Fracture neck of femur (NOF) in elderly is a serious debilitating injury and has been presenting in increasing proportions. Some of these patients are unfortunate to come back with a contralateral injury. We attempted at looking into the incidence of these episodes in a cohort attending our trust and compared various parameters We retrospectively assessed our hospital theatre data for fracture NOF in patients over 60 years in the last 3 years. We reviewed their demographics, mode of injury, time to contralateral injury, incidence of any other insufficiency fracture, operative procedure and any complications. There were 1435 patients who underwent surgery for fracture NOF over the 3 years. Forty-three of these had bilateral fractures. Females had 3 times more incidence as compared to males; average age at first injury was 84 years and at contralateral side was 85 years. Time between the two injuries ranged from 20 to 855 days (Median 242 days). Almost equal incidence of intra / extracapsular fractures was noted. Contralateral fracture pattern (Intra vs Extracapsular) for the was similar in 34 patients. Twelve patients had an associated insufficiency fracture. Fracture NOF in elderly is a rising epidemic. Only 3% of these patients suffer a contralateral fracture NOF which usually occurs within a year. The fracture pattern is frequently similar to the first fracture in and hence similar implants have been used. Only 21% patients were on bone protection medications. It is rather difficult to identify this small group and hence prevent a second contralateral incident.
Total Knee Replacement (TKR) is one of the commonest elective arthroplasty operations. Crepe dressings are used following TKR by most surgeons as it may provide comfort and hemostasis through external pressure however, may reduce early range of motion (ROM). Avoiding crepe dressings after TKR saves operating time, avoids bulky dressings (which may reduce ROM) and allows interventions such as cryotherapy in the early post-operative period. There are no published studies comparing the use of crepe dressing after TKR with an impermeable dressing alone We did a retrospective study, analysing patients who had a TKR with the use of crepe dressings compared with patients who had an impermeable dressing alone. All patients had cruciate retaining PFC Implants through the medial para-patellar approach. We compared ROM (at initial physio contact and on discharge), rate of wound leakage, opioid requirements and duration of inpatient stay.Background of study
Materials and Methods
Outcomes for patients with acute illnesses may be affected by the day of the week they present to hospital. Policy makers state this ‘weekend effect’ to be the main reason for pursuing a change in consultant weekend working patterns. However, it is uncertain whether such a phenomenon exists for elective orthopaedic surgery. This study investigated whether a ‘weekend effect’ contributed to adverse outcomes in patients undergoing elective hip and knee replacements. Retrospectively collected data was obtained from our institutions electronic patient records. Using univariate analysis, we examined potential risk factors including; Age, Sex, ASA Grade, Comorbidities, as well as the day of the week surgery was undertaken. Subsequent multivariate analyses identified covariate-adjusted risk factors, associated with prolonged hospital stays. 30-day mortality data was assessed according to the day of the week surgery was performed.Background
Methods
Outcomes for patients with acute illnesses may be affected by the day of the week they present to hospital. Policy makers state this ‘weekend effect’ to be the main reason for pursuing a change in consultant weekend working patterns. However, it is uncertain whether such a phenomenon exists for elective orthopaedic surgery. This study investigated whether a ‘weekend effect’ contributed to adverse outcomes in patients undergoing elective hip and knee replacements. Retrospectively collected data was obtained from our institutions electronic patient records. Using univariate analysis, we examined potential risk factors including; Age, Sex, ASA Grade, Comorbidities, as well as the day of the week, hospital admission and surgery occurred. Subsequent multivariate analyses identified covariate- adjusted risk factors, associated with prolonged hospital stays. 30-day mortality data was assessed according to the day of the week surgery was performed. 892 patients underwent arthroplasty surgery from 01/09/2014 till the 31/08/2015. 457 patients had a total hip and 435 had a total knee replacement. 814 patients (91.3%) underwent surgery during the week, while 78 (8.7%) had surgery on a Saturday. There was no difference in the average Length of Stay (LOS) between groups (5.0, 2.6 versus 5.0, 3.4, p=0.95), and weekend surgery was not associated with a LOS greater than 4 days. The two variables found to be associated with a prolonged LOS were; increasing age (RR) 1.02 (95% CI: 1.01–1.03, p<0.001) and an ASA score of 2, (RR) 1.6 (95% CI: 1.15 − 2.20, p=0.005). There was one death in a patient who was ASA III, and who underwent surgery on a Monday. There is no ‘weekend effect’ for elective orthopaedic surgery. Changes in consultant weekend working patterns are unlikely to have any effect on mortality or LOS for elective orthopaedic patients.
We prospectively reviewed a consecutive series of 101 patients with mobile bearing total knee replacement (TKR) and 72 patients with the fixed bearing cruciate retaining TKR. Patients were assessed for diagnoses, range of motion, pre- and post-operative Oxford knee scores and complications. In the mobile bearing group of 113 knees in 101 patients, 97 had minimum 10-year follow up. By ten years, 16 patients had died of unrelated causes. Mean Revised Oxford Knee score improved from 16 pre-operatively to 42 at last follow up. The mean range of flexion was 115 degrees (75 – 130). One patient dislocated the bearing and needed manipulation. One patient reported superficial infection which resolved with antibiotics. One patient had deep vein thrombosis and one had non-fatal pulmonary embolism. In the fixed bearing group, 89 TKR's were performed in 72 patients. The mean age was 71.9 years and the mean follow up was 12.1 (10–14.1) years. 19 patients died during this study period. The mean range of flexion was 111.2 (80–135) degrees of flexion at latest follow- up. There was an improvement in the mean Oxford knee score from 16.2 preoperatively, to 42.5 to date. One patient required revision surgery at 12 years for polyethylene wear. One patient developed deep infection 10 years after the primary procedure but declined revision surgery. At ten years no revisions were performed in either group. This series has highlighted excellent results with both fixed and mobile bearing CR knees with hundred percent survival at ten years.
Severe deformity and bone loss in patients with degenerative changes of the knee present a challenging surgical dilemma to the knee surgeon. We present the outcome following complex primary total knee replacements at our unit over 12 years undertaken by a single surgeon. 65 patients were followed up prospectively with regards to their pre- and post-operative Oxford knee scores, diagnoses, preoperative deformity, bone loss, surgical technique, type of implant used, bone substitutes, and perioperative, or long term complications. These patients were followed up annually. 70 complex primary total knee replacements were performed in 65 patients. The mean age was 70.5 years and the mean follow up was 62.4 months. Sleeve/wedge augmentation, and stemmed implant (Sigma®TC3- DePuy) were used in general. Bone grafting was utilized for contained bone defects. All except 4 patients were allowed to fully weight bear immediately postoperatively. The mean range of flexion was 112.5 degrees at their last follow up. The mean preoperative Oxford Knee Score was 12.8, and 41.5 postoperatively. 89.4% of patients had either an excellent or good, and the rest a fair outcome. Radiological appearance has been satisfactory in all patients at subsequent follow up, with no evidence of implant loosening. None required revision surgery. 6 patients required blood transfusion postoperatively. 2 patents developed symptomatic deep vein thrombosis and a further 2 had pulmonary embolusMethod:
Result:
To undertake a biomechanical study to determine the existence of any difference in the early tibial component fixation to bone, between two widely used techniques of cementation, which may confer an influence on implant survival. 20 tibial saw bones were prepared by standard methods using extramedullary instrumentation to receive a fixed bearingtibial component (PFC, DePuy). Under controlled laboratory conditions, thetibial trayswere implanted with CMW cement using either of the two following cementation techniques (10 implants in each group): Full cementation–application of cement to the undersurface of the tibial tray, the keel, the cut surface of the tibia and its stem hole. Surface cementation – application of cement only to the undersurface of thetibial tray and the cut surface of the tibia. 72 hours after implantation, the fixation of the cemented components was assessed by determining the load to failure under controlled tensile stresses (using an Instron Electro-mechanical tensile tester).Aim
Method
This retrospective study evaluates the midterm results of the Rotating Platform PFC Sigma Total Knee Arthroplasty System. We reviewed 161 cases in 147 patients with an average follow-up of 5 years (4 to 7 years) operated on at our institution between June 2001 and June 2004. Patient outcomes were measured using the Oxford and American Knee Society Scores and radiographs underwent independent radiological evaluation. Average pre-operative Oxford Scores improved from 43(29-55) to 21 (13 - 44) postoperative;y and average Knee Society Scores improved from 57 (43-70) preoperatively to 80 (58-90) at last follow up. Range of movement improved from 91 degrees (70 - 110) to 113 degrees (75 - 130). There were 5 complications reported; one superficial infection treated with antibiotics, one patient required manipulation under anaesthesia at 3 months for post operative stiffness, which improved. There was one arthrotomy for dislocation of the bearing immediate postoperatively. There was one case of DVT and one non-fatal PE. There were no deep infections. The PFC Sigma Knee Rotating Platform system offers excellent mid-term results in our review.
