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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_19 | Pages 23 - 23
1 Nov 2016
Johnson-Lynn S Cooney A Ferguson D Bunn D Gray W Coorsh J Kakwani R Townshend D
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Platelet rich plasma has been advocated for the treatment of plantar fasciitis but there are few good quality clinical trials to support its use. We report a pilot double blind randomised controlled trial of platelet rich plasma versus normal saline.

Methods

Patients with more than 6 months of MRI proven plantar fasciitis who had failed conservative management were invited to participate in this study. Patients were block randomised to either platelet rich plasma injection (intervention) or equivalent volume of normal saline (control). The techniques used for the injection and rehabilitation were standardised for both groups. The patient and independent assessor were blinded. Visual analogue scale for pain (VAS) and painDETECT were recorded pre-op and at 6 months.

Results

Twenty-eight patients (19 females, mean age 50 years) were recruited, with 14 randomised to each arm. At 6 month follow-up, 8 patients (28.6%) were lost to follow-up. There was a significant change in VAS score from baseline to follow-up in both intervention (mean change 37.2, p = 0.008) and control (mean change 42.2, p = 0.003) groups. However there was no difference between the arms in terms of the change in VAS score from baseline to follow-up (p = 0.183). There was no correlation between pre-op PainDETECT score and change in VAS.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 79 - 79
1 Jul 2012
Kazi Z Cooney A Caplan N Newby M Gibson ASC Kader D
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Statement of purpose

To determine whether the Q-angle, measured in a defined and reproducible manner, correlates with the TT-TG distance in patients with patellar instability.

Methods and results

The Q-angle represents the angle between the vector of action of the quadriceps and patellar tendon. The normal angle is 14+/−3° in males and 17+/−3° in females. An increased Q-angle is associated with an increased risk of patellar instability, although there is disagreement on its reliability and validity. It can be affected by the anatomical points used to record the measurement, the position of the limb and whether the quadriceps are relaxed or contracted. TT-TG is ascertained by axial CT scanning, with a value exceeding 20mm associated with patellar instability.

Q-angles were measured in patients presenting to the patella clinic who had previously undergone Lyon protocol CT scanning for patellar instability. Patients were positioned supine with both feet in neutral rotation taped to a specially designed wooden board (the same position used for CT scanning). The anatomical landmarks were the anterior superior iliac spine, the centre of the patella and the centre of the tibial tuberosity. Both knees were measured with the quadriceps relaxed (relaxed Q-angle) and contracted (contracted Q-angle).

Thirty-four knees were measured, 24 pathological and 10 non-pathological. Pearson moment correlation demonstrated a significant correlation between relaxed Q-angle and TT-TG in all knees (R=-0.377; p=0.028). In pathological knees, contracted Q-angle also demonstrated a significant correlation with TT-TG but to a lesser extent than relaxed Q-angle (R=-0.428; p=0.037, R=-0.578; p=0.003 respectively). Linear regression analysis demonstrated relaxed Q-angle as a significant predictor of TT-TG distance in pathological knees. Contracted Q-angle was not significant.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XI | Pages 24 - 24
1 Apr 2012
Wilkinson A Cooney A Chappell A
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In recent years the majority of X-ray departments have moved to a digital format of recording and archiving radiographs. These digital images (as with previous ‘films’) have a built in magnification factor (variable with each patient), which, may cause errors in templating for joint replacement surgery. Placing a marker of known size at the same level as the joint in question allows calculation of the magnification. This may help to restore hip offset in total hip replacement.

To establish the magnification factor for digital radiographs taken in our unit.

To assess the usefulness of marker images in accurate preoperative templating. Preoperative marker radiographs were identified retrospectively. The apparent size of the marker was measured on digital image. This value was used to calculate the magnification of the image. The scaled X-ray was up loaded to a digital templating software programme. This software uses a ‘scaling tool’ to calculate the magnification of the image. The hip joint templating tool was the used to calculate the offset of the proximal femur, this was performed with the calculated magnification and also an assumed magnification of 120%. The recommended offset of Exeter V40 stem was noted for both values.

Images were identified for 40 patients with markers. The average magnification was 122% for both PACS and Orthoview with a range 113% – 129% and a standard deviation of 4%. The median value for magnification was 120%. The average change in offset between calculated and estimated magnification was 1.275mm with a maximum change of 3mm. In two cases this difference resulted in a change in the recommended offset (5%).

The use of marker radiographs is widely described. In this small series the magnification is the same as previously reported in other studies. The difference in offset between calculated and estimated magnification was relatively small and caused a change in the recommended offset in only two patients. Variation in the use of the templating tool in our software can produce a much greater change in offset. Marker radiographs will only be useful as part of a standardised method of pre-operative templating.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 364 - 364
1 May 2009
Cooney A Kumar C
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Introduction: Hallux valgus corrective surgery is frequently performed, often with the administration of prophylactic antibiotics, although opinion is divided as to whether these antibiotics confer any benefit with little being published on the subject. The few papers that have been published suggest that there is no difference in infection rates, with the overall rate 1–2%.

Furthermore, the increasing incidence of multi-resistant bacteria is a concern to all. The Scottish Health Executive has identified the rationalisation of antibiotic prescribing as one of the principal means of reducing the development of these organisms.

Materials and Methods: All patients undergoing hallux valgus surgery via a first metatarsal osteotomy were included, excluding repeat surgery to the same foot. The operation performed, the use of prophylactic antibiotics and the incidence of postoperative infection were all prospectively recorded. Infection was defined using the Scottish Surgical Site Infection Surveillance criteria.

In addition, Orthopaedic Consultants in the west of Scotland were contacted asking whether they use antibiotics in hallux valgus surgery and what their perception of infection risk was.

Results: The study is currently ongoing. Currently, we have completed data for 64 patients (43 with prophylactic antibiotics, 21 without). Two patients developed a post operative infection both of whom had received prophylactic antibiotics.

Thirty-five consultants replied, of which 15 regularly performed surgery for hallux valgus. Prophylactic antibiotics were used by seven, with the average perception of infection risk 4%.

Discussion: The current results appear to support the literature in suggesting there is no difference in the incidence of infection between those receiving prophylactic antibiotics and those not. We aim to continue this study, aiming for over 100 patients.

Conclusion: Antibiotic prophylaxis during hallux valgus surgery does not appear to lower the risk of postoperative infection, with the overall risk of infection lower than what is generally perceived.