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Allami MK, Fender D, Khaw FM, Sandher DR, Esler C, Harper WM, Gregg PJ. Outcome of Charnley total hip replacement across a single health region in England. ACTA ACUST UNITED AC 2006; 88:1293-8. [PMID: 17012416 DOI: 10.1302/0301-620x.88b10.17933] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using the Trent regional arthroplasty register, we analysed the survival at ten years of 1198 consecutive Charnley total hip replacements carried out across a single health region of the United Kingdom in 1990. At ten years, information regarding outcome was available for 1001 hips (83.6%). The crude revision rate was 6.2% (62 of 1001) and the cumulative survival rate with revision of the components as an end-point was 93.1%. At five years, a review of this series of patients identified gross radiological failure in 25 total hip replacements which had previously been unrecognised. At ten years the outcome was known for 18 of these 25 patients (72%), of whom 13 had not undergone revision. This is the first study to assess the survival at ten years for the primary Charnley total hip replacement performed in a broad cross-section of hospitals in the United Kingdom, as opposed to specialist centres. Our results highlight the importance of the arthroplasty register in identifying the long-term outcome of hip prostheses.
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Affiliation(s)
- M K Allami
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
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Fender D, van der Meulen JHP, Gregg PJ. Relationship between outcome and annual surgical experience for the charnley total hip replacement. Results from a regional hip register. J Bone Joint Surg Br 2003; 85:187-90. [PMID: 12678350 DOI: 10.1302/0301-620x.85b2.12759] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using a regional arthroplasty register, we assessed the outcome, at five years, of 1198 primary Charnley total hip replacements (THRs) undertaken across a single health region in England in 1990. An independent clinical and radiological assessment was completed for 497 operations, carried out in 18 different hospitals, under the care of 56 consultants and by differing grades of surgeon. The overall number of failures in this group was 44 (8.9%). We found that the risk of failure in patients operated on by a consultant whose firm carried out 60 or more THRs in 1990 was 25% of that of patients under the care of a consultant whose firm undertook less than 30, adjusting for a number of patient, surgeon and hospital characteristics (16% v 4%; p < 0.001 for linear trend). Our study shows that the early outcome of hip replacement surgery varies with the number of replacements undertaken by the consultant firm. A national arthroplasty register would be a convenient source for such data.
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Affiliation(s)
- D Fender
- University of Leicester, England, UK
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Chambers IR, Fender D, McCaskie AW, Reeves BC, Gregg PJ. Radiological features predictive of aseptic loosening in cemented Charnley femoral stems. ACTA ACUST UNITED AC 2001. [DOI: 10.1302/0301-620x.83b6.0830838] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The radiological features of the cement mantle around total hip replacements (THRs) have been used to assess aseptic loosening. In this case-control study we investigated the risk of failure of THR as predictable by a range of such features using data from patients recruited to the Trent Regional Arthroplasty Study (TRAS). An independent radiological assessment was undertaken on Charnley THRs with aseptic loosening within five years of surgery and on a control group from the TRAS database. Chi-squared tests were used to test the probability of obtaining the observed data by chance, and odds ratios were calculated to estimate the strength of association for different features. Several features were associated with a clinically important increase (> twofold) in the risk of loosening, which was statistically significant for four features (p < 0.01). Inadequate cementation (Barrack C and D grades) was the most significant feature, with an estimated odds ratio of 9.5 (95% confidence interval 3.2 to 28.4, p < 0.0001) for failure.
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Affiliation(s)
- I. R. Chambers
- Department of Orthopaedic Surgery, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - D. Fender
- Department of Orthopaedic Surgery, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - A. W. McCaskie
- Department of Orthopaedic Surgery, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - B. C. Reeves
- Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London WC2A 3PN, UK
| | - P. J. Gregg
- Middlesborough General Hospital, Ayresome Green Lane, Middles-borough TS5 5AZ, UK
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Chambers IR, Fender D, McCaskie AW, Reeves BC, Gregg PJ. Radiological features predictive of aseptic loosening in cemented Charnley femoral stems. J Bone Joint Surg Br 2001; 83:838-42. [PMID: 11521925 DOI: 10.1302/0301-620x.83b6.11659] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The radiological features of the cement mantle around total hip replacements (THRs) have been used to assess aseptic loosening. In this case-control study we investigated the risk of failure of THR as predictable by a range of such features using data from patients recruited to the Trent Regional Arthroplasty Study (TRAS). An independent radiological assessment was undertaken on Charnley THRs with aseptic loosening within five years of surgery and on a control group from the TRAS database. Chi-squared tests were used to test the probability of obtaining the observed data by chance, and odds ratios were calculated to estimate the strength of association for different features. Several features were associated with a clinically important increase (>twofold) in the risk of loosening, which was statistically significant for four features (p < 0.01). Inadequate cementation (Barrack C and D grades) was the most significant feature, with an estimated odds ratio of 9.5 (95% confidence interval 3.2 to 28.4, p < 0.0001) for failure.
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Affiliation(s)
- I R Chambers
- Department of Orthopaedic Surgery, Freeman Hospital, Newcastle upon Tyne, England, UK
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Schreiber M, Ilamathi E, Wolfson M, Fender D, Mueller S, Baudoin M. Preliminary findings from the National Pre-ESRD Education Initiative. Nephrol News Issues 2000; 14:44-6. [PMID: 11933390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Regardless of age or race, more patients preferred peritoneal dialysis (PD) than would be expected from the current ratio of patients treated with PD in the U.S. The percent of patients choosing PD seems to be largely influenced by the scope of information they receive prior to therapy initiation. In the absence of thorough treatment option education, a significant number of patients may be assigned a therapy when, in reality, they would have selected an alternative option. There is a need to further understand the correlation between a practice's PD utilization rate and the extent to which patients are given dialysis treatment options.
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Affiliation(s)
- M Schreiber
- Cleveland Clinic Foundation, Cleveland, OH, USA
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Abstract
We have assessed the usefulness of a regional hip register in the assessment of the outcome of primary total hip replacement (THR). Over 97% of THRs performed in the Trent region in 1990 were captured onto the register and the inaccuracies recorded were less than 1.8%. In an independent assessment of 2111 patients five years after THR, 85.9% of those available for assessment responded, and 66.8% agreed to an assessment. The cost of this independent assessment at five years, utilising a regional hip register, was approximately £50 per implant. This is a reasonable outlay to identify problems early. Some form of registration and outcome assessment should be performed on a national level.
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Affiliation(s)
- D. Fender
- Department of Trauma and Orthopaedic Surgery, The Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH, UK
| | - W. M. Harper
- Department of Trauma and Orthopaedic Surgery, The Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH, UK
| | - P. J. Gregg
- Department of Trauma and Orthopaedic Surgery, The Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH, UK
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Abstract
We have assessed the usefulness of a regional hip register in the assessment of the outcome of primary total hip replacement (THR). Over 97% of THRs performed in the Trent region in 1990 were captured onto the register and the inaccuracies recorded were less than 1.8%. In an independent assessment of 2111 patients five years after THR, 85.9% of those available for assessment responded, and 66.8% agreed to an assessment. The cost of this independent assessment at five years, utilising a regional hip register, was approximately ł50 per implant. This is a reasonable outlay to identify problems early. Some form of registration and outcome assessment should be performed on a national level.
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MESH Headings
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/standards
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Cause of Death
- Cohort Studies
- Costs and Cost Analysis
- Databases as Topic
- England
- Follow-Up Studies
- Hospital Costs
- Humans
- Outcome Assessment, Health Care/economics
- Outcome Assessment, Health Care/statistics & numerical data
- Registries
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- D Fender
- University of Leicester, England, UK
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Abstract
Using a regional arthroplasty register we assessed the outcome at five years of 1198 primary Charnley total hip replacements (THRs) carried out in 1152 patients across a single UK health region in 1990. Information regarding outcome was available for 1080 hips (90%) and 499 had an independent clinical and radiological assessment. By five years the known rate of aseptic loosening was 2.3%, of deep infection 1.4%, of dislocation 5.0% and of revision 3.2%. The radiological assessment of 499 THRs revealed gross failure in a further 5.2%, which had been previously unrecognised. The combined rate of failure of nearly 9% is higher than those published from specialist centres and surgeons, but is probably more representative of the norm. Our study supports the need for a national register and surveillance of THRs. It emphasises that all implants should be followed, and suggests that the results of such surgery, when performed in the general setting, may not be as good as expected.
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Affiliation(s)
- D. Fender
- Department of Trauma and Orthopaedic Surgery, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK
| | - W. M. Harper
- Department of Trauma and Orthopaedic Surgery, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK
| | - P. J. Gregg
- Department of Trauma and Orthopaedic Surgery, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK
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Fender D, Harper WM, Gregg PJ. Outcome of Charnley total hip replacement across a single health region in England: the results at five years from a regional hip register. J Bone Joint Surg Br 1999; 81:577-81. [PMID: 10463724 DOI: 10.1302/0301-620x.81b4.9859] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using a regional arthroplasty register we assessed the outcome at five years of 1198 primary Charnley total hip replacements (THRs) carried out in 1152 patients across a single UK health region in 1990. Information regarding outcome was available for 1080 hips (90%) and 499 had an independent clinical and radiological assessment. By five years the known rate of aseptic loosening was 2.3%, of deep infection 1.4%, of dislocation 5.0% and of revision 3.2%. The radiological assessment of 499 THRs revealed gross failure in a further 5.2%, which had been previously unrecognised. The combined rate of failure of nearly 9% is higher than those published from specialist centres and surgeons, but is probably more representative of the norm. Our study supports the need for a national register and surveillance of THRs. It emphasises that all implants should be followed, and suggests that the results of such surgery, when performed in the general setting, may not be as good as expected.
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Affiliation(s)
- D Fender
- University of Leicester, England
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Best AJ, Fender D, Harper WM, McCaskie AW, Oliver K, Gregg PJ. Current practice in primary total hip replacement: results from the National Hip Replacement Outcome Project. Ann R Coll Surg Engl 1998; 80:350-5. [PMID: 9849338 PMCID: PMC2503116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
As part of the National Study of Primary Hip Replacement Outcome, 402 consultant orthopaedic surgeons from three regions were contacted by postal questionnaire which covered all aspects of total hip replacement (THR). There was a 70% response rate of which 71 did not perform hip surgery, a further 33 refused to take part, leaving 181 valid responses. Preoperative assessment clinics were used by 89% of surgeons, but anaesthetists and rehabilitation services were rarely involved at this stage. Of respondents, 99% used routine thromboprophylaxis, with 79% using a combination of mechanical and chemical methods. Of surgeons, 84% routinely used stockings, whereas 95.5% used chemical prophylaxis, 63% employed low molecular weight heparins. Theatre facilities were shared with other surgical specialties by 6% of surgeons and 18% regularly used body exhaust suits for THR. Antibiotic loaded cement was used by 69% of surgeons, the majority (65%) used a single brand of normal viscosity cement with 9% using reduced viscosity formulations. Modern cementing techniques were commonly used at least in part, 87% used a cement gun and 94% a cement restrictor for femoral cementing. On the acetabulum, 47% pressurised the cement. In all, 36 different femoral stems and 35 acetabular cups were in routine use, but the majority of surgeons (55%) used Charnley type prostheses. Of the surgeons, 57% performed only cemented THR, while 3% exclusively used uncemented THR. Of consultants, 21% followed up their patients to 5 years, the majority discharge patients within the first year. Of concern is a large proportion of surgeons using low molecular weight heparins despite a lack of evidence with regard to reducing fatal pulmonary embolism, and also the small number of surgeons using prostheses of unproven value. Third generation cementing techniques have yet to be fully adopted. The introduction of a national hip register could help to resolve some of these issues.
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Affiliation(s)
- A J Best
- Department of Orthopaedic Surgery, University of Leicester, Glenfield General Hospital
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Schroer RJ, Phelan MC, Michaelis RC, Crawford EC, Skinner SA, Cuccaro M, Simensen RJ, Bishop J, Skinner C, Fender D, Stevenson RE. Autism and maternally derived aberrations of chromosome 15q. Am J Med Genet 1998; 76:327-36. [PMID: 9545097 DOI: 10.1002/(sici)1096-8628(19980401)76:4<327::aid-ajmg8>3.0.co;2-m] [Citation(s) in RCA: 250] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Of the chronic mental disabilities of childhood, autism is causally least well understood. The former view that autism was rooted in exposure to humorless and perfectionistic parenting has given way to the notion that genetic influences are dominant underlying factors. Still, identification of specific heritable factors has been slow with causes identified in only a few cases in unselected series. A broad search for genetic and environmental influences that cause or predispose to autism is the major thrust of the South Carolina Autism Project. Among the first 100 cases enrolled in the project, abnormalities of chromosome 15 have emerged as the single most common cause. The four abnormalities identified include deletions and duplications of proximal 15q. Other chromosome aberrations seen in single cases include a balanced 13;16 translocation, a pericentric inversion 12, a deletion of 20p, and a ring 7. Candidate genes involved in the 15q region affected by duplication and deletion include the ubiquitin-protein ligase (UBE3A) gene responsible for Angelman syndrome and genes for three GABA(A) receptor subunits. In all cases, the deletions or duplications occurred on the chromosome inherited from the mother.
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Affiliation(s)
- R J Schroer
- Greenwood Genetic Center, South Carolina 29646, USA
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12
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Fender D. Quality process initiatives can help dialysis centers improve patient outcomes and reduce costs. Perit Dial Int 1998; 18:155-6. [PMID: 9576362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Fender D, Harper WM, Thompson JR, Gregg PJ. Mortality and fatal pulmonary embolism after primary total hip replacement. Results from a regional hip register. J Bone Joint Surg Br 1997; 79:896-9. [PMID: 9393900 DOI: 10.1302/0301-620x.79b6.7677] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We calculated the rates for perioperative mortality and fatal pulmonary embolism (PE) after primary total hip replacement in a single UK health region, using a regional arthroplasty register and the tracing service of the Office of National Statistics. During 1990, there were 2111 consecutive primary replacements in 2090 separate procedures. Within 42 days of operation a total of 19 patients had died (0.91%, 95% CI 0.55 to 1.42). Postmortem examination showed that four deaths (0.19%, 95% CI 0.05 to 0.49) were definitely due to PE. The overall perioperative mortality and fatal PE rates are low and in our study did not appear to be altered by the use of chemical thromboprophylaxis (perioperative mortality rate: one-tailed Fisher's exact test, p = 0.39; fatal PE rate: one-tailed Fisher's exact test, p = 0.56). The routine use of chemical thromboprophylaxis for primary THR is still controversial. The issue should be addressed by an appropriate randomised, prospective study using overall mortality and fatal PE rate as the main outcome measures, but the feasibility of such a study is questioned.
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Affiliation(s)
- D Fender
- University of Leicester, England, UK
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Cuccaro ML, Wright HH, Rownd CV, Abramson RK, Waller J, Fender D. Professional perceptions of children with developmental difficulties: the influence of race and socioeconomic status. J Autism Dev Disord 1996; 26:461-9. [PMID: 8863096 DOI: 10.1007/bf02172830] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M L Cuccaro
- University of South Carolina School of Medicine, Columbia, USA
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Affiliation(s)
- D Fender
- University Urology Unit, Freeman Hospital, Newcastle upon Tyne, UK
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von Campenhausen C, Fender D. A direct experiment on the problem of the light sensitivity of the iris. Pflugers Arch Gesamte Physiol Menschen Tiere 1967; 295:227-31. [PMID: 5241428 DOI: 10.1007/bf01844102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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