Aims

To date, no study has demonstrated an improvement in postoperative outcomes following elective joint arthroplasty with a focus on nutritional intervention for patients with preoperative hypoalbuminaemia. In this prospective study, we evaluated differences in the hospital length of stay (LOS), rate of re-admission, and total patient charges for a malnourished patient study population who received a specific nutrition protocol before surgery.

Aims

The aim of this study was to determine the general postoperative opioid consumption and rate of appropriate disposal of excess opioid prescriptions in patients undergoing primary unilateral total knee arthroplasty (TKA).

1. An enterogenous cyst lying in the cauda equina opposite the third lumbar vertebra, and associated with spina bifida occulta of the fifth lumbar vertebra and spondylolisthesis of the fifth lumbar on the first sacral vertebra, is described in a man aged thirty-five suffering from chronic low back pain and sciatica. 2. Current embryological theories concerning the formation of intraspinal enterogenous cysts from primitive gut cells are further substantiated by the features of this case

Aims

The purpose of this study was to compare outcomes of combined total joint arthroplasty (TJA) (total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed during the same admission) versus bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJAs performed on the same day were compared with those staged within the same admission episode.

We have treated osteochondral lesions of the talus using cortical bone pegs. We examined 27 ankles (27 patients) after a mean follow-up of 7.0 years (2 to 18.8). The mean age of the patients was 27.8 years (12 to 62). An unstable osteochondral fragment or osteosclerotic changes in the bed of the talus were regarded as indications for the procedure. The clinical results were good in 24 ankles (89%) and fair in three (11%); none had a poor result. There was also radiological improvement in 24 ankles. Repair of the articular surface and stability of the lesion can be achieved even in unstable chronic lesions

We report the two- to four-year results following the insertion of the Leeds-Keio prosthetic ligament for chronic anterior cruciate deficiency. Virtually all the 20 patients were less disabled by instability, but objective results were good or excellent in only two-thirds and under anaesthesia the pivot shift sign was still positive in half. Arthroscopic and histological assessment in 16 patients failed to show the development of a functional neoligament, and the common appearance of a synovitic reaction to polyester particles gave concern

We have studied the histological appearances of forty femoral heads with idiopathic avascular necrosis. The characteristic histopathological changes of recurrent necrosis were present in 83 per cent. Recurrent necrosis occurred widely after revascularisation had progressed as far as the subchondral zone. The aetiology of idiopathic avascular necrosis of the femoral head may be a chronic condition which produces repeated infarction. The deformation and incomplete revascularisation of the femoral head may be due to repeated episodes of infarction as well as to mechanical factors related to weight-bearing

1. A diagnosis of upward translocation of the dens was made in eight patients with chronic rheumatoid arthritis selected from a group of patients who had radiographic studies of the cervical spine and from whom a number of patients with atlanto-axial subluxation were also identified. 2. Two of the patients presented with an acute neurological syndrome of serious import and required a stabilisation operation. Though this is an uncommon complication of rheumatoid arthritis it seems that urgent neurological syndromes are likely to be more common than in atlanto-axial subluxation

Our experience of five children with chronic thorn synovitis indicates that removal of free thorn fragments and all the macroscopically abnormal synovium is required in order to achieve a complete cure. Four children required total synovectomy for diffuse proliferative synovitis and one needed partial synovectomy of the area immediately around the embedded thorn. Joint washouts and partial synovectomy were unsuccessful in children with diffuse synovitis. Careful review is required following removal of a thorn as fragments may be retained within the joint

We have reviewed 107 patients of 80 years or over who underwent primary total hip replacement. They had many more complications than younger patients. Thus, acute dislocation occurred in 15%, and became chronic in 9%; there were femoral shaft fractures in 4.6% and these, with shaft perforation gave universally poor results. Nevertheless, 75% of patients had a satisfactory outcome, with worthwhile relief of pain. It would seem sensible to warn elderly patients and their relatives of the increased risks in this age group

Aims

The best marker for assessing glycaemic control prior to total knee arthroplasty (TKA) remains unknown. The purpose of this study was to assess the utility of fructosamine compared with glycated haemoglobin (HbA1c) in predicting early complications following TKA, and to determine the threshold above which the risk of complications increased markedly.

Aims

Anterior cruciate ligament (ACL) and multiligament knee (MLK) injuries increase the risk of development of knee osteoarthritis and eventual need for total knee arthroplasty (TKA). There are limited data regarding implant use and outcomes in these patients. The aim of this study was to compare the use of constrained implants and outcomes among patients undergoing TKA with a history of prior knee ligament reconstruction (PKLR) versus a matched cohort of patients undergoing TKA with no history of PKLR.

Aims

To our knowledge, there is currently no information available about the rate of venous thromboembolism (VTE) or recommendations regarding chemoprophylaxis for patients whose lower limb is immobilized in a plaster cast. We report a retrospective case series assessing the rate of symptomatic VTE in patients treated with a lower limb cast. Given the complex, heterogeneous nature of this group of patients, with many risk factors for VTE, we hypothesized that the rate of VTE would be higher than in the general population.

Persistent back pain in the presence of an intact posterior fusion is commonly seen and is often regarded as being psychogenic in origin. This paper discusses five patients, all of whom were chronically disabled by such pain; all five had a confirmed posterior and/or lateral fusion. In each case lateral discography identified the disc within the fused segment as the source of symptoms and pain relief was obtained with an anterior interbody fusion. This source of pain should be considered as a possibility in similar cases of failed back surgery

Problem drinking was found to be likely in 21% of inpatients in a general orthopaedic and fracture service, and in 42% of outpatients attending the fracture clinics. The questionnaire showed that the problem was most common among young men, particularly among outpatients. Previous hospital admissions were more frequent in this group. Many of the health problems associated with the chronic abuse of alcohol are directly relevant to orthopaedic practice. Early intervention may be highly successful, and it is recommended that screening for problem drinking be considered in orthopaedic and fracture services

Denervation surgery has been a mainstay of our management of chronic pain in the wrist. If there is useful movement at the wrist we prefer denervation to arthrodesis. We have reviewed 22 patients at a mean of 50 months after such denervation surgery at the wrist. This was the only treatment in 16 patients; the other six also had other treatments. Pain was reduced in 16 patients, and 17 were satisfied or improved. None of the patients wished to have a supplementary arthrodesis. We stress the importance of preoperative blockade tests and of a very detailed knowledge of the local anatomy

1. Haemophilic cysts are a rare but serious complication of bleeding ilito the musculo-skeletal system. Five cases are reported. 2. The cysts may arise from bleeding into muscle, under periosteum, or into bone. 3. In early cases conservative treatment by immobilisation and replacement therapy should produce resolution. 4. When alarming increase in size or progressive neurovascular compression occurs, excision of the cyst or amputation should be carried out to prevent the dangerous consequences of rupture, sinus formation or chronic infection

We have carried out a blind, prospective study of 50 consecutive patients undergoing replacement arthroplasty of the hip using two different approaches. Clinical assessment, including the Harris hip score and a modified Trendelenberg test, and electrophysiological examination of the abductor muscles of the hip were undertaken before and three months after surgery. We found that 48% of patients had preoperative evidence of chronic injury to the superior gluteal nerve. Perioperative injury to the nerve occurred commonly with both approaches to the hip. We did not find a significant correlation between injury to the superior gluteal nerve and clinical problems