Aims

Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) have both been shown to be effective treatments for osteoarthritis (OA) of the knee. Many studies have compared the outcomes of the two treatments, but less so with the use of robotics, or individualized TKA alignment techniques. Functional alignment (FA) is a novel technique for performing a TKA and shares many principles with UKA. Our aim was to compare outcomes from a case-matched series of robotic-assisted UKAs and robotic-assisted TKAs performed using FA.

Keywords

Shoulder; dislocation; instability; skeletal immaturity; arthroscopic Bankart repair; outcomes

Introduction

The purpose of this study was to comprehensively evaluate syndactyly correction. Patient selection, complexity, technique and aftercare are compared with scar quality, web-creep, hand function and patient satisfaction.

Background: Arthroscopic menisectomy is one of the most commonly performed procedures in the NHS, yet there is no recent review of contemporary knee arthroscopy for meniscal tears or comparisons of tear morphology and clinical findings. We aim to address this problem with a large, prospective longitudinal study.

Aims: The aims of this study were to examine the anatomical location and morphology of meniscal tears encountered at arthroscopy and to correlate this to the clinical findings.

Method: Data on 775 consecutive patients undergoing knee arthroscopy by a single surgeon between 1994 and 2004 was prospectively collected. Clinical data included age, sex, history of trauma, joint line tenderness and presence of an effusion. Meniscal tears were arthroscopically classified by site (medial/lateral, anterior/middle/posterior) and type (flap, horizontal cleavage, bucket-handle, radial, degenerative and other).

Results: Data was complete for 724 patients (517 male and 207 female [m:f 2.5:1]). The mean age was 48 years (range 10 to 87 years). Mean duration of symptoms was 8 months.

54% of meniscal tears were medial, 12% lateral and 10% bilateral. Patients with a lateral tear were significantly younger (45 Vs 51 yrs, p< 0.001).

The most common type of medial tear was a flap tear (34%), followed by horizontal cleavage tears [HCT] (18%). The posterior 1/3 is the most common position. Laterally the tear morphology shows HCT comprising 25% and degenerative tears 17%, with the most common position a middle 1/3 tear. Lateral tears are more common in females (p< 0.05)

Patients with bucket handle tears were significantly younger (41 Vs 53yrs, p< 0.001) and more likely to have a history of trauma (p< 0.001). Medial joint line tenderness was the most sensitive test (79%) and had the highest positive predictive value (81%). McMurry’s test is the most specific for both medial and lateral tears (90%) but is not sensitive. Medial meniscal tears are more accurately diagnosed clinically than lateral (79% Vs 50%).

Conclusion: Meniscal tears are a common pathology, particularly on the medial side. Morphology and position of tears vary as to which side the tear is. Clinical details can help determine the type of tear found with clinical examination being more accurate for medial meniscal tears.

We examined rates of MRSA wound infection in patients admitted to the Leicester Royal Infirmary Trauma Unit between January 2004 and June 2006. The influence of MRSA status at the time of their admission, together with age, sex and diagnosis were examined using multivariant analysis.

3.2%(79/2473)) were MRSA carriers at time of admission and 96.8%(2394/2473) were MRSA negative. Those carrying MRSA at the time of admission were more likely to develop MRSA surgical site infections [8.8% (7/79)] as compared to non MRSA carrier at the time of admission [2.2% (54/2394), p< 0.001]. Further analysis revealed that hip fracture and increasing age (linear increase in relative risk of 1.8% per year) were also risk factors.

MRSA carriage at admission, age and pathology are all associated with an increased rate of developing MRSA wound infections. Identification of such risk factors at admission helps to target health care resources such as the use of glycopeptides at induction and increased vigilance for wound infection in the post operative phase

A consecutive group of 150 patients undergoing primary TKA performed by a single surgeon using single prosthesis were studied prospectively. The purpose of this study was to compare the clinical and radiographic results of TKA in obese and non-obese patients.

The patients were categorized into two groups: non-obese (body mass index (BMI < 30 kg/m2) and obese (BMI > 30 to 40 kg/m2). The Primary outcome measures: SF-12 and WOMAC scores were used as generic outcome measures, and the Knee Society scores were used to assess clinical outcome of TKA. The scores were done pre-operatively and at 1, 3 and 5 years post-operatively. Secondary outcome measures included patellar position, anterior knee pain, infections, revision rates, deep-vein thrombosis and pulmonary embolism, length of hospital stay and mortality.

Seventeen patients have died since and none were lost to follow-up. Obese patients had less benefit and overall KSS outcome scores at one year (p-value 0.05) but had similar scores at 3 and 5 years (p-values 0.3 and 0.5). Pre-operative WOMAC and SF-12 scores were significantly worst in obese patients (p-value 0.009 and 0.005) but had the similar outcome at 1, 3 and 5 years. Three patients in the series required revision surgery for infection. One patient had DVT and another had PE post-operatively.

Overall obese patients although had lower KSS scores at one year but had better outcome in SF-12 and WOMAC scores at one year. There was no difference at 3 and 5 years. We found that body weight did not influence adversely the outcome of TKA at medium term.

Background: Clostridium difficile (C diff) diarrhoea is a growing UK hospital problem. However, it is controversial whether patients die with C diff or of C diff. A series of infection control measures were introduced from August 2006 onwards to reduce the rate of C diff infection and to treat patients suffering from diarrhoea. These included a five-day antibiotic stop policy, a diarrhoea treatment policy, a hand washing campaign, increased investment in environmental cleaning and a change in policy for antimicrobial prophylaxis to coamoxiclav instead of cefuroxime. The aim of this study was to assess the impact of these measures on the incidence of C diff infection and to record the mortality associated with C diff. Fracture neck of femur patients were chosen as they are at particular risk.

Method: We assessed data on orthopaedic admissions in particular fracture neck of femur patients, C diff samples, and mortality up to one year. The incidence of C diff was compared between fracture neck of femur patients and other orthopaedic admissions and also before and since the introduction of the infection control policies. This was followed by a comparison of mortality between C diff positive patients and a control group matched by age, sex, ASA grade and place of residence. Mortality data was at 30days, 6 month and 1 year.

Results: Clostridium difficile was much more common in patients with fracture neck of femur (72 out of 1800, 4%) than in other orthopaedic admissions (51 out of 10000, 0.5%, p < 0.001). The incidence of C diff in patients with fracture neck of femur decreased from 49 of 548 (9%) in the 9 months pre-policy to 28 of 562 (5%, p=0.009) in the 9 months since policy Introduction: In those with C diff, mortality at 30 days and 6 months was 10/49 (20%) and 35/49 (71%) pre-policy and 9/28 (32%) and 20/28 (71%) since policy Introduction: Regardless of policy introduction, the overall mortality in 168 C diff positive patients at 30days, 6 months and 1 year was 31 (19%), 112 (67%) and 117 (70%) whilst that in the 168 matched controls was 19 (11%), 43 (26%) and 48 (29%).

Conclusion: The matched group data indicates that C diff increases mortality. It does not simply colonise the most frail. The percentage of deaths in C diff positive patients was no different after the diarrhoea treatment policy Introduction: The incidence of C diff was reduced by 43% using infection control measures. Our results indicate that the best way to reduce mortality due to C diff is to reduce the incidence, our current treatment policy was ineffective or in other words, ‘prevention was better than cure’. We recommend that similar measures could be introduced in other orthopaedic units in order to reduce the incidence and mortality in fracture neck of femur patients from Clostridium difficile.