Heterotopic Ossification(HO) is a recognized complication following Total Hip Arthroplasty(THA) that can compromise patient outcomes. Our objectives were to report its incidence and risk factors in a modern arthroplasty unit(MAU). 2305 consecutive primary THAs in 2150 patients(887♂;1263♀) undertaken at a single centre and followed-up for at least one year constituted the study cohort. A retrospective review of patient demographics (age, side, body mass index[BMI], type of anaesthesia, surgical approach, method of fixation, estimated blood loss[EBL] and operative time), serial radiographs and outcome measure (The Oxford hip score[OHS]) were undertaken. All HO were further followed for additional four years to determine the incidence of Revision THA at five years. Descriptive statistics and logistic regression was undertaken to identify the risk factors for HO using Statistical Package(SPSS) version16.Introduction
Methods
Healthcare interventions are under increasing scrutiny regarding cost-effectiveness and outcome measures have revolutionised clinical research. To identify all available outcome questionnaires designed for lowback, lumbar spine pathologies and to perform qualitative analysis of these questionnaires for their clinimetric properties. A comprehensive e-search on PUBMED & EMBASE for all available outcome measures and published review articles for lowback and lumbar spine pathologies was undertaken over a two month period (Nov-Dec 2009). Twenty-eight questionnaires were identified in total. These outcomes questionnaires were evaluated for clinimetric properties viz:- Validity (content, construct & criterion validity) Reliability (internal consistency & reproducibility) Responsiveness and scored on a scale of 0-6 points. Eight outcomes questionnaires had satisfied all clinimetric domains in methodological evaluation (score 6/6). Oswestry disability index (ODI) Roland-Morris disability questionnaire (RMDQ) Aberdeen lowback pain scale Extended Aberdeen spine pain scale Functional rating index Core lowback pain outcome measure Backpain functional scale Maine-Seattle back questionnaire. Sixteen of these questionnaires scored =5 when evaluated for clinimetric domains. RMDQ had the highest number of published and validated translations followed by ODI. Criterion validity was not tested for NASS-AAOS lumbar spine questionnaire. 32%(9/28) of the outcome instruments have undergone methodological evaluation for =3 clinimetric properties. Clinicians should be cautious when choosing appropriate validated outcome measures when evaluating therapeutic/surgical intervention. We suggest use of few validated outcome measures with high clinimetric scores (=5/6) to be made mandatory when reporting clinical results.
8 patients with cervical myelopathy treated by French-door laminoplasty and internal fixation. A novel technique of fixation is employed to provide immediate stability, pain relief and rapid mobilisation. To report the clinical and radiological outcomes of this new fixation device for French–door laminoplasty with minimum follow-up of 30 months. Hardware assisted laminoplasty has the potential advantage of instant stability and prevention of recurring stenosis. The use of titanium mini-plates has been described in open-door laminoplasty and now we describe this technique in French–door laminoplasty. 8 patients with cervical myelopathy secondary to congenital stenosis (2) and multi-level spondylotic myelopathy (6) underwent 2-4 level French–door laminoplasty and mini-plate fixation. The average follow-up was 46.5 months. Autogenous iliac crest bone graft was interposed between the sagittally split spinous processes and 16-18 holed titanium mini-plates were contoured into a trapezoidal shape and secured to the posterior elements with screws. Patients then mobilised without external support. The mean follow-up was 46.5 months. The mean improvement in NDI at final follow-up was 35% and mean improvement in VAS was 4 points. JOA score improved from a mean of 10 to a mean of 14.8 post-operatively. All patients had achieved a significant neurological improvement and pain relief. There were no post-operative hardware related complications, pseudarthrosis or neurological deterioration. French-door laminoplasty is an excellent alternative to laminectomy for treatment of young patients with cervical myelopathy. The use of titanium mini-plates not only provides instant stability and pain relief but also seems to minimize the risk of C5 nerve root palsy. Internal fixation appears to provide instant stability, early mobilisation and therefore reduces hospital stay and associated costs.
Spinal pathologies requiring spinal/neurospinal unit’s input/opinion from tertiary centres for their management are initially admitted to DGHs. The referral is made by mailing radiographs with clinical details to the on-call registrar who gets back with a management plan. This arrangement is fraught with delays at various levels having an impact on patient care, financial and medico-legal implications. We discuss these issues between index DGH (Poole General Hospital) and its tertiary referral centres. To review the existing management of spinal injury admissions at our hospital, analyse critical/adverse incidents and to identify areas for improving patient care. A comprehensive retrospective review of all spinal admissions/referrals made to tertiary centres over 6 months was undertaken. Twenty eight of the 64 admissions warranted referrals. A structured proforma was used to document the time of admission, time of booking and performing scans, time of referral &
response from tertiary centre and time of transfer from hospital notes and delays at each level were critically analysed. Seven of the 28 referrals had either neurodeficit or spinal instability. Common issues were delay in obtaining CT/MRI scans (av 2.5 days), delay due to reporting/failing to act on results (av 1.8 days), delays due to missing/lost in transit’ scans (av 1.5 day), delay in obtaining opinion (av 4 days) and non-availability of bed for transfer (av 5.5 days). There was 1 mortality and 5 other complications while awaiting transfer. The financial costs incurred were approximately £73,000 &
loss of 246 patient-days. Training on induction day, implementation of spinal care pathway and diligent documentation/communication coupled with succinct referral were strictly enforced following this study. The website
Only Gender specific knee closely mimicked normal variation in AR and is available only for females (in India). Most of the available TKR prosthesis designs differ from true knee morphometry of Indian population. These data provides the basis for designing optimal prosthesis for people of Indian/Asian origin in UK/overseas.
DJK could be prevented by including 1st lordotic disc in LIV. Extending lower Instrumentation to L3 would reduce the risk of implant failure in obese patients. There was no advantage of cages over rib grafts.
To identify radiological patterns of compression (POC) of the spinal cord To develop a surgical protocol based on POC and determine its efficacy. To identify parameters predicting outcome of surgery
Pattern I – predominant one/two level compression in normal/narrow canal Pattern II – anterior &
posterior compression at one/ two levels (pincer cord) Pattern III – Three or more levels of predominant anterior compression with a normal canal Pattern III(A) – Pattern III in a patient with multiple medical co-morbidities Pattern IV – Three/more levels of anterior compression in narrow canal +/− posterior compression (beaded cord) Pattern IV(A) – Pattern IV with one/two level severe compression amongst the multiple anterior compressions. Mean follow-up was 3 yrs (2–8). ACDF was performed for patterns I, II &
III and posterior decompression for pattern IV and III(A). For pattern IV(A), a two stage primary posterior decompression followed by targeted ACDF at the site of maximal compression was performed. The clinical outcome was measured by modified JOA (mJOA) score, Hirayabashi Recovery Rate (HRR) and functional outcome by modified Neck Disability Index (NDI).