Objective. To study the effect of hyaluronic acid (HA) on local anaesthetic
chondrotoxicity in vitro. Methods. Chondrocytes were harvested from bovine femoral condyle cartilage
and isolated using collagenase-containing media. At 24 hours after
seeding 15 000 cells per well onto a 96-well plate, chondrocytes
were treated with media (DMEM/F12 + ITS), PBS, 1:1 lidocaine (2%):PBS,
1:1 bupivacaine (0.5%):PBS, 1:1 lidocaine (2%):HA, 1:1 bupivacaine (0.
5%):HA, or 1:1 HA:PBS for one hour. Following treatment, groups
had conditions removed and 24-hour incubation. Cell viability was
assessed using PrestoBlue and confirmed visually using fluorescence
microscopy. Results. Media-treated groups had a mean of 1.55×10. 4. cells/well
(. sem. 783). All treated cells showed statistically significant reduced
viability when compared with media alone (all p <
0.003). Cells
treated with bupivacaine + HA (6.70×10. 3. cells/well (. sem. 1.10×10. 3. ))
survived significantly more than bupivacaine (2.44×10. 3. cells/well
(. sem . 830)) (p <
0.001). Lidocaine + HA (1.45×10. 3. cells/well
(. sem. 596)) was not significantly more cytotoxic than lidocaine
(2.24×10. 3. cells/well (. sem. 341)) (p = 0.999).
There was no statistical difference between the chondrotoxicities
of PBS (8.49×10. 3. cells/well (. sem. 730) cells/well)
and HA (4.75×10. 3. cells/well (. sem. 886)) (p =
0.294). Conclusions. HA co-administration reduced
Aims. In the UK, fasciectomy for Dupuytren’s contracture is generally performed under general or regional
The effect of timing of a manipulation under
anaesthetic (MUA) and injection of corticosteroid and local
Aims. Manipulation under
Intra-articular injections of steroid into the hip are used for a variety of reasons in current orthopaedic practice. Recently their safety prior to ipsilateral total hip replacement has been called into question owing to concerns about deep joint infection. We undertook a retrospective analysis of all patients who had undergone local
Intra-operative, peri-articular injection of
local anaesthesia is an increasingly popular way of controlling
pain following total knee replacement. At the same
time, the problems associated with allogenic blood transfusion have led
to interest in alternative methods for managing blood loss after
total knee replacement, including the use of auto-transfusion of
fluid from the patient’s surgical drain. It is safe to combine peri-articular
infiltration with auto-transfusion from the drain. We performed
a randomised clinical trial to compare the concentration of local anaesthetic
in the blood and in the fluid collected in the knee drain in patients
having either a peri-articular injection or a femoral nerve block.
Clinically relevant concentrations of local
Using a computer-based quality assurance program, we analysed peri-operative data on 160 patients undergoing one-stage bilateral hip or knee arthroplasties under regional anaesthesia with routine
We investigated 42 patients who were being considered for primary total hip arthroplasty (THA), but in whom it was uncertain whether the hip was the source of their pain. They were given an injection of local
We report a case of iatrogenic sciatic nerve injury caused by pre-operative intraneural injection of local
Aims. As the world continues to fight successive waves of COVID-19 variants, we have seen worldwide infections surpass 100 million. London, UK, has been severely affected throughout the pandemic, and the resulting impact on the NHS has been profound. The aim of this study is to evaluate the impact of COVID-19 on theatre productivity across London’s four major trauma centres (MTCs), and to assess how the changes to normal protocols and working patterns impacted trauma theatre efficiency. Methods. This was a collaborative study across London’s MTCs. A two-month period was selected from 5 March to 5 May 2020. The same two-month period in 2019 was used to provide baseline data for comparison. Demographic information was collected, as well as surgical speciality, procedure, time to surgery, type of anaesthesia, and various time points throughout the patient journey to theatre. Results. In total, 1,243 theatre visits were analyzed as part of the study. Of these, 834 patients presented in 2019 and 409 in 2020. Fewer open reduction and internal fixations were performed in 2020 (33.5% vs 38.2%), and there was an increase in the number of orthoplastic cases in 2020 (8.3% vs 2.2%), both statistically significant results (p < 0.000). There was a statistically significant increase in median time from 2019 to 2020, between sending for a patient and their arrival to the
1. There seem to be two distinct methods of destruction of the foot, once pain sensibility has been lost: the first is a slow erosion and shortening associated with perforating ulcers under the distal weight-bearing end of the foot. The second is a proximal disintegration of the tarsus in which mechanical forces often determine onset and progress of the condition. 2. Once the tarsus begins to disintegrate it is difficult to halt the rapid destruction of the foot. 3. It is possible to detect early stages of this condition in time to take preventive measures. Routine palpation of
Seven subjects with normal joints were tested for active and passive position sense of ankle inversion, peroneal reflex reaction time to sudden ankle inversion, and postural stability during single-leg stance. The tests were performed before and after regional block of the ankle and foot with local
Aims. This study aimed to assess the carbon footprint associated with total hip arthroplasty (THA) in a UK hospital setting, considering various components within the operating theatre. The primary objective was to identify actionable areas for reducing carbon emissions and promoting sustainable orthopaedic practices. Methods. Using a life-cycle assessment approach, we conducted a prospective study on ten cemented and ten hybrid THA cases, evaluating carbon emissions from
With the aim of controlling pain after Keller's operation, a solution of a long-acting local
The purpose of this study was to compare clinical
outcomes of total knee arthroplasty (TKA) after manipulation under
anaesthesia (MUA) for post-operative stiffness with a matched cohort
of TKA patients who did not requre MUA. In total 72 patients (mean age 59.8 years, 42 to 83) who underwent
MUA following TKA were identified from our prospective database
and compared with a matched cohort of patients who had undergone
TKA without subsequent MUA. Patients were evaluated for range of
movement (ROM) and clinical outcome scores (Western Ontario and
McMaster Universities Arthritis Index, Short-Form Health Survey,
and Knee Society Clinical Rating System) at a mean follow-up of
36.4 months (12 to 120). MUA took place at a mean of nine weeks
(5 to 18) after TKA. In patients who required MUA, mean flexion
deformity improved from 10° (0° to 25°) to 4.4° (0° to 15°) (p <
0.001),
and mean range of flexion improved from 79.8° (65° to 95°) to 116°
(80° to 130°) (p <
0.001). There were no statistically significant
differences in ROM or functional outcome scores at three months,
one year, or two years between those who required MUA and those
who did not. There were no complications associated with manipulation At most recent follow-up, patients requiring MUA achieved equivalent
ROM and clinical outcome scores when compared with a matched control
group. While other studies have focused on ROM after manipulation,
the current study adds to current literature by supplementing this
with functional outcome scores. Cite this article:
Enhanced perioperative protocols have significantly improved patient recovery following primary total knee arthroplasty (TKA). Little has been investigated the effectiveness of these protocols for revision TKA (RTKA). We report on a matched group of aseptic revision and primary TKA patients treated with an identical pain and rehabilitation programmes. Overall, 40 aseptic full-component RTKA patients were matched (surgical date, age, sex, and body mass index (BMI)) to a group of primary cemented TKA patients. All RTKAs had new uncemented stemmed femoral and tibial components with metaphyseal sleeves. Both groups were treated with an identical postoperative pain protocol. Patients were followed for at least two years. Knee Society Scores (KSS) at six weeks and at final follow-up were recorded for both groups.Aims
Methods
This Although many agents commonly injected into joints are chondrotoxic,
in this Cite this article:
Aims. Intra-articular (IA) injection may be used when treating hip osteoarthritis (OA). Common injections include steroids, hyaluronic acid (HA), local