Orthopaedics

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Barriers to the completion of radiation therapy in cervical cancer treatment in Nigeria : a review of socioeconomic, geographical, and psychosocial factors
(Springer, 2024-10) Adebisi, Ajibola A.; Onobun, Daniel E.; Orji, Chijioke; Ononye, Reginald; Royal College of Surgeons of England; South Warwickshire University NHS Foundation Trust; Liverpool University Hospitals NHS Foundation Trust; Glan Clwyd Hospital, Denbighshire; Orthopaedics; Medical and Dental; Onobun, Daniel E.
Cervical cancer is a major health concern in Nigeria, where it is one of the primary causes of cancer-related deaths among women. Despite the crucial role of radiation therapy in treating cervical cancer, many patients in Nigeria do not complete their prescribed treatment courses. This review examines the barriers contributing to this issue. Factors such as low awareness and utilization of Pap smears, inadequate HPV vaccination, financial constraints, insufficient radiotherapy infrastructure, and the psychological burden of cancer treatment are explored. Limited screening and vaccination efforts exacerbate the high incidence of cervical cancer in Nigeria. Financial barriers are a primary obstacle, with many patients unable to afford the high cost of radiotherapy. Nigeria's radiotherapy infrastructure is severely lacking leading to significant treatment delays and cancellations. Geographical barriers further complicate access, as many patients must travel long distances to reach treatment centers. Psychosocial issues, including anxiety and depression, significantly impact treatment adherence and completion. These psychological factors, coupled with the physical side effects of radiotherapy, contribute to high rates of treatment interruption. To address these challenges, the review suggests enhancing cervical cancer prevention through increased human papillomavirus (HPV) vaccination and screening, expanding radiotherapy capacity by increasing the number of treatment centers, and providing comprehensive support systems to address financial and psychosocial barriers. By implementing these strategies, it is possible to improve treatment adherence and outcomes for cervical cancer patients in Nigeria. Keywords: cervical cancer; external beam radiotherapy; nigeria; pelvic radiation; radiotherapy
Ipsilateral intracapsular hip fracture 2 years after fixation of extracapsular fracture by dynamic hip screw
(Indian Orthopaedic Research Group, 2015-04) Syed, Farhan; Nunag, Perrico; Mustafa, Abubakar; Pillai, Anand; South Warwickshire University NHS Foundation Trust; University Hospital of South Manchester; Trauma and Orthopaedics; Medical and Dental; Syed, Farhan
Introduction: Sustaining an intracapsular fracture in a hip which was previously fixed with dynamic hip screw for extracapsular fracture, is a very rarely reported occurrence. We present one such case in order to discuss the presentation and management of this fracture. We have also reviewed the literature and pooled the previously reported cases to look at potential cause & risk factors. Case report: A 92 year old female, presented with new onset hip pain following a trivial injury. Couple of years back, she had sustained an extracapsular fracture on same side which was treated by DHS fixation. Further investigations confirmed a de-novo fracture which was treated by removal of DHS and cemented bipolar hemiarthroplasty. Conclusion: This complication might not be as rare as earlier thought to be. All patients, especially elderly females who present with new onset hip pain following DHS fixation of their hip fracture previously must be evaluated for a de-novo intracapsular fracture. On confirmation of diagnosis, they can be treated by removal of dynamic hip screw and hemiarthroplasty as most of these are low demand elderly patients. Keywords: Dynamic hipscrew; Extracapsularfracture; Hipfractures.
Patellofemoral joint replacement and nickel allergy : an unusual presentation
(Wiley, 2015-10-12) Syed, Farhan; Jenner, Edward; Faisal, Mohammad; South Warwickshire University NHS Foundation Trust; Trauma and Orthopaedics; Medical and Dental; Syed, Farhan; Jenner, Edward; Faisal, Mohammad
Metal allergy is an unusual complication of joint replacement that may cause aseptic loosening and necessitate joint revision surgery. We present the case of nickel allergy causing aseptic loosening following patellofemoral joint replacement (PFJR) in a 54-year-old male. Joint revision surgery to a nickel-free total knee replacement was performed with good results. Our literature review shows that there is no evidence to guide the management of metal allergy in PFJR. The evidence from studies of total knee replacement is limited to retrospective case series and case reports and gives contradictory recommendations. The optimal management strategy for metal allergy in PFJR is not clear. We recommend allergy testing in patients with history of metal allergy and use of an allergen-free implant in those with positive tests. As there is no gold standard test to establish metal allergy, the choice of test should be guided by availability and recommendation from the local unit of dermatology and allergy testing. We recommend investigation for metal allergy in patients with implant loosening where other causes have been excluded.
A new nail with a locking blade for complex proximal humeral fractures
(Springer, 2016-07-26) Hashmi, F. R.; Mayr, Edgar; South Warwickshire University NHS Foundation Trust; Orthopaedics; Medical and Dental; Hashmi, F. R.
Introduction: The objective of this study was to assess the clinical outcome of displaced proximal humerus fracture treated with a new locking blade nail. Materials and methods: This prospective study included a series of 92 patients with acute fracture of the proximal humerus treated in one hospital level I trauma centre with locking blade nail between December 2010 and December 2013. According to the Neer classification, all fractures were two- to four-part fractures. Age adopted Constant score, DASH and visual analogue scores were used as outcome measures. Results: A total of 92 patients were enrolled in the study. However, 29 patients were excluded due to loss to follow-up and death. Ultimately, 63 patients were available for final follow-up and data analysis. The mean duration of follow-up was 22 months (range 16-48 months). On average at 1 year, all fractures had united. The mean weighted Constant score was 84.2 % and the median disabilities of the arm, shoulder and hand (DASH) score was 26, the range of elevation was 115 and range of abduction was 97. The head shaft angle was 130, and pain visual analogue was 1.6. We found that 5 of the 63 patients (8 %) demonstrated complications. Two patients (3 %) displayed secondary displacement and require device removal. Two patients (3 %) had impingement due to prominent metal work, and one patient had a superficial wound infection which was treated with a course of antibiotics. Conclusion: Our study shows excellent results with new locking blade nail for displaced proximal humerus fractures. We think the locking blade nail offers stiff triangular fixation of the head fragment and support of the medial calcar region to prevent secondary varus collapse. Level of evidence: III. Keywords: Calcar; Functional outcome; Insufficient primary stability; Locked blade; Minimal soft tissue damage; Outcome measures; Proximal humeral fractures; Rotator cuff; Triangular fixation.
Patellofemoral joint arthroplasty : early results and functional outcome of the Zimmer Gender Solutions Patello-Femoral Joint system
(Korean Orthopaedic Association, 2017-08-04) Osarumwense, Donald; Syed, Farhan; Nzeako, Obi; Akilapa, Segun; Zubair, Omer; Waite, Jon; Kings College Hospital, London; South Warwickshire University NHS Foundation Trust; Orthopaedics; Medical and Dental; Syed, Farhan; Zubair, Omer; Waite, Jon
Background: Improved knee prosthesis designs have led to an increase in the use of patellofemoral arthroplasty as a primary treatment option in recent times. We report the early results and outcomes of the Zimmer Gender Solutions Patello-Femoral Joint (PFJ) system used to treat isolated patellofemoral osteoarthritis (PFA). Methods: We retrospectively reviewed and analysed data of patients who underwent PFJ replacement (PFJR) at our institution with a minimum follow-up of 2 years. Results: Median Oxford Knee score (OKS) was 38 (interquartile range, 28 to 42) at the latest follow-up with a significant improvement from preoperative scores (p < 0.0005). Median OKS was 40 for unilateral PFJRs and 39 for nonobese patients (body mass index [BMI] < 30 kg/m2). There was no significant difference in OKS between unilateral and bilateral procedures (p = 0.462). Likewise, there was no significant difference in OKS between obese and nonobese patients (p = 0.272). Two knees (4%) were revised for progression of osteoarthritis. No complications were reported related to infectious or thromboembolic causes. Conclusions: Our study showed good early results of the PFJ system, at least equal to those of other leading brands in the National Joint Registry for England, Wales and Northern Ireland (NJR). There have been no complications related to either the implantation technique or prosthetic design for this new implant. Progression of tibiofemoral arthritis remains a major concern. Our study also suggests that PFJR in obese patients and bilateral procedures can have good results. Keywords: Arthroplasty; Knee joint; Patellar; Patellofemoral; Prosthesis.
Blood metal ion thresholds to identify patients with metal-on-metal hip implants at risk of adverse reactions to metal debris : an external multicenter validation study of Birmingham hip resurfacing and Corail-Pinnacle implants
(Lippincott, Williams & Wilkins, 2017-09-20) Matharu, Gulraj; Berryman, Fiona; Judge, Andrew; Reito, Aleksi; McConnell, Jamie; Lainiala, Olli; Young, Stephen; Eskelinen, Antti; Pandit, Hemant G.; Murray, David W.; University of Oxford; Nuffield Orthopaedic Centre, Oxford; The Royal Orthopaedic Hospital, Birmingham; University of Southampton; Coxa Hospital for Joint Replacement, Tampere, Finland; South Warwickshire University NHS Foundation Trust; Chapel Allerton Hospital, Leeds; Trauma and Orthopaedics; Orthopaedics; Medical and Dental; McConnell, Jamie; Young, Stephen
Background: The authors of recent studies have reported newly devised implant-specific blood metal ion thresholds to predict adverse reactions to metal debris (ARMD) in patients who have undergone unilateral or bilateral metal-on-metal (MoM) hip arthroplasty. These thresholds were most effective for identifying patients at low risk of ARMD. We investigated whether these newly devised blood metal ion thresholds could effectively identify patients at risk of ARMD after MoM hip arthroplasty in an external cohort of patients. Methods: We performed a validation study involving 803 MoM hip arthroplasties (323 unilateral Birmingham Hip Resurfacing [BHR], 93 bilateral BHR, and 294 unilateral Corail-Pinnacle implants) performed in 710 patients at 3 European centers. All patients underwent whole-blood metal ion sampling, and were divided into 2 groups: those with ARMD (leading to revision or identified on imaging; n = 75) and those without ARMD (n = 635). Previously devised implant-specific blood metal ion thresholds (2.15 μg/L of cobalt for unilateral BHR; 5.5 μg/L for the maximum of either cobalt or chromium for bilateral BHR; and 3.57 μg/L of cobalt for unilateral Corail-Pinnacle implants) were applied to the validation cohort, and receiver operating characteristic curve analysis was used to establish the discriminatory characteristics of each threshold. Results: The area under the curve, sensitivity, specificity, and positive and negative predictive values for the ability of each implant-specific threshold to distinguish between patients with and without ARMD were, respectively, 89.4% (95% confidence interval [CI] = 82.8% to 96.0%), 78.9%, 86.7%, 44.1%, and 96.9% for unilateral BHR; 89.2% (CI = 81.3% to 97.1%), 70.6%, 86.8%, 54.5%, and 93.0% for bilateral BHR; and 76.9% (CI = 63.9% to 90.0%), 65.0%, 85.4%, 24.5%, and 97.1% for unilateral Corail-Pinnacle implants. Using the implant-specific thresholds, we missed 20 patients with ARMD (2.8% of the patients in this series). We missed more patients with ARMD when we used the fixed thresholds proposed by regulatory authorities: 35 (4.9%) when we used the U.K. threshold of 7 μg/L for both cobalt and chromium (p = 0.0003), 21 (3.0%) when we used the U.S. threshold of 3 μg/L for both cobalt and chromium (p = 1.0), and 46 (6.5%) when we used the U.S. threshold of 10 μg/L for both cobalt and chromium (p < 0.0001). Conclusions: This external multicenter validation study confirmed that patients with blood metal ion levels below new implant-specific thresholds have a low risk of ARMD after MoM hip arthroplasty. Using these implant-specific thresholds, we missed fewer patients with ARMD compared with when the thresholds currently proposed by regulatory authorities were used. We therefore recommend using implant-specific blood metal ion thresholds when managing patients who have undergone MoM hip arthroplasty. Level of evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Oxford Medial Partial Knee Replacement. The rationale for a femur first technique
(Elsevier, 2012-05-11) Shakespeare, David; Waite, Jon; Warwickshire Nuffield Hospital; South Warwickshire University NHS Foundation Trust; Orthopaedics; Medical and Dental; Waite, Jon
Background: The Oxford Medial Partial Knee Replacement (PKR) has been in clinical use for more than 20 years. The current surgical technique requires a number of judgements to be made, and even in the most experienced hands surgery can be challenging. We present an alternative surgical technique, which we believe addresses the unpredictability of the current method. The technique is based on precise femoral positioning prior to tibial resection. Method: A prospective series of 125 Oxford Medial PKRs was performed using this new technique and a radiographical analysis was performed. We used meniscal thickness, meniscal position and femoral position as measures of reproducibility of the procedure. Results: Variability in meniscal thickness has been minimised with a 3mm meniscal bearing used in 21 knees (15%), 4mm (the target thickness) in 73 knees (59%) and 5mm in 30 knees (24%). The mean meniscal position relative to the tibial tray upright was 2mm (SD 1mm). Femoral component position relative to the tibial tray, which defines the excursion of the meniscus was also assessed. Mean coronal plane alignment was 2° of valgus (SD 2.8). Mean flexion/extension was 3.8° (SD 3.1). The mean rotation was 10° internal (SD 5°). Conclusion: We believe this new technique makes this procedure more reproducible, and should be considered as a viable alternative to the current recommended technique. It may be a better technique for those surgeons who are relatively inexperienced with this prosthesis.
Knee surgery and its evidence base
(Royal College of Surgeons of England, 2016-03) Sharma, A.; Hasan, K.; Carter, A.; Zaidi, R.; Cro, S.; Briggs, T.; Goldberg, A.; Royal National Orthopaedic Hospital NHS Trust; Barts Health NHS Trust; South Warwickshire University NHS Foundation Trust; Medical Research Council; Orthopaedics; Medical and Dental; Carter, A.
Introduction: Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade. Methods: Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend. Results: The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic. Conclusions: Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study's level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence. Keywords: Arthroplasty; Evidence-based medicine; Knee; Review.
The clinical relevance of sound changes produced during cementless hip arthroplasty : a correctly sized femoral broach creates a distinctive pattern of audio frequencies directly related to bone geometry
(British Editorial Society of Bone and Joint Surgery, 2018-12-01) McConnell, J. S.; Saunders, P. R. J.; Young, S. K.; South Warwickshire University NHS Foundation Trust; Orthopaedics; Medical and Dental; McConnell, J. S.; Saunders, P. R. J.; Young, S. K.
Aims: Cementless femoral stems must be correctly sized and well-seated to obtain satisfactory biological fixation. The change in sound that occurs during impaction of the femoral broach is said to indicate good fit, but this has not been widely studied. We set out to find whether the presence or absence of these sound changes could predict correct sizing. Patients and methods: We recorded the sound generated during femoral broaching for 105 cementless total hip arthroplasties using the Corail stem. Four cases were excluded, leaving 101 recordings for analysis. There were 36 male patients and 65 female patients, with a mean age of 69.9 years (sd 12.3) and median body mass index (BMI) of 29 kg/m 2 (interquartile range (IQR) 26 to 32). The recordings were analyzed to identify the frequencies of the sounds produced during impaction of the femoral broach. Results: The emergence of a low-frequency band of sound in the 1 kHz range, during the final femoral broaching, was a strong predictor of a well-sized implant stem. The frequency was related to femoral length, supporting our hypothesis that the sound arose from the bone itself. Conclusion: The low-frequency sound generated during femoral broaching can be monitored spectrographically, its frequency can be predicted from femoral length, and it is a good predictor of appropriate stem sizing. Keywords: Arthroplasty; Basic science; Cementless; Femoral broach; Hip.
A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures - An alternative treatment option
(Elsevier, 2017-01-10) Atrey, Amit; Hussain, Nasir; Gosling, Oliver Burton; Giannoudis, P; Shepherd, Andrew J.; Young, Steve; Waite, J.; St Michael’s Hospital, Toronto, Canada; Orthopaedics and Traumatology, Leeds; Michigan University, USA; SW Training Rotation, UK; Warwick Hospital Orthopaedic Research Unit; Department of Orthopaedics; Medical and Dental; Shepherd, Andrew J.; Young, Steve; Waite, J.
Introduction: Although the use of an endoprosthesis for distal femoral fractures remains a valid treatment option the widespread use is in its infancy. Methodology: In this retrospective case series, we review cases of distal femoral fracture treated with endoprosthetic replacement (EPR). The outcomes we assessed were the time to start mobilising, the time to discharge, morbidity and mortality as well as an Oxford knee score to assess pain and function and also the early survivorship. 6 of the 11 from the cohort had existing Total Knee Replacements (TKRs) in situ. Results: There were 11 knees in our cohort with a mean age of 81.5 years (range 52-102 years). The median time to follow up was 3.5 years (range 1.6 to 5.5 years). The median times to theatre was 3 days and to discharge was 16 days. Oxford functional and pain scores were 32/48. Discussion: In the appropriate patient and fracture pattern, Endoprosthetic knee replacement is an excellent option in the treatment of distal femoral fractures whether associated with an existing TKR or not. The implant is more costly than traditional open reduction and internal fixation, but the earlier return to full mobility post-operatively may save on hospital/care home stay and free up hospital space and minimise complications.
601 metal-on-metal total hip replacements with 36 mm heads a 5 minimum year follow up: Levels of ARMD remain low despite a comprehensive screening program
(Elsevier, 2016-10-31) Atrey, Amit; Hart, Alister; Hussain, Nasir; Waite, Jonathon; Shepherd, Andrew J.; Young, Steve; St Michael's Hospital, Toronto, Canada; University of Toronto, Canada; Royal National Orthopaedic Hospital, Stanmore, London; Central Michigan University College of Medicine, USA; Warwick Hospital; Department of Orthopaedics; Medical and Dental; Waite, Jonathon; Shepherd, Andrew J.; Young, Steve
Background: We conducted a retrospective study to assess the clinical outcome, failure rate, and reason for failure of a large consecutive series of 36 mm MoM Corail/Pinnacle total hip replacements (THRs). Methods: Between 2006 and 2011, 601 consecutive 36 mm MoM THRs were performed (585 patients). Patients were followed according to the UK Medicines and Healthcare Products Regulatory Agency (MHRA) guidelines. All patients were accounted for and 469 patients (78%) were clinically and radiographically assessed. 328 females and 141 males with a median age of 73 (range 36-94 years) and a median follow up of 7.2 years (range 5.2-9.7 years) were followed. Clinical data included blood cobalt and chromium, Oxford Hip Score (OHS), plain radiograph, ultrasound of hip and intra-operative findings in those patients who had revision surgery. Results: 56 patients died of causes unrelated to their hip replacement. The mean survivorship of the implant was 92.8% (range 91.6-94%, 95% CI) at a median time to follow up of 84 months (62-113 months). The functional outcome was good with a median OHS of 38 out of 48 (23-44). The dislocation rate was 0.99%, with all these 6 cases requiring revision. 476 patients had blood tests. 100 patients (21%) had elevated levels of either cobalt above MHRA guidelines of 7 parts per billion (120 and 135 nmol/L respectively for cobalt and chromium). Cobalt was elevated independently of chromium in 75% of the cases (but never vice versa). The mean cup inclination angle was 42°. Each incremental stem size increase resulted in a decrease in cobalt by 11 nmol/L. The most common reason for revision was adverse reaction to metal debris (ARMD) (12 cases). Conclusion: This paper is the largest and longest follow up of 36 mm MoM THRs. Using the MHRA guidelines for follow up, the revision rates of this cohort has remained low compared to other studies, but unacceptably higher than that of other bearing surfaces. Level of Evidence: III.
Ankle arthroplasty: A review and summary of results from joint registries and recent studies
(BioScientifica, 2018-06-28) Syed, Farhan; Ugwuoke, Anthony; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; Medical and Dental; Syed, Farhan; Ugwuoke, Anthony
Total ankle arthroplasty offers a reasonable alternative to ankle arthrodesis in carefully selected patients. It is debatable whether rheumatoid arthritis patients have better outcomes compared with those who have ankle arthroplasty for either primary osteoarthritis or post-traumatic arthritis. Aseptic loosening and infection are the most common complications requiring revision. It is worth noting that some of the best survival rates are seen in the surgeon-designer case series. The uncemented mobile or fixed bearing prostheses have better outcomes compared with their older counterparts. There is no convincing evidence to suggest superiority of one design over another among the currently available prostheses. Ankle arthroplasty surgery has a steep learning curve; the prosthesis choice should be driven by the surgeon's training and experience.
Risk of subsidence and peri-prosthetic fractures using collared hydroxyapatite-coated stem for hip arthroplasty in the elderly
(SAGE Publications, 2018-11-28) Syed, Farhan; Hussein, Amr; Katam, Krishnaiah; Saunders, Paul; Young, Stephen K; Faisal, Mohammad; South Warwickshire University NHS Foundation Trust; Trauma and Orthopaedics; Medical and Dental; Syed, Farhan; Hussein, Amr; Katam, Krishnaiah; Saunders, Paul; Young, Stephen K; Faisal, Mohammad
Introduction: Subsidence has been noted with both cemented and uncemented stems in hip arthroplasty. On most occasions, it's minimal (i.e. less than 2 mm) and stabilises at 1 year. However, when its progressive and significant, it causes loss of length and horizontal offset, and when symptomatic warrants a revision. Materials and methods: A retrospective radiological review of the patient database was carried out to identify all patients with age ≥ 70 years who underwent elective hip arthroplasty using uncemented HA coated collared stem and had radiographs at 1 year follow up. A total of 176 patients were identified from January 2009 to June 2010. 2 independent investigators classified the proximal femur based on Dorr type and calculated the subsidence based on Engh and Massin method of calculating the distance between the tip of greater trochanter and shoulder of the prosthesis. Results: 7 patients (4 Bs, 2 As, 1 C) had a subsidence of ≥ 2 mm (2-3.2 mm) at 1 year. None of them was symptomatic. 1 of them was secondary to a missed calcar crack and continued to subside for 9 mm before it stabilised on the lesser trochanter at 4 years follow up. There were Dorr 22 (12.5%) type A, 147(83.5%) type B and 7(4%) type C. The mean age was 77.4 years (70-91 years) and male: female ratio was 7:15. 3 patients had an intraoperative calcar crack requiring cabling. All were mobilised full weight-bearing postoperatively, and none had a subsidence of >2 mm at 1 year follow-up. Discussion: Our subgroup analysis identified that subsidence can happen when the collar is "non-functional" and the initial press fit of the stem wasn't achieved. It can also occur in an event of calcar crack, which is missed intraoperatively. In cases of calcar crack which went on to have to cable during the primary procedure, it neither changed the post-operative rehabilitation nor did it show an increased risk of subsidence. Conclusion: A fully hydroxyapatite (HA) coated collared stem, when used in elderly age group for elective THR, has only 2% risk of intraoperative periprosthetic fracture. There's a 4% risk of radiologically significant subsidence (i.e. ≥2 mm), however, it has not proven to be clinically significant in our study. Dorr canal type had no bearing on either risk of periprosthetic fracture or subsidence. Collared stems did not have a statistically significant difference in risk of subsidence and peri-prosthetic fracture in comparison to un-collared stem, although there was a non-significant trend in favour of collar use. Keywords: Corail; fracture; hip arthroplasty; peri-prosthetic; subsidence.
Cemented Lateral Unicompartmental Knee Replacement: A retrospective single centre independent series
(SAGE Publications, 2022-03) Hefny, Mamdouh; Smith, Nick; Waite, Jon; South Warwickshire University NHS Foundation Trust; Orthopaedics; Medical and Dental; Hefny, Mamdouh H.; Smith, Nick A.; Waite, Jon
Background Unicompartmental knee replacement (UKR) has functional and economic benefits when compared with total knee replacement, however it is technically demanding and may be associated with higher failure rates. The primary aim of this independent series study was to evaluate the survival of lateral UKRs implanted in our institution and their clinical outcomes. The secondary outcome was to compare the results of mobile and fixed-bearing prostheses. Methods This is a retrospective series study of 183 cemented lateral UKRs implanted in 170 patients, for advanced isolated lateral compartment arthritis, under the care of two senior surgeons. Fixed or mobile-bearing prostheses were used according to the surgeon's preference. Kaplan Meier analysis was used to evaluate prosthesis survival with the endpoint being revision for any reason. A subgroup analysis of survival was also done for each bearing type. Functional outcomes were evaluated using the Oxford knee score (OKS) at final follow-up. Results This series included 103 Fixed-bearing and 80 mobile-bearing prostheses. Median follow-up was 6.9 years. 9 knees required revision. The commonest reason for revision was progression of arthritis to the medial compartment. Dislocation was the commonest cause of revision in the mobile-bearing group. Survival at 10 years was 91.9% with no significant difference (p = 0.083) between bearing types (fixed-bearing 93.8% and mobile-bearing 90.6%). The OKS were comparable in both groups, the mean OKS was 44/48. Conclusion Good survival and functional outcomes can be achieved using cemented lateral UKRs with both bearing types. There was a trend towards superior outcomes in the fixed-bearing group.
Should we avoid shoulder surgery in wheelchair users? A systematic review of outcomes and complications.
(Elsevier, 2018) Jordan, Robert W; Sloan, Roger; Saithna, Adnan; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; Nottingham Trent University; Renacres Hospital; Orthopaedics; Medical and Dental; Sloan, Roger
Introduction: The prevalence of shoulder pathology in wheelchair dependent patients is high. The shoulder joint is critical for maintaining independence but traditionally there has been reluctance to offer surgical intervention in view of perceived poor outcomes. The aim of this study was to provide patients and surgeons with a realistic overview of outcomes following surgical intervention for shoulder pathology in wheelchair dependent patients. Methods: A systematic review of the online databases Medline and Embase was performed in September 2017. Studies reporting functional outcomes, complications or rate of revision surgery after shoulder surgery in patients' dependent on wheelchair for mobility were included. A narrative synthesis of the studies and appraisal using the MINORS tool was performed. Results: The search strategy identified 11 eligible studies; 7 assessed rotator cuff repair and 4-shoulder arthroplasty. Six of the seven studies reporting on rotator cuff repairs demonstrated improvement in pain, range of motion and functional outcomes with a retear rate between 12 and 39%. Although total shoulder arthroplasty and hemiarthroplasty reportedly improved pain and function, the subsequent risk of rotator cuff failure was reported up to 100%. The two studies assessing reverse arthroplasty demonstrated significant improvement in function and pain with the largest series reporting a 15.8% failure rate. Conclusion: Rotator cuff repairs and reverse shoulder arthroplasties performed in wheelchair users are associated with significant functional improvement and a slightly higher complication profile to those performed in ambulatory patients. This review provides a resource to aid surgeons and patients in holding realistic expectations following shoulder surgery in wheelchair users. Keywords: Rotator cuff; Shoulder; Shoulder arthroplasty; Wheelchair dependence; Wheelchair user.
How do I encourage older people to become physically active?
(RCN Publishing (RCNi), 2020) Jennings, J.; South Warwickshire University NHS Foundation Trust; Orthogeriatrics; Nursing and Midwifery Registered; Jennings, Jo
Article exploring physical activities that can benefit older adults.
Impact of COVID-19 on clinical outcomes for patients with fractured hip: a multicentre observational cohort study
(British Editorial Society of Bone and Joint Surgery, 2020-11) Rasidovic, Damir; Ahmed, Imran; Thomas, Christopher; Kimani, Peter; Wall, Peter; Mangat, Karanjit; NOF-COV19 Study Collaborative Group; South Warwickshire University NHS Foundation Trust; University Hospital Coventry and Warwickshire NHS Trust; University of Warwick; Orthopaedics; Medical and Dental; Rasidovic, Damir; Thomas, Christopher; Mangat, Karanjit; Wall, Peter; Ahmed, Imran
Aims: There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic. Methods: We completed a multicentre cohort study across ten hospitals in England. Data were collected from 1 March 2020 to 6 April 2020, during which period the World Health Organization (WHO) declared COVID-19 to be a pandemic. Patients ≥ 60 years of age admitted with hip fracture and a minimum follow-up of 30 days were included for analysis. Primary outcome of interest was mortality at 30 days post-surgery or postadmission in nonoperative patients. Secondary outcomes included length of hospital stay and discharge destination. Results: In total, 404 patients were included for final analysis with a COVID-19 diagnosis being made in 114 (28.2%) patients. Overall, 30-day mortality stood at 14.4% (n = 58). The COVID-19 cohort experienced a mortality rate of 32.5% (37/114) compared to 7.2% (21/290) in the non-COVID cohort (p < 0.001). In adjusted analysis, 30-day mortality was greatest in patients who were confirmed to have COVID-19 (odds ratio (OR) 5.64, 95% confidence interval (CI) 2.95 to 10.80; p < 0.001) with an adjusted excess risk of 20%, male sex (OR 2.69, 95% CI 1.37 to 5.29; p = 0.004) and in patients with ≥ two comorbidities (OR 4.68, CI 1.5 to 14.61; p = 0.008). Length of stay was also extended in the COVID-19 cohort, on average spending 17.6 days as an inpatient versus 12.04 days in the non-COVID-19 group (p < 0.001). Conclusion: This study demonstrates that patients who sustain a neck of femur fracture in combination with COVID-19 diagnosis have a significantly higher risk of mortality than would be normally expected.Cite this article: Bone Joint Open 2020;1-11:697-705. Keywords: COVID-19; Coronavirus; Hip fracture; NOF; Neck of femur fracture.
Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach
(SAGE Publications, 2020-06) Baraka, Mostafa M.; Hefny, Hany M.; Thakeb, Mootaz F.; Fayyad, Tamer A.; Abdelazim, Haytham; Hefny, Mamdouh H; Mahran, Mahmoud A.; Ain-Shams University, Cairo, Egypt; South Warwickshire University NHS Foundation Trust; Orthopaedic Surgery; Medical and Dental; Hefny, Mamdouh H.
Purpose: Treatment of moderate to severe stable slipped capital femoral epiphysis (SCFE) remains a challenging problem. Open reduction by modified Dunn procedure carries a considerable risk of osteonecrosis (ON). Imhauser osteotomy is capable of realigning the deformity without the risk of ON, but the remaining metaphyseal bump is implicated with significant chondro-labral lesions and accelerated osteoarthritis. We conducted this study to evaluate the efficacy and safety of Imhauser osteotomy combined with osteochondroplasty (OCP) through the surgical hip dislocation (SHD) approach. Methods: A prospective series of 23 patients with moderate-severe stable SCFE underwent Imhauser osteotomy and OCP through SHD. The mean age was 14.4 years (13 to 20) and the mean follow-up period was 45 months (24 to 66). The outcome measures included clinical and radiological parameters and Harris hip score (HHS) was used as a functional score. Results: The mean HHS improved significantly from 65.39 to 93.3. The limb length discrepancy improved by a mean of 1.72 cm. The mean flexion and abduction arcs showed a significant improvement (mean increase of 37.5° and 18.5°, respectively). The mean internal rotation demonstrated the most significant improvement (mean increase of 38.5°). All the radiographic parameters improved significantly; including anterior and lateral slip angles (mean improvement 37.52° and 44.37°, respectively). The mean alpha angle decreased by 39.19°. The articulo-trochanteric distance significantly increased to a mean of 23.26 mm. No cases of ON or chondrolysis were identified. Conclusion: Combined Imhauser osteotomy and OCP through the surgical dislocation approach provide a comprehensive and safe management of moderate to severe stable SCFE. Level of evidence: IV. Keywords: Imhauser osteotomy; hip impingement; hip preservation; slipped capital femoral epiphysis; surgical hip dislocation.
Do intrathecal opioids in spinal anaesthesia have a role in enhanced recovery protocols for lower limb arthroplasty procedures?
(Elsevier, 2020-10) Denning, A.; Waite, Jon; Young, Stephen; Syed, Farhan; Smith, Nick; South Warwickshire University NHS Foundation Trust; Orthopaedics; Medical and Dental; Denning, A.; Waite, J.; Young, S.; Syed, F.; Smith, N.
Introduction: Adequate pain relief with minimal side effects plays an important role in enhanced recovery protocols (ERPs) after lower limb arthroplasty. It ensures early mobilisation, shortens length of hospital stay and improves patients’ overall experience. Intrathecal opioids given during spinal anaesthesia are believed to provide better perioperative pain relief, however can cause systemic symptoms including dizziness, pruritus and nausea which may delay patients’ recovery.
Survivorship and radiological analysis of a monoblock, hydroxyapatite-coated titanium stem in revision hip arthroplasty
(Elsevier, 2020-06) Saunders, Paul; Shaw, Debbie; Sidharthan, Sijin; Siney, Paul D.; Young, Stephen; Board, Tim; South Warwickshire University NHS Foundation Trust; Wrightington Hospital, Wigan, United Kingdom; Orthopaedics; Medical and Dental; Saunders, Paul R. J.; Young, Stephen K.
Background: We evaluated the survivorship, incidence of complications, radiological subsidence, proximal stress shielding, and patient-reported outcomes of a conservative, monoblock, hydroxyapatite-coated femoral stem. Methods: This retrospective cohort study reports on 254 revision hip arthroplasties between January 2006 and June 2016. The mean age of patients was 71 years. The mean length of follow-up was 62 months (range 12-152). Results: There were 13 stem re-revisions: infection (4), periprosthetic fracture (4), aseptic stem loosening (3), stem fracture (1), and extended trochanteric osteotomy nonunion (1). Kaplan-Meier aseptic stem survivorship was 97.33% (confidence interval 94-100) at 6 years. There were 29 intraoperative fractures. There were 6 cases of subsidence greater than 10 mm; however, none required revision. Ninety-six percent of cases showed no proximal stress shielding. Thigh pain was reported in 3% of cases. Conclusion: This study confirms that this stem provides good survivorship at 6 years, acceptable complication rates, adequate proximal bone loading, low incidences of thigh pain, and reliable clinical performance in revision hip arthroplasty. Key message: A monoblock, fully hydroxyapatite-coated titanium stem is reliable in revision arthroplasty with mild-moderate femur deficiencies.

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