To investigate the bone penetration of intravenous antibiotic
prophylaxis with flucloxacillin and gentamicin during hip and knee
arthroplasty, and their efficacy against Bone samples from the femoral head, neck and acetabulum were
collected from 18 patients undergoing total hip arthroplasty (THA)
and from the femur and tibia in 21 patients during total knee arthroplasty
(TKA). The concentration of both antibiotics in the samples was
analysed using high performance liquid chromatography. Penetration
was expressed as a percentage of venous blood concentration. The
efficacy against common infecting organisms was measured against
both the minimum inhibitory concentration 50, and the more stringent epidemiological
cutoff value for resistance (ECOFF).Aims
Patients and Methods
The aim of this study was to determine if positive Waddell signs
were related to patients’ demographics or to perception of their
quality of life. This prospective cross-sectional study included 479 adult patients
with back pain from a university spine centre. Each completed SF-12
and Oswestry Disability Index (ODI) questionnaires and underwent
standard spinal examinations to elicit Waddell signs. The relationship
between Waddell signs and age, gender, ODI, Mental Component Score
(MCS), and Physical Component Score (PCS) scores was determined.Aims
Patients and Methods
To evaluate the outcomes of cemented total hip arthroplasty (THA)
following a fracture of the acetabulum, with evaluation of risk
factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of
57 years (25 to 87) underwent cemented THA at a mean of 6.5 years
(0.1 to 25) following acetabular fracture. A total of 38 had undergone
surgical fixation and 11 had been treated non-operatively; 13 patients
died at a mean of 10.2 years after THA (0.6 to 19). Patients were
assessed pre-operatively, at one year and at final follow-up (mean
9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant
survivorship was assessed. An age and gender-matched cohort of THAs
performed for non-traumatic osteoarthritis (OA) or avascular necrosis
(AVN) (n = 98) were used to compare complications and patient-reported outcome
measures (PROMs).Aims
Patients and Methods
Our aim was to evaluate the radiographic characteristics of patients
undergoing total hip arthroplasty (THA) for the potential of posterior
bony impingement using CT simulations. Virtual CT data from 112 patients who underwent THA were analysed.
There were 40 men and 72 women. Their mean age was 59.1 years (41
to 76). Associations between radiographic characteristics and posterior
bony impingement and the range of external rotation of the hip were
evaluated. In addition, we investigated the effects of pelvic tilt
and the neck/shaft angle and femoral offset on posterior bony impingement.Aims
Patients and Methods
Our aim was to report survivorship data and lessons learned with
the Corail/Pinnacle cementless total hip arthroplasty (THA) system. Between August 2005 and March 2015, a total of 4802 primary cementless
Corail/Pinnacle THAs were performed in 4309 patients. In March 2016,
we reviewed these hips from a prospectively maintained database.Aims
Patients and Methods
Cervical spondylosis is often accompanied by dizziness. It has
recently been shown that the ingrowth of Ruffini corpuscles into
diseased cervical discs may be related to cervicogenic dizziness.
In order to evaluate whether cervicogenic dizziness stems from the
diseased cervical disc, we performed a prospective cohort study
to assess the effectiveness of anterior cervical discectomy and
fusion on the relief of dizziness. Of 145 patients with cervical spondylosis and dizziness, 116
underwent anterior cervical decompression and fusion and 29 underwent
conservative treatment. All were followed up for one year. The primary
outcomes were measures of the intensity and frequency of dizziness.
Secondary outcomes were changes in the modified Japanese Orthopaedic
Association (mJOA) score and a visual analogue scale score for neck
pain.Aims
Patients and Methods
Post-operative migration of cemented acetabular components as
measured by radiostereometric analysis (RSA) has a strong predictive
power for late, aseptic loosening. Also, radiolucent lines predict
late loosening. Migration has been reduced by systemic bisphosphonate
treatment in randomised trials of hip and knee arthroplasty. Used
as a local treatment, a higher local dose of bisphosphonate can
be achieved without systemic exposure. We wished to see if this
principle could be applied usefully in total hip arthroplasty (THA). In this randomised placebo-controlled, double-blinded trial with
60 participants, we compressed gauze soaked in bisphosphonate solution
(ibandronate) or saline against the acetabular bone bed immediately
before cementing the acetabular component. RSA, classification of
radiolucent lines, the Harris Hip Score (HHS) and the Western Ontario McMasters
Universities Osteoarthritis Index (WOMAC) were carried out at three-,
six-, 12-, and 24-month follow-up.Aims
Patients and Methods
The aim of this study was to compare the design of the generic
OptiStem XTR femoral stem with the established Exeter femoral stem. We obtained five boxed, as manufactured, implants of both designs
at random (ten in total). Two examiners were blinded to the implant
design and independently measured the mass, volume, trunnion surface
topography, trunnion roughness, trunnion cone angle, Caput-Collum-Diaphyseal
(CCD) angle, femoral offset, stem length, neck length, and the width
and roughness of the polished stem shaft using peer-reviewed methods.
We then compared the stems using these parameters.Aims
Materials and Methods
The aim of this study was to determine whether the rates of revision
for metal-on-metal (MoM) total hip arthroplasties (THAs) with Pinnacle
components varied according to the year of the initial operation,
and compare these with the rates of revision for other designs of
MoM THA. Data from the National Joint Registry for England and Wales included
36 mm MoM THAs with Pinnacle acetabular components which were undertaken
between 2003 and 2012 with follow-up for at least five years (n
= 10 776) and a control group of other MoM THAs (n = 13 817). The
effect of the year of the primary operation on all-cause rates of revision
was assessed using Cox regression and interrupted time-series analysis.Aims
Patients and Methods
Promising medium-term results from total shoulder arthroplasty
(TSA) have been reported for the treatment of primary osteoarthritis
in young and middle-aged patients. The aim of this study was to
evaluate the long-term functional and radiological outcome of TSA
in the middle-aged patient. The data of all patients from the previous medium-term study
were available. At a mean follow-up of 13 years (8 to 17), we reviewed
21 patients (12 men, nine women, 21 shoulders) with a mean age of
55 years (37 to 60). The Constant-Murley score (CS) with its subgroups
and subjective satisfaction were measured. Radiological signs of implant
loosening were analysed.Aims
Patients and Methods
The purposes of this study were to clarify first, the incidence
of peroneal tendon dislocation in patients with a fracture of the
talus and second the factors associated with peroneal tendon dislocation. We retrospectively examined 30 patients (30 ankles) with a mean
age of 37.5 years, who had undergone internal fixation for a fracture
of the talus. Independent examiners assessed for peroneal tendon
dislocation using the pre-operative CT images. The medical records
were also reviewed for the presence of peroneal tendon dislocation.
The associations between the presence of dislocation with the patient
characteristics or radiological findings, including age, mechanism
of injury, severity of fracture, and fleck sign, were assessed using Fisher’s
exact tests.Aims
Patients and Methods
We present a retrospective review of patients treated with extracorporeally
irradiated allografts for primary and secondary bone tumours with
the mid- and long-term survivorship and the functional and radiographic
outcomes. A total of 113 of 116 (97.4%) patients who were treated with
extracorporeally irradiated allografts between 1996 and 2014 were
followed up. Forms of treatment included reconstructions, prostheses
and composite reconstructions, both with and without vascularised
grafts. Survivorship was determined by the Kaplan-Meier method.
Clinical outcomes were assessed using the Musculoskeletal Tumor
Society (MSTS) scoring system, the Toronto Extremity Salvage Score
(TESS) and Quality of Life-C30 (QLQ-30) measures. Radiographic outcomes
were assessed using the International Society of Limb Salvage (ISOLS)
radiographic scoring system.Aims
Patients and Methods
The aim of this study was to report a retrospective, consecutive
series of patients with adolescent idiopathic scoliosis (AIS) who
were treated with posterior minimally invasive surgery (MIS) with
a mean follow-up of two years ( We prospectively collected the data of 70 consecutive patients
with AIS treated with MIS using three incisions and a muscle-splitting
approach by a single surgeon between June 2013 and February 2016
and these were retrospectively reviewed. There were eight male and
62 female patients with a mean age of 15 years (Aims
Patients and Methods
Loss or absence of proximal femoral bone in revision total hip
arthroplasty (THA) remains a significant challenge. While the main
indication for the use of proximal femoral replacements (PFRs) is
in the treatment of malignant disease, they have a valuable role
in revision THA for loosening, fracture and infection in patients
with bone loss. Our aim was to determine the clinical outcomes,
implant survivorship, and complications of PFRs used in revision
THA for indications other than malignancy. A retrospective review of 44 patients who underwent revision
THA using a PFR between 2000 and 2013 was undertaken. Their mean
age was 79 years (53 to 97); 31 (70%) were women. The bone loss
was classified as Paprosky IIIB or IV in all patients. The mean
follow-up was six years (2 to 12), at which time 22 patients had
died and five were lost to follow-up.Aims
Patients and Methods
