web of Science, Scopus, Cochrane,
PubMed Publisher, CINAHL, EBSCO and Google Scholar were searched
for clinical studies reporting on ‘THA’, ‘TKA’, ‘car driving’, ‘reaction
time’ and ‘brake response time’. Two researchers (CAV and JJT) independently
screened the titles and abstracts for eligibility and assessed the
risk of bias. Both fixed and random effects were used to pool data
and calculate mean differences (MD) and 95% confidence intervals
(CI) between pre- and post-operative total brake response time (TBRT).Aims
Materials and Methods
Patients who have limb amputation for musculoskeletal
tumours are a rare group of cancer survivors. This was a prospective
cross-sectional survey of patients from five specialist centres
for sarcoma surgery in England. Physical function, pain and quality
of life (QOL) outcomes were collected after lower extremity amputation
for bone or soft-tissue tumours to evaluate the survivorship experience
and inform service provision. Of 250 patients, 105 (42%) responded between September 2012 and
June 2013. From these, completed questionnaires were received from
100 patients with a mean age of 53.6 years (19 to 91). In total
60 (62%) were male and 37 (38%) were female (three not specified).
The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour
in 37. A total of 20 tumours were located in the hip or pelvis,
31 above the knee, 32 between the knee and ankle and 17 in the ankle
or foot. In total 22 had hemipelvectomy, nine hip disarticulation,
35 transfemoral amputation, one knee disarticulation, 30 transtibial
amputation, two toe amputations and one rotationplasty. The Toronto
Extremity Salvage Score (TESS) differed by amputation level, with
poorer scores at higher levels (p <
0.001). Many reported significant
pain. In addition, TESS was negatively associated with increasing
age, and pain interference scores. QOL for Cancer Survivors was
significantly correlated with TESS (p <
0.001). This relationship appeared
driven by pain interference scores. This unprecedented national survey confirms amputation level
is linked to physical function, but not QOL or pain measures. Pain
and physical function significantly impact on QOL. These results
are helpful in managing the expectations of patients about treatment
and addressing their complex needs. Cite this article:
The October 2015 Spine Roundup360 looks at: Traumatic spinal cord injury under the spotlight; The odontoid peg nonunion; Driving and spinal surgery; Drains and antibiotics post-spinal surgery; Vertebroplasty and kyphoplasty equally effective; Who will benefit from steroid injections?; Back pain following lumbar discectomy
Patients with osteoarthritis of the knee commonly have degenerative
meniscal tears. Arthroscopic meniscectomy is frequently performed,
although the benefits are debatable. Recent studies have concluded
that there is no role for arthroscopic washout in osteoarthritis
of the knee. Our aim was to perform a systematic review to assess
the evidence for the efficacy of arthroscopic meniscectomy in patients
with meniscal tears and degenerative changes in the knee. A literature search was performed, using the PubMed/MEDLINE database,
for relevant articles published between 1975 and 2015. A total of
six studies, including five randomised controlled trials and one
cross-sectional study of a prospective cohort, met the inclusion
criteria. Relevant information including study design, operations,
the characteristics of the patients, outcomes, adverse events and
further operations were extracted.Aims
Patients and Methods
