Revision total knee replacement: A two-year review of complexity data and regional workload in South West England.

BACKGROUND: The GIRFT report (2012) sought to address the need for sustainable orthopaedic treatment delivered through regional "networks"; the aim being improved care, decreased cost and reduced revision rate. The aims of this study were to record the number and complexity of revision total knee replacements within a regional network using a validated classification over a two-year period and audit this against National Joint Registry (NJR) records. METHODS: A region-wide network model where revision TKR cases are assessed locally using the Revision Knee Complexity Classification (RKCC) and local multi-disciplinary team (MDT) was introduced. Data was collected from 8 revision centres over a two-year period using the RKCC. The case volume was audited against the NJR records. RESULTS: In year 1 (01/01/2018-31/12/2018) 237 RKCC forms were collected from eight centres. 46% of R2s and 63% of R3s were carried out at the higher volume centre. 211 K2 forms were received by the NJR. In year 2 (01/01/2019-31/12/2019) 252 RKCC forms were collected. 46% of R2s and 64% of R3s were carried out at the higher volume centre. 267 K2 forms were received by the NJR. CONCLUSION: This is the first published set of revision knee data showing complexity percentages across a region. The RKCC has been successfully introduced into the region and this has been sustained. The findings show that a successful network has been established and majority of complex revision knee surgery is occurring in the high-volume centre. NJR data suggests that the RKCC is capturing the complexity and volume of our work accurately.

Reliability of radiographic measurements of knee motion following knee arthroplasty for use in a virtual knee clinic.

INTRODUCTION: We sought to validate radiographic measurements of range of motion of the knee after arthroplasty as part of a new system of virtual clinics. METHODS: The range of motion of 52 knees in 45 patients was obtained by 2 clinicians using standardised techniques and goniometers. Inter-rater reliability and intraclass correlation coefficients (ICCs) were calculated. Radiographs of these patients' knees in full active flexion and extension were also used to calculate intra and inter-rater reliability compared with clinical measurements using four different methods for plotting angles on the radiographs. RESULTS: The ICC for inter-rater reliability using the goniometer was very high. The ICC was 0.91 in extension and 0.85 in flexion while repeatability was 8.49° (-8.03-8.99°) in extension and 5.23° (-4.54-5.74°) in flexion. The best ICC for radiographic measurement in extension was 0.86, indicating 'near perfect' agreement, and repeatability was 5.43° (-4.04- 6.12°). The best ICC in flexion was 0.95 and repeatability was 5.82° (-3.38-6.55°). The ICC for intrarater reliability was 0.98 for extension and 0.99 for flexion on radiographic measurements. CONCLUSIONS: Validating the use of radiographs to reliably measure range of motion following knee arthroplasty has allowed us to set up a 'virtual knee clinic'. Combining validated questionnaires and radiographic measurement of range of motion, we aim to maintain high quality patient surveillance following knee arthroplasty, reduce our ratio for new to follow-up patients in line with Department of Health guidelines and improve patient satisfaction through reduced travel to hospital outpatients.

Equine castration: review of anatomy, approaches, techniques and complications in normal, cryptorchid and monorchid horses.

Complications associated with equine castration are the most common cause of malpractice claims against equine practitioners in North America. An understanding of the embryological development and surgical anatomy is essential to differentiate abnormal from normal structures and to minimise complications. Castration of the normal horse can be performed using sedation and regional anaesthesia while the horse is standing, or under general anaesthesia when it is recumbent. Castration of cryptorchid horses is best performed under general anaesthesia at a surgical facility. Techniques for castration include open, closed and half-closed techniques. Failure of left and right testicles to descend occurs with nearly equal frequency, however, the left testicle is found in the abdomen in 75% of cryptorchid horses compared to 42% of right testicles. Bilateral cryptorchid and monorchid horses are uncommon. Surgical approaches described for the castration of cryptorchid horses include an inguinal approach with or without retrieval of the scrotal ligament, a parainguinal approach, or less commonly a suprapubic paramedian or flank approach. Laparoscopic castration of cryptorchid horses has recently been described but the technique has limited application in practice at this time. A definitive diagnosis of monorchidism can only be made after surgical exploration of the abdomen, removal of the normal testis and hormonal testing. Hormonal assays reported to be useful include analysis of basal plasma or serum testosterone or oestrone sulphate concentrations, testosterone concentrations following hCG stimulation, and faecal oestrone sulphate concentrations. Reported complications of castration include postoperative swelling, excessive haemorrhage, eventration, funiculitis, peritonitis, hydrocele, penile damage and continued stallion-like behaviour.

Reintroduction of Profilicollis Meyer, 1931, as a genus in acenthocephala: significance of the intermediate host.

Polymorphid acanthocephalans with long necks, spheroid proboscides, and eggs without polar swellings of the fertilization membrane constitute a morphologically distinct group of species. In the past, this taxon was considered a separate genus, Profilicollis. More recently, workers have been unwilling to accept these features as generic-level characters, and presently the group is considered a subgenus of Polymorphus. An analysis prompted by our studies of various polymorphid cystacanths in crabs along the coasts of Scotland and the U.S.A. reveals that all records of Polymorphus in decapods refer to species with 6 cement glands frequently assigned to Hexaglandula, to incidental occurrences of species purported to be Polymorphus minutus, or to species of the subgenus Profilicollis. Occurrence in decapod crustaceans implies substantial life history differences from the other species of the genus occurring in amphipod crustaceans. We conclude this, together with morphological distinctiveness, justifies return of Profilicollis to full generic status within Polymorphidae.

Metabolic clearance and plasma half-disappearance time of D-TRP6 and exogenous luteinizing hormone-releasing hormone.

The MCR and t1/2 of D-Trp6 LRH, a potent analog of LRH, were compared to those of exogenous LRH. Studies were performed on eight normal subjects during and after cessation of a constant infusion of D-Trp6 LRH and LRH. The D-Trp6 LRH and LRH were quantitated individually by sensitive and specific RIAs which did not cross-react with the other peptide infused or fragments of the degraded peptides. High performance liquid chromatography of plasma from a patient infused with D-Trp6 LRH alone yielded one peak, which coeluted with D-Trp6 LRH. The kinetics of peptide clearance were biphasic, with a rapid and a slow component of elimination. The t1/2 of the rapid component of D-Trp6 LRH clearance was 18.7 +/- 1.8 (SEM) min. This was significantly longer (P less than 0.001) than the t1/2 for the LRH of 7.8 +/- 1.1 min. The MCRs for D-Trp6 LRH and LRH were 503.4 +/- 196.4 and 1766.6 +/- 404.3 ml/min, respectively (P less than 0.01). The longer t1/2 of D-Trp6 LRH compared to that of LRH reflects the slower clearance, which is probably due to a decreased rate of degradation. These findings indicated that the enhanced bioactivity of D-Trp6 LRH is in part due to a decreased rate of degradation.

Testicular function in patients with spinal cord damage.

Vaying degrees of testicular dysfunction are found in men with traumatic spinal cord damage. Eighteen paraplegic men have been studied and the gonadotropin response to luteinizing hormone-releasing hormone (LRH) measured. Basal serum testosterone estimations were made and in eight of the patients testicular testosterone reserve was assessed by the testosterone response to human chorionic gonadotropin (HCG). Testicular biopsies were performed in seven cases. In three of these patients, the testicular biopsies were abnormal. Five of the patients had elevated Follicle stimulating hormone levels and abnormalities of Luteinizing hormone kinetics were found in the same five patients. There was no significant difference between the plasma testosterone levels of the paraplegic patients when compared to the control group. In all the patients tested, there was an adequate testosterone reserve, and this included the three patients with the abnormal testicular biopsies. No relationship was found between the level of cord lesion and any of the hormonal parameters measured. This study confirms the primary nature of the seminiferous tubular damage which occurs in some patients with paraplegia.