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Purpose

To clarify the true association with pathological DDH and ASC (asymmetrical skin crease).

Method

Between 1st January 1995 and 31st December 2015 all paediatric referrals with suspected hip instability were assessed in a one-stop DDH clinic. All patients had clinical and sonographic assessment with results prospectively recorded onto a database.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 26 - 26
1 May 2017
Hoggett L Anderton M Khatri M
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Background

Advances in surgical and anesthetic technique have resulted in a reducing length of stay for lumbar decompression, with the first day case procedure published in the literature in 1980. Current evidence suggests day case surgery is associated with improved patient satisfaction, faster recovery, reduced infection rates and financial savings. Following the introduction of a locally agreed day case protocol for lumbar microdiscectomy, we reviewed our 30-day postoperative complication rates.

Aims

To review postoperative complication rates for patients who underwent day case primary lumbar microdiscectomy.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 10 - 10
1 May 2017
Anderton M Hoggett L Khatri M
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Background

PROMs have become an integral assessment tool of clinical effectiveness and patient satisfaction. To date, PROMs for lumbar discectomy are not an NHS requirement, although voluntary collection via the British Spine Registry is encouraged. Despite this, PROMs for day case microdiscectomy is scarcely reported. We present PROMs for day case microdiscectomy at Lancashire Teaching Hospitals.

Aims

To review PROMs to quantify leg pain, back pain, EQ5D and ODI scores.

Evaluate PROMs data collection compliance.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 127 - 127
1 Sep 2012
Anderton M Ede MN Holt E
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Aims

Accurate knowledge of the normal shoulder range of movement (ROM) is imperative for evaluating pathology and clinical success. However, in orthopaedic texts, the quoted normal shoulder ROM has significant variation. Furthermore we suspect there is a high incidence of intra and inter observer error during shoulder ROM examination.

The aims of our study were thus:

To perform a literature review and record the published values for normal shoulder ROM. Subsequently, to calculate the average of these published values.

To perform visual and goniometer measurement of shoulder ROM in 10 volunteers and assess the agreement between the two methods.

Methods

A literature search of textbooks, Pub Med and scoring systems was undertaken. Statistical analysis was performed to identify the average value of shoulder movements. Two researchers (specialist trainees in T&O) prospectively assessed 20 shoulders in 10 healthy volunteers. Second observations were made after two weeks. Visual estimation and goniometry assessments were conducted. Bland Altman analysis was performed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 146 - 146
1 Apr 2012
Kanwar A Anderton M Peet H Wigfield C
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To assess concordance between hospital coding and clinician coding for patients undergoing spinal instrumentation procedures and determine if our coding systems result in accurate financial reimbursement from the primary care trust (PCT).

We conducted a one year retrospective review of 41 patients who underwent spinal instrumentation procedures. Data collected from IT systems included: operation description, clinician procedure code, hospital procedure code, Hospital Health Resource grouping (HRG), clinician HRG, instrumentation costs and PCT reimbursement fees. From this data we compared coding based re-imbursement fees and actual surgical costs, taking into account exact instrumentation prices.

In all cases the primary hospital and clinician coding values differed. Using the clinician code would have altered the HRG group in 16 patients. Using solely clinician coding would have generated less financial reimbursement than using hospital coding.

In 23 patients undergoing complex spinal procedures, instrumentation costs represented a significant proportion of the final fee obtained from the PCT, thus leaving a small proportion for the associated hospital stay costs. This suggests instrumentation costs are inadequately reimbursed from the PCT.

Hospital coding appears more accurate than clinician coding and results in greater financial reimbursement. On the whole, we found there to be insufficient reimbursement from the PCT. The variable and sometimes substantial cost of spinal instrumentation procedures results in inadequate reimbursement for many procedures. We feel the payment by results (PBR) scheme is suboptimal for such procedures and adequate reimbursement can only be achieved by direct billing on an individual case basis.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 294 - 294
1 Jul 2011
Anderton M Shah F Webb M Harvey I
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Introduction: Nerve conduction study (NCS) examination of the ulnar nerve is a diagnostic tool when investigating patients presenting with cubital tunnel syndomre (CTS). However, NCS are associated with a false negative rate. Decompressive surgery of the ulnar nerve remains the primary treatment of cubital tunnel syndrome. The aim of our study was to look at:

The correlation between the results of NCS and the subsequent outcome from surgery

Compare these results with a similar group of patients that underwent decompressive surgery without NCS.

Method: A retrospective study of 75 cases of CTS was undertaken. All patients had clinical examination with documentation of features, followed by NCS if indicated. If NCS were carried out, the results of the study was graded (negative, mild, moderate or severe). All patients had decompressive surgery of the ulnar nerve at the elbow. Operative functional outcomes was evaluated pre and post operatively using standard DASH score. A successful outcome was defined as resolution of symptoms.

Results: There were 53 men and 22 women. Patient age showed a normal distribution (range 26–84, mean 49 years). Overall, 65 patients (87%) had resolution of symptoms postoperatively and 10 patients (13%) had unresolved symptoms (5 sensory, 1 pain, 2 sensory & pain, 2 sensory & motor). Outcomes of patients that did not undergo NCS showed a resolution rate of 89% (24/27). Those that had a negative NCS, showed a resolution rate of 100% (12/12), whilst those that had a positive NCS showed a resolution rate of 81% (29/36).

Discussion: Our study highlighted that patients with electro-negative CTS can be effectively and safely treated by simple decompression. Surgical outcome can be correlated to the severity of the pre-operative NCS. There would seem no reason to refer patients for NCS prior to offering operative treatment.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 91 - 91
1 Mar 2009
GAJJAR S Anderton M Campbell D
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Aim: The dorsal flange stem was introduced following reports of stem fracture using the Charnley “flat-back” stem. This retrospective study reports the outcome using the Flanged Charnley stem in total hip replacement.

Materials and methods: Between January 1983 to December 1996, 1170 cemented total hip replacements (915 patients) were performed using the flanged Charnley stem. The main indications were osteoarthritis, rheumatoid arthritis and avascular necrosis. There were 532 females and 383 males aged 32 to 83 years (average 70.2 years). 612 patients were alive at an average follow-up of 16.6 years (9 to 22 years). All operations were performed by the trans-trochanteric or antero-lateral approach. Patients were evaluated using the Charnley’s modification of Merle d’Aubigne system.

Results: All patients had an improvement in function following the operation. Aseptic loosening of the stem was noted in 32 patients. Survivorship to revision of the femoral stem was 94% at 10 years (95% CI, 89%–99%) and 90% (95% CI, 81%–99%) at 15 years. The common complications included dislocation, wire breakage and trochanteric non-union. Femoral stem fracture resulted in 1 patient requiring stem revision.

Conclusion: The use of the Flanged Charnley stem in total hip replacement gives good long term outcome.