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Bone & Joint 360
Vol. 10, Issue 5 | Pages 7 - 10
1 Oct 2021
Morris DLJ Cresswell T Espag M Tambe AA Clark DI Ollivere BJ


The Bone & Joint Journal
Vol. 103-B, Issue 8 | Pages 1333 - 1338
2 Aug 2021
Kankanalu P Borton ZM Morgan ML Cresswell T Espag MP Tambe AA Clark DI

Aims

Reverse total shoulder arthroplasty (RTSA) using trabecular metal (TM)-backed glenoid implants has been introduced with the aim to increase implant survival. Only short-term reports on the outcomes of TM-RTSA have been published to date. We aim to present the seven-year survival of TM-backed glenoid implants along with minimum five-year clinical and radiological outcomes.

Methods

All consecutive elective RTSAs performed at a single centre between November 2008 and October 2014 were reviewed. Patients who had primary TM-RTSA for rotator cuff arthropathy and osteoarthritis with deficient cuff were included. A total of 190 shoulders in 168 patients (41 male, 127 female) were identified for inclusion at a mean of 7.27 years (SD 1.4) from surgery. The primary outcome was survival of the implant with all-cause revision and aseptic glenoid loosening as endpoints. Secondary outcomes were clinical, radiological, and patient-related outcomes with a five-year minimum follow-up.


The Bone & Joint Journal
Vol. 103-B, Issue 8 | Pages 1331 - 1332
1 Aug 2021
Kankanalu P Borton ZM Morgan ML Cresswell T Espag MP Tambe AA Clark DI


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_2 | Pages 86 - 86
1 Mar 2021
Bommireddy L Granville E Davies-Jones G Gogna R Clark DI
Full Access

Abstract

Objectives

Clavicle fractures are common, yet debate exists regarding which patients would benefit from conservative versus operative management. Traditionally shortening greater than 2cm has been accepted as an indicator for surgery. However, clavicle length varies between individuals. In a cadaveric study clavicle shortening greater than 15% was suggested to affect outcomes. There is no clinical correlation of this in the literature. In this study we investigate outcomes following middle third clavicle fractures and the effect of percentage shortening on union rates.

Methods

We identified a consecutive series of adults with primary midshaft clavicle fractures presenting to our institution from April 2015-March 2017. Clinical records and radiographs were reviewed to elicit outcomes. Time to union was measured against factors including; percentage shortening, displacement, comminution and smoking. Statistical significance was calculated.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_2 | Pages 87 - 87
1 Mar 2021
Bommireddy L Crimmins A Gogna R Clark DI
Full Access

Abstract

Objectives

Operative management of distal humerus fractures is challenging. In the past, plates were manually contoured intraoperatively, however this was associated with high rates of fixation failure, nonunion and metalwork removal. Anatomically pre-contoured distal humerus locking plates have since been developed. Owing to the rarity of distal humeral fractures, literature regarding outcomes of anatomically pre-contoured locking plates is lacking and patient numbers are often small. The purpose of this study is to investigate the outcomes of these patients.

Methods

We retrospectively identified patients with distal humeral fractures treated at our institution from 2009–2018. Inclusion criteria were patients with a distal humeral fracture, who underwent two-column plate fixation with anatomically pre-contoured locking plates. Clinical records and radiographs were reviewed to elicit outcome measures, including range of motion, complications and reoperation rate.


Bone & Joint 360
Vol. 6, Issue 4 | Pages 2 - 7
1 Aug 2017
Titchener AG Tambe AA Clark DI


The Bone & Joint Journal
Vol. 98-B, Issue 7 | Pages 969 - 975
1 Jul 2016
Theivendran K Varghese M Large R Bateman M Morgan M Tambe A Espag M Cresswell T Clark DI

Aim

We present the medium-term clinical results of a reverse total shoulder arthroplasty with a trabecular metal glenoid base plate.

Patients and Methods

We reviewed 125 consecutive primary reverse total shoulder arthroplasties (RTSA) implanted in 124 patients for rotator cuff arthropathy. There were 100 women and 24 men in the study group with a mean age of 76 years (58 to 89). The mean follow-up was 32 months (24 to 60). No patient was lost to follow-up.


The Bone & Joint Journal
Vol. 96-B, Issue 10 | Pages 1359 - 1365
1 Oct 2014
Large R Tambe A Cresswell T Espag M Clark DI

Medium-term results of the Discovery elbow replacement are presented. We reviewed 51 consecutive primary Discovery total elbow replacements (TERs) implanted in 48 patients. The mean age of the patients was 69.2 years (49 to 92), there were 19 males and 32 females (37%:63%) The mean follow-up was 40.6 months (24 to 69). A total of six patients were lost to follow-up. Statistically significant improvements in range movement and Oxford Elbow Score were found (p < 0.001). Radiolucent lines were much more common in, and aseptic loosening was exclusive to, the humeral component. Kaplan–Meier survivorship at five years was 92.2% (95% CI 74.5% to 96.4%) for aseptic loosening. In four TERs, periprosthetic infection occurred resulting in failure. A statistically significant association between infection and increased BMI was found (p = 0.0268). Triceps failure was more frequent after the Mayo surgical approach and TER performed after previous trauma surgery. No failures of the implant were noted.

Our comparison shows that the Discovery has early clinical results that are similar to other semi-constrained TERs. We found continued radiological surveillance with particular focus on humeral lucency is warranted and has not previously been reported. Despite advances in the design of total elbow replacement prostheses, rates of complication remain high.

Cite this article: Bone Joint J 2014;96-B:1359–65


The Bone & Joint Journal
Vol. 96-B, Issue 3 | Pages 350 - 353
1 Mar 2014
White JJE Titchener AG Fakis A Tambe AA Hubbard RB Clark DI

Little is known about the incidence of rotator cuff pathology or its demographic associations in the general population. We undertook a large epidemiological study of rotator cuff pathology in the United Kingdom using The Health Improvement Network (THIN) database. The incidence of rotator cuff pathology was 87 per 100 000 person-years. It was more common in women than in men (90 cases per 100 000 person-years in women and 83 per 100 000 person-years in men; p < 0.001). The highest incidence of 198 per 100 000 person-years was found in those aged between 55 and 59 years. The regional distribution of incidence demonstrated an even spread across 13 UK health authorities except Wales, where the incidence was significantly higher (122 per 100 000 person-years; p < 0.001). The lowest socioeconomic group had the highest incidence (98 per 100 000 person-years). The incidence has risen fourfold since 1987 and as of 2006 shows no signs of plateauing.

This study represents the largest general population study of rotator cuff pathology reported to date. The results obtained provide an enhanced appreciation of the epidemiology of rotator cuff pathology and may help to direct future upper limb orthopaedic services.

Cite this article: Bone Joint J 2014;96-B:350–3.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_23 | Pages 14 - 14
1 May 2013
Hassan S Salar O Lau K Espag M Cresswell T Clark DI
Full Access

Purpose

Assess and report the functional and post-operative outcomes of complex acute radial head fractures with elbow instability treated by arthroplasty using an uncemented modular anatomic prosthesis.

Methods

Over a 3-year period (2007–2010), 21 patients (mean age 51.9 years) were treated primarily with modular radial head arthroplasty (mean follow up of 27.1 months). Data was collected retrospectively using clinical notes, operation documentation and prospectively using validated scoring systems namely the Oxford Elbow Index, Quick DASH and the Mayo Elbow Performance Score. Associated elbow fractures, ligamentous injury and short to mid term post-operative outcomes including radiographic assessment were recorded.


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 3 | Pages 351 - 353
1 Apr 2003
Espag MP Back DL Clark DI Lunn PG

We have carried out a retrospective review of 11 Souter-Strathclyde primary total elbow arthroplasties in ten patients with osteoarthritis, over a period of nine years. The diagnosis was primary osteoarthritis in nine elbows and post-traumatic arthritis in two. The mean follow-up was 68 months (15 to 117).

Although no patient was symptomatic, radiological review revealed evidence of loosening affecting three humeral and two ulnar components, one of which subsequently failed and was revised at 97 months. There were no dislocations, deep infections or mechanical failures. Complications included two superficial wound infections and two neurapraxias of the ulnar nerve which resolved.

This study shows that the unlinked Souter-Strathclyde total elbow arthroplasty can be considered for patients with osteoarthritis and gives good symptomatic relief and improvement in function.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_I | Pages 45 - 45
1 Jan 2003
Forster MC Clark DI Lunn PG
Full Access

Since described by Kashiwagi in 1978, the Outerbridge - Kashiwagi procedure (OK procedure) has been used to treat osteoarthritis of the elbow when simple measures have failed. Despite being used for 20 years, there have been surprisingly few series. The aim of this study was to assess the medium to long term results of the OK procedure and to analyse the preoperative and operative findings to identify features which predict a good outcome.

A consecutive series of 43 patients (44 elbows) underwent ulnohumeral debridement (OK procedure) for osteoarthritis of the elbow. Their mean age was 57 years (range 24 – 85 years) with one female patient. 35 patients (36 elbows) were reviewed after a mean follow up of 39 months (range 12 – 71 months). Overall, 81% of patients were satisfied with 12 good, 19 fair and 5 poor outcomes. The mean arc of flexion/extension (p=0.001), pain score (p=0.002) and locking (p=0.003) were significantly improved but a significant number of patients developed rest pain (p< 0.0001). There was a complication rate of 17% (2 ulna nerve entrapment, 1 ulna nerve neuropraxia which resolved completely, 1 superficial wound infection, 1 wound haematoma and 1 myocardial infarction). The reoperation rate was 8% (2 revision OK procedures and 1 ulna nerve decompression).

Patients with symptoms for less than 2 years, considerable preoperative pain or cubital tunnel syndrome had a significantly increased chance of a good outcome. The absence of preoperative locking was associated with a significantly increased chance of a poor outcome. Joint space narrowing on radiographs or presence of posterior loose bodies at operation was associated with an increased chance of a good outcome but these were not statistically significant. A history of trauma, the preoperative range of movement and Xray score did not predict outcome.


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 1 | Pages 149 - 149
1 Jan 2003
AHMED AB CLARK DI MORAN CG BAXENDALE BR


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 3 | Pages 414 - 418
1 Apr 2001
Clark DI Ahmed AB Baxendale BR Moran CG

In a prospective, controlled study, we measured the effect on cardiac output of the introduction of methylmethacrylate during hemiarthroplasty for displaced fractures of the femoral neck. We treated 20 elderly patients who were similar in age, height, weight and preoperative left ventricular function with either cemented or uncemented hemiarthroplasty. Using a transoesophageal Doppler probe, we measured cardiac output before incision and at six stages of the procedure: during the surgical approach, reaming and lavage of the femoral canal, the introduction of cement, the insertion of the prosthesis, and in reduction and closure.

We found that before the cement was introduced, there was no difference in stroke volume or cardiac output (p > 0.25). Cementation produced a transient but significant reduction in cardiac output of 33% (p < 0.01) and a reduction in stroke volume of 44% (p < 0.02). The introduction of cement did not affect the heart rate or mean arterial pressure. There was no significant difference in cardiac function on insertion of the prosthesis. Standard non-invasive haemodynamic monitoring did not detect the cardiovascular changes which may account for the sudden deaths that sometimes occur during cemented hemiarthroplasty.

The fall in stroke volume and cardiac output may be caused by embolism occurring during cementation, but there was no similar fall during reaming or insertion of the prosthesis.


The Journal of Bone & Joint Surgery British Volume
Vol. 80-B, Issue 4 | Pages 631 - 635
1 Jul 1998
Clark DI Chell J Davis TRC

We have reviewed 11 patients with congenital absence of the thumb, treated by pollicisation of the index finger, after follow-up for 20 to 38 years. Seven of the hands also had an associated radial club-hand deformity.

Function as assessed by the Percival score was excellent in six, good in three, fair in two and poor in four; three of the poor results were in patients with radial club hand. Ten of the 15 transfers were used as normal thumbs, but in five hands function required trick movements. Of the seven unilateral cases, two transplants were used as the dominant hand, and in another two thumb strength was more than 50% of that on the opposite side.

For patients with isolated congenital absence of the thumb, pollicisation of the index finger gives good functional and cosmetic results which are maintained. The results are less reliable for those with radial club hand.


The Journal of Bone & Joint Surgery British Volume
Vol. 80-B, Issue 3 | Pages 485 - 489
1 May 1998
Clatworthy MG Clark DI Gray DH Hardy AE

We performed a randomised, prospective trial to evaluate the use of unreamed titanium nails for femoral fractures. Of 48 patients with 50 femoral fractures 45 were followed to union; 23 with an unreamed and 22 with a reamed nail. The study was stopped early because of a high rate of implant failure.

The fractures in the unreamed group were slower to unite (39.4 weeks) than those in the reamed group (28.5 weeks; p = 0.007). The time to union was over nine months in 57% of the unreamed group and in 18% of the reamed group.

In the unreamed group 14 secondary procedures were required in ten patients to enhance healing compared with three in three patients in the reamed group. Six implants (13%) failed, three in each group. Four of these six fractures showed evidence of delayed union.

To achieve quicker union and fewer implant failures we recommend the use of reamed nails of at least 12 mm in diameter for female patients and 13 mm in males.