This study aimed to characterise and qualitatively grade the severity of the corrosion particles released into the hip joint following taper corrosion. The 26 cases examined were CoC/ABG Modular (n = 13) and ASR/SROM (n = 13). Blood serum metal ion levels were collected before and after revision surgery. The haematoxylin and eosin tissue sections were graded on the presence of fibrin exudates, necrosis, inflammatory cells and corrosion products. The corrosion products were identified based on visible observation and graded on abundance. Two independent observers blinded to the clinical patient findings scored all cases. Elemental analysis was performed on corrosion products within tissue sections. X-Ray diffraction was used to identify crystalline structures present in taper debris.Objectives
Methods
To determine whether there is any difference in infection rate
at 90 days between trauma operations performed in laminar flow and
plenum ventilation, and whether infection risk is altered following
the installation of laminar flow (LF). We assessed the impact of plenum ventilation (PV) and LF on the
rate of infection for patients undergoing orthopaedic trauma operations.
All NHS hospitals in England with a trauma theatre(s) were contacted
to identify the ventilation system which was used between April
2008 and March 2013 in the following categories: always LF, never
LF, installed LF during study period (subdivided: before, during
and after installation) and unknown. For each operation, age, gender,
comorbidity, socio-economic deprivation, number of previous trauma
operations and surgical site infection within 90 days (SSI90) were
extracted from England’s national hospital administrative Hospital
Episode Statistics database. Crude and adjusted odds ratios (OR)
were used to compare ventilation groups using hierarchical logistic
regression. Subanalysis was performed for hip hemiarthroplasties.Aims
Patients and Methods
Anatomical total knee arthroplasty alignment
The aims of this study were to estimate the cost of surgical
treatment of fractures of the proximal humerus using a micro-costing
methodology, contrast this cost with the national reimbursement
tariff and establish the major determinants of cost. A detailed inpatient treatment pathway was constructed using
semi-structured interviews with 32 members of hospital staff. Its
content validity was established through a Delphi panel evaluation.
Costs were calculated using time-driven activity-based costing (TDABC)
and sensitivity analysis was performed to evaluate the determinants
of costAims
Methods
This study describes the Osseointegration Group of Australia’s
Accelerated Protocol two-stage strategy (OGAAP-1) for the osseointegrated
reconstruction of amputated limbs. We report clinical outcomes in 50 unilateral trans-femoral amputees
with a mean age of 49.4 years (24 to 73), with a minimum one-year
follow-up. Outcome measures included the Questionnaire for persons
with a Trans-Femoral Amputation, the health assessment questionnaire
Short-Form-36 Health Survey, the Amputation Mobility Predictor scores
presented as K-levels, 6 Minute Walk Test and timed up and go tests.
Adverse events included soft-tissue problems, infection, fractures
and failure of the implant.Aims
Patients and Methods
We wished to compare the clinical outcome, as assessed by questionnaires
and the rate of complications, in total knee arthroplasty (TKA)
undertaken with patient-matched positioning guides (PMPGs) or conventional
instruments. A total of 180 patients (74 men, 106 women; mean age 67 years)
were included in a multicentre, adequately powered, double-blind,
randomised controlled trial. The mean follow-up was 44 months (24
to 57).Aims
Patients and Methods
The purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty. The transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, Objectives
Methods
Reconstruction of the acetabulum after failed total hip arthroplasty
(THA) can be a surgical challenge in the presence of severe bone
loss. We report the long-term survival of a porous tantalum revision
acetabular component, its radiological appearance and quality of
life outcomes. We reviewed the results of 46 patients who had undergone revision
of a failed acetabular component with a Paprosky II or III bone
defect and reconstruction with a hemispherical, tantalum acetabular
component, supplementary screws and a cemented polyethylene liner.Aims
Patients and Methods
We aimed to identify the pattern of nerve injury associated with
paediatric supracondylar fractures of the humerus. Over a 17 year period, between 1996 and 2012, 166 children were
referred to our specialist peripheral nerve injury unit. From examination
of the medical records and radiographs were recorded the nature
of the fracture, associated vascular and neurological injury, treatment
provided and clinical course.Aims
Patients and Methods
This study aimed to determine the relationship between pedicle-lengthening
distance and bulge-canal volume ratio in cases of lumbar spinal
stenosis, to provide a theoretical basis for the extent of lengthening
in pedicle-lengthening osteotomies. Three-dimensional reconstructions of CT images were performed
for 69 patients (33 men and 36 women) (mean age 49.96 years; 24
to 81). Simulated pedicle-lengthening osteotomies and disc bulge
and spinal canal volume calculations were performed using Mimics
software. Aims
Methods
Osteochondritis Dissecans (OCD) is a condition
for which the aetiology remains unknown. It affects subchondral bone
and secondarily its overlying cartilage and is mostly found in the
knee. It can occur in adults, but is generally identified when growth
remains, when it is referred to as juvenile OCD. As the condition
progresses, the affected subchondral bone separates from adjacent
healthy bone, and can lead to demarcation and separation of its associated
articular cartilage. Any symptoms which arise relate to the stage
of the disease. Early disease without separation of the lesion results
in pain. Separation of the lesion leads to mechanical symptoms and
swelling and, in advanced cases, the formation of loose bodies. Early identification of OCD is essential as untreated OCD can
lead to the premature degeneration of the joint, whereas appropriate
treatment can halt the disease process and lead to healing. Establishing
the stability of the lesion is a key part of providing the correct
treatment. Stable lesions, particularly in juvenile patients, have
greater propensity to heal with non-surgical treatment, whereas
unstable or displaced lesions usually require surgical management. This article discusses the aetiology, clinical presentation and
prognosis of OCD in the knee. It presents an algorithm for treatment,
which aims to promote healing of native hyaline cartilage and to
ensure joint congruity. Take home message: Although there is no clear consensus as to
the best treatment of OCD, every attempt should be made to retain
the osteochondral fragment when possible as, with a careful surgical
technique, there is potential for healing even in chronic lesions Cite this article:
We chose unstable extra-capsular hip fractures as our study group
because these types of fractures suffer the largest blood loss.
We hypothesised that tranexamic acid (TXA) would reduce total blood
loss (TBL) in extra-capsular fractures of the hip. A single-centre placebo-controlled double-blinded randomised
clinical trial was performed to test the hypothesis on patients
undergoing surgery for extra-capsular hip fractures. For reasons
outside the control of the investigators, the trial was stopped
before reaching the 120 included patients as planned in the protocol. Aims
Patients and Methods
Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed.Objective
Methods
This study evaluated the mechanical performance, under low-load cyclic loading, of two different knotless suture anchor designs: sutures completely internal to the anchor body (SpeedScrew) and sutures external to the anchor body and adjacent to bone (MultiFIX P). Using standard suture loops pulled in-line with the rotator cuff (approximately 60°), anchors were tested in cadaveric bone and foam blocks representing normal to osteopenic bone. Mechanical testing included preloading to 10 N and cyclic loading for 500 cycles from 10 N to 60 N at 60 mm/min. The parameters evaluated were initial displacement, cyclic displacement and number of cycles and load at 3 mm displacement relative to preload. Video recording throughout testing documented the predominant source of suture displacement and the distance of ‘suture cutting through bone’.Objectives
Methods
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
This paper aims to provide evidence-based guidance for the general orthopaedic surgeon faced with the presentation of a potential soft tissue sarcoma in an extremity.
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
The results of the DRAFFT (distal radius acute
fracture fixation trial) study, which compared volar plating with
Kirschner (K-) wire fixation for dorsally displaced fractures of
the distal radius, were published in August 2014. The use of K-wires
to treat these fractures is now increasing, with a concomitant decline
in the use of volar locking plates. We provide a critical appraisal of the DRAFFT study and question
whether surgeons have been unduly influenced by its headline conclusions. Cite this article:
Our aim, using English Hospital Episode Statistics data before
during and after the Distal Radius Acute Fracture Fixation Trial
(DRAFFT), was to assess whether the results of the trial affected
clinical practice. Data were grouped into six month intervals from July 2005 to
December 2014. All patient episodes in the National Health Service
involving emergency surgery for an isolated distal radial fracture
were included.Aims
Patients and Methods
