Background

Total hip arthroplasty (THA) is increasingly used for active patients with displaced intracapsular hip fractures. Dislocation rates in this cohort remain high postoperatively compared to elective practice, yet it remains unclear which patients are most at risk. The aim of this study was to determine the dislocation rate for these patients and to evaluate the contributing patient and surgeon factors.

Aims

Interest in soft tissue Radiostereometric Analysis (RSA) is rising. Previous authors have tried, with varying levels of success, to use this technique to analyse the intra-substance portion of anterior cruciate ligament (ACL) graft constructs. These methods were either prone to large amounts of marker migration, deemed unsuitable for in-vivo use or, where alternative markers such as stainless steel sutures were used, lost the inherent accuracy that made RSA an attractive tool in the first place. We describe a modification of tantalum marker balls that allows for a new method of secure fixation to soft tissue in order to accurately analyse stretch, displacement and, potentially, dynamic movement using RSA.

Coccygectomy, surgical excision of the coccyx, may be used to treat coccydynia, a chronic and disabling condition of the lowest part of the spine. It is a controversial and infrequently performed operation that many surgeons are reluctant to perform due to the risks of rectal perforation and infection. The criteria for patient selection for coccygectomy remain ill-defined. We present a single surgeon case series of 17 patients who underwent coccygectomy for chronic coccydynia.

This was a retrospective observarional case series analysis. Case notes of 17 patients who underwent coccygectomy from 1999 -2009 were obtained and analysed. We then carried out telephone survey for which only 15 patients were contactable. We used the Milton Keynes Orthopaedic Patient Satisfaction survey and the modified Oswestry low back pain disability questionnaire.

All patients had a two to three year history of coccydynia; 15 following trauma, one following a caudal injection and one following birth delivery. All patients had received between one and five lignocaine/methylprednisolone injections prior to coccygectomy, with documented initial symptom relief. All 17 patients had documented hypermobile sacro-coccygeal joints. Post-operative symptom relief varied between 60% and 100%, with all patients reporting that they would have their surgery again. Complications included three post-operative wound infections. There were no cases of rectal perforation. Coccygectomy for intractable coccydynia is sometimes the only option available. With good patient selection, including identification of a hypermobile joint with initial symptom relief following local injection, coccygectomy is a successful and safe treatment.

We report the case of an 82-year-old man who underwent fasciectomy for a severe Dupuytren’s contracture, during which an ossified lesion was encountered within the contracture and surrounding the neurovascular bundle. The abnormal tissue was removed with difficulty and heterotopic ossification was confirmed histologically. We believe this is the first report of heterotopic ossification in Dupuytren’s disease.

Aim: To determine the effects of the different types of headgear on bacterial shedding in laminar flow theatres.

Material and Methods: Sham experiments were carried out using standard theatre clothing, sterile gowns and face masks with visors. Three experimental groups were utilised; no headgear (control), surgeons hoods or fabric balaclavas (known colloquially as “chicken hats”). The sham experiments consisted of two surgeons, scrubbed and gowned, both wearing the same headgear, talking and moving hands for 30 minutes over a sterile mock operating field. 5 bacterial plates were placed on the sterile sheets to capture shed bacteria. An additional 5 plates were placed above head height in the laminar flow enclosure. An air sampler was positioned within the laminar flow and set off for the middle 5 mins of the experiment. Plates were then incubated for 48hrs at 37oC and the number of colony forming units at head and waist height as well as in the air sampler were counted. Each experiment was repeated 5 times.

Results: The bacterial shedding rate at waist height was 0.2 CFUs/plate (314 CFUs/m2/hr) for the control experiment, 0 CFUs/plate (0 CFUs/m2/hr) for the surgeons hoods and 0.08 CFUs/plate (126 CFUs/m2/hr) for the fabric balaclavas.

Conclusion: These experiments show very low bacterial shedding rates with standard clothing and headgear in laminar flow theatres. Although these results demonstrate worse bacterial shedding with fabric balaclavas (which contradicts conventional thinking), the low rate of shedding rates means the results are not statistically significant. It therefore raises the question as to whether we should be using the more expensive fabric balaclavas without proven benefit, and the possibility of increased bacterial shedding.

The aim of this study was to review the outcome of semi-constrained total elbow arthroplasty (TEA) in osteoarthritis and compare it to the rheumatoid group. This was performed on a single-surgeon, single-prosthesis (GSB III) series of patients. Two groups of patients assessed. In the first group with the diagnosis of rheumatoid arthritis 40 replaced elbows in 31 patients (25 female and 1 male), with average age of 67 (range 49–82) were reviewed. The second group consisted of 14 elbows in 14 patients (9 female and 5 male) with post-traumatic osteoarthritis. Average age in this group was 71 (range 54–84). All patients were recalled for clinical review. Fresh radiographs obtained and compared to the immediate postoperative images. Mayo elbow performance (MEPS) and Liverpool elbow scores (LES) were used as the outcome measure. Kaplan-Meier survival analysis for the two groups was performed. The average follow up for the first group was 53 (range 20–90) and second group 60 months (range 21–103). According to the MEPS 87.1% of patients in group 1 and 63.6% in group 2 had excellent or good outcome. This different was not statistically significant (p=0.09). Only one patient from group one and none in group two had the joint revised. No significant difference was observed in MEPS of group one (86 ± 17) and group two (77 ± 24), (p=0.25). Also the LES in the two groups were not different (p=0.85) (group one 8 ± 1 vs. group two 8 ± 2). The outcome of TEA is satisfactory in both groups. No statistically significant difference was noted in the two groups. The recommendation of TEA in patients with osteoarthritis is supported by this study.

Aims: To review the results from a series of GSB III total elbow arthroplasties performed at an independent centre. Between 1996 and 2004 the senior author performed 58 total elbow arthroplasties in 44 patients (10 males, 34 females) using the GSB III implant. These were reviewed and the outcome assessed through the use of a patient-answered questionnaire and clinical and radiological review. Mean age was 65 (49 to 84 years). Indications for surgery included rheumatoid arthritis (46 elbows) and post-traumatic osteoarthritis (11 elbows). Mean F/up was 4.1 years (0.8 to 8.5 years). 4 patients had died (6 elbows) and 4 patients (4 elbows) were unavailable for review. 2 of the implants had been revised (1x aseptic loosening, 1x deep infection), leaving a total of 46 elbows available for review. The survival rate at a mean of 4 years was 98% with aseptic loosening as the endpoint. Complications included 1 case of intraoperative fracture and 1 persistent ulnar neuritis. Overall patient satisfaction was high. The mean Mayo Elbow Performance Score was 83 out of 100 (range, 34 to 100) and mean Liverpool Elbow Score was 8 out of 10 (range, 1 to 10).

Conclusion: Previous studies of outcome following total elbow arthroplasty using the GSB III elbow prosthesis at independent centres have shown satisfactory results, but have looked at small groups of patients. Our results offer more robust data to show that the medium term outcome following total elbow arthroplasty using the GSB III prosthesis is satisfactory.

Aims: To review the results from a series of GSB III total elbow arthroplasties performed at an independent centre.

Between 1996 and 2004, the senior author performed 58 total elbow arthroplasties in 44 patients (10 males, 34 females) using the GSB III implant. These were reviewed and the outcome assessed through the use of a patient-answered questionnaire and clinical and radiological review. Mean age was 65 (49 to 84 years). Indications for surgery included rheumatoid arthritis (46 elbows) and post-traumatic osteoarthritis (11 elbows). Mean F/up was 4.1 years (0.8 to 8.5 years). Four patients had died (six elbows) and four patients (four elbows) were unavailable for review. Two of the implants had been revised (1x aseptic loosening, 1x deep infection), leaving a total of 46 elbows available for review. The survival rate at a mean of four years was 98% with aseptic loosening as the endpoint.

Complications included one case of intraoperative fracture and one persistent ulnar neuritis. Overall patient satisfaction was high. The mean Mayo Elbow Performance Score was 83 out of 100 (range, 34 to 100) and mean Liverpool Elbow Score was 8 out of 10 (range, 1 to 10).

Conclusion: Previous studies of outcome following total elbow arthroplasty using the GSB III elbow prosthesis at independent centres have shown satisfactory results, but have looked at small groups of patients. Our results offer more robust data to show that the medium term outcome following total elbow arthroplasty using the GSB III prosthesis is satisfactory.