Medium Term Radiographic and Clinical Outcomes Using a Modular Tapered Hip Revision Implant.

BACKGROUND: The rate of revision hip arthroplasty surgery is rising. Surgeons must use implants with proven outcomes to help overcome the technical challenges faced during revision surgery. However, outcome studies using these implants are limited. The aim of this study is to investigate the radiographic and clinical outcomes of the Stryker Restoration stem, the most commonly used hip revision stem in the United Kingdom (UK). METHODS: A retrospective review of a single surgeon case series was performed. Immediate postoperative radiographs were analyzed for offset and leg length discrepancy. Radiographic evidence of subsidence was assessed using follow-up radiographs. Kaplan-Meier survival analysis was applied using explantation and reoperation as endpoints. Patient-reported outcomes were measured using the Oxford Hip Score and EQ-5D-5L. RESULTS: One hundred ninety-eight cases were identified. Mean follow-up duration was 51.8 months (range: 24-121). Stem survival during this period was 98%. Reoperation for any reason was 13%. Mean subsidence was 4.18 mm. Analysis of variance testing showed no difference in mean subsidence between revision indications. Mean offset and leg length discrepancies were measured at 4.5 mm and 4.3 mm, respectively. The mean Oxford Hip Score for participants was 27.6. CONCLUSIONS: This series demonstrates excellent implant survival, with radiographic parameters for reconstruction and subsidence levels comparable to those in the existing literature. The tapered modular hip revision stem provides surgeons with the intraoperative flexibility to overcome some of the anatomical difficulties encountered during revision surgery; this is reflected in the radiographic and clinical outcomes of the cohort in this study.

Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer.

Hospital-acquired infections (HAI) are often seen as preventable incidents that result from unsafe practices or poor hospital hygiene. This however ignores the fact that transmissibility is not only a property of the causative organisms but also of the hosts who can translocate bacteria when moving between hospitals. In an epidemiological sense, hospitals become connected through the patients they share. We here postulate that the degree of hospital connectedness crucially influences the rates of infections caused by hospital-acquired bacteria. To test this hypothesis, we mapped the movement of patients based on the UK-NHS Hospital Episode Statistics and observed that the proportion of patients admitted to a hospital after a recent episode in another hospital correlates with the hospital-specific incidence rate of MRSA bacteraemia as recorded by mandatory reporting. We observed a positive correlation between hospital connectedness and MRSA bacteraemia incidence rate that is significant for all financial years since 2001 except for 2008-09. All years combined, this correlation is positive and significantly different from zero (partial correlation coefficient r = 0.33 (0.28 to 0.38)). When comparing the referral pattern for English hospitals with referral patterns observed in the Netherlands, we predict that English hospitals more likely see a swifter and more sustained spread of HAIs. Our results indicate that hospitals cannot be viewed as individual units but rather should be viewed as connected elements of larger modular networks. Our findings stress the importance of cooperative effects that will have a bearing on the planning of health care systems, patient management and hospital infection control.

Influenza and pneumococcal vaccine uptake among nursing home residents in Nottingham, England: a postal questionnaire survey.

BACKGROUND: Previous studies have shown influenza vaccine uptake in UK nursing home residents to be low. Very little information exists regarding the uptake of pneumococcal vaccine in this population. The formulation of policies relating to the vaccination of residents has been proposed as a simple step that may help improve vaccine uptake in care homes. METHODS: A postal questionnaire was sent to matrons of all care homes with nursing within the Greater Nottingham area in January 2006. Non respondents were followed up with up to 3 phone calls. RESULTS: 30% (16/53) of respondents reported having a policy addressing influenza vaccination and 15% (8/53) had a policy addressing pneumococcal vaccination. Seasonal influenza vaccine coverage in care homes with a vaccination policy was 87% compared with 84% in care homes without a policy (p = 0.47). The uptake of pneumococcal vaccination was found to be low, particularly in care homes with no vaccination policy. Coverage was 60% and 32% in care homes with and without a vaccination policy respectively (p = 0.06). This result was found to be statistically significant on multivariate analysis (p = 0.03, R = 0.46) CONCLUSION: The uptake of influenza vaccine among care home residents in the Nottingham region is relatively high, although pneumococcal vaccine uptake is low. This study shows that there is an association between pneumococcal vaccine uptake and the existence of a vaccination policy in care homes, and highlights that few care homes have vaccination policies in place.

Long-term follow-up of a hydroxyapatite ceramic-coated threaded cup: an analysis of survival and fixation at up to 15 years.

We evaluated the survival of 112 consecutive JRI hydroxyapatite ceramic-coated threaded acetabular components (JRI Ltd, London, UK). Follow-up was for a minimum of 13 years (range, 13-15 years). Patients were assessed clinically and radiographically using the Merle d'Aubigné and Postel scoring systems and the De Lee and Charnley zones. Cup angle, migration, and signs of radiolucency were used to assess loosening. The criteria for failure were revision or impending revision due to pain and septic or aseptic loosening. The mean results of the Merle d'Aubigné and Postel score for pain, motion, and ability to walk were 2.2/2.7/2.2 preoperatively and 5.6/4.3/5.1 postoperatively. There was 100% endosteal bone formation in De Lee and Charnley zones 1 and 3 and 87% in zone 2. No reactive lines were seen in any zone in any cup. There were no cases of migration, change in cup angle, or revision for loosening. Our survival was 99% at 13 years (95% confidence interval, 96-100).

Long-term follow-up of the surgically corrected clubfoot.

We describe a 17-year follow-up of 44 surgically corrected clubfeet. They were classified preoperatively as mild, moderate or severe and grouped into those operated on before or after 3 months of age. Moderate and severe deformities underwent a posteromedial release after a trial of conservative management. The mean Ponseti score for both groups was 83.9 (good). Severely deformed feet achieved a more favourable result when operated upon before 3 months than those operated later. We conclude that early application of surgery yields better results with severely deformed feet and produces a good functional outcome in the majority of feet.

Sexually transmitted infections in teenagers.

Prevention of sexually transmitted infection in teenagers is a high priority. The introduction of non-invasive methods for diagnostic testing of Chlamydia trachomatis and Neisseria gonorrhoeae has enabled screening for these sexually transmitted micro-organisms in a range of community-based settings among populations at high risk, such as teenagers, who do not readily access existing sexual health services.