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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_11 | Pages 27 - 27
1 Jun 2016
Barrow J Panchani S Boden R Chitre A Porter M Gambhir A Board T
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Introduction

A recent paper suggested implanting an uncemented acetabular shell which is 6mm or greater than the native femoral head in total hip arthroplasty (THA) significantly increased the risk of postoperative pain. We retrospectively analyzed 265 Delta ceramic-on-ceramic (DCoC) THA comparing the native femoral head size to the implanted shell and reviewing if the patient suffered with post-operative pain (POP).

Methods

265 consecutive THAs were performed using the Corail and Pinnacle prostheses with DCoC bearing. Native femoral head size was calculated retrospectively on pre-operative radiographs using TraumaCad software. All patients were sent questionnaires requesting information on satisfaction, sounds, postoperative pain and complications. Statistical analysis was then undertaken on the data.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 180 - 180
1 Sep 2012
Banks D Boden R Mehan R Fehily M
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Background

Magnetic resonance arthrography is the current method of choice for investigating patients with a clinical diagnosis of femoroacetabular impingement prior to performing hip arthroscopy. The aim of our study was to assess the efficacy of this investigation by comparing the findings of MR arthrogram with those found at arthroscopy, with reference to labral tears and chondral damage.

Methods

A prospective trial to investigate the sensitivity, specificity, accuracy and predictive value of MRA for diagnosis of labral tears and chondral defects. Over a 25-month period 69 hips undergoing hip arthroscopy were investigated with MRA prior to the definitive operative procedure. MRA findings were compared to the intraoperative findings.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 150 - 150
1 Sep 2012
Boden R Nuttall G Paton R
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Background

The optimal management of idiopathic clubfoot has changed over three decades. Recently there has been an enthusiastic embracing of the Ponseti technique. The purpose of this 14-year comparative prospective longitudinal study was to directly assess the differences in results between these two treatment methods.

Methods

Over the period of this study there were 52,514 births in the local population and all newborns with clubfoot were referred directly to the Pediatric Orthopedic Surgeon. Patient demographics, the Harrold & Walker Classification, and associated risk factors for clubfoot were collected prospectively and analyzed. If conservative treatment failed to correct the deformity adequately, a radical subtalar release (RSR) was undertaken (the primary outcome measure of the study).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 475 - 475
1 Sep 2012
Choudhry M Boden R Akhtar S Fehily M
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Background

Femoroacetabular impingement (FAI) may be a predisposing factor in progression of osteoarthritis. The use of hip arthroscopy is in its infancy with very few studies currently reported. Early reports show favourable results for treatment of young patients with FAI. This prospective study over a larger age spectrum represents a significant addition to this expanding field of minimally invasive surgery.

Methods

Over a twenty-two month period all patients undergoing interventional hip arthroscopy were recorded on a prospective database. Patient demographics, diagnosis, operative intervention and complications were noted. Patients were scored pre-operatively and postoperatively at 6 months and 1 year using the McCarthy score.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 138 - 138
1 Mar 2012
Boden R Burgess E Enion D Srinivasan M
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Background

Successful use of bioabsorbable anchors for capsulolabral and rotator cuff repair is well documented. The bioknotless anchor (DePuy mitek) has demonstrated reliable fixation of these pathologies. However, this poly (L-lactide) polymer has recently demonstrated some similar complications to those documented for the earlier polyglycolic acid implants; namely synovitis and chondral damage with osteolysis. We report three cases with osteolysis and chondral damage associated with bioknotless anchors.

Methods

A prospective record of shoulder arthroscopy is maintained by the senior author. From this, three patients with post-operative complications of arthropathy and osteolysis, following bioabsorbable anchor repair of capsulolabral lesions were identified. A retrospective review of case notes, radiographs, operative records and intraoperative video and photographic material was undertaken.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_VI | Pages 10 - 10
1 Mar 2012
Boden R Paton R
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Purpose of study

The results clinically & statistically of a 14 year longitudinal study comparing the traditional ‘stretch & strap’ method (1994-2002) with the Ponseti technique (2002-2008)

Methods & Results

A 14 year prospective longitudinal comparative study was undertaken into management and outcome of CTEV. There were 114 feet (80 patients), 64 feet (45 patients) treated traditionally and 50 feet (35 Patients) with the Ponseti technique. Patient demographics, the Harold & Walker Classification, and associated risk factors for CTEV were analysed. If conservative treatment failed a radical sub-talar release operation (RSR) was undertaken.

The incidence of fixed CTEV was 1.6 per 1000 live births with a male to female ratio of 2.8 to 1. Idiopathic CTEV was present in 77.5% of patients, (22.5% with a primary aetiology). Mean time to RSR was comparable: 37.43 weeks (CI: 33.65 to 41.21) and 46 weeks (CI: 39.18 to 52.82) for the traditional and Ponseti groups respectively. In the traditional group 65.6% (CI: 53.4 to 76.1%) of feet underwent RSR surgery compared to just 25.5% (CI: 15.8 to 38.3%) in the Ponseti group, When idiopathic CTEV was analysed separately these rates reduce to 56.5% (CI: 42.3 to 69.8%) and 15.8% (CI: 7.4 to 30.4%) respectively. The Relative Risk of requiring RSR surgery in traditional compared to Ponseti groups was 2.58 (CI: 1.59 to 4.19) for all patients and 3.58 (CI: 1.65 to 7.78) for idiopathic CTEV (statistically significant). The results of the Ponseti method improved with time suggesting a learning curve.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 21 - 21
1 Jan 2011
Boden R Whitehouse S Kalale P Ilango B
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In the current climate of increasing financial pressures and reducing bed numbers, a predictor of length of stay (LOS) may have a bearing on hospital finances. Independent sector treatment centres may also skew the ASA grade and co-morbidity of the patient group treated in a hospital setting. We performed a study of 100 consecutive patients undergoing Total hip or knee arthroplasty between April and September 2006.

Median age was 71 years (35 – 88) with 75% of patients having significant (cardiac, renal or respiratory) pre-existing medical conditions (24% with 3 or more conditions). Average ASA grade was 2 (15% grade 3) and average BMI was 30. A significant reduction in LOS from 8.47 to 5.87 days was seen in under 70 year olds when compared with those over 70 years (p = 0.0004), having 3 or more co-morbidities (compared with 2 or less) increased average LOS from 6.61 days to 9.3 days (p = 0.002), ASA grade of 3 increased LOS to 9.56 days from 6.27 and 6.87 for grade 1 and 2 respectively (p = 0.014) and living alone (compared with cohabiting) increased LOS from 6.55 days to 9.19 days (p = 0.0017). However no statistical significance was seen for BMI with an average of 7.19 days for < 30 and 7.37 days for patients with BMI of 30 or above (p = 0.82)

Regardless of this patient group being elderly and obese with significant co-morbidity, an acceptable outcome was seen, with 70% of patients discharged within 7 days and only 4% staying > 14 days. Although BMI did not predict outcome, number of co-morbidities, ASA, age greater than 70 years and living alone all demonstrated a significant increase in LOS. Increased resources in this at risk group within a pre-admission setting could reduce length of hospital stay.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 161 - 162
1 Mar 2006
Stott P Day A Boden R
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Background: The use of sacro-iliac screws to restore the stability of posterior pelvic ring dissociations has become a standard technique. Several methods are described including fluoroscopy, CT and computer assisted techniques. Fluoroscopically assisted insertion is the standard technique. Multiple exposures of ionising radiation permit acquisition of a target in sequential planes, requiring a process of interpolation for 3-D localisation. A computer assisted technique facilitates the simultaneous visualisation of multiple planes following a single image intensifier acquisition and registration process in each plane. The purpose of this study is to demonstrate the accuracy of a computer assisted surgery technique and quantify the predicted reduction in radiation exposure.

Methods: 10 embalmed human cadavers were used. In each specimen, a sacro-iliac screw was simulated by passing a 5mm reamer over a 3.2mm guide wire. The index track was formed with a closely sheathed 4.8mm drill and was inserted with the standard fluoroscopically assisted technique in the left hemipelvis and a computer assisted technique(Vector Vision trauma) on the right. Registration of the system is achieved by the placement of infra red reflective arrays on all tracked objects. These include the right and left hemi-pelvis, the fluoroscope, the drill guide and the driver unit. The system is an open platform which registers arrays of known geometry whilst permitting the registration of instruments by means of an instrument calibration matrix. The pelvic T and Y pattern fiducials are fixed rigidly to inter-table threaded pins at the level of the gluteal tuberosities. The standard acquisition projections are inlet and outlet views for both techniques with the addition of lateral projections although the latter were not directly used for navigation. Postoperative CT scans demonstrate the actual tracks and analysis is facilitated by means of a digital mapping technique.

Results: The accuracy of the fluoroscopically assisted and computer assisted techniques is identical. The procedure time was significantly longer for the computer assisted technique although most of the additional time was accounted for by the “line of sight” registration process. There was a reduction in both the total screening time and the measured radiation dose in the case of the computer assisted technique although this did not reach statistical significance as the sample size is relatively small.

Conclusions: The navigation of sacro-iliac screw tracks by means of both fluoroscopically assisted and computer assisted techniques proves equally accurate in a human cadaveric model.