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Bone & Joint Research
Vol. 12, Issue 10 | Pages 636 - 643
10 Oct 2023
Hamilton V Sheikh S Szczepanska A Maskell N Hamilton F Reid JP Bzdek BR Murray JRD

Aims

Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians’ health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations.

Methods

The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures.


The Bone & Joint Journal
Vol. 104-B, Issue 6 | Pages 680 - 686
1 Jun 2022
Robinson JR Bruce D Davies H Porteous AJ Murray JRD Howells NR

Aims

The best surgical strategy for the management of displaced bucket-handle (BH) meniscal tears in an anterior cruciate ligament (ACL)-deficient knee is unclear. Combining meniscal repair with ACL reconstruction (ACLR) is thought to improve meniscal healing rates; however, patients with displaced BH meniscal tears may lack extension. This leads some to advocate staged surgery to avoid postoperative stiffness and loss of range of motion (ROM) following ACLR.

Methods

We reviewed the data for a consecutive series of 88 patients (mean age 27.1 years (15 to 49); 65 male (74%) and 23 female (26%)) who underwent single-stage repair of a displaced BH meniscal tear (67 medial (76%) and 21 lateral (24%)) with concomitant hamstring autograft ACLR. The patient-reported outcome measures (PROMs) EuroQol visual analogue scale (EQ-VAS), EuroQol five-dimension health questionnaire (EQ-5D), Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score (IKDC), and Tegner score were recorded at final follow-up. A Kaplan-Meier survival analysis was performed to estimate meniscal repair survivorship. Analyses were performed with different cut-offs for meniscal and ACL injury-to-surgery time (within three weeks, three to ten weeks, and more than ten weeks).


The Bone & Joint Journal
Vol. 103-B, Issue 4 | Pages 672 - 680
1 Apr 2021
Clement ND Scott CEH Murray JRD Howie CR Deehan DJ

Aims

The aim of this study was to assess the quality of life of patients on the waiting list for a total hip (THA) or knee arthroplasty (KA) during the COVID-19 pandemic. Secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery.

Methods

During the study period (August and September 2020) 843 patients (THA n = 394, KA n = 449) from ten centres in the UK reported their EuroQol five dimension (EQ-5D) scores and completed a waiting list questionnaire (2020 group). Patient demographic details, procedure, and date when listed were recorded. Patients scoring less than zero for their EQ-5D score were defined to be in a health state “worse than death” (WTD). Data from a retrospective cohort (January 2014 to September 2017) were used as the control group.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 119 - 119
1 Feb 2003
Murray JRD Birdsall PD Deehan DJ Weir DJ Pinder IM
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There is little data on the long-term outcome of rotating hinge total knee arthroplasty. We provide a clinical and radiographic assessment of survivorship of the Kinematic rotating hinge total knee arthroplasty (How-medica, Rutherford, NJ), in a series of 72 implants, performed by a single surgeon in one unit, between 1983 and 1997. Survival analysis using known all cause revision revealed a 92% five-year implant survival, but worst-case scenario was 31% at five years.

In a subset of 27 patients we used the Nottingham Health Profile (NHP) to assess prospectively the changes in health-related quality of life following rotating hinge arthroplasty. In this salvage arthroplasty setting we demonstrate a significant improvement in two modalities of the NHP (pain and physical mobility).


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_II | Pages 167 - 167
1 Jul 2002
Murray JRD Birdsall PD Deehan DJ Weir D Pinder IM
Full Access

Aim: To determine the quality of life and radiological outcome of the rotating hinge total knee prosthesis as a salvage procedure for failed knee arthroplasty.

Methods: Forty-seven consecutive revision total knee arthroplasties, using the rotating hinge component, implanted between November 1983 and June 1997, were studied. The principal indications for surgery were pain with ligamentous laxity and gross bone loss. There were 43 patients, 11 males, 32 females, 19 left and 28 right, 21 with rheumatoid disease and 22 with osteoarthritis. The mean age at revision was 68 years, mean time from primary procedure to revision of 8 years and a mean number of previous knee procedures of 1.6 (range 1–5). The average time to final follow-up was 5 years. Quality of life was determined using the Nottingham Health Profile (NHP) combined with standard clinical and radiological assessment.

Results: Of the 47 revision procedures, full clinical follow-up information was available on 43 (91.5%), radiographic follow-up on 38 (80.9%). Complications occurred in 10 out of the 47 arthroplasties (21.3%) including 4 deep infections, 2 femoral fractures, 2 patients with clinically apparent aseptic loosening and 2 significant extensor mechanism problems. Survivorship analysis revealed a 5year cumulative implant survival of 89%. Significant improvements in quality of life (pain and physical mobility) were shown at 12 months post-operatively.

Discussion: This is a prospectively-studied series of salvage arthroplasty procedures. We regard quality of life as a key indicator of surgical success after knee arthroplasty. Rotating hinge arthroplasty offers objective and reproducible improvement in quality of life for failed knee arthroplasty with ligamentous instability.