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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_5 | Pages 63 - 63
1 Mar 2017
Oh K Tan H
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Cervical total disc replacement has been in practice for years now as a viable alternative to cervical fusion in suitable cases, aspiring to preserve spinal motion and prevent adjacent segment disease. Reports are rife that neck pain emerges as an annoying feature in the early postoperative period. The facet joint appears to be the most likely source of pain.

50 patients were prospectively followed up through 5 years after having received disc replacement surgery, indicated for symptomatic soft disc herniation of the cervical spine presenting with radiculopathy.

• All were skeletally mature and aged between 22 to 50.• All had failed a minimum of 6 months conservative therapy.• Up to 2 disc levels were addressed. C3 till C7 levels
• Single surgeon (first author)• NDI > 30% (15/50)• Deteriorating radicular neurology

We excluded those with degenerative trophic changes of the cervical spine, focal instability, trauma, osteoporosis, previous cervical spine surgery, previous infection, ossifying axial skeletal disease and inflammatory spondyloarthritides. The device used was an unconstrained implant with stabilizing teeth. Over the 5 years, we studied their postoperative comfort level via the Neck Disability Index (NDI) and Visual Analogue Score (VAS). Pre-operative and post-operative analysis of the sagittal axis and of involved facet joints were done.

22 patients suffered postoperative neck pain as reflected by the NDI and VAS scores. Of these, 10 reported of neck pain even 24 months after surgery. However, none were neurologically worse and all patients returned to their pre-morbid functions and were relieved of pain by 28 months. All 22 patients reported of rapid dissolution of neckache after peri-facetal injections of steroids were done under image guidance.

We draw attention to the facet joint as the pain generator, triggered by inappropriate implant height, eccentric stresses via hybrid constructs, eccentric loading due to unconstrained devices and unaddressed Luschka joint degeneration. Such factors require careful selection of patients for surgery, necessitate proper pre-operative templating and call for appropriate technical solutions during surgery.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 172 - 172
1 Jan 2013
Tan H Jones E Henshaw K McGonagle D Giannoudis P
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Objective

The aim of this study was to investigate PDGF release in the peripheral circulation following trauma and to correlate it with the numbers of MSCs in iliac crest bone marrow (BM) aspirate.

Methods

Trauma patients with lower extremity fractures (n=18, age 21–64 years) were recruited prospectively. Peripheral blood was obtained on admission, and at 1, 3, 5 and 7 days following admission. The serum was collected and PDGF was measured using ELISA. Iliac crest (BM) aspirate (20ml) was obtained on days 0–9 following admission. MSCs were enumerated using standard colony-forming unit fibroblasts (CFU-F) assay.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 155 - 155
1 Sep 2012
Obakponovwe O Mouzopoulos G Tan H Giannoudis P
Full Access

Purpose

In children presenting with irritable hip symptoms we wished to determine the incidence of hip septic arthritis, pathogen characteristics and the functional outcome.

Methods

Between May 2007 and January 2010, children presenting to our institution with irritable hip symptoms were eligible to participate. Exclusion criteria were history of trauma to the hip, systemic inflammatory diseases. Data collected included; demographics, clinical symptoms, temperature, haematological profile, ultrasound and culture reports, microorganism isolated and outcome. The minimum follow up was 6 months (6–24).