The Medium-Term Survival Analysis of an All-Polyethylene Tibia in a Single-Series Cohort of Over 1000 Knees.

BACKGROUND: Total knee arthroplasty is a successful elective orthopedic procedure with an increasing number being undertaken. Original knee arthroplasties used an all-polyethylene tibia; however, with concerns over tibial loosening, the trend moved toward the metal-backed variety. Modern designs providing more conformity and changes in manufacturing of the polyethylene make it an equivalent but cheaper option. METHODS: We analyzed the medium-term outcome in 1092 patients with an all-polyethylene tibial component in their total knee arthroplasty. RESULTS: Twenty-six patients had further surgery on their knee for a variety of reasons. Assessing reoperation for any reason, the 7-year survival rate was 96.96% with an overall infection rate of 0.37%. Seven-year survival analysis using aseptic loosening as a criteria was 99.28%. Both the Short Form 12 physical score and Western Ontario and McMaster Universities Osteoarthritis Index score significantly improved and was sustained at 7 years. Body mass did not correlate to either outcomes or complications. CONCLUSION: An all-polyethylene tibia in a total knee arthroplasty has good outcome data and high patient satisfaction with good survivorship in the medium term, coupled with potential cost-saving benefits.

Guided Growth of the Distal Posterior Tibial Physis and Short Term Results: A Potential Treatment Option for Children With Calcaneus Deformity.

BACKGROUND: We present our experience of using tension band plates to achieve guided growth in children for correction of calcaneus deformity around the ankle. METHODS: Our study included 9 consecutive patients (11 ankles) with calcaneus deformity, over a period of 4 years. Surgical treatment with extra periosteal application of flexible 2 hole plate and screws on posterior aspect of distal tibial physis was carried out.The indications for treatment were residual clubfoot deformity in 9, posttraumatic in 1, and neurologic in 1. The average age of the patients was 10 years (range, 4 to 13 y). There were 7 males and 2 females.Serial preoperative and postoperative radiographs were used to measure deformity correction and anterior distal tibia angle (ADTA), lateral distal tibial angle (LDTA), and Screw Divergence Angle (angle subtended by lines passing through the screws) were measured. A 2-tailed student t test was used to determine statistical significance. RESULTS: The ADTA showed mean correction of 8.41 degrees (range, 3.1 to 16.6 degrees) this was statistically significant with P-value of 0.0003.The change in LDTA was not statistically significant (P-value=0.05) reinforcing the aptness of the procedure and that the procedure did not result in coronal plane deformities. Six ankles required revision of fixation: 4 due to metalwork reaching its maximum limit of divergence at an average of 1 year, 1 ankle had screw pull-out, and another ankle was revised due to technical error in screw selection. In our study there were no cases of infection. CONCLUSIONS: We report satisfactory short-term results of correction of calcaneus deformity using flexible tension band plates and screws. In our opinion this is an effective alternative providing gradual correction with easy and minimally invasive surgical technique. It does not violate the physis and is easy to remove and revise. It is safe and well tolerated and can be grouped with other procedures with ease. LEVEL OF EVIDENCE: Level IV­case series.

The role of fracture reduction and plate position in the aetiology of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures.

BACKGROUND: Flexor pollicis longus (FPL) rupture has been described as complication following volar plating for distal radius fractures. It has been hypothesised that this is due to plate prominence. The aim of the study was to investigate the relationship between sub-optimal plate position and fracture reduction on plate prominence. METHODS: Plate prominence was measured in two experimental models. In the first, the effect of plate position was investigated using 18 fresh frozen cadavers with prominence being measured using a micrometer. In the second study, the effect of fracture reduction on plate prominence was investigated using similar methodology with simulated mal-reductions on dry bone models. RESULTS: The results of the first study showed a significant increase in lift-off for three plates (DVR, Synthes Universal and Acu-Loc), if the plates were moved distally or proximally from the anatomical position. Similar increases in prominence were also seen with rotational mal-positions. The results of the second study showed a statistically significant effect on plate prominence for even a 5° mal-reduction (p = 0.001) with worsening lift-off with increasing mal-reduction. These changes are significantly different from baseline and also significantly different to the lift-off recorded with mal-reductions 5° better and worse. Mal-reductions also necessitate more proximal placement of the plate to avoid screw penetration of the articular surface, and each 5° increment is significantly different from baseline. CONCLUSIONS: The results show a statistically and clinically significant effect of both plate position and fracture reduction on plate prominence and support the theory that both contribute to the aetiology of post-operative FPL rupture.

The effect of preoperative foot and ankle physiotherapy group on reducing inpatient stay and improving patient care.

BACKGROUND: Benefits of day case foot and ankle surgery include reduced hospital stay, cost savings, high patient satisfaction, quicker recovery with no increased complications. The preoperative foot and ankle group was set up in 2007 to reduce inpatient hospital stays and increase the rate of day case procedures. METHODS: We evaluated length of stay and physiotherapy intervention for all our patients during the first three months of 2007-2011. RESULTS: Median length of stay was statistically significant (p<0.05) in all groups apart from the ankle group. Day case surgery rates increased in all groups apart from hindfoot group but the result was only significant for forefoot and midfoot groups. CONCLUSION: The results show that the setting up our group has resulted in reduced inpatient stay, increase in day case surgery rates with significant cost savings.

Beware of finger tourniquets: a case report and update by the National Patient Safety Agency.

Finger tourniquets have been used in finger surgery for a long time to provide a bloodless field while operating on digits. Many different techniques have been described for a 'safe and reliable' finger tourniquet including Penrose drains, coloured rubber gloves and gloves with haemostat. The potential injury that can be caused by leaving the tourniquet in situ for longer than is necessary is devastating to the patient. Although there have been many articles describing a safe tourniquet technique, vigilance needs to be maintained by the operating surgeon to remove the tourniquet. We are presenting a case of retained finger tourniquet to highlight this problem and highlight the rapid response report published by the National Patient Safety Agency in December 2009.

Haemostasis in Open Carpal Tunnel Release: Tourniquet vs Local Anaesthetic and Adrenaline.

Open carpal tunnel release is one of the commonest performed procedures in hand surgery. We performed a prospective randomised control trial to compare the efficacy and patient satisfaction of the traditional arm tourniquet versus infiltration of adrenaline and local anaesthetic solution to achieve haemostasis during the procedure. Using a combination of objective and subjective measures we concluded that infiltration of local anaesthetic and adrenaline not only provided adequate haemostasis but also provided a significantly more tolerable experience for the patient during the procedure.

Inflammatory pseudotumor of the Kidney.

BACKGROUND: Inflammatory pseudotumor of the kidney or inflammatory myofibroblastic tumor (IMT) is composed of spindle cells admixed with variable amount of proliferating myofibroblasts, fibroblasts, extracellular collagen, lymphocytes and plasma cells. This mainly affects the urinary bladder or prostate. Renal involvement is rare. CASE PRESENTATION: A 56 year-old man was diagnosed with asymptomatic left sided hydronephrosis while being investigated for rheumatoid arthritis. CT scan imaging showed ill defined fascial plains around the kidney and thickening around the renal hilum suggestive of localized inflammatory change. Worsening intermittent left loin pain with increasing hydronephrosis, significant cortical thinning and marked deterioration of renal function necessitated nephrectomy. Macroscopy showed a hydronephrotic fibrotic kidney with microscopy and immunohistochemistry consistent with a histological diagnosis of IMT. CONCLUSION: We report a case of an inflammatory pseudotumor of the kidney. It is unique in that the patient presented with painless hydronephrosis followed two years later with progressive deterioration in renal function and worsening loin pain.

Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility?

OBJECTIVE: To report clinical findings associated with an increased incidence of mumps orchitis in Liverpool, UK, as in the last 2 years there has been a four-fold increase in the number of notified viral mumps cases in the UK. PATIENTS AND METHODS: In the 8 months before April 2005, patients presenting to the Accident and Emergency/Urology Departments of the Royal Liverpool University Hospital with a diagnosis of epididymo-orchitis were identified from the emergency urological admission database. RESULTS: Of 195 males presenting with an acute history of testicular pain and swelling, 25 gave a history of mumps parotitis 4-11 days earlier. Three had bilateral orchitis and two needed scrotal exploration to exclude torsion. Scrotal ultrasonography findings varied from increased vascularity to abnormal testicular echo texture. Treatment included analgesia, scrotal support, re-hydration and broad-spectrum antibiotics. Of the 10 patients followed-up to date, four had testicular abnormalities; one had persistent testicular pain, one a change in testicular consistency, one a noticeably reduced size of one testis, and one significant testicular atrophy. CONCLUSION: As postpubertal mumps in males is associated with a 40% incidence of orchitis, parents should be made aware that failing to immunize their children threatens the future fertility of their sons. Young men not immunized as children should be counselled and offered urgent vaccination. Clinicians should be aware that epididymo-orchitis may be secondary to mumps infection even with no history or clinical evidence of parotitis.