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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 144 - 144
1 Mar 2012
Davis N Powell-Smith E Phillips S Hobby J Lowdon I
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Introduction

PIPJ replacement has become increasingly popular however, there is very little clinical data available apart from small studies and those from the originators of the prostheses. We present a review of our initial experience with the Acension(c) Pyro-carbon PIP joint.

Results

Data was collected from 62 joints in 39 patients with one patient lost to follow-up. Mean age was 61.6 years. 29 patients were female and 10 male. Mean follow up was 22.3 months (range 11 to 54). 7 patients or 11% needed further surgery. The majority were for stiffness with 3 operations for dislocation or component malposition. The total complication rate was 32%, again the biggest problem was stiffness. 4 joints have subluxed or dislocated, 2 had superficial infections. There was no statistical difference in the rate of complications compared to the operated finger or the pre-operative diagnosis.

Post-operatively patients had a mean fixed flexion deformity of 19° and flexed to 76° (58° arc). However patients undergoing surgery following trauma do not do as well as the other groups with a decrease in ROM of 33°.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_III | Pages 141 - 141
1 Feb 2012
Reynolds J Murray J Mandalia V Sinha M Clark G Jones A Ridley N Lowdon I Woods D
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Background

In suspected scaphoid fracture the initial scaphoid series plain radiographs are 84-94% sensitive for scaphoid fractures. Patients are immobilised awaiting diagnosis. Unnecessary lengthy immobilisation leads to lost productivity and may leave the wrist stiff. Early accurate diagnosis would improve patient management. Although Magnetic Resonance Imaging (MRI) has come to be regarded as the gold standard in identifying occult scaphoid injury, recent evidence suggests Computer Tomography (CT) to be more accurate in identifying scaphoid cortical fracture. Additionally CT and USS are frequently a more available resource than MRI.

We hypothesised that 16 slice CT is superior to high spatial resolution Ultrasonography (USS) in the diagnosis of radiograph negative suspected cortical scaphoid fracture and that a 5 point clinical examination will help to identify patients most likely to have sustained a fracture within this group.

Methods

100 patients with two negative scaphoid series and at least two out of five established clinical signs of scaphoid injury (anatomical snuffbox tenderness (AST), scaphoid tubercle tenderness (STT), effusion, pain on circumduction and pain on axial loading) were prospectively investigated with CT and USS. MRI was arranged for patient with persistent symptoms but negative CT/USS.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 181 - 181
1 May 2011
Vasireddy A Navadgi B Deo S Satish V Lowdon I
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Purpose of study: With the increasing demand for arthroplasty surgery, it is important to maintain a high quality of care. We describe a clinical governance framework for a simple, easy to implement method of assessing and monitoring radiological outcome following total knee arthroplasty.

Methods: We completed a two-year prospective study (January 2006 to December 2007 inclusive) of all total knee arthroplasty operations. This included 1,295 procedures, the majority of which were undertaken by two Consultant Surgeons and up to eight independent middle grade surgeons. The two Consultant Knee Surgeons assessed component position on standard post-operative weight-bearing antero-posterior and lateral knee radiographs on a weekly basis. They were blinded to both the patient and surgeon details, and used our own simple grading system, whose weighted Kappa variance showed ‘moderate’ interobserver (K = 0.41) and intraobserver reliability (K = 0.51). Our system comprised of only three ordinal scores, which were good (score of 1), acceptable (score of 2) and poor (score of 3).

Results: We provided individual surgeons with their results on a six-monthly basis. The average score for all the surgeons was good. The scores of the independent middle-grade surgeons were analysed by the Consultants, and feedback was provided in the form of formal advice and supervised surgery sessions. Repeat proportional analysis of their radiological scores showed significant improvements for all the individual surgeons (Pearson-Chi Square p value < 0.05).

Conclusions: Clinical governance is an important facet of excellence in medical practice. Our system allows continued prospective assessment of radiological outcome following total knee arthroplasty. By utilising such systems and ensuring an atmosphere of clinical excellence, we are able to employ more surgeons and undertake an increased workload, whilst maintaining high standards. This assessment tool can also be used to assess and appraise trainees during their progression.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 531 - 531
1 Oct 2010
Vasireddy A Brooks A Ivory J Lowdon I Rigby M
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Purpose of study: With the increasing demand for arthroplasty surgery, it is important to maintain a high quality of care. We describe a clinical governance framework for monitoring radiological outcome following total hip arthroplasty.

Methods: We completed a two-year prospective study (January 2006 to December 2007 inclusive) of all total hip arthroplasty operations. This included 1,143 procedures, the majority of which were undertaken by three Consultant Surgeons and four independent middle grade surgeons. The three Consultant Hip Surgeons assessed component position on post-operative weight-bearing anteroposterior pelvic/hip radiographs on a weekly basis. They were blinded to both the patient and surgeon details, and used our own simple grading system. Weighted Kappa variance showed substantial interobserver (kappa = 0.60) and intraobserver reliability (kappa = 0.92). Our system comprised of only three ordinal scores, which were ‘good’ (score of 1), ‘acceptable’ (score of 2) and ‘poor’ (score of 3).

Results: We provided individual surgeons with their results on a six-monthly basis. The average score for all the surgeons was ‘good’. The scores of the independent middle-grade surgeons were analysed by the Consultants, and feedback was provided in the form of formal advice and supervised surgery sessions. Repeat analysis of their radiological scores showed significant improvements for certain individual surgeons (Pearson-Chi Square p value 0.006)

Conclusions: Clinical governance is an important facet of excellence in medical practice. Our system allows continued prospective assessment of radiological outcome following total hip arthroplasty. By utilising such systems and ensuring an atmosphere of clinical excellence, we are able to employ more surgeons and undertake an increased workload, whilst maintaining high standards. This assessment tool can also be used to appraise trainees during their progression.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 424 - 424
1 Jul 2010
Vasireddy A Navadgi B Deo S Satish V Lowdon I
Full Access

Purpose of study: With the increasing demand for arthroplasty surgery, it is important to maintain a high quality of care. We describe a clinical governance framework for a simple, easy to implement method of assessing and monitoring radiological outcome following total knee arthroplasty.

Methods: We completed a two-year prospective study (January 2006 to December 2007 inclusive) of all total knee arthroplasty operations. This included 1,295 procedures, the majority of which were undertaken by two Consultant Surgeons and up to eight independent middle grade surgeons. The two Consultant Knee Surgeons assessed component position on standard post-operative weight-bearing antero-posterior and lateral knee radiographs on a weekly basis. They were blinded to both the patient and surgeon details, and used our own simple grading system, whose weighted Kappa variance showed ‘moderate’ interobserver (K = 0.41) and intraobserver reliability (K = 0.51). Our system comprised of only three ordinal scores, which were good (score of 1), acceptable (score of 2) and poor (score of 3).

Results: We provided individual surgeons with their results on a six-monthly basis. The average score for all the surgeons was good. The scores of the independent middle-grade surgeons were analysed by the Consultants, and feedback was provided in the form of formal advice and supervised surgical sessions. Repeat proportional analysis of their radiological scores showed significant improvements for all the individual surgeons (Pearson-Chi Square p value < 0.05).

Conclusions: Clinical governance is an important facet of excellence in medical practice. Our system allows continued prospective assessment of radiological outcome following total knee arthroplasty. By utilising such systems and ensuring an atmosphere of clinical excellence, we are able to employ more surgeons and undertake an increased workload, whilst maintaining high standards. This assessment tool can also be used to assess and appraise trainees during their progression.


The Journal of Bone & Joint Surgery British Volume
Vol. 67-B, Issue 1 | Pages 58 - 59
1 Jan 1985
Lowdon I