The Norwich Osteoarthritis of the Ankle MRI Score (NOAMS): a reliability study.

AIM: To define and test the inter- and intra-rater reliability of a grading system for staging osteoarthritis (OA) of the ankle with magnetic resonance imaging (MRI) (Norwich Osteoarthritis of the Ankle MRI Score, NOAMS). MATERIALS AND METHODS: The MRI features to be included in the score were defined by a multidisciplinary expert panel through a Delphi process. An anonymised randomised dataset of 50 MRI studies was created from patients with concurrent plain radiographs to include 10 ankles of each of the Kellgren-Lawrence grades 0 to 4. Two experienced musculoskeletal radiologists and two trainees scored each ankle MRI twice independently and blinded to the plain radiographs. RESULTS: The inter-rater kappa coefficient of agreement for cartilage disease was 0.88 (95% confidence interval [CI]: 0.85, 0.91) for experienced raters and 0.71 (95% CI: 0.67, 0.76) for trainees. Inter-rater agreement for subchondral bone marrow oedema and cysts varied from 0.73 to 0.82 for experienced raters and from 0.63 to 0.75 for trainees with lowest 95% CI of 0.48 and 0.63. When bone marrow lesions were combined into a total joint score the level of agreement increased to between 0.88 and 0.97 with lowest 95% CI of 0.86. Combining cartilage zone scores did not increase the reliability coefficients. CONCLUSION: An expert panel considered that cartilage degradation and subchondral bone marrow lesions were the most important features for staging the severity of ankle OA on MRI. Experienced observers can grade the severity of ankle OA on MRI with a clinically useful high degree of reproducibility.

The 15 year ankle arthroplasty experience in a university hospital.

INTRODUCTION: The study aim was to review the experience of ankle replacement surgery in a university teaching hospital. METHODS: A retrospective review of primary ankle replacements performed between 2005 and 2019 was undertaken. Implant survival and reasons for revision surgery were assessed, along with patient reported outcomes and complications. RESULTS: There were 157 ankle replacements implanted in 140 patients with a mean follow up 7.5 years (range 1.0-14.5). There were 108 Mobility™, 19 Zenith™ and 30 Infinity™ ankle replacements with an overall revision rate of 9.6% at a mean 4.0 years (range 0.1-11.0). Overall survivorship analysis for 5, 10 and 15 years was respectively 92.4%, 89.3% and 86.6%. DISCUSSION: The revision rate was comparable to international registers and aseptic loosening was the commonest reason for revision. This study, in a teaching university hospital with an average of 10 primary ankle replacements each year, highlighted ankle arthroplasty provides good functional outcomes and medium term implant survivorship. This supports the use of ankle arthroplasty within foot and ankle specialist centres achieving appropriate outcomes.

Complications following arthroscopic surgery of the hip: a systematic review of 36 761 cases.

AIMS: The number of patients undergoing arthroscopic surgery of the hip has increased significantly during the past decade. It has now become an established technique for the treatment of many intra- and extra-articular conditions affecting the hip. However, it has a steep learning curve and is not without the risk of complications. The purpose of this systematic review was to determine the prevalence of complications during and following this procedure. MATERIALS AND METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in designing this study. Two reviewers systematically searched the literature for complications related to arthroscopy of the hip. The research question and eligibility criteria were established a priori. Pertinent data were abstracted and analysed. RESULTS: We found 276 relevant studies with a total of 36 761 arthroscopies that met the inclusion criteria. The mean age of the patients was 36.7 years (1.7 to 70) and the mean body mass index was 25.7 kg/m2 (20.2 to 29.2). Femoroacetabular impingement and labral tears were the most common indications for the procedure. The total number of complications was 1222 (3.3%). Nerve injury (0.9%), mainly involving the pudendal and lateral femoral cutaneous nerves, and iatrogenic chondral and labral injury (0.7%), were the two most common complications. There were 58 major complications (0.2%), the most common being intra-abdominal extravasation of fluid, which was found in 13 cases (0.04%). There were three deaths (0.008%). CONCLUSION: Arthroscopic surgery of the hip is a procedure with a relatively low rate of complications, although some may be significant in this young cohort of patients. This study relied on the reported complications only and the results should be interpreted with caution. Cite this article: Bone Joint J 2017;99-B:1577-83.

5 year retrospective follow-up of new cases of Charcot neuroarthropathy-A single centre experience.

BACKGROUND: Few data describe the natural history of Charcot neuroarthropathy treated with a total contact plaster cast (TCC). METHODS: A 5 year retrospective analysis of 50 patients presenting with an acute CN, Assessing time to clinical resolution into appropriate footwear and assessing if initial immobilisation device influenced resolution time. RESULTS: During the study period 42 patients (84%) of patients went into remission, 2 died during their treatment, 4 had major amputations, in 2 patients treatment was ongoing. 36 patients were treated with combination offloading devices, 6 were treated with one modality only. Median time to resolution for patients initially treated with a TCC was not significantly shorter than for those treated with a removable below knee boot. 34.9% required re-casting due to clinical deterioration in the removable device. CONCLUSIONS: More precise measures of resolution of CN are needed to assess the impact of initial treatment modality on time to resolution.

Is there an anatomical marker for the deep peroneal nerve in midfoot surgical approaches?

The deep peroneal nerve (DPN) passes over the dorsum of the foot and is susceptible to injury during surgical approaches. The purpose of this anatomical study is to examine the relationship of the extensor hallucis brevis (EHB) as it passes over the DPN. Ten cadaver feet specimens were dissected and the anatomical structures surrounding the neurovascular bundle containing the DPN were examined. In nine out of the ten specimens the DPN was under the EHB musculotendinous junction. In one case it passed through the musculotendinous junction. This cadaver study has found a consistent easily identifiable landmark for protecting the neurovascular bundle containing the DPN during dorsal midfoot surgery.

Frozen shoulder: a clinical review.

Frozen shoulder is a common condition which can cause considerable morbidity for a prolonged duration. With recognition of the condition's time scale, management can be directed to help reduce the morbidity. Many treatments are recognized and the gold standard is still to be identified.

Thermal insulation and clothing area factors of typical Arabian Gulf clothing ensembles for males and females: measurements using thermal manikins.

The thermal insulation of clothing is one of the most important parameters used in the thermal comfort model adopted by the International Standards Organisation (ISO) [BS EN ISO 7730, 2005. Ergonomics of the thermal environment. Analytical determination and interpretation of thermal comfort using calculation of the PMV and PPD indices and local thermal comfort criteria. International Standardisation Organisation, Geneva.] and by ASHRAE [ASHRAE Handbook, 2005. Fundamentals. Chapter 8. American Society of Heating Refrigeration and Air-conditioning Engineers, Inc., 1791 Tullie Circle N.E., Atlanta, GA.]. To date, thermal insulation values of mainly Western clothing have been published with only minimal data being available for non-Western clothing. Thus, the objective of the present study is to measure and present the thermal insulation (clo) values of a number of Arabian Gulf garments as worn by males and females. The clothing ensembles and garments of Arabian Gulf males and females presented in this study are representative of those typically worn in the region during both summer and winter seasons. Measurements of total thermal insulation values (clo) were obtained using a male and a female shape thermal manikin in accordance with the definition of insulation as given in ISO 9920. In addition, the clothing area factors (f cl) determined in two different ways were compared. The first method used a photographic technique and the second a regression equation as proposed in ISO 9920, based on the insulation values of Arabian Gulf male and female garments and ensembles as they were determined in this study. In addition, fibre content, descriptions and weights of Arabian Gulf clothing have been recorded and tabulated in this study. The findings of this study are presented as additions to the existing knowledge base of clothing insulation, and provide for the first time data for Arabian Gulf clothing. The analysis showed that for these non-Western clothing designs, the most widely used regression calculation of f cl is not valid. However, despite the very large errors in f cl made with the regression method, the errors this causes in the intrinsic clothing insulation value, I cl, are limited.

Effects of taipan (Oxyuranus scutellatus) venom on erythrocyte morphology and blood viscosity in a human victim in vivo and in vitro.

The case of a snake handler with envenoming due to Australian taipan (Oxyuranus scutellatus) showing marked morphological changes in his red blood cells is presented. The red cells underwent sphero-echinocytic transformation and in subsequent experiments in vitro the effects of taipan venom on red cells were further characterized. Taipan venom induced sphero-echinocytic transformation at nanogram/ml concentrations and led to a marked increase in whole blood viscosity. These changes have not been featured in previous reports of taipan envenomation and are reported to highlight the diagnostic value of blood film examination in cases of suspected envenomation. The significance of the hyperviscosity, and consequent reduction in blood fluidity, is unknown and requires further investigation.

Evidence for sialylated type 1 blood group chains on human erythrocyte membranes revealed by agglutination of neuraminidase-treated erythrocytes with Waldenström's macroglobulin IgMWOO and hybridoma antibody FC 10.2.

Haemagglutination studies have been performed with untreated and neuraminidase-treated human erythrocytes of the three Lewis antigen types Le(a-b-), Le(a+b-) and Le(a-b+) using two monoclonal antibodies, IgMWOO and FC 10.2, which were previously shown to recognize the type 1 based blood group chains: Gal beta 1----3GlcNAc beta 1----3Gal beta 1----4Glc/GlcNAc (for explanation of abbreviations see table IV legend). Both antibodies behaved as cold agglutinins with neuraminidase-treated but not with untreated erythrocytes of the three Lewis antigen types. Neuraminidase-treated erythrocytes of i antigen type were similarly agglutinated. This haemagglutination was specifically inhibited by the type 1 based milk oligosaccharide lacto-N-tetraose. Thus, there is strong evidence for the occurrence of sialylated type 1 chains on human erythrocyte membranes of I and i antigen types. In addition, evidence for the presence of type 1 chains which are both sialylated and fucosylated was obtained by (1) haemagglutination of Le(a+b-) erythrocytes with the monoclonal antibody 19.9; (2) increased haemagglutination of neuraminidase-treated erythrocytes with anti-H antibodies of Bombay serum; (3) increased haemagglutination of neuraminidase-treated Le(a+b-) cells with anti-Lea antibodies, and (4) the appearance of Lea antigen activity on neuraminidase-treated erythrocytes of Le(a-b+) type.