One method of femoral head preservation following avascular necrosis
(AVN) is core decompression and insertion of a tantalum rod. However,
there may be a high failure rate associated with this procedure.
The purpose of this study was to document the clinical and radiological
outcomes following total hip arthroplasty (THA) subsequent to failed
tantalum rod insertion. A total of 37 failed tantalum rods requiring total hip arthroplasty
were identified from a prospective database. There were 21 hips
in 21 patients (12 men and nine women, mean age 37 years, 18 to
53) meeting minimum two year clinical and radiographic follow-up
whose THAs were carried out between November 2002 and April 2013
(mean time between tantalum rod implantation and conversion to a
THA was 26 months, 6 to 72). These were matched by age and gender
to individuals (12 men, nine women, mean age 40 years, 18 to 58)
receiving THA for AVN without prior tantalum rod insertion.Aims
Patients and Methods
We performed a retrospective, comparative study of elderly patients
with an increased risk from anaesthesia who had undergone either
anterior screw fixation (ASF) or halo vest immobilisation (HVI)
for a type II odontoid fracture. A total of 80 patients aged 65 years or more who had undergone
either ASF or HVI for a type II odontoid fracture between 1988 and
2013 were reviewed. There were 47 women and 33 men with a mean age
of 73 (65 to 96; standard deviation 7). All had an American Society
of Anesthesiologists score of 2 or more.Aims
Patients and Methods
Between 2002 and 2011, 81 patients with a traumatic total brachial
plexus injury underwent reconstruction by double free muscle transfer
(DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve
transfers (NT, 18 cases). They were evaluated for functional outcome and quality of life
(QoL) using the Disability of Arm, Shoulder and Hand questionnaire,
both pre- and post-operatively. The three groups were compared and
followed-up for at least 24 months.Aims
Methods
Osteosarcoma of the pelvis is a particularly difficult tumour
to treat as it often presents late, may be of considerable size
and/or associated with metastases when it presents, and is frequently
chondroid in origin and resistant to chemotherapy. The aim of this study was to review our experience of managing
this group of patients and to identify features predictive of a
poor outcome. Between 1983 and 2014, 121 patients, (74 females and 47 males)
were treated at a single hospital: 74 (61.2%) patients had a primary
osteosarcoma and 47 (38.8%) had an osteosarcoma which was secondary
either to Paget’s disease (22; 18.2%) or to previous pelvic irradiation
(25; 20.7%). The mean age of those with a primary osteosarcoma was 29.3 years
(nine to 76) and their mean follow-up 2.9 years (0 to 29). The mean
age of those with a secondary sarcoma was 61.9 years (15 to 85)
and their mean follow-up was one year (0 to 14). A total of 22 patients with a primary sarcoma (52.4%) and 20
of those with a secondary sarcoma (47.6%) had metastases at the
time of presentation. Aims
Patients and Methods
We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis. The MEDLINE, EMBASE and Cochrane Library databases were searched using defined search terms. The primary outcome measure was spinal fusion, assessed as success or failure in accordance with radiograph, MRI or CT scan review at 24-month follow-up. The secondary outcome measure was time to fusion.Objectives
Methods
This non-blinded randomised controlled trial compared the effect
of patient-controlled epidural analgesia (PCEA) A total of 242 patients were randomised; 20 were excluded due
to failure of spinal anaesthesia leaving 109 patients in the PCEA
group and 113 in the LIA group. Patients were reviewed at six weeks
and one year post-operatively.Aims
Patients and Methods
We investigated the changes seen on serial metal
artefact reduction magnetic resonance imaging scans (MARS-MRI) of
metal-on-metal total hip arthroplasties (MoM THAs). In total 155
THAs, in 35 male and 100 female patients (mean age 70.4 years, 42
to 91), underwent at least two MRI scans at a mean interval of 14.6
months (2.6 to 57.1), at a mean of 48.2 months (3.5 to 93.3) after
primary hip surgery. Scans were graded using a modification of the
Oxford classification. Progression of disease was defined as an
increase in grade or a minimum 10% increase in fluid lesion volume
at second scan. A total of 16 hips (30%) initially classified as
‘normal’ developed an abnormality on the second scan. Of those with
‘isolated trochanteric fluid’ 9 (47%) underwent disease progression,
as did 7 (58%) of ‘effusions’. A total of 54 (77%) of hips initially
classified as showing adverse reactions to metal debris (ARMD) progressed,
with higher rates of progression in higher grades. Disease progression
was associated with high blood cobalt levels or an irregular pseudocapsule
lining at the initial scan. There was no association with changes
in functional scores. Adverse reactions to metal debris in MoM THAs
may not be as benign as previous reports have suggested. Close radiological
follow-up is recommended, particularly in high-risk groups. Cite this article:
We sought to determine if a durable bilayer implant composed of trabecular metal with autologous periosteum on top would be suitable to reconstitute large osteochondral defects. This design would allow for secure implant fixation, subsequent integration and remodeling. Adult sheep were randomly assigned to one of three groups (n = 8/group): 1. trabecular metal/periosteal graft (TMPG), 2. trabecular metal (TM), 3. empty defect (ED). Cartilage and bone healing were assessed macroscopically, biochemically (type II collagen, sulfated glycosaminoglycan (sGAG) and double-stranded DNA (dsDNA) content) and histologically.Objectives
Materials and Methods
Compartment syndrome results from increased intra-compartmental
pressure (ICP) causing local tissue ischaemia and cell death, but
the systemic effects are not well described. We hypothesised that
compartment syndrome would have a profound effect not only on the affected
limb, but also on remote organs. Using a rat model of compartment syndrome, its systemic effects
on the viability of hepatocytes and on inflammation and circulation
were directly visualised using intravital video microscopy.Aims
Methods
The Swansea Morriston Achilles Rupture Treatment
(SMART) programme was introduced in 2008. This paper summarises
the outcome of this programme. Patients with a rupture of the Achilles
tendon treated in our unit follow a comprehensive management protocol
that includes a dedicated Achilles clinic, ultrasound examination,
the use of functional orthoses, early weight-bearing, an accelerated
exercise regime and guidelines for return to work and sport. The
choice of conservative or surgical treatment was based on ultrasound
findings. The rate of re-rupture, the outcome using the Achilles Tendon
Total Rupture Score (ATRS) and the Achilles Tendon Repair Score,
(AS), and the complications were recorded. An elementary cost analysis
was also performed. Between 2008 and 2014 a total of 273 patients presented with
an acute rupture 211 of whom were managed conservatively and 62
had surgical repair. There were three
re-ruptures (1.1%). There were 215 men and 58 women with a mean
age of 46.5 years (20 to 86). Functional outcome was satisfactory.
Mean ATRS and AS at four months was 53.0
( The SMART programme resulted in a low rate of re-rupture, a satisfactory
outcome, a reduced rate of surgical intervention and a reduction
in healthcare costs. Cite this article:
Loosening of pedicle screws is a major complication of posterior
spinal stabilisation, especially in the osteoporotic spine. Our
aim was to evaluate the effect of cement augmentation compared with
extended dorsal instrumentation on the stability of posterior spinal
fixation. A total of 12 osteoporotic human cadaveric spines (T11-L3) were
randomised by bone mineral density into two groups and instrumented
with pedicle screws: group I (SHORT) separated T12 or L2 and group
II (EXTENDED) specimen consisting of T11/12 to L2/3. Screws were
augmented with cement unilaterally in each vertebra. Fatigue testing
was performed using a cranial-caudal sinusoidal, cyclic (1.0 Hz)
load with stepwise increasing peak force.Aims
Materials and Methods
We aimed to determine whether there is evidence of improved patient
outcomes in Major Trauma Centres following the regionalisation of
trauma care in England. An observational study was undertaken using the Trauma Audit
and Research Network (TARN), Hospital Episode Statistics (HES) and
national death registrations. The outcome measures were indicators
of the quality of trauma care, such as treatment by a senior doctor
and clinical outcomes, such as mortality in hospital.Aims
Patients and Methods
Flail chest from a blunt injury to the thorax is associated with
significant morbidity and mortality. Its management globally is
predominantly non-operative; however, there are an increasing number
of centres which undertake surgical stabilisation. The aim of this
meta-analysis was to compare the efficacy of this approach with
that of non-operative management. A systematic search of the literature was carried out to identify
randomised controlled trials (RCTs) which compared the clinical
outcome of patients with a traumatic flail chest treated by surgical
stabilisation of any kind with that of non-operative management.Aims
Patients and Methods
Tissue responses to debris formed by abrasion of polymethylmethacrylate
(PMMA) spacers at two-stage revision arthroplasty for prosthetic
joint infection are not well described. We hypothesised that PMMA
debris induces immunomodulation in periprosthetic tissues. Samples of tissue were taken during 35 two-stage revision arthroplasties
(nine total hip and 26 total knee arthroplasties) in patients whose
mean age was 67 years (44 to 85). Fourier transform infrared microscopy
was used to confirm the presence of PMMA particles. Histomorphometry
was performed using Sudan Red and Haematoxylin-Eosin staining.
CD-68, CD-20, CD-11(c), CD-3 and IL-17 antibodies were used to immunophenotype
the inflammatory cells. All slides were scored semi-quantitatively
using the modified Willert scoring system.Aims
Patients and Methods
The aims of this study were to compare the diagnostic test characteristics
of ultrasound alone, metal artefact reduction sequence MRI (MARS-MRI)
alone, and ultrasound combined with MARS-MRI for identifying intra-operative
pseudotumours in metal-on-metal hip resurfacing (MoMHR) patients
undergoing revision surgery. This retrospective diagnostic accuracy study involved 39 patients
(40 MoMHRs). The time between imaging modalities was a mean of 14.6
days (0 to 90), with imaging performed at a mean of 5.3 months (0.06
to 12) before revision. The prevalence of intra-operative pseudotumours
was 82.5% (n = 33).Aims
Methods
To determine whether there is any difference in infection rate
at 90 days between trauma operations performed in laminar flow and
plenum ventilation, and whether infection risk is altered following
the installation of laminar flow (LF). We assessed the impact of plenum ventilation (PV) and LF on the
rate of infection for patients undergoing orthopaedic trauma operations.
All NHS hospitals in England with a trauma theatre(s) were contacted
to identify the ventilation system which was used between April
2008 and March 2013 in the following categories: always LF, never
LF, installed LF during study period (subdivided: before, during
and after installation) and unknown. For each operation, age, gender,
comorbidity, socio-economic deprivation, number of previous trauma
operations and surgical site infection within 90 days (SSI90) were
extracted from England’s national hospital administrative Hospital
Episode Statistics database. Crude and adjusted odds ratios (OR)
were used to compare ventilation groups using hierarchical logistic
regression. Subanalysis was performed for hip hemiarthroplasties.Aims
Patients and Methods
The aim of this study was to present data on 11 459 patients
who underwent total hip (THA), total knee (TKA) or unicompartmental
knee arthroplasty (UKA) between November 2002 and April 2014 with
aspirin as the primary agent for pharmacological thromboprophylaxis. We analysed the incidence of deep vein thrombosis (DVT) and pulmonary
embolism (PE) then compared the 90-day all-cause mortality with
the corresponding data in the National Joint Registry for England
and Wales (NJR). Aims
Patients and Methods
