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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 550 - 550
1 Sep 2012
Singisetti K Raju P Langton D Nargol A
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INTRODUCTION

A detailed clinical examination and investigations are required to evaluate the cause of persisting groin pain following a metal on metal (MoM) hip replacement. Adverse reaction to metallic debris (ARMD) is an emerging problem with MoM hip replacements. It is an umbrella term encompassing metallosis, pseudo-tumors and aseptic lymphocytic vasculitis associated lesions (ALVAL). The role of imaging in the diagnosis of this complex problem is still unclear. A study was undertaken to evaluate the efficacy of ultrasound in diagnosis of ARMD following a MoM hip replacement.

METHODS

The study group included 35 patients with a clinical and histological diagnosis of ARMD, who had a preoperative ultrasound. All ultrasound procedures were performed on the anterior and lateral aspects of the painful hip with a high frequency probe of 9–13 MHz (Sonoline Antares – Siemens).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 90 - 90
1 Jun 2012
Lakkol S Taranu R Raju P Trewhella M Dennis R Reddy G Friesem T
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Aim

The purpose of this study is to compare the pre and post-operative magnetic resonance image clarity of titanium and PEEK based cervical arthroplasty devices at the level of implantation and adjacent level discs.

Methodology and Results

This is a prospective, blinded, randomised study on imaging of cervical arthroplasty devices. The pre and postoperative MRI images of 16 patients who underwent cervical arthroplasty using Prestige LP(r) (Medtronic Sofamor Danek) and NuNec(tm) Cervical Arthroplasty System (Pioneer Surgical Technology, Marquette, Mich., USA) were assessed. Two independent radiologists who were blinded and provided with a sets of random images to score using a four point Jarvick grading system. Statistical analysis was completed using SPSS 16.0 statistical package (SPSS Inc, Chicago, IL) and analysis included comparing MR image quality before and after cervical arthroplasty at the operated and adjacent levels, and in between two types of implant.

The pre-operative MR image quality at operated and adjacent levels was excellent in both groups. In the post-operative images, the adjacent level visualisation was adequate in both groups without much difference in average scores. However, at operated level, the quality of MR images in the NuNec group (PEEK on PEEK articulating disc) was excellent and clear visualisation of the cord, central canal, foramen and disc.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 360 - 360
1 Jul 2008
Alshryda S Tripurneni V Vinayagam R Raju P Bayliss NC
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Background: One stop shoulder clinic was established in the North Tees University Hospital as part of conjoint effort between the department of trauma and orthopaedics and radiology in the year 2005. A consultant shoulder surgeon, consultant radiologist, extended scope shoulder physiotherapist and shoulder nurse practitioners run the clinic on weekly basis.

The aims are:

Immediate and more accurate diagnosis and plan accordingly.

Avoid unnecessary or inappropriate treatment while waiting for radiological test.

High patient satisfaction.

Reduce waiting time for definitive treatment.

Reduce number of patients’ visits.

Improve and advance clinical and radiological skills.

Reduce the cost to the NHS.

Promote a multi-disciplinary approach to patient healthcare.

Methods and materials: A retrospective study of 150 patients who had been seen in the one stop shoulder clinic and conventional clinic. We studied the number of hospital visits, the waiting time for final intervention and or discharge, the accuracy of initial diagnosis and treatment and the cost-benefit analysis.

Results and discussions: One-stop clinics have been successfully established in a few fields of medicine. One stop breast lump clinic has been running for almost 10 years with a very good reputation of rapid, accurate and cost-effective diagnosis of breast lumps. Similar successful examples have been emerged in gynaecology such as fertility clinic and uterine bleeding clinic; and in urology such as haematuria clinic. To our best knowledge, this is the first study that investigated the one-stop clinic in shoulder problems. Our results showed similar trend of success in term of reduction of patients’ hospital visits, waiting time to treatment and accuracy of the diagnosis. We also conducted a cost-benefit analysis of the one stop shoulder clinic in comparison with the conventional shoulder clinic and we concluded that it is cost effectiveness.