Aims

To devise a simple clinical risk classification system for patients undergoing primary total knee arthroplasty (PTKR) to facilitate risk and cost estimation, and aid pre-operative planning.

Methods

We retrospectively reviewed a series of consecutive PTKRs performed by the senior author. A classification system was devised to take account of principal risk factors in PTKR. Four groups were devised: 1) Non complex PTKR (CP0): no local or systemic complicating factors; 2) CPI: Locally complex: Severe or fixed deformity and/or bone loss, previous bony surgery or trauma, or ligamentous instability; 3) CPII Systemic complicating factors: Medical co-morbidity, steroid or immunosuppressant therapy, High BMI, (equivalent to ASA of III or more); 3) CPIII: Combination of local and systemic complicating factors (CPI+CPII). The patients were grouped accordingly and the following were compared: 1) length of stay, 2) post-operative complications, and 3) early post-discharge follow-up assessment. The complications were divided into local (wound problems, DVT, sepsis) and systemic (cardiopulmonary, metabolic, and systemic thromboembolic) complications.

Introduction

Fifty thousand knee replacements are performed annually in the UK at an estimated cost of £150 million. However, there is uncertainty as to the best surgical approach to the knee joint for knee arthroplasty. We undertook a randomised controlled trial to compare a standard medial parapatellar arthrotomy with sub-vastus arthrotomy for patients undergoing primary total knee arthroplasty in terms of short and long term knee function.

Methods

Two hundred and thirty-one patients undergoing primary total knee arthroplasty during 2001-2003 were recruited into the study. Patients were randomised into subvastus (116) or medial parapatellar (115) approaches to knee arthroplasty. The primary outcome measures were the American Knee Society and WOMAC Scores. The secondary outcome measures were patient-based measures of EuroQol and SF-36. All outcomes were measured pre-operatively and 1, 6, 12 and 52 weeks post-operatively. We also looked at a pain diary, analgesia diary, ease of surgical exposure, and complications.

Objective

To compare clinical parameters associated with medial parapatellar and midvastus approaches for total knee arthroplasty in the early post-operative period.

Methods and results

We present a prospective observational study of 77 patients undergoing primary total knee arthroplasty using medial parapatellar(40) or midvastus approach(37). The prosthetic design and physical intervention was standardised in all the patents. The Oxford Knee Score, pain scale, knee flexion, unassisted straight leg raise, standing and walking were compared at 3rd, 5th and 7th day post-operatively, then at 6 weeks and at 3 months. The patients and physiotherapist were blinded to the type of approach used. The average age was 67 years (range 42 to 88). There were 42 women and 35 men. The average hospital stay was 7 days (range 2 to 15). There was statistically significant difference in duration of hospital stay, unassisted straight leg raise and standing at 3 days (p=0.001) and pain scale at 5 days, all in favour of midvastus approach. There was no statistically significant difference in Oxford Knee Scores and duration to achieving full flexion and walking. The average duration to achieving straight leg raise for the midvastus group was 5 days and for the medial parapatellar approach group was 8 days.

Aims

To compare a randomised group of patients undergoing UKA to investigate the advantages of the minimal invasive approach in the early post-operative stage.

Results

100 patients on the waiting list for UKA were recruited into the trial. Patients were prospectively randomised into 2 groups: Group 1 – longitudinal skin incision with dislocation of the patella, Group 2 – the minimally invasive approach. Standard milestones were recorded post-operatively: time to achieve IRQ, independent stair climbing and to discharge. Additionally, patients were scored with the AKSS and Oxford knee questionnaire pre-operatively, at 6 weeks, 6 months and 1 year. No significant differences were found between the 2 groups in the measured parameters.

Aim

To compare the results of total knee replacement in a consecutive series of morbidly obese patients (body mass index (BMI) > 40 kg/m²) with a matched group of non-obese (BMI< 30 kg/m²) patients.

Methods

41 consecutive total knee replacements performed in morbidly obese patients were matched pre-operatively with 41 total knee replacements performed in non-obese patients for age, sex, diagnosis, type of prosthesis, laterality, knee score and function score components of the Knee Society Score (KSS). All patients were prospectively followed up and the post-operative KSS, radiographs, complications (superficial wound infection, deep joint infection, deep venous thrombosis, peri-operative mortality) and five-year survivorship compared for the two groups. No patients were lost to follow-up (mean follow-up in morbidly obese: 38.5 (range 6-66) months; non-obese: 44 (range 6-67) months).

Introduction

Elective Orthopaedics has been targeted by the UK Department of Health as a maximum six-month waiting time for operations could not be met. The National Orthopaedic Project was initiated as a consequence and Independent Sector Treatment Centres (ISTCs) and well established private hospitals were utilised to treat NHS long wait patients.

Materials and methods

We audited the primary total hip replacements performed in our hospital in 1998 and 2003 to compare the differences in the patient characteristics in particular age, length of stay and ASA grade.

Aims

To establish the cost of primary hip (THR) and knee (TKR) arthroplasty in an elective orthopaedic centre in the UK and to compare it with current government reimbursement to NHS hospitals and the costs in North America.

Methods

In 2004 an elective orthopaedic centre was set up in South West London which performs mainly primary lower limb arthroplasty. We used a retrospective analysis of financial statements from September 2004-June 2005 inclusive to establish operative costs (including implant), perioperative costs and post-operative costs until discharge.

Background

Hip fracture in the elderly has high morbidity and mortality. National guidelines have recommended low molecular weight (LMW) heparin or aspirin for thromboprophylaxis in hip fracture. Unlike other types of major surgery, there is a lack of trial evidence for graduated elasticated compression (GEC) stockings in hip fracture patients.

Objective

To explore the effect of thromboprophylaxis on survival in hip fracture patients.

Aim

To compare the clinical effectiveness, functional outcome and patient satisfaction following intra articular injection with Synvisc^¯ and Hyalgan^¯ in patients with osteoarthritis (OA) of the knee.

Methods

348 consecutive patients were randomised into two groups to receive either Hylan G-F 20 -Synvisc (n= 181) or Sodium Hyaluronate -Hyalgan (n=167). All patients were prospectively reviewed by independent assessors blinded for the treatment. Knee pain on a VAS were recorded. The functional outcome was assessed using Tegner, UCLA, Oxford knee score and EuroQol-5D scores. VAS was used to quantify patient satisfaction. Mean follow-up was 12 months.

Aim

To investigate the incidence, types and trends in diagnosis of venous thromboembolic events (VTE) in patients undergoing total knee arthroplasty (TKA) over a ten-year period.

Methods

Data from 5100 consecutive TKAs performed in our unit between April 1996 and March 2006 were prospectively collected by the Scottish Arthroplasty Project (SAP). This database contains data on 100% of arthroplasty cases in Scotland. We retrospectively reviewed casenotes of these patients to identify thromboprophylaxis given, the diagnosis of VTE, treatment and adverse outcomes.

Introduction

Electrolyte imbalance in the elderly is a clinical problem faced by both elderly care physicians and orthopaedic surgeons alike. Hyponatraemia is a common condition with a vague clinical profile and severe consequences if untreated. Recent medical editorials have criticised orthopaedic handling of this problem. We therefore sought to establish the incidence of hyponatraemia within our orthopaedic population and a similar age-matched elderly care population in the light of changing attitudes to fluid management.

Methods

Retrospective, consecutive analysis of the serum sodium concentrations and fluid regimes of all patients admitted with a fractured neck of femur during a three-month period. An age-matched control group of elderly care patients was used for comparison. Data was analysed using paired t-test and independent t-test as appropriate.

Introduction

Pre-operative urine screening is accepted practice during pre-operative assessment in elective orthopaedic practice. There is no evidence surrounding the benefits, effects or clinical outcomes of such a practice.

Methods

A series of 558 patients undergoing elective admission were recruited during pre-assessment for surgery and were screened for UTIs according to a pre-existing trust protocol. All patients had their urine dipstick tested and positive samples were sent for culture and microscopy. Patients with a positive urine culture were treated prior to surgery and were admitted to the elective centre where strict infection control methods were implemented. The patients were followed up after their surgery and divided into three clinical groups: uneventful surgery; Suspected wound infection; Confirmed wound infection

Aim

To assess the role of Tc-99m labelled anti granulocyte monoclonal antibody Fab' fragment (Sulesomab) in the diagnosis of bone and joint infections.

Methods

We analysed the results of 95 patients referred with a clinical suspicion of bone and joint infections. There were 47 male and 48 female patients with a mean age of 60 years (range=16 to 89). Referrals were made for suspected infection of prosthetic total joint replacements (38), long bones (32), primary joints (12) and feet (13). Sulesomab imaging was done with 650 MBq of 99mTcSulesomab. The final diagnosis was determined by conclusive microbiology, culture and/or histology, intra-operative findings, aspiration, complementary investigations like CT/MRI and long term clinical follow-up. The findings of 99mTcSulesomab images were compared with the clinical outcome to arrive at the decision of True Positive/ False positive/ True negative/ False negative results. Using the above definitions sensitivity, specificity and diagnostic accuracy of 99mTcSulesomab for suspected bone and joint infection were calculated.

Aims

To determine whether a delay of greater than 6 hrs from injury to initial surgical debridement and the timing of antibiotic administration affect infection rates in open long-bone fractures in a typical district general hospital in the UK.

Methods

In a prospective study, 248 consecutive open long-bone fractures (248 patients) were recruited over a 10-year period between 1996 and 2005. The data were collected in weekly audit meetings. Patients were followed until clinical or radiological union occurred or until a secondary procedure for non-union or infection was performed. The timing of the injury, initial surgical debridement, timing of antibiotic administration, and definitive procedures were all recorded. We also recorded the bone involved and the Gustillo and Anderson (GA) score. Patients who died within 3 months from the injury or who were transferred for definitive treatment were excluded.

Introduction

The purpose of this study was to establish whether men and women with a fragility hip fracture were equally investigated and treated for osteoporosis.

Methods

A retrospective review was carried out including 91 patients (48 females, 43 males) who were admitted with a fragility hip fracture between March 2003 and April 2004. Data about age, sex, investigations and medication were collected from the case notes, GP surgeries and the bone densitometry database. Investigations and treatment were compared with current guideline recommendations (SIGN 2003, NICE 2005). Data were analysed using SPSS Version 13.0.

Introduction

This study was to investigate the association of developmental dysplasia of the hip (DDH) and primary protrusion acetabuli (PPA) with Vitamin D receptor polymorphisms TaqI and FokI and oestrogen receptor polymorphisms Pvu II and XbaI.

Methods

45 patients with DDH and 20 patients with PPA were included in the study. Healthy controls (n=101) aged 18-60 years were recruited from the same geographical area. The control subjects had a normal acetabular morphology based on a recent pelvic radiograph performed for an unrelated cause. DNA was obtained from all the subjects from peripheral blood. Genotype frequencies were compared in the three groups. The relationship between the genotype and morphology of the hip joint, severity of the disease, age at onset of disease and gender were examined.

Introduction

We report the results of a prospective study of 1349 patients undergoing 1509 total knee replacements, identifying factors increasing the risk of infection.

Methods

Data were collected prospectively between October 1998 and February 2002 by a dedicated audit nurse. Pre-operative demographic and medical details were recorded. Operative and post-operative complications were noted. The definitions of surgical-site infection were based on a modification of those published by the Centre for Disease Control (CDC) in 1992. A superficial wound infection had a purulent discharge or positive culture of organisms from aseptically-aspirated fluid, tissue, or from a swab. Deep infection was counted as an infection that required a secondary procedure. Patients were seen at 6, 18 and 36 months post-operatively in a dedicated knee audit clinic and infection details recorded. The association between infection and other factors was tested by chi-squared or Mann-Whitney tests for categorised or quantitative factors respectively.

Background

Unicompartmental knee replacements (UKR) converted to total knee replacements (TKR) have often been viewed with scepticism because of the perceived difficulty of the revision and because revision procedures generally do less well than primaries.

Methods

This is a prospective review of TKRs converted from a UKR between 1982 and 2000. We present the survivorship of a 77 patient cohort and the clinical results of 35 patients. All information was recorded at the time of surgery onto a database and patients have been regularly reviewed since.

Introduction

Despite advances in surgical technique and prosthetics there continues to be a number of patients who are dissatisfied with the results of their knee replacement procedure. The outcome after total knee arthroplasty (TKA) has been reported frequently with use of condition-specific measures, but patient satisfaction has not been well studied.

Material and methods

160 patients who received primary total knee arthroplasty (TKA) were evaluated prospectively to evaluate factors that may be associated with patient satisfaction. At minimum one year follow-up all patients were evaluated and completed validated self-report satisfaction questionnaires. Patient, surgeon, implant and process of care variables were assessed along with WOMAC, Oxford Knee and SF-12 scores. Univariate and multivariate analyses were performed to assess for independent factors associated with post-operative satisfaction.

Methods

There were 106 men and 94 women (mean age 65 years; 22 - 85). 69 patients had inflammatory arthritis and 131 osteo-arthritis. 27 patients (13 B-P, 14 STAR) had a pre-operative varus/valgus deformity greater than or equal to 20 degrees. Mean follow-up was 48 months (36-72).

Results

Ten patients had died from unrelated cause with satisfactory final outcome assessment. Thirteen ankles (4 STAR, 9 B-P) required revision surgery. The causes of failure were: early deep infection (1 STAR), recurrent deformity (1 STAR, 4BP) aseptic loosening (1STAR, 4 BP), implant failure (1STAR, 1 BP). Six revised ankles (5BP, 1STAR) had pre-operative varus/valgus deformity of 20 degrees or more. AOFAS score for pain improved from 0 to 35 and for function from 30 to 43. There was no difference between the two groups. Pre-operative range of movement was predictive of the final range of movement. Radiographic assessment showed that 30 patients (17BP, 13 STAR) had recurrent deformity (edge loading) as shown by the UHMWPE insert no longer articulating congruently with the metallic components. 14 ankles (8BP, 6 STAR) from this group had pre-operative deformity of 20 degrees or more.

Aim

This controlled study uses gait analysis to evaluate patients' pre- and post-ankle arthroplasty, post-ankle arthrodesis and compares the results with a healthy control group to assess whether these theoretical benefits are borne out in clinical practice.

Method

Five patient groups (arthrodesis, arthroses, arthroplasty after 6 and 12 months and control) each consisting of 12 patients were analysed in our gait laboratory and the following parameters obtained at two different walking speeds: velocity, cadence, step length, stride length, the timing of toe off and the duration of stance phase. In addition, the ground reaction force during the whole gait cycle was recorded, as well as the range of movement of the knee and of the foot in relation to the tibia in walking and functional tests.

Purpose

The aim of this prospective study was to determine the usefulness of a gravity stress view in detecting instability in isolated Weber B fractures of the fibula.

Materials and methods

We used a standard protocol for patient selection, exclusion, surgery/conservative management and follow-up. Open fractures, fracture dislocations, those with medial/posterior malleolus fractures and those with preliminary X-rays showing a talar shift/tilt were excluded. If the medial clear space increased beyond 4mm on stress radiographs, surgical reduction and fixation of the lateral malleolus was performed. If this remained 4mm or less conservative treatment was undertaken. We followed these patients at 2, 4, 6 and 12 weekly intervals.

Aim

The aim of this study was to compare the diagnostic accuracy of the Magnetic Resonance Imaging with that of Stress views of the ankle in testing the integrity of the lateral ankle ligaments. Arthroscopic diagnosis was used as the gold standard.

Methods

This was a prospective study involving 45 patients who had previous trauma to the ankle and reported symptoms of ankle instability. Our patients were recreational athletes or military patients. These patients had MRI evaluation prior to arthroscopic evaluation and treatment of the ankle. The diagnosis regarding the integrity of the Calcaneofibular ligament (CFL) and the Anterior Talo-fibular ligament (ATFL), as obtained from the MRI was compared against the assessment of integrity from the stress views. These were compared against the assessment made by direct visualisation of the ligaments during arthroscopy. The sensitivity, specificity, negative (NPV) and positive predictive values (PPV) and accuracy were then calculated.

Background

Post-operative pain following forefoot surgery can be difficult to control with oral analgesia so regional analgesic methods have become more prominent in foot and ankle surgery. It was the aim of this study to evaluate the efficacy of a combination of popliteal and ankle blocks and decide if they provide significantly better post-operative analgesia than ankle block alone in forefoot surgery.

Methods

This was a prospective, randomised, controlled and single blind study. The total number of patients was 63, with 37 in ankle block only group (control) and 26 in ankle and popliteal blocks group. All patients underwent forefoot surgery. Post-operative pain was evaluated in the form of a visual analogue scale and verbal response form. Evaluations took place four times for each patient: in the recovery room, 6 hours post-operatively, 24 hours post-operatively and on discharge. The pain assessor, who helped the patient complete the pain evaluation forms, was blinded to the number of blocks used. The amount of opiate analgesia required whilst as an inpatient was also recorded. On discharge the patient was asked to rate their satisfaction with the pain experienced during their hospital stay. Results were analysed using Mann-Whitney tests.

Introduction

In patients with shoulder pain one of the important initial determinations is to assess the integrity of the rotator cuff. Clinical examination is often inconclusive. Compared with MRI and arthrography, ultrasound allows dynamic evaluation, is non-invasive, less expensive, less time-consuming and more acceptable to patients. The aim of the present study was to evaluate the accuracy of high resolution shoulder ultrasonography compared with arthroscopy in a series of consecutive patients with clinically suspected rotator cuff disease.

Materials and methods

100 shoulders in 99 consecutive patients with shoulder pain who had undergone standardised pre-operative ultrasonography and subsequent arthroscopy between May 2004 and March 2006 were included in the study. There were 53 males and 46 females with a mean age of 59 years. The mean time interval between the ultrasonographic and the arthroscopic examinations was 227 days. For full thickness tears ultrasonography showed a sensitivity of 100%, specificity 83%, positive predictive value 80%, negative predictive value 100% and accuracy 90%. Ultrasonography showed a sensitivity of 83% in detecting partial thickness tears, specificity 94%, positive predictive value 86%, negative predictive value 93% and accuracy 91%.

Background

Frozen Shoulder is a common condition which causes significant morbidity in people of working age. The 2 most popular forms of surgical treatment for this condition are Manipulation under Anaesthesia (MUA) or MUA plus Arthroscopic Capsular Release (ACR). Both treatment modalities are known to give good results, but no-one has compared the two to see which is better.

Aim

To compare the outcome in patients with primary frozen shoulder, who are treated by either MUA or MUA plus ACR.

Aims

To determine whether a correlation exists between the clinical symptoms and signs of impingement, and the severity of the lesions seen at bursoscopy.

Methods

Fifty-five consecutive patients who underwent arthroscopic subacromial decompression were analysed. Pre-operatively patients completed an assessment form consisting of visual analogue pain score, and shoulder satisfaction. The degree of clinical impingement was also recorded. At arthroscopy impingement was classified according to the Copeland-Levy classification. Clinical assessment and scoring was performed at 6 months post-operatively. Linear regression coefficients were calculated to determine if the degree of impingement at arthroscopy correlated with pre-operative pain, satisfaction and clinical signs of impingement.

Introduction

We present an all arthroscopic technique for modified Weaver Dunn reconstruction of symptomatic chronic type III acromioclavicular joint injuries.

Method

Over a 1 year period we performed 12 all arthroscopic modified Weaver-Dunn procedures. All patients had failed non-operative management for at least 6 months, with symptoms of pain and difficulty with overhead activities. The technique involved excision of the lateral end of clavicle, stabilisation with a suture cerclage technique from 2 anchors placed in the base of the coracoid and coracoacromial ligament transfer from the acromion to lateral end of clavicle. The technique is identical to our open technique and those published previously by Imhoff. Post-operatively the patients were immobilised for six weeks, followed by an active rehabilitation programme and return to work and sports at 3 months.

Introduction

The treatment of Neer type 2 lateral end clavicle fractures presents a difficult problem due to the high incidence of non-union, delayed union, shoulder girdle instability and the need for implant removal. We report our experience in 10 patients with acute fractures treated with a simple modified tension band suturing technique.

Surgical technique

Following accurate reduction of the fracture, antero-posterior holes are drilled through both fracture fragments. Ethibond suture (number 5) is passed through the drill holes and tied in a ‘figure of 8’ on the superior side. This is reinforced with an identical second tension band suture. As the coracoclavicular ligaments remain attached to the lateral fragment, the principle of the surgery is to maintain the approximation of the fracture fragments with the tension band until fracture union, thereby resuming shoulder girdle stability.

Introduction

Advances in the management of open tibial fractures have reduced the incidence of long-term complications of these injuries. However, a number of patients continue to suffer from sequelae such as infection, non-union and malunion. Many orthopaedic surgeons believe a below-knee amputation with a well-fitted prosthesis is a better alternative to limb reconstruction surgery. There are few studies that evaluate the long-term functional outcomes of amputees against patients who have undergone limb salvage procedures, and their results are conflicting. The hypothesis of this study is that patients who have undergone limb salvage have as good or better outcomes than those who have had below-knee amputations.

Methods

This is a retrospective case study. One group (n=12) had been treated with below-knee amputation following a variety of lower limb fractures. The other group (n=11) had developed complications following tibial fractures and undergone limb salvage surgery using the Ilizarov method. The groups were compared by means of a postal questionnaire, comprising the Oswestry Disability Index and the SF-36 Health Survey.

Introduction

The Ilizarov method for non-union comprises a range of treatment protocols designed to generate tissue, correct deformity, eradicate infection and secure union. The choice of specific reconstruction method is difficult, but should depend on the biological and mechanical needs of the non-union. We present a prospective series of patients with non-union of the tibia managed using a treatment algorithm based on the Ilizarov method and the viability of the non-union.

Patients and methods

Forty-four patients (34 men and 10 women) were treated with 26 viable and 18 non-viable non-unions. Mean duration of non-union was 19 months (range 2-168). 25 patients had associated limb deformity and 37 cases were infected. 42 patients had undergone at least one previous operation. Bone resection was dictated by the presence of non-viable and infected tissue. Four Ilizarov protocols were used (monofocal distraction in 18 cases, monofocal compression in 11 cases, bifocal compression-distraction in 10 cases and 5 bone transports) depending on the stiffness of the non-union or the presence of segmental defect.

Aim

Does pre-operative angiography of OTFs benefit patient management?

Method

43 patients were admitted with OTFs to Charing Cross Hospital, London between 3/2004 and 6/2005. Pedal pulses were documented and routine pre-operative angiography performed following primary surgical debridement. At definitive operation, data was collected prospectively assessing vasculature and the microsurgical findings. All patients underwent free flap reconstruction or amputation. Comparison was made with angiographic findings and whether surgical management had been affected. Retrospective audit of all angiograms was performed by a consultant radiologist establishing the sensitivity/specificity.

Background

Distraction Osteogenesis can be complicated by regenerate insufficiency resulting in prolonged implant usage or regenerate failure with malalignment or fracture. Experimental evidence has demonstrated that bisphosphonates may mediate improved local limb BMD and regenerate strength.

Methods

A prospective series of 14 patients over 5 years. One cohort (Group A) of these cases presented with established regenerate insufficiency leading to consideration for surgical intervention. Patients received a therapeutic regime of intravenous bisphosphonate A further cohort (Group B) of 7 patients was commenced on bisphosphonate therapy at an earlier stage, prior to the regenerate maturation phase.

Background

Osteoarthritis (OA) has been described as a non-inflammatory arthritis and yet the choice of drug treatment is NSAIDs.

Aim

To test the hypothesis that cytokines and chemokines are associated with inflammation in OA.

Introduction

Osteoarthritis (OA) has historically been thought of as a degenerative joint disease, but inflammation and angiogenesis are increasingly being recognised as contributing to the pathogenesis, symptoms and progression of OA. b-dystroglycan (b-DG) is a pivotal element of the transmembrane adhesion molecule involved in cell-extracellular matrix adhesion and angiogenesis. Matrix metalloproteinases (MMPs) are the main enzymes responsible for cartilage extracellular matrix breakdown and are also implicated in both angiogenesis and b-DG degradation in a number of malignancies. We aimed to investigate the expression and localisation of b-DG and MMP-3, -9, and -13 within cartilage, synovium and synovial fluid and establish their roles in the pathogenesis of OA.

Methods

Following ethical committee approval, cartilage, synovium and synovial fluid were obtained from the hip joints of 5 osteoarthritic (patients undergoing total hip replacement) and 5 control hip joints (patients undergoing hemiarthroplasty for femoral neck fracture). The samples were analysed for b-DG expression using Western Blotting and for the distribution of b-DG, MMP-3, -9, and -13 using immunohistochemistry on paraffin embedded tissue.

Introduction

Modern processing techniques in bone banking are thought to decrease the presence of allogenic material in bone. This project was performed to observe any changes in peripheral blood lymphocyte subsets in response to allografted bone used in revision hip replacement.

Methods

87 patients were entered into this prospective study and grouped according to whether impaction allograft was used or not. Samples were collected pre-operatively and at set time intervals up to one year post-operatively. Using flow cytometry, analysis of venous blood allowed counts of the following cells: Helper T-lymphocytes, cytotoxic T-lymphocytes, memory T-lymphocytes, naïve T-lymphocytes, Natural Killer cells and B-lymphocytes.

Purpose

To compare the post-operative morbidity, of a novel vertical approach, with that of the standard transverse one, for procurement of Autologous bone graft from the iliac crest, for the purpose of cervical spine fusions.

Methodology

Eighty patients undergoing procurement of bone graft from the iliac crest were prospectively randomised into two groups. The study group (36) underwent the procedure through a novel vertical approach, while the controls (44) had the standard transverse approach. Both groups were evaluated by a blinded observer at 1 month and 6 months post-operatively. The visual analogue pain score, (VAS), use of analgesics, disruption of cutaneous nerve function and local tenderness were recorded.

Introduction

Improvements in material properties of total joint prostheses and methods of fixation mean that arthroplasty is the most effective means of restoring mobility in osteoarthritic patients. Aseptic loosening is the major cause of long-term failure of prostheses. Cobalt particles may act directly on osteoblasts, decreasing bone formation and potentially playing a role in osteolysis and aseptic loosening.

Objectives

To assess gene expression profiles of primary human osteoblasts exposed to cobalt ions in a temporal manner, and to identify gene clusters underpinning the osteoblast response to cobalt.

Introduction

The success of total hip replacement in the young has consistently been worse both radiologically and clinically when compared to the standard hip replacement population.

Methods

We describe the clinical and radiological outcome of 58 consecutive polished tapered stems (PTS) in 47 patients with a minimum of 10 years follow-up (mean 12 years 6 months) and compared this to our cohort of standard patients. There were 22 CPT stems and 36 Exeter stems.

Purpose

We describe an update of our experience with the implantation of the first 325 Exeter Universal hips. The fate of every implant is known.

Methods and results

The first 325 Exeter Universal stems (309 patients) were inserted between March 1988 and February 1990. The procedures were undertaken by surgeons of widely differing experience. Clinical and radiological review was performed at a mean of 15.7 years. At last review 185 patients had died (191 hips). 103 hips remain in situ. Survivorship at 17 years with revision for femoral component aseptic loosening was 100% (95% CI 97 to 100), with revision for acetabular component aseptic loosening was 90.4% (95% CI 83.1 to 94.7) and with any re-operation as the endpoint was 81.1% (95% CI 72.5 to 89.7). 12 patients (12 hips) were not able to attend for review due to infirmity or emigration, and scores were obtained by phone (x-rays were obtained in 4 patients). Mean D'Aubigné and Postel scores (Charnley modification) at review were 5.4 for pain and 4.8 for function. The mean Oxford score was 21.6 +/− 9.8 and the mean Harris score 71.7 +/− 19.7. On radiological review there were no femoral component failures. Three sockets (2.9%) were loose as demonstrated by migration or change in orientation (two patients were asymptomatic) and 5 sockets (4.9%) had radiolucent lines in all 3 zones but no migration. There are two patients awaiting socket revision.

Introduction

Up to date there are only few reports in literature on the long term survival of uncemented stems. As for cemented THA, 10 year survival of at least 90% is required for any THA.

Materials and methods

We followed the first 354 consecutive implantations of an uncemented, straight femoral stem (CLS, Zimmer Inc, Warsaw, USA) in 326 patients. Mean time of follow-up evaluation was 17 years (range, 15-20 years).

Purpose

Metal-on-Metal (MoM) hip bearings are being implanted in ever-increasing numbers and into ever-younger patients. The consequence of chronic exposure to metal ions is a cause for concern. Therefore, using cytogenetic biomarkers, we investigated a group of patients who have had MoM bearings in situ for in excess of 30 years.

Method

Whole blood specimens were obtained from an historical group of patients who have had MoM bearings in situ for in excess of 30 years. Blood was also obtained from an age and sex matched control group and from patients with Metal-on-Polyethylene (MoP) components of the same era. The whole blood was cultured with Pb-Max karyotyping medium and harvested for cytogenetics after 72 hrs. The 24 colour FISH (Fluorescent In Situ Hybridisation) chromosome painting technique was performed on the freshly prepared slides, allowing chromosomal mapping. Each slide was evaluated for chromosomal aberrations (deletions, fragments and translocations) against the normal 46 (22 pairs and two sex) chromosomes. At least 20 metaphases per sample were scored and the number of aberrations per cell calculated.

Background

It was hypothesised that preserving a layer of gliding tissue, the parietal layer of the ulnar bursa, between the contents of the carpal tunnel and the soft tissues incised during carpal tunnel surgery might reduce scar pain and improve grip strength and function following open carpal tunnel decompression.

Methods

Patients consented to randomisation to treatment with either preservation of the parietal layer of the ulnar bursa beneath the flexor retinaculum at the time of open carpal tunnel decompression (57 patients) or division of this gliding layer as part of a standard open carpal tunnel decompression (61 patients). Grip strength was measured, scar pain was rated and the validated Patient Evaluation Measure questionnaire was used to assess symptoms and disability pre-operatively and at eight to nine weeks following surgery in seventy-seven women and thirty-four men; the remaining seven patients were lost to follow-up.

Background

The aim of this study was to identify and quantify any benefits of early active treatment of paediatric femoral shaft fractures for patients, their families, and the hospital.

Patients and methods

Our protocol (1999-2002) uses flexible intramedullary nails for children older than five, early hip spica (within one week of injury) for the under five year olds, and external fixation for polytrauma (Early Active Group[EAG], n = 25). Prior to this (1999-2002), treatment consisted of late application of a hip spica (3-4 weeks following injury) or inpatient traction (Traditional Group [TG], n = 41). Outcome measures were length of hospital stay, degree of malunion, knee and hip movements, and leg length discrepancy. The financial burden to the family including waged and non-waged time lost, transport, childminder, and other extra costs were estimated. Hospital costs including inpatient stay, theatre, and implant costs were analysed.

Introduction

The Stanmore Percentage of Normal Shoulder Assessment (SPONSA) is a simple, fast and reproducible measure of the subjective state of a shoulder. It has been invaluable in our busy clinical practice. This study validates the SPONSA score against the Oxford Shoulder and Constant score and demonstrates a greater sensitivity to change.

Methods

The SPONSA involves defining the concept of ‘normality’ in a shoulder and then asking patients to express the current state of their shoulder as a percentage of normal. The score uses a specific script which is read exactly as typed.

The SPONSA, Oxford Shoulder and Constant scores were measured by an independent observer in 61 consecutive patients undergoing treatment for shoulder conditions in our unit. Scores were recorded at 2-6 weeks before admission, immediately before intervention, and between 3-6 months post-intervention. The time taken to measure each score was recorded.

Background

One of the prime concerns when managing patients in plaster casts is loss of reduction. There have been studies showing that proper moulding of the plaster cast is critical in maintaining reduction. Recent studies have negated concerns that fibreglass (FG) casts do not allow swelling, when compared to plaster of Paris (POP) casts. However, their potential in maintenance of reduction has not been investigated.

Materials and methods

We compared the three-point bending properties of FG casts with POP casts over the first 48 hours. The effect of splitting the casts, at one hour and 24 hours, was studied. Three identical jigs with hinged metal rods were designed to simulate a Colles fracture. The bending force was provided by 0.5 kg weight applied at one end of the jig. The resultant displacement was measured to nearest 0.01 mm over the next 48 hours. Each test was repeated 6 times (total 6 groups and 36 tests).

Background

A consecutive series of 76 patients (101 hips) underwent primary open reduction, capsulorrhaphy and innominate osteotomy for late presenting developmental hip dislocation. They were aged 1.5 to 5 years at the time of surgery between 1958 and 1965. This study was designed to review their outcome into middle age.

Methods

We located and reviewed 60 patients (80 hips) using a public records search. This represents a 79% rate of follow-up at 40-48 years post-operatively.

19 patients (24 hips) had undergone total hip replacement and 3 had died. The remaining 38 patients (53 surviving hips) were assessed by the WOMAC^¯ and Oxford hip outcome questionnaires, physical examination and standing pelvic radiograph. The radiographs were analysed for minimum joint space width and the Kellgren and Lawrence score. Accepted indices of hip dysplasia were measured.

Introduction

The standard plane imaging of Graf and the dynamic methods of Harcke are well established methods in assessing hip dysplasia but give limited information in the flexed-abducted treatment position used in the Pavlik harness. The femoral head may sit on the edge of the acetabulum in a flexed position and only reduce when the hips are abducted. This may mean that hips, which reduce when abducted in the Pavlik harness, appear subluxed when scanned in neutral abduction. Harness treatment may thereby be abandoned prematurely due to the failure to confirm reduction. This study identifies ultrasound landmarks on an anterior hip scan which could be used to confirm reduction of the hip in Pavlik Harness.

Materials and method

Hips of a newborn piglet were scanned, imaged with magnetic resonance and x-rayed both before and after anatomical dissection.

Radiographic markers delineated the position of the tri-radiate cartilage and potential ultrasound landmarks identified to help confirm hip reduction in the flexed-abducted position. Porcine imaging was then compared with that of a human newborn.

Method

The anteroposterior pelvic radiographs of 84 children (87 hips with developmental dysplasia) seen between 1995 and 2004 were reviewed retrospectively. Each radiograph was photographed digitally and converted to the negative using Microsoft Photo Editor. Arthrograms were also assessed at the time of femoral head reduction. The acetabular index (AI) and femoral head deformity were assessed. Acetabular response was measured using the AI at 6 and 12 months post-reduction.

Results

Mean age at presentation was 11 months for the closed reduction group, versus 19 months for those with an arthrographic soft tissue obstruction requiring open reduction. Additionally, the average age of the children that underwent open reduction who later required a Salter osteotomy was 27 ± 3 months compared to an average of 14 ± 1.5 months for those who did not.

The acetabular response was maximal during the first 6 months following treatment. Closed reduction (24 hips) gave comparable results to open reduction (63 hips), although the initial AI was greater in those requiring open reduction (39.5 ± 6.3° versus 36.1 ± 4.6°). Using two separate Bonferroni pairwise comparisons revealed no statistical difference in response between closed and open reduction. Arthrography revealed that hips requiring open reduction were more deformed, with spherical femoral heads in 29% as opposed to 68% in the closed reduction group. The AI was also slightly less (36.6 ± 3.2°) when the femoral head was spherical in comparison to those hips with an aspherical femoral head (38.0 ± 6.6°).

Background

Paediatric pelvic corrective surgery for developmentally dysplastic hips requires that the acetabular roof is angulated to improve stability and reduce morbidity. Accurate bony positioning is vital in a weight-bearing joint as is appropriate placement of metalwork without intrusion into the joint. This can often be difficult to visualise using conventional image intensifier equipment in a 2D plane.

Methods

The ARCADIS Orbic 3D image intensifier produces CT-quality multi-axial images which can be manipulated intra-operatively to give immediate feedback of positioning of internal fixation. The reported radiation dose is 1/5 and 1/30 of a standard spiral CT in high and low quality modes, respectively.

Introduction

The gastrocnemius tendon extends from the musculotendinous junction proximally to the conjoint junction with soleus distally. The morphology of the junction has not, to our knowledge, been described previously. Lengthening of the gastrocnemius tendon is a standard surgical procedure in surgery for cerebral palsy. The aims of the study were to describe the morphology of the conjoint junction and to identify the location of the gastrocnemius tendon relative to palpable bony landmarks to assist with incision planning.

Methods

Twenty-one embalmed adult cadaveric specimens were dissected to document the morphology of the conjoint junction. The location of the gastrocnemius tendon was measured relative to the distance between the palpable bony landmarks of the calcaneus and the head of the fibula.

Background

Scaphoid fracture malunion with flexion and shortening results in the ‘humpback deformity’. This is thought to be associated with poor clinical results when assessed with the lateral intra-scaphoid angle and the Green and O'Brien wrist evaluation scale. This method of deformity measurement is now considered unreliable and the functional score has not been validated in the setting of scaphoid fractures.

Aims & objectives

To assess the outcome of scaphoid malunion at one year using the height to length ratio, a reliable measure of deformity, and the Patient Evaluation Measure (PEM), a functional assessment validated specifically for scaphoid fracture outcome.

Objective

To compare the ability of a new composite bio-absorbable screw and two conventional metal screws to maintain fixation of scaphoid waist-fractures under dynamic loading conditions.

Methods

Fifteen porcine radial carpi, with morphology comparable to human scaphoids, were osteotomised at the waist. Specimens were randomised in three groups: Group I were fixed with a headed metal screw, group II with a headless tapered metal screw and group III with a bio-absorbable composite screw. Each specimen was oriented at 45° and cyclically loaded using four blocks of 1000 cycles, with peak loads of 40, 60 (normal load), 80 and 100 N (severe load) respectively. Permanent displacement and translation (step-off) at the fracture site was measured after each loading block from a standardised high-magnification photograph using image analysis software (Roman v1.70, Institute of Orthopaedics, Oswestry). Statistical analysis was by ANOVA and tolerance limits.

Background

Percutaneous K-wire fixation is a well-recognised and often performed method of stabilisation for distal radius fractures. However, there is paucity in the literature regarding the infection rate after percutaneous K-wire fixation for distal radius fractures.

Aims

To analyse the rate and severity of infection after percutaneous K-wire fixation for distal radius fractures.

Introduction

Midcarpal instability is an uncommon but troublesome problem. Patients have loss of dynamic control of the wrist in pronation and ulnar deviation due to laxity of the volar wrist ligaments that is often congenital or due to minor trauma. For those in whom conservative measures fail, open ligament reconstruction or fusions have been described.

Aim

We prospectively studied a series of fourteen patients who underwent arthroscopic thermal capsular shrinkage for midcarpal instability.

Background

A randomised prospective study has already demonstrated that at 1-year follow-up, palmaris longus interposition or flexor carpi radialis (FCR) ligament reconstruction and tendon interposition do not improve the outcome of trapeziectomy for the treatment of painful osteoarthritis of the trapeziometacarpal joint. This study consisted of 183 thumbs in 162 women.

Aims

114 of the 183 thumbs have now completed their 5-year follow-up and this study reports their results.

Conclusion

Improvements in design of distal femoral replacements have significantly decreased the risk of revision surgery. Infection remains a serious problem for these patients.

Methods

Between 1966 and 1995, 3716 patients were seen with a suspected neoplasm and 776 patients underwent EPRs. Patients receiving growing endoprostheses were excluded from the study as they invariably require revision, leaving 667 replacements. Insufficient data was available in 6 cases, leaving 661 patients in the study group. Information was reviewed concerning the diagnosis, survival of implant and patient, subsequent surgery, complications and functional outcome. Kaplan-Meier survival analysis was used for implant survival with end points defined as revision for mechanical failure (aseptic loosening, implant fracture, instability, avascular necrosis, periprosthetic fracture, pain and stiffness) and revision for any cause (infection, local recurrence and mechanical failure).

Results

Mean age at diagnosis was 34 years. Overall patient survival was 52.7% at 10 years and 45.7% at 20 years. The mean follow-up for all patients was 9 years, and for those patients who survived their original disease, the mean follow-up was 15 years. 227 (34%) patients underwent revision surgery, 75 patients for infection (33%), 36 patients for locally recurrent disease (16%) and mechanical failure in 116 patients (51%). With revision for mechanical failure as the end-point, implant survival was 75% at 10 years and 52% at 20 years. With revision any cause as an end-point implant survival was 58% at 10 years and 38% at 20 years. Overall limb salvage was maintained in 91% of patients at 10 years from reconstruction and 79% at 20 years. There was a significant difference between survival of implant between implantation sites, with the proximal humeral implant survival being the best and tibial reconstructions being the worst. The MTSS functional score was available on 151 patients, with a mean score of 25/30 (83%) at last follow-up visit.

Introduction

Despite the advances in adjuvant chemotherapy and surgical techniques, the diagnosis of a bone tumour still carries with it a significant risk of mortality. This study investigates factors affecting survival, in patients treated for malignant tumours of bone using Endoprosthetic replacement (EPR).

Methods

Our tertiary referral musculoskeletal tumour unit has taken referrals over 40 years. Electronic patient records have been prospectively kept on all patients seen since 1986 and data has been entered retrospectively for patients seen between 1966 and 1986. A consecutive series of 1264 patients underwent endoprosthetic reconstruction; after 158 patients were excluded, 1106 patients were left in the study group. Factors including diagnosis, size of tumour, surgical margins, percentage tumour necrosis following chemotherapy, tumour site, local recurrence, decade of reconstruction, fracture and post-operative deep infection were analysed.

Background

Endoprosthetic reconstruction is an established method of treatment for primary bone tumours in children. Traditionally these were implanted with cemented intramedullary fixation. Hydroxyapatite collars at the shoulder of the implant are now standard on all extremity endoprostheses, but older cases were implanted without collars. Uncemented intramedullary fixation with hydroxyapatite collars has also been used in an attempt to reduce the incidence of problems such as aseptic loosening. Currently there are various indications that dictate which method is used.

Aims

To establish long term survivorship of cemented versus uncemented endoprosthesis in paediatric patients with primary bone tumours.

Aim

To identify patient, tumour or treatment factors that influence outcome in patients with radiation induced sarcoma of bone.

Method

A retrospective review of an oncology database supplemented by referral back to original records.

Introduction

The Two Week Waiting Time Standard, which requires that patients with suspected cancer referred by general practitioners should be seen within 2 weeks, was introduced in 2000. We reviewed the performance of this standard with regards to proportion of patients seen and tumour detection rates.

Methods and results

We reviewed all the referrals sent under the ‘two week’ rule from January 2004 to December 2005, to our bone and soft tissue sarcoma service. These referrals were evaluated for:

Whether or not the referral met established referral guidelines for bone and soft tissue tumours

This was compared with the total number of referrals to the unit and their tumour detection rates.

A total of 40 patients were referred under the ‘two week’ rule. 95% of these were seen within two weeks of referral. Of the 40 patients, three patients had soft tissue metastasis from a primary tumour elsewhere, and six had primary malignant soft tissue tumours. 13 had a benign bone/ soft tissue tumour. 18 (45%) patients had a non neoplastic pathology (6 Muscle tear/ herniation; 4 ganglion/bursa; 2 lumps that disappeared) During the same period a total of 507 patients were referred by other routes.

Subjects

A prospective study of 127 patients who underwent posterior spinal arthrodesis and segmental spinal instrumentation with iliac crest bone graft for correction of adolescent idiopathic scoliosis. Patients were divided according to their Cobb angle into two groups. Group 1 (n= 78) with a Cobb angle > 70° who underwent an additional concave rib osteotomy (CRO) and group 2 (n= 49) with a Cobb angle < 70° who did not (NCRO). All patients received a pulmonary rehabilitation programme post-operatively. Vital capacity (VC) and peak expiratory flow rate (PEF) were measured pre-operatively, at 3 months and 12 months post-operatively.

Summary of background data

Concave rib osteotomy technique is used for giving more mobility and flexibility of the spine during correction especially in rigid and severe curves. Only a few studies in the literature have looked at the effect of concave rib osteotomy on pulmonary function.

Introduction

Radiographic parameters have been shown to have a poor correlation with clinical outcome after open scoliosis procedures. However this has not been previously addressed after endoscopic surgery. The purpose of our study was to examine prospectively the relationship between curve correction and clinical outcome for endoscopic scoliosis surgery.

Methods

We studied 50 consecutive patients who underwent endoscopic instrumentation, with a minimum follow-up of two years. All patients were assessed pre-operatively and at 24 months post-operatively. Radiological parameters were measured from plain standing radiographs including the coronal Cobb angle, sagittal alignment, coronal alignment and shoulder elevation. Clinical outcome was assessed using the Scoliosis Research Society Outcomes Instrument (SRS-24). Correlation between radiological parameters and SRS-24 scores were determined using the Pearson correlation coefficient.

Introduction

This study investigates the effect of somatisation on results of lumbar surgery.

Methods

Pre- and post-operative data of all primary discectomies and posterior lumbar decompressions were prospectively collected. Pain using the Visual Analogue Score (VAS) and disability using the Oswestry Disability Index (ODI) were measured. Psychological assessment used the Distress Risk Assessment Method (DRAM). Follow-up was at 1 year.

Purpose of the study

In a recent study, O'Leary et al. [2005] reported their observations on the patterns of Charité disc prosthesis motion under physiologic loads. The purpose of this study was to investigate whether the motion patterns observed in the in vitro model are replicated in clinical practice.

Methods

55 patients with implanted SB Charité 111 artificial lumbar discs were subjected to flexion extension x-rays. Two consultant spinal surgeons and a neuro-radiological consultant were asked to classify the pattern of motion in the clinical subjects based on the patterns observed in the in vitro model. The results were recorded independently then collated. Following this first round of observations an algorithm was devised and the method of measurement was standardised.

Summary of findings: There was modest correlation amongst the three observers in distinguishing motion from nonmotion (Kappa 5.6). There was less agreement on what type of motion was present. On both counts using the algorithm there was no correlation. The clinical study based on patients' flexion-extension radiographs identified the following patterns of prosthesis motion:

angular motion between both the upper and lower endplates and core, with visual evidence of core motion;

Introduction

Atlanto-occipital dislocation is rare and usually fatal. Stabilisation is typically from Occiput to C2, sacrificing atlanto-axial movement. To preserve movement, screw fixation from the articular mass of C1 to the occipital condyle has been described. Amongst other structures, the hypoglossal nerve is at risk. No previous study has addressed the anatomy of the hypoglossal canal in relation to screw trajectory. We aim to identify landmarks to aid safe screw passage into the occipital condyle.

Methods

20 dry skulls provided 40 hypoglossal canals (HCs) and 40 occipital condyles (OCs). No distinction was made between sex, race or age. 9 parameters were measured for each HC, and relation to skull base was noted.

Background

High velocity vertical aircraft ejection seat systems are credited with aircrew survival of 80-95% in modern times. Use of these systems is associated with exposure of the aircrew to vertical acceleration forces in the order of 15-25G. The rate of application of these forces may be up to 250G per sceond. Up to 85% of crew ejecting suffer skeletal injury and vertebral fracture is relatively common (20-30%) when diagnosed by plain radiograph. The incidence of subtle spinal injury may not be as apparent.

Aim

A prospective study to evaluate spinal injury following high velocity aircraft ejection.

Purpose

We report our surgical management of a series of primary and metastatic tumours of the lumbosacral junction, highlighting different methods of fixation, outcome and complications.

Method

Seven patients with primary and four with secondary tumours involving the lumbosacral junction underwent surgery. After tumour resection, iliolumbar fixation was performed in all but one case, using Galveston rods (4) or iliac screws (6). All constructs were attached proximally with pedicle screws. Cross links were used in all instrumented cases and autologous and allogenic bone graft applied.

Purpose

To report a retrospective study of 103 cases of primary spinal infection, the largest ever such series from the UK, analysing presenting symptoms, investigations, bacteriology and the results of treatment.

Method

This is a retrospective review of all patients (54 Male, 49 Female) treated for primary spinal infection in a Teaching Hospital in the UK.

Introduction

Following the publication of our original survey in 2000 (Eur. Sp. J. 11(6):515-8 2002) we have sought to re-evaluate the perceptions and attitudes towards spinal surgery of the current UK orthopaedic Specialist Registrars (SpRs), and to identify factors influencing an interest in spinal surgery. At that time 175 orthopaedic spinal surgeons in the UK needed to increase by 25% to satisfy parity with other European countries.

Methods

A postal questionnaire was sent to all 917 SpRs. The questionnaire sought to identify perceptions in spinal surgery, levels of current training and practice, and intentions to pursue a career in spinal surgery.

Background

Referral to centres with a pelvic service is standard practice for the management of displaced acetabular fractures.

Hypothesis

The time to surgery: (1) is a predictor of radiological and functional outcome and (2) this varies with the fracture pattern.

Background

Acetabular or pelvic ring injuries are invariably associated with high-energy trauma that could lead to a significant degree of disability. The purpose of this study was to investigate whether patients who had surgical treatment of isolated acetabular or pelvic injuries were able to return to their previous sporting activities.

Patients and method

Between January 2001 and January 2002 90 patients were treated in our institution with pelvic (PF) and acetabular (AF) fractures. We excluded 22 of them who had sustained other associated injuries in order to eliminate the potential bias that the associated injuries could have on the results. Demographics, fracture classification, rehabilitation, outcome and complications were documented prospectively. Frequency, level of activity and sports participation before and after surgery, as well as EuroQol (EQ-5D) were also recorded.

Mechanism of injury

football 75, fall 52, RTA 49, others 20. 33 patients had an additional 74 injuries: 38 fractures/dislocations (3 open), 7 compartment syndromes, 7 head injuries, 16 chest injuries, 9 soft tissue injuries. According to AO classification system: 33 A1, 47 A2, 42 A3, 15 B1, 46 B2, 7 B3. Time to fracture healing was 19 weeks on average (range 9-87). 15 patients had coronal deformity >5 degrees and 1 also had saggital deformity >10 degrees. One osteotomy for correction of malunion. 279 pin site infections requiring antibiotics in 35 patients. 7 fixators removed early due to pin site infection. One established osteomyelitis-lautenbach. 7 refractures, all healed (5 with pop, 2 with further fixator). Non-union: 5 hypertrophic, 2 atrophic-all healed with further external fixation. Our results show that external fixation of closed tibial fracture is a viable alternative to other treatment methods with regard to healing time and angular deformity.

Our study also uses a well validated end point to define fracture healing and does not rely on the difficulty of defining union on clinical and radiological grounds.

Introduction

The results of a prospective study of primary bone grafting in a selective group of patients with High energy open fractures (Grade III) of limbs with communition or bone loss are presented.

Materials and methods

Out of 310 Gustilo Grade III Open injuries managed over a 4 year period, 42 patients with Grade III injuries underwent bonegrafting after satisfying the inclusion criteria (Age <60, Debridement within 12hrs, Stable fracture fixation, wound cover within 72hrs) at or before the time of wound closure or soft tissue cover. Patients with Grade IIIc fractures, farmyard injuries, needing freeflaps, ASA grade of 3 or more, injury severity score > 25 or monomelic polytrauma were excluded. The bone involved was femur in 26 patients, tibia in 4, forearm in 9 and humerus in 3 patients. The injury was Grade IIIA in 11 and Grade IIIB in 31 patients. Wounds were primarily closed immediately after debridement in 28 (66.7%) patients, by split thickness skingrafting in 7 (16.7%) and by suitable regional flaps in 7 (16.7%) patients. Rigid fixation was achieved in all patients with variety of implants depending on the fracture personality. Autologous Cortico-cancellous bonegrafting was done immediately after debridement in 33 (78.6%) and within 72hrs at the time of soft tissue cover in 9 (21.4%) patients.

Introduction

Primary wound closure in open tibial fractures has not been recommended. Traditionally initial debridement with fracture stabilisation and delayed wound closure was the accepted treatment. However this practice was developed before the use of prophylactic intravenous antibiotics and improved techniques for fracture stabilisation. Studies suggest that infections are not caused by the initial contamination but the organisms acquired in the hospital. Subsequent primary wound closure after adequate wound care and fracture stabilisation should be a safe concept and should not increase the rate of complications.

Material/methods

In a retrospective study we analysed 95 patients with open tibial fractures Gustilo-Anderson Type 1-3a treated at two different teaching hospitals with primary fracture stabilisation and delayed wound closure as group I and primary fracture stabilisation and primary wound closure as group II. Exclusion criteria to the study were the following conditions: Grade 3b and 3c fractures, polytrauma, other fractures, significant medical history, previous surgery 6 months prior to admission. In group I 46 patients (38 males, 8 females) with a mean age of 30.2 years (16-56) were included. 19 sustained Grade 1 open, 16 Grade 2 open, 4 Grade 3a open and 7 gunshot fractures to the shaft of the tibia. In group II 49 patients (36 males, 13 females) with a mean age of 33.4 (18-69) were included. 19 sustained Grade 1 open, 19 Grade 2 open, 3 Grade 3a open and 8 gunshot fractures. The mean follow-up in group 1 was 11.5 (9-18) and 11.7 (8-16) months. The criteria for post-operative infection were clinical/radiological.

Aim

The aim of this study was to compare the results of humerus intramedullary nail (IMN) and dynamic compression plate (DCP) for the management of diaphyseal fractures of humerus.

Material & methods

47 patients with diaphyseal fracture of shaft humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion were Grade 1.2a compound fractures; Polytrauma; Early failure of conservative treatment; Unstable fracture.

Patients with pathological fracture, Grade 3 open fracture, refracture or old neglected fracture of humerus were excluded from the study. 23 patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach.

Aims

To describe the distribution and clinical presentation of SLAP tears in rugby players, and time taken for return to sport.

Method

A retrospective review of 51 shoulder arthroscopies performed on professional rugby players over a 35 month period was carried out. All patients diagnosed with a SLAP lesion at arthroscopy were identified. Each patient's records were reviewed to record age, injury side, mechanism of injury, clinical diagnosis, investigations and results, management, and return to play.

Introduction

This biomechanics investigation evaluated commercially available studded and bladed football boots to determine whether boot type influences potential non-contact ACL injury when football players sidestep cut.

Methods

Fifteen professional outfield male football players, without history of lower limb injury, with at least two consecutive injury-free seasons participated. Each undertook three trials of a straight line run and sidestep cuts at 30° and 60° with approach velocity 5.5ms^-1 - 6.0ms^-1 on a FIFA (Fédération Internationale de Football Association) approved artificial football surface. Four pairs of standardised football boots (two bladed and two studded) were investigated. Using 3D inverse dynamics analyses based on an eight camera gait analysis system (120Hz) synchronised with a force platform (960Hz), peak absolute knee internal tibial rotational moments (M_z), valgus moments (M_y) and anterior joint forces (F_x) were determined throughout the stance phase. Values were compared with cadaveric critical limits for ACL injury. A univariate repeated measures ANOVA quantified differences between the variables as a function of cutting angle and boot type.

Introduction

The purpose of this study is to evaluate the early functional outcome and activity level in athletes and soldiers with large full thickness cartilage defects of the knee that underwent either ‘classic’ autologous chondrocyte implantation using periosteal flap coverage (ACI-P) or 3-D matrix-assisted chondrocyte implantation (ACI-M).

Methods

Between April 2002 and January 2004, 19 patients (15 male, 4 female, average age 32.2 years) with 22 full-thickness cartilage defects in 19 knees were treated with ACI in our centre. The mean post-injury interval was 39.8 months whereas 17 (89.5%) patients had undergone at least one surgical procedure before ACI. The average defect size was 6.54 cm² (located in MFC:7, LFC:7 or trochlear:2 while 3 patients had bifocal lesions in both LFC and TRC). Novocart^¯ cultured chondrocytes with periosteal flap coverage were used in 11 patients and Novocart-3D^¯ cell impregnated collagen patch in 8. The functional outcome was evaluated with IKDC form, Tegner activity scale and Lysholm score after a mean follow-up period of 26.5 months.

Introduction

Government figures show a trend of increasing incidence in motorcycle trauma in the UK over the last decade. These patients often have multiple injuries and place a significant burden on the admitting units. In the face of changes to health service funding, with the introduction of Payment by Results, we wanted to determine the true cost of treating these patients in the setting of a District General Hospital.

Methods

We undertook a retrospective case-note review of all the motorcyclists involved in road traffic accidents (MRTAs) requiring admission for treatment in 2004. Patients were identified using the hospital computer system. A supplementary telephone survey was also undertaken to retrieve information not previously recorded. The following parameters were analysed: demographic and admission details, motorcycle and accident details, admitting specialty, injury pattern, nature and number of investigations, treatment, outcome and cost.

Background

A retrospective review of all patients transferred by helicopter ambulance to the Great Western Hospital over a 20-month period between January 2003 and September 2004 was undertaken to establish the case-mix of patients (trauma and non-trauma) transferred and the outcome of their admission and length of hospital stay.

Methods

Details of all Helicopter Emergency Ambulance Service (HEAS) transfers to this unit in the study time period were obtained from the three HEAS providers in the area and case notes for all patients (where available) were reviewed.

Introduction

Nonagenarian patients with hip fractures present many challenges to the clinician, both in terms of their advanced age and medical co-morbidities with potential orthopaedic complications. Our aims were to assess outcome of hip fractures in a nonagenarian population with respect to pre-operative predictors of outcome, immediate and long-term morbidity, and survival rates.

Methods

Nonagenarian patients with a hip fracture admitted between January 2000 and December 2003 were considered. Eighty-one patients were included, the majority being female (M: F 14: 67). Ages ranged from 90 to 98 years for female patients (mean 92.5 years, SD 2.2) compared to 90 to 95 years for male patients (mean 92.7 years, SD 2).

Introduction

Four weeks after the earthquake in Kashmir, multidisciplinary surgical teams were organised within the UK (MiST). The aim was to help with disaster victims who had been transferred to Rawalipindi. We reviewed the work carried by one such team from the 5-18 November 2005.

Patients

There were 78 patients: 50 lower limb injuries only, 21 upper limb, 7 combined, injuries. Mean age was 24 (0.5-80). 24 patients were under 10 and only 5 over 60. 274 procedures were performed over 11 days (average 25 per day).

Introduction

Hydroxyapatite (HA) coated femoral stems require a press fit for initial stability prior to osteointegration occurring. However this technique can lead to perioperative femoral fracture.

Materials and Methods

506 consecutive patients under 72 years who underwent primary total hip replacements (THR) under 72 years were investigated for perioperative femoral fractures. All patients were independently assessed pre- and post-operatively in a research clinic. Assessment was made by Merle d'Aubigné and Postel (MDP) hip scores and radiographs. Between 1995 and 2001 patients were randomised to a partially HA coated, Osteonics Omnifit or fully HA coated Joint Replacement Instrumentation Furlong stem. Between 2001 and 2004 all patients received an Anatomique Benoist Girard (ABG II) stem partially coated. Fractures were identified from check radiographs and operative notes. The type of fracture was classified according to the modified Vancouver classification. The incidence of revision was also recorded.

Introduction

Femoroacetabular impingement (FAI) causes anterior hip pain, labral tears and damage to the articular cartilage leading to early osteoarthritis of the hip. Surgical hip dislocation and osteoplasty of the femoral neck and acetabular rim is a technique pioneered by the Bernese group for the treatment of FAI. We present and discuss our results of this technique.

Methods

Functional outcome was measured in hips with over 12 month follow-up using the Oxford hip and McCarthy non-arthritic hip scores pre- and post-operatively.

Background

Fracture non-union is still a major challenge to the orthopaedic surgeon and established non-union has zero probability of achieving union without intervention.

Aim

The purpose of this study was to evaluate the effect of low intensity ultrasound for the treatment of established long bone non-union.

Objective

To investigate the effects of trauma and fracture surgery on leukocyte maturation and function.

Background

Unbalanced inflammation triggered by trauma has been linked to multiorgan dysfunction (MOD) and death. In animal and cellular models, changes in neutrophil function and failure of monocyte infiltration and resolution have been implicated as possible causes. The investigators combine assays on neutrophil function with surface antigen expression on circulating neutrophils and monocytes. These are correlated with severity of traumatic injury, type of surgery and clinical outcome to help explain the aetiology of distant organ injury, and pose a case for damage control surgery.

Background

The optimal treatment for pilon fractures remains controversial. We have used early single-stage open reduction and internal fixation to treat these injuries and the purpose of this study was to determine the safety and efficacy of this strategy.

Methods

A cohort of 95 patients with AO type C tibial pilon fractures underwent primary ORIF. Of these patients, 21 had open fractures. Sixty-eight fractures were sustained in falls, 21 in motor vehicle collision, 5 in crushes and one in an aircraft crash. The principal outcome measure was wound dehiscence or infection requiring surgery. Radiological and functional outcomes were assessed at a mean of five years using the SF36 and the Foot and Ankle Outcome Score.

Introduction

Ankle fusion presents a difficult problem in the presence of infection, inadequate soft tissue, poor bone stock and deformity. Nonunion and infection remains a problem even with internal fixation. Ilizarov frame provides an elegant solution to the problem with stable remote fixation while allowing lengthening, deformity correction and weight bearing.

Patients and methods

Twenty-one consecutive patients were studied. The mean age at onset of disease was 52 years (range 4-70). Mean duration of the problem was 59.9 months (6-372). Aetiology included traumatic arthritis in 5, traumatic arthritis with osteomyelitis in 1, failed ankle fusion in 8, septic arthritis in 1, infected ankle fracture nonunion in 1, avascular necrosis of talus in 1, congenital deformity in 3 and failed ankle arthroplasty in 1. 15 patients had deformity of the ankle at the time of presentation. 15 of the 21 patients had either clinical or radiological evidence of infection. Treatment principles involved local excision, deformity correction with good alignment and soft tissue management. Static Compression was achieved with an Ilizarov frame while dynamic fixation was performed in 3 cases for lengthening. Antibiotics treatment was continued until union in the infected cases. On achieving union the frame was removed and a below knee cast was applied for 4 weeks.

Type of study

Consecutive Case Series study using prospectively gathered data.

Methods

Eighty consecutive patients (80 ankles) having ankle arthroscopy (between 1998 and 2000) with the finding of OA or impingement were identified and their outcome at five years ascertained.

Purpose

To elucidate whether there is an advantage in external fixation supplementation of K-wires in comparison to K-wires and plaster, in the treatment of distal radius fractures without metaphyseal comminution.

Indications

Distal intraarticular radius fractures, Frykman VIII or VIII without metaphyseal comminution.

Aims

To evaluate the results of Elastic Stable Intramedullary Nailing (ESIN) for displaced, unstable paediatric forearm diaphyseal fractures.

Method

A retrospective, consecutive series study of 60 patients treated with ESIN between February 1996 and July 2005.

Introduction

The elbow is the second most common site of non prosthetic joint dislocation. Simple elbow dislocation alone contributes to 11-28% of all elbow injuries. Post-reduction treatment methods include traditional plaster of Paris (POP) immobilisation followed by physiotherapy, sling application followed by early mobilisation and rapid motion. The aim of the study was to evaluate the final outcome and cost-effectiveness of the pop and the sling groups.

Study Design

Retrospective cohort study

Introduction

Symptomatic neglected and displaced three- and four-part proximal humeral fractures are often difficult to reconstruct. Replacement has been reported to give poor functional outcome and hence is not the ideal treatment option. We report our results of secondary reconstruction of these difficult fractures with a locking plate system.

Material and methods

Between 2003 and 2005, 15 healthy active patients with displaced three- to four-part fractures underwent revision/secondary open reduction and internal fixation with a locking plate system (Philos, Stratec UK Ltd). Ten patients had delayed presentation. Three patients had failed previous internal fixation. One patient had non-union and one had malunited fracture. Their average age was 63 years. Objective assessment was measured by the Constant score, subjective assessment by the Oxford questionnaire. The mean follow-up was 14 months.

Background

In suspected scaphoid fracture the initial scaphoid series plain radiographs are 84-94% sensitive for scaphoid fractures. Patients are immobilised awaiting diagnosis. Unnecessary lengthy immobilisation leads to lost productivity and may leave the wrist stiff. Early accurate diagnosis would improve patient management. Although Magnetic Resonance Imaging (MRI) has come to be regarded as the gold standard in identifying occult scaphoid injury, recent evidence suggests Computer Tomography (CT) to be more accurate in identifying scaphoid cortical fracture. Additionally CT and USS are frequently a more available resource than MRI.

We hypothesised that 16 slice CT is superior to high spatial resolution Ultrasonography (USS) in the diagnosis of radiograph negative suspected cortical scaphoid fracture and that a 5 point clinical examination will help to identify patients most likely to have sustained a fracture within this group.

Methods

100 patients with two negative scaphoid series and at least two out of five established clinical signs of scaphoid injury (anatomical snuffbox tenderness (AST), scaphoid tubercle tenderness (STT), effusion, pain on circumduction and pain on axial loading) were prospectively investigated with CT and USS. MRI was arranged for patient with persistent symptoms but negative CT/USS.

Introduction

Scaphoid fracture is the most common undiagnosed fracture. Occult scaphoid fractures occur in 20-25 percent of cases where the initial X-rays are negative. Currently, there is no consensus as to the most appropriate investigation to diagnose these occult frctures. At our institution MRI has been used for this purpose for over 3 years. We report on our experience and discuss the results.

Materials and methods

All patients with occult scaphoid fractures who underwent MRI scans over a 3 year period were included in the study. There was a total of 619 patients. From the original cohort 611 (98.7%) agreed to have a scan, 6 (0.97%) were claustrophobic and did not undergo the investigation and 2 (0.34%) refused an examination. 86 percent of the cases were less than 30 years of age. Imaging was performed on a one Tiesla Siemen's scanner using a dedicated wrist coil. Coronal 3mm T1 and STIR images were obtained using a 12cm field of view as standard. Average scanning time was 7 minutes.

Aim

The aim of this study was to determine the medium term survivorship and function of the Exeter Universal Hip Replacement when used in younger patients, a group that is deemed to place high demands on their arthroplasties. Since 1988 The Exeter Hip Research Unit has prospectively gathered data on all patients who have had total hip replacements at the Princess Elizabeth Orthopaedic Hospital. There were 130 Exeter Universal total hip replacements (THR) in 107 patients who were 50 years or younger at the time of surgery and whose surgery was performed at least 10 years before. Mean age at surgery was 42 years (range 17-50 years.) Six patients who had 7 THRs had died, leaving 123 THRs for review. Patients were reviewed at an average of 12.5 years (range 10-17 years). No patient was lost to follow-up.

Results

At review, 12 hips had been revised. Of these, 9 were for aseptic loosening of the acetabular component and one cup was revised for focal lysis and pain. One hip was revised for recurrent dislocation. One femoral component required revision in 1 case of infection. Radiographs showed that a further 11 (10%) of the remaining acetabular prostheses were loose but that no femoral components were loose. Survivorship of stem and cup from all causes was 94%, at an average of 12.5 years. Survivorship of stem only from all causes was 99% and from aseptic loosening was 100%.

Introduction

Secondary osteoarthritis in a dysplastic hip is a surgical challenge. Severe leg length discrepancies and torsional deformities add to the problem of inadequate bony support available for the socket. Furthermore, many of these patients are young and wish to remain active, thereby jeopardising the long-term survival of any arthroplasty device.

For such severely dysplastic hips, the Birmingham Hip Resurfacing (BHR) device provides the option of a dysplasia component, a hydroxyapatite-coated porous uncemented socket with two lugs to engage neutralisation screws for supplementary fixation into the solid bone of the ilium more medially. The gap between the superolateral surface of the socket component and the false acetabulum is filled with impacted bone graft.

Methods and results

One hundred and thirteen consecutive dysplasia BHRs performed by the senior author (DJWM) for the treatment of severely arthritic hips with Crowe grade II and III dysplasia between 1997 and 2000 have been reviewed at a minimum five year follow-up. There were 106 patients (59M and 47F). Eighty of the 113 hips were old CDH or DDH, 29 were destructive primary or secondary arthritis with wandering acetabulae and four were old fracture dislocations of the hip. Mean age at operation was 47.5 years (range 21 to 68 years – thirty-six men and forty-four women were below the age of 55 years).

There were two failures (1.8%) out of the 113 hips at a mean follow-up of 6.5 years (range 5 to 8.3 years). One hip failed with a femoral neck fracture nine days after the operation and another failed due to deep infection at 3.3 years.

Aim

The aim of this study was to compare a single-incision minimally invasive (MI) posterior approach with a standard posterior approach in a double-blind prospective randomised controlled trial.

Method

A pilot study was carried out to assess the efficacy of the MI approach. Primary total hip replacements meeting the inclusion criteria were randomised to either the MI approach or the standard posterior approach. Patients were blinded to allocation. Patients were scored by a blinded physiotherapist pre-operatively, at Day 2, 2 weeks and 6 weeks.

The primary outcome measure was function, assessed using the Oxford hip score, SF-12 questionnaire, Iowa score, 6-minute walk test and the number of walking aids required after 2 and 6 weeks post-operatively. Secondary outcomes were complication rates, patient satisfaction, soft tissue trauma and radiographic analysis.

Introduction

A new surgical approach for minimally invasive hip resurfacing is described with early results.

Method

A posterior gluteus maximus splitting approach is used. The incision is in line with the fibres of gluteus maximus and is placed 5 cm. distal to the tip of the greater trochanter. Special instruments were necessary to carry out surgery: MIS targeting device for placement of centring pin, MIS retractor system, Chana curved acetabular reamer handle, and curved acetabular impactor.

Aim

The aim of the study was to assess the impact of a self aligning unidirectional mobile tibial bearing and the use of a patella button on lateral patella release rates within a knee system using a common femoral component for both the fixed and mobile variants.

Methods and results

A total of 347 patients undergoing TKR were included in the study and randomly allocated to receive either a Mobile Bearing (171 knees) or a Fixed Bearing (176 knees) PS PFC Sigma TKR. Further sub-randomisation into patella resurfacing or retention was performed for both designs. The need for lateral patella release was assessed during surgery using the ‘no thumbs’ technique.

The lateral release rate was similar for fixed bearing (9.65%) and mobile bearing (9.94%) implants (p=0.963).

Patella resurfacing resulted in lower lateral release rates when compared to patella retention (5.8% vs 13.8%; p=0.0131). This difference was most marked in the mobile bearing group where the lateral release rate was 16.3% with patella retention compared to 3.5% with patella resurfacing (p=0.005).

Introduction

The Bristol Knee Group has prospectively followed the results of over 500 isolated patellofemoral arthroplasties. Initial experience with the Lubinus prosthesis was disappointing. The main causes of failure were mal-tracking and instability leading to excessive polythene button wear and disease progression in the tibio femoral joint.

This experience resulted in the design of a new prosthesis to correct the tracking problems and improve the wear. We have now performed over 425 Avon arthroplasties with a maximum follow-up of 9 years.

Results

Survivorship at 5 years and the functional outcome have been reported with 95.8% survivorship, and improved function with Oxford score from 18 to 39 points out of 48. There have been 14 cases with mal-tracking (3%). Several of these cases have required proximal or distal realignment with the Elmslie or Insall procedures. Two knees with patella alta required distalisation of the tibial tubercle. Symptomatic progression of the arthritic disease in the medial or lateral tibio-femoral compartments has occurred in 28 cases (7%) causing recurrent joint pain. Radiographic follow-up has shown a higher rate of disease progression emphasising the importance of careful assessment of patients prior to operation.

We have investigated 8 cases of persistent unexplained pain. Analysis of these cases suggests 3 possible causes. An extended anterior cut leading to overstuffing, insufficient external rotation and over sizing of the femoral component leading to medial or lateral retinacular impingement. Six of these cases have been successfully treated by revision of the femoral component leading to dramatic resolution of the symptoms.

Purpose

We report on minimum 2 year follow-up results of 71 patients randomised to autologous chondrocyte implantation (ACI) using porcine-derived collagen membrane as a cover (ACI-C) and matrix-induced autologous chondrocyte implantation (MACI) for the treatment of osteochondral defects of the knee.

Introduction

ACI is used widely as a treatment for symptomatic chondral and osteochondral defects of the knee. Variations of the original periosteum-cover technique include the use of porcine-derived type I/type III collagen as a cover (ACI-C) and matrix-induced autologous chondrocyte implantation (MACI) using a collagen bilayer seeded with chondrocytes.

Introduction

The treatment of distal femoral cartilage defects using autologous chondrocyte implantation (ACI) and matrix-guided autologous chondrocyte implantation (MACI) is become increasingly common. This prospective 7-year study reviews and compares the clinical outcome of ACI and MACI.

Methods

We present the clinical outcomes of 159 knees (156 patients) that have undergone autologous chondrocyte implantation from July 1998. One surgeon performed all operations with patients subsequently assessed on a yearly basis using 7 independent validated clinical, functional and satisfaction rating scores.

Aims

To investigate (1) The relationship between macroscopic grading and durability of cartilage repair following collagen-covered autologous chondrocyte implantation (ACI-C) in the knee; (2) The influence of histology on durability of cartilage repair; (3) The relationship between macroscopic appearance and histology of repair tissue.

Patients and methods

The modified Cincinnati scores (MCRS) of eighty-six patients were evaluated prospectively at one year and at the latest follow-up (mean follow-up = 4.7yrs. Range = 4 to 7 years). Needle biopsies of their cartilage repair site were stained with Haematoxylin and Eosin and some with Safranin O and the neo-cartilage was graded as hyaline-like (n=32, 37.2%), mixed fibro-hyaline (n=19, 22%) and fibro-cartilagenous tissue (n=35, 40.7%). Macroscopic grading of the repair tissue using the international cartilage repair society grading system (ICRS) was available for fifty-six patients in the study cohort. Statistical analyses were performed to investigate the significance of histology and ICRS grading on MCRS at 1 year and at the latest follow-up.

Objective

The aim of this study was to assess the results of combined arthroscopically assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in patients with chronic (3 months or more) symptomatic instability and pain.

Patients & methods

A retrospective analysis of all the patients who had a combined reconstruction of the posterior cruciate ligament and the posterolateral corner between 1996 and 2003 was carried out. Nineteen patients who had the combined reconstruction were identified from the database. All the patients were assessed pre- and post-operatively by physical examination and three different ligament rating scores. All the patients also had weight bearing radiographs, MRI scans and an examination under anaesthesia and arthroscopy pre-operatively. The PCL reconstruction was performed using an arthroscopically assisted single anterolateral bundle technique and the posterolateral corner structures were reconstructed using an open Larson type of tenodesis.

Aim

To assess the efficacy and ease of use of the Oxford Knee Score (OKS) in soft tissue knee pathology.

Method

In a prospective study, we compared the OKS against the International Knee Documentation Committee 2000 (IKDC) and the Lysholm Scores (Lys). We also assessed the OKS with retrograde (Reversed OKS: 48=worst symptoms, 0=asymptomatic) and antegrade (as currently used in Oxford) numbering. All patients completed 3 questionnaires (OKS, Lys, and IKDC, or RevOKS, Lys, and IKDC) stating which was the simplest from their perspective. We recruited 93 patients from the orthopaedic and physiotherapy clinics. All patients between the ages of 15 and 45 with soft tissue knee derangements, such as ligamentous, and meniscal injuries were included. Exclusions were made in patients with degenerative and/or inflammatory arthritidis. Patients who had sustained bony injuries or underwent bony surgery were also excluded.