The Hintegra total ankle replacement: survivorship, failure modes and patient reported outcomes in seventy consecutive cases with a minimum five year follow-up.

PURPOSE: The Hintegra total ankle replacement (TAR) has been widely used worldwide for ankle arthroplasty since its introduction in 2000. The implant survivorship, patient reported outcomes, rate of periprosthetic cyst formation and reoperation rates are variably reported. The purpose of this study is to determine the functional outcomes and survivorship of the Hintegra TAR, in consecutive cases by multiple surgeons in a single UK institution, with a minimum of five year follow-up. METHODS: A retrospective review of prospectively collected data for 70 consecutive Hintegra TAR cases performed between 2010 and 2014. Data collected included patient demographics, complications, reoperations, revisions and patient reported outcome measures (PROMS: AOS, MOX-FQ, pain VAS and EQ-5D 3L). RESULTS: Seventy patients underwent Hintegra TAR (54 male/16 female) with an average age of 69 (range 48-84 years). Mean follow up was 76 months (range 60-104), 10 patients died during the follow-up. Implant survivorship was 81.7% at most recent follow-up. The commonest radiographic finding was periprosthetic cysts (n = 28, 40%): size range (7-40 mm). Nine patients required re-operation: six periprosthetic cyst debridement and grafting at a mean of 61 months (range 27-91), one lateral gutter debridement, one periprosthetic fracture and one debridement for deep infection. PROMS data was available for the majority of patients. Mean final follow-up scores were total AOS 35 (range: 0-97), MOX-FQ 36 (range: 2-93), pain VAS 34.6 (range: 0-100) and EQ-5D 3L Index 0.69 (range: 0.08-1.00). CONCLUSION: Our experience demonstrates implant survivorship similar to other TAR studies. We have identified a high incidence of periprosthetic cysts and would recommend ongoing surveillance of these patients.

Remote monitoring of clubfoot treatment with digital photographs in low resource settings: Is it accurate?

BACKGROUND: Clinical examination and functional assessment are often the first steps to assess outcome of clubfoot treatment. Clinical photographs may be an adjunct used to assess treatment outcomes in lower resourced settings where physical review by a specialist is limited. We aimed to evaluate the diagnostic performance of photographic images of patients with clubfoot in assessing outcome following treatment. METHODS: In this single-centre diagnostic accuracy study, we included all children with clubfoot from a cohort treated between 2011 and 2013, in 2017. Two physiotherapists trained in clubfoot management calculated the Assessing Clubfoot Treatment (ACT) score for each child to decide if treatment was successful or if further treatment was required. Photographic images were then taken of 79 feet. Two blinded orthopaedic surgeons assessed three sets of images of each foot (n = 237 in total) at two time points (two months apart). Treatment for each foot was rated as 'success', 'borderline' or 'failure'. Intra- and inter-observer variation for the photographic image was assessed. Sensitivity, specificity, positive and negative predictive values were calculated for the photographic image compared to the ACT score. RESULTS: There was perfect correlation between clinical assessment and photographic evaluation of both raters at both time-points in 38 (48%) feet. The raters demonstrated acceptable reliability with re-scoring photographs (rater 1, k = 0.55; rater 2, k = 0.88). Thirty percent (n = 71) of photographs were assessed as poor quality image or sub-optimal patient position. Sensitivity of outcome with photograph compared to ACT score was 83.3%-88.3% and specificity ranged from 57.9%-73.3%. CONCLUSION: Digital photography may help to confirm, but not exclude, success of clubfoot treatment. Future work to establish photographic parameters as an adjunct to assessing treatment outcomes, and guidance on a standardised protocol for photographs, may be beneficial in the follow up of children who have treated clubfoot in isolated communities or lower resourced settings.

Varicella zoster virus infection is an unusual cause of splenic rupture.

A 22-year-old man presented with a 1-day history of severe abdominal pain. He developed a generalised vesicular rash 12 h prior to admission. On examination, he was maximally tender with peritonism in the lower abdomen. Working diagnosis was perforated appendix and a decision to investigate with CT was made, which showed intra-abdominal haemorrhage likely arising from a ruptured spleen. After a period of observation, he subsequently underwent laparotomy and emergency splenectomy. Viral PCR from vesicular fluid was positive for varicella zoster virus. Viral serology was otherwise negative.

Identification of factors that predict outpatient utilisation of a Plastic Dressing Clinic. A retrospective review of 287 paediatric burn cases.

INTRODUCTION: This study investigated aetiology of burn cases presenting to the Royal Hospital for Sick Children in Edinburgh to identify factors that influence the number of outpatient visits patients make to the Plastic Dressing Clinic (PDC) following discharge. METHODS: A retrospective review was performed of all paediatric burn cases presenting between January 2009 and July 2012. Information gathered included patient demographics, burn aetiology, details of inpatient admission and outpatient PDC attendance. RESULTS: 287 cases were identified, mean age 2.79 years (range 0-15), gender ratio 1.52:1 (M:F). Scald was the most common aetiology, n=172 (59.9%). Most burns were superficial thickness, n=173 (60.3%). One-way ANOVA showed that full thickness burn, skin graft and pressure garment therapy significantly increased the number of PDC appointments (p<0.05). Pearson correlation coefficient found that length of stay in hospital and time spent in theatre were positively correlated to the number of PDC appointments (p<0.01). CONCLUSION: Outpatient utilisation of the PDC can be predicted from burn characteristics. Full thickness burn, skin graft and pressure garment therapy are identified to significantly increase the number of PDC appointments following paediatric burn.