Custom rotating-hinge primary total knee arthroplasty in patients with skeletal dysplasia

Patients with skeletal dysplasia are prone to developing advanced osteoarthritis of the knee requiring total knee replacement (TKR) at a younger age than the general population. TKR in this unique group of patients is a technically demanding procedure owing to the deformity, flexion contracture, generalised hypotonia and ligamentous laxity. We retrospectively reviewed the outcome of 11 TKRs performed in eight patients with skeletal dysplasia at our institution using the Stanmore Modular Individualised Lower Extremity System (SMILES) custom-made rotating-hinge TKR. There were three men and five women with mean age of 57 years (41 to 79). Patients were followed clinically and radiologically for a mean of seven years (3 to 11.5). The mean Knee Society clinical and function scores improved from 24 (14 to 36) and 20 (5 to 40) pre-operatively, respectively, to 68 (28 to 80) and 50 (22 to 74), respectively, at final follow-up. Four complications were recorded, including a patellar fracture following a fall, a tibial peri-prosthetic fracture, persistent anterior knee pain, and aseptic loosening of a femoral component requiring revision. Our results demonstrate that custom primary rotating-hinge TKR in patients with skeletal dysplasia is effective at relieving pain, with a satisfactory range of movement and improved function. It compensates for bony deformity and ligament deficiency and reduces the likelihood of corrective osteotomy. Patellofemoral joint complications are frequent and functional outcome is worse than with primary TKR in the general population.

Bizarre parosteal osteochondromatous proliferation of bone: clinical management of a series of 22 cases

We describe 22 cases of bizarre parosteal osteochondromatous proliferation, or Nora's lesion. These are surface-based osteocartilaginous lesions typically affecting the hands and feet. All patients were identified from the records of a regional bone tumour unit and were treated between 1985 and 2009. Nine lesions involved the metacarpals, seven the metatarsals, one originated from a sesamoid bone of the foot and five from long bones (radius, ulna, tibia, and femur in two). The mean age of the patients was 31.8 years (6 to 66), with 14 men and eight women. Diagnosis was based on the radiological and histological features. The initial surgical treatment was excision in 21 cases and amputation of a toe in one. The mean follow-up was for 32 months (12 to 162). Recurrence occurred in six patients (27.3%), with a mean time to recurrence of 49 months (10 to 120). Two of the eight patients with complete resection margins developed a recurrence (25.0%), compared with four of 14 with a marginal or incomplete resection (28.6%). Given the potential surgical morbidity inherent in resection, our data suggest that there may be a role for a relatively tissue-conserving approach to the excision of these lesions.

Use of metal proximal radial endoprostheses for treatment of non-traumatic disorders

We have reviewed five adult patients treated with endoprosthetic reconstruction of the proximal radius following resection of non-traumatic lesions. The patients had a mean age of 33.4 years (20 to 60) at the time of surgery and the mean follow-up was 7.6 years (0.8 to 16).

Following surgery, all elbows were clinically stable and there was 100% survivorship of the prosthesis. Evaluation of function was assessed clinically and by the Mayo Elbow Performance Score, achieving a mean of 86% (70 to 100).

Results at medium-term follow-up are encouraging with regards to elbow stability, implant survivorship and functional outcome.

Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability

Polymethyl methacrylate spacers are commonly used during staged revision knee arthroplasty for infection. In cases with extensive bone loss and ligament instability, such spacers may not preserve limb length, joint stability and motion. We report a retrospective case series of 19 consecutive patients using a custom-made cobalt chrome hinged spacer with antibiotic-loaded cement. The "SMILES spacer" was used at first-stage revision knee arthroplasty for chronic infection associated with a significant bone loss due to failed revision total knee replacement in 11 patients (58%), tumour endoprosthesis in four patients (21%), primary knee replacement in two patients (11%) and infected metalwork following fracture or osteotomy in a further two patients (11%). Mean follow-up was 38 months (range 24-70). In 12 (63%) patients, infection was eradicated, three patients (16%) had persistent infection and four (21%) developed further infection after initially successful second-stage surgery. Above knee amputation for persistent infection was performed in two patients. In this particularly difficult to treat population, the SMILES spacer two-stage technique has demonstrated encouraging results and presents an attractive alternative to arthrodesis or amputation.

Custom-made endoprostheses for the femoral amputation stump: an alternative to hip disarticulation in tumour surgery

Disarticulation of the hip in patients with high-grade tumours in the upper thigh results in significant morbidity. In patients with no disease of the proximal soft tissue a femoral stump may be preserved, leaving a fulcrum for movement and weight-bearing. We reviewed nine patients in whom the oncological decision would normally be to disarticulate, but who were treated by implantation of an endoprosthesis in order to create a functioning femoral stump. The surgery was undertaken for chondrosarcoma in four patients, pleomorphic sarcoma in three, osteosarcoma in one and fibrous dysplasia in one. At follow-up at a mean of 80 months (34 to 132), seven patients were alive and free from disease, one had died from lung metastases and another from a myocardial infarction. The mean functional outcome assessment was 50 (musculoskeletal tumor society), 50 and 60 (physical and mental Short-form 36 scores). Implantation of an endoprosthesis into the stump in carefully selected patients allows fitting of an above-knee prosthesis and improves wellbeing and the functional outcome.

Current Practice of Obtaining Informed Consent for Local Steroid Injection among the Shoulder and Elbow Surgeons in United Kingdom

Background

Local steroid injection is a common procedure and not without risks.

Aim

To establish the current practice of obtaining informed consent for local steroid injection among shoulder and elbow surgeons in the UK.

Methods

A postal questionnaire survey was distributed to 176 orthopaedics surgeons in UK who were members of the British Elbow and Shoulder Society.

Results

68% of the surgeons considered local steroid injection invasive. 88% of the surgeons obtained verbal consent only. Of these, only 19% recorded the discussion. Almost all the surgeons (96%) explained the desired effects and 26% provided statistical evidence of local steroid injection. About 88% of the surgeons mentioned other drugs included in the injection. Only 13% of them mentioned the dose of the steroid used. 82% and 77% of the surgeons offered alternative treatment options and the right to refuse injection respectively. 85% and 59% of the surgeons discussed local and systemic risks of steroid injection, respectively. The most common risk mentioned by the surgeons is short term increase of pain.

Conclusions

Majority of the surgeons used verbal consent only for local steroid injection. The consent discussion was not regularly documented in case notes and the information delivered varies.

The representativeness of sentinel practice networks

BACKGROUND

The representativeness of practice networks is important when using the information obtained to guide health policy.

AIM

To develop a model for examining the representativeness of practice networks.

METHODS

Comparison of surveyed population, practice structure and prescribing characteristics with the national data using the Weekly Returns Service (WRS) for 2006 as an example of practice network. The population monitored was compared with the national PCT population. The practice postcode was linked to the Index of Multiple Deprivation and the distribution compared with the national equivalents. Doctor and practice-specific structural data (obtained by questionnaire) and practice-prescribing data were compared with the national equivalents. The significance of differences was evaluated using non-parametric tests.

RESULTS

The WRS population was closely matched with the national data by age, gender and deprivation index. Compared with the national equivalents, WRS practices, included more younger GPs, had a larger average list per GP and fewer practices with a list of less than 1499 per GP. Prescribing patterns were similar to their PCT equivalents excepting for small reductions of antibacterial prescribing (items 7% and cost 5%).

CONCLUSION

We demonstrate a low-cost model methodology for examining the representativeness of practice networks using independent data with minimum practice input.

Search for maximal flavor violating scalars in same-charge lepton pairs in pp collisions at sqrt[s]=1.96 TeV

Models of maximal flavor violation (MxFV) in elementary particle physics may contain at least one new scalar SU(2) doublet field Phi(FV)=(eta(0),eta(+)) that couples the first and third generation quarks (q_(1), q_(3)) via a Lagrangian term L(FV)=xi(13)Phi(FV)q(1)q(3). These models have a distinctive signature of same-charge top-quark pairs and evade flavor-changing limits from meson mixing measurements. Data corresponding to 2 fb(-1) collected by the Collider Dectector at Fermilab II detector in pp[over ] collisions at sqrt[s]=1.96 TeV are analyzed for evidence of the MxFV signature. For a neutral scalar eta(0) with m_(eta;(0))=200 GeV/c(2) and coupling xi(13)=1, approximately 11 signal events are expected over a background of 2.1+/-1.8 events. Three events are observed in the data, consistent with background expectations, and limits are set on the coupling xi(13) for m(eta(0)=180-300 GeV/c(2).

Search for doubly charged Higgs bosons with lepton-flavor-violating decays involving tau leptons

We search for pair production of doubly charged Higgs particles (H+/- +/-) followed by decays into electron-tau (etau) and muon-tau (mutau) pairs using data (350 pb(-1) collected from [over]pp collisions at sqrt[s]=1.96 TeV by the CDF II experiment. We search separately for cases where three or four final-state leptons are detected, and combine results for exclusive decays to left-handed etau (mutau) pairs. We set an H+/- +/- lower mass limit of 114(112) GeV/c(2) at the 95% confidence level.

Search for pair production of scalar top quarks decaying to a tau lepton and a b quark in pp over collisions at sqrt s=1.96 TeV

We search for pair production of supersymmetric top quarks (t over1), followed by R-parity violating decay t over1-->taub with a branching ratio beta, using 322 pb(-1) of pp over collisions at sqrt s=1.96 TeV collected by the upgraded Collider Detector at Fermilab. Two candidate events pass our final selection criteria, consistent with the standard model expectation. We set upper limits on the cross section sigma(t over1t over1) x beta2 as a function of the top-squark mass m(t over1). Assuming beta=1, we set a 95% confidence level limit m(t over1)>153 GeV/c2. The limits are also applicable to the case of a third-generation scalar leptoquark (LQ3) decaying LQ3-->taub.

Search for resonant tt[overline] production in pp[overline] collisions at sqrt[s]=1.96 TeV

We report on a search for narrow-width particles decaying to a top and antitop quark pair. The data set used in the analysis corresponds to an integrated luminosity of 680 pb(-1) collected with the Collider Detector at Fermilab in run II. We present 95% confidence level upper limits on the cross section times branching ratio. Assuming a specific top-color-assisted technicolor production model, the leptophobic Z' with width Gamma(Z')=0.012M(Z'), we exclude the mass range M(Z')<725 GeV/c(2) at the 95% confidence level.

Search for the Higgs boson in events with missing transverse energy and b quark jets produced in pp collisions at square root(s)=1.96 TeV

We search for the standard model Higgs boson produced in association with an electroweak vector boson in events with no identified charged leptons, large imbalance in transverse momentum, and two jets where at least one contains a secondary vertex consistent with the decay of b hadrons. We use approximately 1 fb(-1) integrated luminosity of pp collisions at square root(s)=1.96 TeV recorded by the Collider Detector at Fermilab II experiment at the Tevatron. We find 268 (16) single (double) b-tagged candidate events, where 248+/-43 (14.4+/-2.7) are expected from standard model background processes. We observe no significant excess over the expected background and thus set 95% confidence level upper limits on the Higgs boson production cross section for several Higgs boson masses ranging from 110 to 140 GeV/c(2). For a mass of 115 GeV/c(2), the observed (expected) limit is 20.4 (14.2) times the standard model prediction.

Strong evidence for ZZ production in pp[over] collisions at sqrt[s]=1.96 TeV

We report the first evidence of Z boson pair production at a hadron collider with a significance exceeding 4 standard deviations. This result is based on a data sample corresponding to 1.9 fb(-1) of integrated luminosity from pp[over] collisions at sqrt[s]=1.96 TeV collected with the Collider Detector at Fermilab II detector. In the lll'l' channel, we observe three ZZ candidates with an expected background of 0.096(-0.063)+0.092 events. In the llnunu channel, we use a leading-order calculation of the relative ZZ and WW event probabilities to discriminate between signal and background. In the combination of lll'l' and llnunu channels, we observe an excess of events with a probability of 5.1 x 10(-6) to be due to the expected background. This corresponds to a significance of 4.4 standard deviations. The measured cross section is sigma(pp[over]-->ZZ)=1.4(-0.6)+0.7(stat+syst) pb, consistent with the standard model expectation.

Observation of the decay Bc+/--->J/psipi+/- and measurement of the Bc+/- mass

The Bc+/- meson is observed through the decay Bc+/--->J/psipi+/-, in data corresponding to an integrated luminosity of 2.4 fb(-1) recorded by the Collider Detector at Fermilab II detector at the Fermilab Tevatron. A signal of 108+/-15 candidates is observed, with a significance that exceeds 8sigma. The mass of the Bc+/- meson is measured to be 6275.6+/-2.9(stat)+/-2.5(syst) MeV/c2.

First flavor-tagged determination of bounds on mixing-induced CP violation in Bs0 --> J/psiphi decays

This Letter describes the first determination of bounds on the CP-violation parameter 2beta(s) using B(s)(0) decays in which the flavor of the bottom meson at production is identified. The result is based on approximately 2000 B(s)(0)-->J/psiphi decays reconstructed in a 1.35 fb(-1) data sample collected with the CDF II detector using pp collisions produced at the Fermilab Tevatron. We report confidence regions in the two-dimensional space of 2beta(s) and the decay-width difference DeltaGamma. Assuming the standard model predictions of 2beta(s) and DeltaGamma, the probability of a deviation as large as the level of the observed data is 15%, corresponding to 1.5 Gaussian standard deviations.

Search for heavy toplike quarks using lepton plus jets events in 1.96 TeV pp collisions

We present the results of a search for pair production of a new heavy toplike quark t' decaying to a W boson and another quark using the Collider Detector at Fermilab II detector in run II of the Tevatron pp collider. Using a data sample corresponding to 760 pb(-1) of integrated luminosity, we fit the observed spectrum of total transverse energy and reconstructed t' quark mass to a combination of standard model processes and t' pair production. We see no evidence for t't' production, and we infer a lower limit of 256 GeV/c(2) on the mass of the t' at 95% C.L. assuming standard strong couplings for the t'.

Measurement of Lifetime and Decay-Width Difference in B_{s};{0}-->J/psivarphi Decays

We measure the mean lifetime tau=2/(Gamma_{L}+Gamma_{H}) and the decay-width difference DeltaGamma=Gamma_{L}-Gamma_{H} of the light and heavy mass eigenstates of the B_{s}{0} meson, B_{sL}{0} and B_{sH}{0}, in B_{s}{0}-->J/psivarphi decays using 1.7 fb;{-1} of data collected with the CDF II detector at the Fermilab Tevatron pp[over ] collider. Assuming CP conservation, a good approximation for the B_{s}{0} system in the standard model, we obtain DeltaGamma=0.076_{-0.063}{+0.059}(stat)+/-0.006(syst) ps{-1} and tau=1.52+/-0.04(stat)+/-0.02(syst) ps, the most precise measurements to date. Our constraints on the weak phase and DeltaGamma are consistent with CP conservation.

Evidence for D0-D(0) mixing using the CDF II detector

We measure the time dependence of the ratio of decay rates for the rare decay D{0}-->K{+}pi{-} to the Cabibbo-favored decay D{0}-->K{-}pi;{+}. A signal of 12.7x10;{3} D{0}-->K{+}pi{-} decays was obtained using the Collider Detector at Fermilab II detector at the Fermilab Tevatron with an integrated luminosity of 1.5 fb;{-1}. We measure the D0-D[over ]{0} mixing parameters (R_{D},y{'},x{'2}), and find that the data are inconsistent with the no-mixing hypothesis with a probability equivalent to 3.8 Gaussian standard deviations.

Search for Bs0 --> micro+ micro- and B0 --> micro+ micro- decays with 2 fb-1 of pp collisions

We have performed a search for B(s)(0) --> micro(+) micro(-) and B(0) --> micro(+) micro(-) decays in pp collisions at square root s = 1.96 TeV using 2 fb(-1) of integrated luminosity collected by the CDF II detector at the Fermilab Tevatron Collider. The observed number of B(s)(0) and B0 candidates is consistent with background expectations. The resulting upper limits on the branching fractions are B(B(s)0) --> micro(+) micro(-)) <5.8 x 10(-8) and B(B(0) --> micro(+) micro(-))<1.8 x 10(-8) at 95% C.L.

Measurement of inclusive jet cross sections in Z/gamma*(-->e+e-) + jets production in pp[over ] collisions at square root s = 1.96 TeV

Inclusive jet cross sections in Z/gamma* events, with Z/gamma* decaying into an electron-positron pair, are measured as a function of jet transverse momentum and jet multiplicity in pp[over ] collisions at square root s = 1.96 TeV with the upgraded Collider Detector at Fermilab in run II, based on an integrated luminosity of 1.7 fb(-1). The measurements cover the rapidity region |y(jet)|<2.1 and the transverse momentum range p(T)(jet)>30 GeV/c. Next-to-leading order perturbative QCD predictions are in good agreement with the measured cross sections.