Abstract

Introduction

Periprosthetic cyst formation following ankle replacement, requiring revision surgery, has previously been reported. The exact pathogenesis of cyst formation is unclear but considered to be due to a combination of biological and mechanical factors. Our objective was to review the incidence of periprosthetic cyst formation following Mobility ankle replacement and their outcome.

Introduction

With increasing numbers of primary total ankle replacements being performed, the number of revision ankle surgeries is expected to rise also. We present the results of the revision procedures for failed Scandinavian total ankle replacements.

Introduction

The main symptoms in multiple myeloma are the result of skeletal destruction mainly the vertebral column. The current treatments for multiple myeloma include radiotherapy and chemotherapy but unfortunately it is still incurable. However, the symptoms and quality of life of these patients can be improved by cement augmentation which has gained popularity in the recent years.

Introduction

There is no established evidence to support the use of drains after total knee replacement; however 94% of orthopaedic surgeons in UK routinely use closed suction drains. Haematomas can form with or without using drains, presence of which in addition may provide portal for infection and may increase blood loss. Blood group and save is routinely performed for every patient undergoing total knee replacement, however actual cross match and transfusion is needed for a small percentage of patients.

To investigate the clinical effectiveness and complications of caudal epidural steroid injections in the treatment of sciatica in patients with an MRI proven sacral tarlov cyst.

A Prospective case control study. All patients with corresponding radicular pain received a course of three caudal epidural steroid injections, two weeks apart and patients were reviewed at 3 months, 6 months and 1 year interval in a dedicated epidural follow up clinic. Data including demographics, MRI results, diagnosis and complications were documented. Outcome measures included the Oswestry Disability Questionnaire (ODQ), the visual analogue score (VAS) and the hospital anxiety and depression (HADS) score.

Overall patient satisfaction was recorded on a scale of 0-10.

38 patients with a sacral tarlov cyst were compared to a matched control group. In the sacral cyst group, mean VAS for axial pain reduced from 5.859 to 2.59 at three months (p<0.001). VAS for limb pain reduced from 6.23 to 2.53(<0.005). Mean ODI reduced from 45.49 at first visit to 21.98 at 3 months. Mean HADS also improved from 17 to 7. There was no statistical difference between the two groups. BMI did not affect the outcome in either group.

Based on our study, we conclude that presence of a sacral tarlov cyst is not a contraindication to caudal epidural steroid injection, as comparable significant improvement in both axial and limb pain in the short and intermediate periods was achieved without any major complications.

Background: Aetiology of venous thromboembolism is multifactorial and thromboprophylaxis includes mechanical and chemical agents. There is no clear consensus on the choice of chemical agent in elective total hip arthroplasty (THA), although National Institute of Clinical Excellence (NICE) recommends low molecular weight heparin or fondaparinux to all patients.

Aim: The aim of our study was to define the efficacy and safety of various chemical agents currently used for venous throboprophylaxis – namely aspirin, warfarin and low molecular weight heparin in primary THA.

Methods: We retrospectively reviewed 905 consecutive patients with primary THA during an 18 month period. Medical notes were reviewed to record demographic data, inpatient and outpatient thromboprophylactic agents, total hospital stay, readmission, incidence of DVT, pulmonary embolism and death following surgery. Post-operative mobility, transfusion requirements and complications were noted. Suspected thromboembolic events were investigated with venous Doppler ultrasound scanning and CTPA.

Results: 417 (46%) patients received aspirin, 253 received enoxaparin, 190 patients had low dose warfarin and 45 patients had none or multiple agents for inpatient thromboprophylaxis. 615 patients had cemented and 290 patients received uncemented total hip arthroplasty. Patients predominantly received aspirin (61%) as outpatient prophylactic agent. 41 patients were investigated for a suspected thromboembolic event. 2 patients had DVT and 2 patients had PE. There were 3 deaths within 6 weeks, one each due to PE, sepsis and unknown cause. All 4 patients with thromboembolism were on enoxaparin for prophylaxis.

Conclusion: In our study aspirin was the preferred choice for thromboprophylaxis following total hip arthroplasty. We found that aspirin was most effective with no complications and enoxaparin was least effective. We advise the use of aspirin as the first choice drug for thromboprophylaxis as reiterated by some recent studies.

Background: Recent evidence suggests that surgical intervention with radiotherapy is superior to radiotherapy alone. Predicting the life expectancy is critical in decision making whether to go for palliative or definitive surgery.

Aim: To assess the accuracy of Modified Tokuhashi’s score (MTS) in predicting survival in patients with metastatic spinal tumours and cord compression; and to assess the incidence and role of early referral and diagnosis.

Material and Methods: In this retrospective study, we collected two years’ data. Medical record was reviewed for the source of referral, delay in symptom onset to diagnosis and treatment, types of tumours, Karnofsky score to assess patients’ disability, Modified Tokuhashi score to assess the expected survival and final outcome.

Results: 37 patients were included. Age ranged from 39 to 87 years(avg:64, median:66).30%(n=11) patients presented with cord compression and 70%(n=26) with instability pain. Cancer diagnosis had already been established in 57% cases off which 57% were referred from oncology and 43% from haematology. Remaining 43% patients were referred from GPs(68%) and medical specialties in the hospital(32%).51% patients presented early(< 3 months) and 22% presented late(> 6 months). Functional outcome improved in 58% patient following surgical intervention in early referral group(avg MTS:9.45) and improved in 61.5% patients in late referral group(avg MTS:9.5).

In patients with cord compression, average MTS was 6.6. Expected survival was < 3 months in 45.4% and 3–12 months in the remaining patients. 81%(n=9) patients of this group had surgical intervention resulting in satisfactory functional outcome in 36%. 3 patients had surgery done within 24 hours and another 4 within 72 hours(median:58).

In patients without cord compression, average MTS was 10.1. Expected survival was > 12 months in 84%. Surgical intervention was done in 84.6%(n=22) patients. 43% patients had posterior decompression and stabilisation with average MTS of 8.5 and satisfactory outcome in 56% patients. 13.5% patients had 2-stage anterior and posterior stabilisation with average MTS of 11.2 and satisfactory outcome in 100%. Average time from referral to definitive treatment was 17 days(mean:8, mode:8). Overall functional outcome was satisfactory in 84% patients.

30% patients died subsequently due to deterioration of their tumour-related problems with mainly Lung CA(36%) and Lymphoma(36%). Average MTS in these patients was 6.8. 5 patients died within 3 months of surgery.

Conclusion: Modified Tokuhashi score was consistent with patients’ expected survival and functional outcome. There was no major difference in functional outcome in relation to early or late referral. We conclude that Modified Tokuhashi score is helpful to make a decision for intervening surgically.