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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_17 | Pages 20 - 20
1 Nov 2017
Singh B Prasad R Bawale R Pillai D Mohanlal P
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Introduction

Adhesive capsulitis is a common condition causing painful limitation of shoulder movements. Hydrodistension is one of the techniques, is well recognised and has shown good outcomes. However, the results of hydro distension release in secondary adhesive capsulitis are not clear.

Patients and Methods

This is a retrospective study on patients undergoing hydro distension release. Patients who had any surgical intervention were classed as secondary whilst the rest were included in the primary group. The hydro distension is a standard technique where in the senior author locates the gleno humeral joint using radio opaque dye, followed by injection of 20 mls 0.5% L-bupivacaine and 80 mg of Triamcinolone, this is followed by use of 60 mls saline to perform the hydro distension.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_17 | Pages 16 - 16
1 Nov 2017
Singh B Bawale R Mohanlal P Prasad VR
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Aim

To see if minor upper limb surgery procedures like CTR, Trigger release, Joint injections are safe for a remote telephonic review by specialist nurse. This arrangement was to help maintain our current agreed departmental New to Follow up ratio of 1:1.56 and also to improve access to specialist clinics.

Methods

This was a prospective study. Patients undergoing minor procedures were informed about the remote follow up arrangements when placed on waiting list and on the day of surgery. Patients were assured access to clinic up to 3 months after procedure. A specialist nurse undertook a telephone consultation at 2 and 6 weeks using a proforma provided by the Consultant.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_17 | Pages 18 - 18
1 Nov 2017
Singh B Bawale R Sinha S Gulihar A Tyler J
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Introduction

A recent meta-analysis published in the British Medical Journal suggested an increased risk of infection, but none of the studies were large enough to reach statistical significance. A prospective, randomised trial was designed at our institution to investigate the wound healing and complications related to surgery following fracture neck of femur in the elderly.

Objectives

The primary aim was to compare the wound problems and infection following two different methods of skin closure: Subcuticular monocryl suture to metal clips for closure of skin. The secondary aim was to look at the duration of surgery after both types of closure. We received ethical approval for this study. We screened and recruited all eligible patients admitted with acute hip fracture undergoing hemi-arthroplasty or dynamic hip screw.

We recruited 541 patients in the study over the period of 3.5 years at our institution.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_10 | Pages 20 - 20
1 Oct 2015
Mohanlal P Bawale R Samsani S Jain S Joshi A Singh B Prasad R Pillai D
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Introduction

The MHRA guidelines for metal on metal (MOM) suggest cobalt and chromium levels of more than 7ppb as potential for soft tissue reaction. However, in some patients soft tissue reaction is seen even in the presence of normal serum metal ions levels.

Methods

A prospective review of all patients who had metal-on-metal hip arthroplasty was done. Patients who had both serum metal ion levels and MARS MRI scan were included in this study.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_10 | Pages 3 - 3
1 Oct 2015
Goyal A Pillai D Bawale R Singh B
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Introduction

One of the disadvantages of lateral decubitus position during arthroscopic rotator cuff repair is the difficulty to control arm rotation intraoperatively making it necessary to create additional portals for anchor placement or an additional scrubbed assistant to control arm rotation.

Methods & Technique

We describe the use of commercially available TRIMANO® support arm from Arthrex as an easy device for secure positioning during arthroscopic rotator cuff repair in lateral decubitus position. Though initially marketed to be used for shoulder arthroplasties performed in beach chair position, the senior author has used TRIMANO® to perform arthroscopic rotator cuff repair in lateral decubitus position. The device is easily connected to the operating table side rail while the affected side forearm of the patient is placed in a disposable sterile foam arm holder and attached to the TRIMANO® arm. The “Click and Move” system of the TRIMANO® allows freedom to move the arm in any direction and also provides traction to distract the joint if needed.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_10 | Pages 36 - 36
1 Oct 2015
Goyal A Pillai D Bawale R Singh B
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Accurate implant size estimation for internal fixation of long bone fractures can reduce intra-operative errors, operative time and radiation exposure. With the advent of pre-packed sterile implants, the exponential increase in the number of internal fixation devices and the lack of standard templates for them on PACS systems, templating has become increasingly difficult. This often results in the opening up of wrong implants leading to increased costs both in terms of increased operative time and additional implants. We describe a technique to determine implant size preoperatively using sterile implant boxes. Post anaesthesia and positioning, the pre packed implant box of approximate size is placed over the limb across the fracture site. An X-ray is then taken using the C-arm. In case of a plate, the number of holes desired on either side of the fracture, the shape of the implant and planned placement of screws are seen. Different implant boxes with the contained implant are placed and once the most appropriate implant for the particular fracture is reached, the box is opened and implant is kept ready for insertion. This technique has been found to be accurate, easy, reproducible and effective for estimating the implant size thereby decreasing the chances of opening wrong implants and saving the intra operative time substantially.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_10 | Pages 18 - 18
1 Oct 2015
Bawale R Samsani SR Jain S Joshi A Ahmed S Singh B Mohanlal P Pillai D Prasad R
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Background

Revision surgery for a failed metal on metal (MoM) hip arthroplasty is often unpredictable and challenging due to associated massive soft tissue and bony lesions. We present the analysis and early outcomes of revision surgery in failed MoM hip arthroplasties at our institution.

Methods

We have retrospectively analysed the findings and outcomes of revision surgery in 61 failed MoM hip arthroplasties performed between 2009 and 2014. These patients were identified in the special MoM hip surveillance pathway. All these patients underwent clinical assessment and relevant investigations. Intra-operative and histopathological findings were analysed.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_19 | Pages 32 - 32
1 Apr 2013
Bawale R Singh B
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Introduction

The wrist arthroscopy has been performed since 1979. With the advances in technology and surgical expertise, wrist arthroscopy has become third commonest procedure after knee and shoulder joint. Wrist arthroscopy has become a gold standard for diagnosing TFCC pathologies and other intercarpal disorders. Our aim was to compare the clinical, MRI and arthroscopic findings while treating various wrist pathologies.

Materials/Method

In retrospective trial, 30 patients (19 male and 11 female) with clinical evidence of wrist lesions were evaluated with MRI followed by wrist arthroscopy. The mean age of the patients at the time of outpatient appointment was 44 years with an average waiting time of 6.6 months. Inclusion criteria: all patients undergoing wrist surgery. Exclusion criteria: septic arthritis, acute distal radius fractures. Kappa analysis was used to compare the three methods of wrist pathology assessment. The total 30 patients were assessed for clinical findings, MRI report and corresponding arthroscopic findings.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 339 - 339
1 May 2010
Thomas G Faisal M Young S Bawale R Asson R Ritson M
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Background: There has been much interest recently in reducing the length of inpatient stay after hip and knee arthroplasty and much of the relevant literature has linked this to minimally invasive surgery. Orthopaedic departments are often under great pressure to reduce inpatient stay in order to increase throughput of patients. However it is incumbent on those of us responsible for patient care to ensure that systems are in place to maintain safety.

Patients and Methods:We looked at a 6 month period of early discharge with a dedicated ‘Accelerated Discharge Team’ (A.T.T.) at our institution. The team consisted of three nurses, two physiotherapists and two ‘technical instructors’. All patients undergoing hip or knee arthroplasty were assessed pre-operatively and post-operatively for admission to the care of the A.T.T. against fixed criteria. Patients were visited at home on the day of discharge and every day until released from the care of the team. 333 patients underwent lower limb arthroplasty during the study period of which 305 (91.6%) were admitted to the care of the A.T.T.

Results: The mean lengths of stay for primary hip and knee replacements were 3.43 and 3.30 days respectively. The mean for revision hip and knee were 5.75 and 3.29 days respectively. 66% (95% C.I. 57%–74%) of patients undergoing primary hip arthroplasty went home by 3 days and 91% (95% C.I. 85%–95%) by 4 days. 73% (95% C.I. 64%–81%) of patients undergoing total knee arthroplasty went home by 3 days and 93% (95% C.I. 87%–97%) by 4 days. The most common reasons for delay were: social reasons or living alone; low blood pressure or haemoglobin level; difficulty walking. Of the 305 patients, 12 (4%) were readmitted to hospital within 6 weeks of discharge, 2 of these patients (1%) were still under the care of the A.T.T. Almost 90% of patients responded to a satisfaction survey. 94.2% of those responding indicated that they would use the A.T.T. scheme again.

Discussion: Other authors have linked early discharge to minimally invasive surgery or to special anaesthetic/ analgesic techniques. It has also been shown that both carepathways and patient education protocols can reduce length of stay. In the year before implementing the A.T.T. the mean stay for primary hip and knee replacements was over 9 days. We were able to reduce this to less than 3.5 days for over 90% of our patients during the study period. This was achieved safely and without any special surgical or anaesthetic techniques. The total cost of the scheme was just under £100 000 for the 6 month period. We estimate that 2000 bed days were saved during the same period. This is cost effective on these terms alone. As well as transferring 12 elective orthopaedic beds to a different department we were able to perform an estimated 75 extra lower limb arthroplasties in the 6 month period.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 417 - 417
1 Sep 2009
Thomas G Faisal M Young S Bawale R Asson R Ritson M
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Aim To review 6 months of early discharge with a dedicated ‘Accelerated Discharge Team’ (A.T.T.) at our institution.

Patients and Methods The team consisted of four nurses and three physiotherapists. Patients undergoing hip or knee arthroplasty were assessed pre-operatively and post-operatively for admission to the care of the A.T.T. against fixed criteria. Patients were visited at home on the day of discharge and every day until released from the care of the team. 333 patients underwent lower limb arthroplasty during the study period of which 305 (91.6%) were admitted to the A.T.T.

Results The mean length of stay for primary knee replacements was 3.30 days. 73% (95% C.I. 64%–81%) of patients undergoing total knee arthroplasty went home by 3 days and 93% (95% C.I. 87%–97%) by 4 days. Results for hip arthroplasty were similar. Of the 305 patients, 12 (4%) were readmitted to hospital within 6 weeks of discharge. Almost 90% of patients responded to a satisfaction survey. 94.2 % of those responding indicated that they would use the A.T.T. scheme again.

Discussion In the year before implementing the A.T.T. the mean stay for primary hip and knee replacements was over 9 days. We reduced this to less than 3.5 days for over 90% of our patients during the study period. The total cost of the scheme was just under £100 000 for the 6 month period. We estimate that 2000 bed days were saved during the same period. This is cost effective on these terms alone. As well as transferring 12 elective orthopaedic beds to a different department we were able to perform an estimated 75 extra lower limb arthroplasty operations in the 6 month period.