Long-term clinical outcomes of arthroscopic supraspinatus tendon repair using the single anchor tension band technique - Minimum 5-years follow-up.

Background: The primary aim of this study was to assess the long-term patient reported outcomes of arthroscopic rotator cuff tear (ARCR) using a single anchor tension band (TB) technique for small and medium supraspinatus tears at minimum 5-years follow-up. Methods: A retrospective cohort study of consecutive ARCRs of small and medium supraspinatus tears using a knotless single anchor TB technique with minimum 5-year follow-up was carried out. Outcomes of interest included: range of motion (ROM) on examination under anaesthesia (EUA), visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) scores, Oxford Shoulder Score (OSS) and Short-Form (SF-12). Results: From 243 consecutive ARCR procedures, 82 patients with a mean age of 55 ± 9.5 years met the inclusion criteria at 6.7 ± 1.5 years follow-up. There were significant improvements in VAS (5.5 ± 2.2 vs. 0.7 ± 1.5), ASES (47.6 ± 16.8 vs. 92.8 ± 13.0), OSS (31.3 ± 7.2 vs. 45.3 ± 3.5) and SF-12 (37.6 ± 7.6 vs. 50.3 ± 7.7) post-operatively (all p < 0.001). Conclusions: The single anchor TB ARCR technique has excellent patient reported outcomes at a minimum of 5 years and is suitable for supraspinatus tears smaller than 20 mm in the sagittal plane. Level of evidence: Level IV; Consecutive Case Series.

Long-term follow-up of the Copeland mark III shoulder resurfacing hemi-arthroplasty.

BACKGROUND: Shoulder humeral resurfacing is being performed in increasing numbers. We report the long-term outcome of patients with the Copeland mark III humeral resurfacing hemi-arthroplasty. METHODS: Ninety-five shoulder hemi-arthroplasties were performed in 85 patients, from 1994 to 2003. Oxford Shoulder Score (OSS) and short form 12 (SF-12) questionnaires were administered. RESULTS: At 12-year follow-up, 49 patients were alive. The OSS was 35.2 and SF-12 score was 83. There were 3 revision operations and 95% survivorship at 18 years. CONCLUSION: This prosthesis has a low revision rate with few post-operative complications and good patient-reported outcome in an elderly population.

The long-term outcome of the Gschwend-Scheier-Bähler III elbow replacement.

BACKGROUND: The Gschwend-Scheier-Bähler III (GSBIII) is a semiconstrained, sloppy-hinge total elbow replacement. We report the long-term functional and radiological outcome of a cohort of patients more than 10 years after surgery. METHODS: All GSBIII prostheses implanted from September 1996 to June 2004 were identified from our surgical database. Functional and radiological assessments were performed at routine patient clinic visits, using the Oxford Elbow Score, the 11-item version of the Disabilities of Arm, Shoulder and Hand score (QuickDASH), and plain radiographs. RESULTS: From 1996 to 2004, 52 elbows in 40 patients were implanted; of these, 18 patients (23 elbows) had died, leaving 22 patients with 29 elbows available for follow-up. Three patients (3 elbows) could not be contacted. Functional and radiological data were available for 19 patients with 26 elbows (90%). Overall survival was a mean of 13.1 years (range, 10.6-16.4 years). Mean age at operation was 63.0 years (range, 49.5-80.6 years). There were 5 male elbows and 21 female elbows. Five total elbow replacements were performed for osteoarthritis and 24 for rheumatoid arthritis. The mean Oxford Elbow Score was 26.9 (range, 18-48). The mean QuickDASH score was 42.6 (range, 2.5-93.2). Of the 52 elbows in 40 patients, 4 elbows (7.7%) required further surgery, 2 (3.8%) of which were revisions. In addition, there was 1 intraoperative complication and 2 postoperative complications not requiring further surgery. Kaplan-Meier 10-year survival shows a 95.9% implant survival with revision as the end point. CONCLUSIONS: The GSBIII elbow replacement provides good long-term function with a low revision rate and few complications. LEVEL OF EVIDENCE: Level IV; Case Series; Treatment Study.

Complications after revision surgery of malreduced ankle fractures.

Ankle fractures are common orthopedic injuries requiring reduction and cast immobilization or fixation. Fractures fixed in a malreduced (misaligned) position can require revision surgery. However, because this has been a relatively rare occurrence, little is known about the complications that can occur after such surgery. We reviewed all adult closed ankle fractures that underwent revision surgery for technical failure in a regional trauma hospital from January 2007 to January 2010. Those with open fractures and those who required external fixation at any point in their treatment were excluded. Nine patients underwent revision surgery during the study period. Of these 9 patients, 3 (33%) developed a deep infection, all with positive microbiology cultures for methicillin-sensitive Staphylococcus aureus. Each of these patients underwent removal of the metalwork and wound debridement, followed by plastic surgery free flap coverage. In addition to the 3 infection cases, those with noninfected complications included 1 patient (11%) with chronic regional pain syndrome, 1 (11%) with failure of plate fixation, and 1 (11%) with persistent pain requiring arthroscopy and debridement. The overall incidence of complications was 66.67% in this group of 9 patients who had undergone revision surgery for the treatment of a malreduced malleolar ankle fracture. Although our observational study involved a small subset of patients who had undergone surgical repair for ankle fracture, we suggest that if revision surgery will be undertaken, the high incidence of infection and the potential need for plastic surgery should be highlighted during the consent process before the original, open reduction internal fixation procedure.

The use of blood cell salvage in acetabular fracture internal fixation surgery.

OBJECTIVES: To determine if the routine use of intraoperative blood cell salvage in acetabular fracture internal fixation reduces the need for allogenic blood transfusion, is cost effective, and whether it is influenced by the acetabular fracture pattern. DESIGN: A retrospective study. SETTING: Tertiary pelvic and acetabular reconstructive center. PATIENTS/PARTICIPANTS: Patients undergoing internal fixation for acetabular fractures. RESULTS: Eighty consecutive patients were reviewed, comprising 26 elementary fracture (EF) and 54 associated fracture (AF) types. The mean volume of autologous blood transfused was 484 mL. The mean volume of 561 mL of autologous blood transfused in patients with AF types was significantly greater than the mean volume of 325 mL transfused in the EF group (P = 0.007). Additional allogenic blood transfusion was required in 5 (19%) patients with EFs and 15 (28%) patients with AFs (P = 0.418). The mean cost of the blood cell salvage and additional blood products in our study was $223 (£135) for all fracture types ($174/£105 for EF and $246/£149 for AF).When treating AF types, the mean cost of using blood cell salvage was $246 (£149) as compared with the mean predicted cost of not using blood cell salvage and transfusing the equivalent of 1.7 units of allogenic blood instead, which was $463 (£281). These distributions are significantly different (P = 0.01). CONCLUSIONS: The use of blood cell salvage for internal fixation surgery for acetabular fracture is cost effective, particularly when treating AF types, and its routine use is advocated to limit the need for allogenic blood transfusion.

The medium term outcome of the Omnifit constrained acetabular cup.

Recurrent dislocation requiring revision surgery occurs in approximately 4% of primary total hip arthroplasties (THAs). To reduce this risk, or to treat those patients who recurrently dislocate, a constrained acetabular component may be used, however there are concerns over the success of such components due to increased mechanical stresses. The purpose of this study was to analyse the survivorship and radiological results for the Omnifit constrained acetabular component, providing a longer patient reported outcome follow-up than previous studies. 117 patients (median age 82 years) underwent a THA with an Omnifit constrained acetabular component. Of these, 45 were primary replacements and 72 were revisions. Survivorship analysis was performed and patients were assessed both radiologically and functionally. At follow-up, 53 patients (45.3%) had died at a median time of 33 months from operation. The median overall follow-up was 7.0 (5.5-8.2) years. Survivors (median age 83 years) reported a median Oxford Hip Score (OHS) of 16.6 (0-48), 87.8% were satisfied with their surgery. 45 (91.8%) of the acetabular components were stable radiologically, 48 (96%) of the femoral components were stable (5 uncemented, 43 cemented) and two possibly unstable. Four of the 117 patients underwent further surgery. Only one required revision of the prosthesis and this was for a periprosthetic fracture. In the medium term the Omnifit constrained acetabular component prevents dislocation and does not cause excessive loosening of either the acetabular or femoral components in our patient population. Our results support the use of the Omnifit constrained acetabular component in elderly patients at risk of dislocation with low functional demand.

Prevention of infection in orthopaedic joint replacement.

Infection of a prosthetic joint is a significant adverse event, affecting the patient, the surgical team, and consuming hospital resources. The patient faces multiple operations, a prolonged hospital stay and a more challenging period of rehabilitation. The surgeon must perform longer and more technically demanding revision operations in order to remove the infected prosthesis, increasing the burden on hospital resources. It has been estimated that that the cost of managing an infected total hip replacement (THR) is four times greater than for a primary procedure (Dreghorn & Hamblen 1989). The personal cost to the patient must also be emphasised.

Mesenteric and coeliac occlusions following heparin-induced thrombocytopenia after aortobiprofunda bypass surgery.

A 56-year-old man developed mid-gut bowel ischaemia following an elective aortobiprofunda bypass for short-distance claudication. The bowel was resected and he was commenced on lifelong total parenteral nutrition. He was found to have developed heparin-induced thrombocytopenia and thrombosis, confirmed by high levels of heparin-platelet factor 4-antibody on enzyme-linked immunosorbent assay (ELISA). He subsequently had foregut ischaemia with a second bout of thrombocytopenia despite not being on heparin. The case describes the first report of bowel ischaemia as a consequence of heparin-induced thrombocytopenia causing sequential superior mesenteric and coeliac arterial thrombosis in this scenario and highlights the importance of the awareness of the association of these pathological entities and subsequent management.

To catheterise or not to catheterise: study in hip and knee primary arthroplasty.

This cross sectional study examines the rate of catheterisation of patients after elective primary hip and knee arthroplasty in an English district general hospital. 50 patients were included in this study, with 19 (37%) being catheterised pre-operatively. Of the remainder, 10 went into retention and had to be catheterised, while the other 21 were managed without a catheter. There was a trend towards more patients requiring catheterisation after axial anaesthetic (42%) compared to non-axial anaesthetic (21%), although this was not significant. We examine the rationale for catheterisation in hip and knee arthroplasty and review the available literature.

The validity of the Gammarus:Asellus ratio as an index of organic pollution: abiotic and biotic influences.

In freshwaters. Gammarus spp. are more sensitive to organic pollution than Asellus spp. and the relative abundance of the two taxa has been proposed as a pollution index. We tested the validity of this by examining the relationship between the Gammarus: Asellus (G : A) ratio and (1) a suite of physico-chemical variables. (2) established biotic (average score per taxon, ASPT) and richness (species richness (S) and Ephemeroptera, Plecoptera and Trichoptera families richness (EPT family richness)) indices generated from the macroinvertebrate community. In addition, we investigated a suspected biotic interaction, predation, between Gammarus and Asellus. Both univariate and multivariate analyses showed that the G: A ratio was sometimes responsive to changes in parameters linked to organic pollution, such as BOD5 and nitrate levels. However, the G : A ratio also appeared responsive to variables not directly linked to organic pollution, such as conductivity and distance from source. There were significant positive correlations among the G : A ratio and the ASPT, S and EPT, indicating that changes in the relative abundances of Gammarus and Asellus were reflected in changes in the pollution sensitivity and richness of the wider macroinvertebrate community. A laboratory experiment revealed significant predation of Asellus aquaticus juveniles by Gammarus duebeni celticus adults, but no reciprocal predation. We propose that the G: A ratio may be useful as a crude measure of organic pollution that could supplement more complex indices in a multimetric approach to pollution monitoring or be used for monitoring individual sites, where a simple technique is required for monitoring purposes over a period of time. Also, we urge recognition of the possible role of biotic interactions among taxa used in the generation of pollution indices.