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Clement ND, Afzal I, Demetriou C, Deehan DJ, Field RE, Kader D. There is no clinically important difference in the Oxford knee scores between one and two years after total knee arthroplasty: The one-year score could be used as the benchmark timepoint to assess outcome. Knee 2020; 27:1212-1218. [PMID: 32711884 DOI: 10.1016/j.knee.2020.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim was to assess the whether there was a clinically important change in the Oxford knee score (OKS) between one and two years after total knee arthroplasty (TKA), and to identify predictors associated with a clinically important change. METHODS A retrospective cohort study was undertaken using an established arthroplasty database of 5857 primary TKA. Patient demographics, body mass index, social deprivation, OKS and EuroQoL five-domain (EQ-5D) score were collected preoperatively and at one and two years postoperatively. A clinically important change in the OKS was defined as ≥5 points. RESULTS There was a 0.2 point increase in the OKS between one and two years, which was statistically significant (95% confidence interval (CI) 0.1 to 0.4, p < .0001), but not clinically important. A better preoperative OKS (p < .001) and in contrast a worse one year OKS (p < .001) were independently associated with a greater improvement from one to two years. There were 1006 (17.3%) patients that had a clinically important improvement in the OKS between one and two years. Receiver operating characteristic curve analysis showed that a one year OKS of less than 35 was a reliable predictor of a clinically important improvement between one and two years (area under the curve 0.77, 95% CI 0.76 to 0.78, p < .001). CONCLUSION There was not a clinically important change in the OKS from one to two years after TKA when assessed as a group. However, individual patients with a one year OKS of less than 35 may demonstrate a clinically important improvement at two years. LEVEL OF EVIDENCE Retrospective diagnostic study, Level III.
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Affiliation(s)
- N D Clement
- Department of Orthopaedics, Freeman Hospital, Newcastle, UK; Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; South West of London Orthopaedic Elective Centre, Epson, UK.
| | - I Afzal
- South West of London Orthopaedic Elective Centre, Epson, UK
| | - C Demetriou
- South West of London Orthopaedic Elective Centre, Epson, UK
| | - David J Deehan
- Department of Orthopaedics, Freeman Hospital, Newcastle, UK
| | - R E Field
- South West of London Orthopaedic Elective Centre, Epson, UK
| | - D Kader
- South West of London Orthopaedic Elective Centre, Epson, UK
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Key S, Scott G, Stammers JG, Freeman MAR, Pinskerova V, Field RE, Skinner J, Banks SA. Does lateral lift-off occur in static and dynamic activity in a medially spherical total knee arthroplasty? A pulsed-fluoroscopic investigation. Bone Joint Res 2019; 8:207-215. [PMID: 31214333 PMCID: PMC6548977 DOI: 10.1302/2046-3758.85.bjr-2018-0237.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives The medially spherical GMK Sphere (Medacta International AG, Castel San Pietro, Switzerland) total knee arthroplasty (TKA) was previously shown to accommodate lateral rollback while pivoting around a stable medial compartment, aiming to replicate native knee kinematics in which some coronal laxity, especially laterally, is also present. We assess coronal plane kinematics of the GMK Sphere and explore the occurrence and pattern of articular separation during static and dynamic activities. Methods Using pulsed fluoroscopy and image matching, the coronal kinematics and articular surface separation of 16 well-functioning TKAs were studied during weight-bearing and non-weight-bearing, static, and dynamic activities. The closest distances between the modelled articular surfaces were examined with respect to knee position, and proportions of joint poses exhibiting separation were computed. Results Overall, 1717 joint poses were analyzed. At a 1.0 mm detection threshold, 37 instances of surface separation were observed in the lateral compartment and four medially (p < 0.001). Separation was activity-dependent, both laterally and medially (p < 0.001), occurring more commonly during static deep flexion in the lateral compartment, and during static rotation in the medial compartment. Lateral separation occurred more frequently than medial during kneeling (7/14 lateral vs 1/14 medial; p = 0.031) and stepping (20/1022 lateral vs 0/1022 medial; p < 0.001). Separation varied significantly between individuals during dynamic activities. Conclusion No consistent association between closest distances of the articular surfaces and knee position was found during any activity. Lift-off was infrequent and depended on the activity performed and the individual knee. Lateral separation was consistent with the design rationale. Medial lift-off was rare and mostly in non-weight-bearing activities. Cite this article: S. Key, G. Scott, J.G. Stammers, M. A. R. Freeman†, V. Pinskerova, R. E. Field, J. Skinner, S. A. Banks. Does lateral lift-off occur in static and dynamic activity in a medially spherical total knee arthroplasty? A pulsed-fluoroscopic investigation. Bone Joint Res 2019;8:207–215. DOI: 10.1302/2046-3758.85.BJR-2018-0237.R1.
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Affiliation(s)
- S Key
- Royal London Hospital, London, UK
| | - G Scott
- Royal London Hospital, London, UK
| | | | - M A R Freeman
- †M.A.R Freeman has deceased since the submission of this manuscript
| | - V Pinskerova
- First Orthopaedic Clinic, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - R E Field
- St George's, University of London, London, UK; Director of Research, South West London Elective Orthopaedic Centre, Epsom, UK
| | - J Skinner
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - S A Banks
- University of Florida, Gainesville, Florida, USA
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Scott G, Imam MA, Eifert A, Freeman MAR, Pinskerova V, Field RE, Skinner J, Banks SA. Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised? A pulsed fluoroscopic investigation. Bone Joint Res 2016; 5:80-6. [PMID: 26965166 PMCID: PMC4852793 DOI: 10.1302/2046-3758.53.2000621] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/18/2016] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Throughout the 20th Century, it has been postulated that the knee moves on the basis of a four-bar link mechanism composed of the cruciate ligaments, the femur and the tibia. As a consequence, the femur has been thought to roll back with flexion, and total knee arthroplasty (TKA) prostheses have been designed on this basis. Recent work, however, has proposed that at a position of between 0° and 120° the medial femoral condyle does not move anteroposteriorly whereas the lateral femoral condyle tends, but is not obliged, to roll back - a combination of movements which equates to tibial internal/ femoral external rotation with flexion. The aim of this paper was to assess if the articular geometry of the GMK Sphere TKA could recreate the natural knee movements in situ/in vivo. METHODS The pattern of knee movement was studied in 15 patients (six male: nine female; one male with bilateral TKAs) with 16 GMK Sphere implants, at a mean age of 66 years (53 to 76) with a mean BMI of 30 kg/m(2) (20 to 35). The motions of all 16 knees were observed using pulsed fluoroscopy during a number of weight-bearing and non-weight-bearing static and dynamic activities. RESULTS During maximally flexed kneeling and lunging activities, the mean tibial internal rotation was 8° (standard deviation (sd) 6). At a mean 112° flexion (sd 16) during lunging, the medial and lateral condyles were a mean of 2 mm (sd 3) and 8 mm (sd 4) posterior to a transverse line passing through the centre of the medial tibial concavity. With a mean flexion of 117° (sd 14) during kneeling, the medial and lateral condyles were a mean of 1 mm (sd 4) anterior and 6 mm (sd 4) posterior to the same line. During dynamic stair and pivoting activities, there was a mean anteroposterior translation of 0 mm to 2 mm of the medial femoral condyle. Backward lateral condylar translation occurred and was linearly related to tibial rotation. CONCLUSION The GMK Sphere TKA in our study group shows movements similar in pattern, although reduced in magnitude, to those in recent reports relating to normal knees during several activities. Specifically, little or no translation of the medial femoral condyle was observed during flexion, but there was posterior roll-back of the lateral femoral condyle, equating to tibiofemoral rotation. We conclude that the GMK Sphere is anteroposteriorly stable medially and permits rotation about the medial compartment.Cite this article: Professor G. Scott. Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised?: A pulsed fluoroscopic investigation. Bone Joint Res 2016;5:80-86. DOI: 10.1302/2046-3758.53.2000621.
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Affiliation(s)
- G Scott
- Trauma and Orthopaedic Department, Royal London Hospital, Whitechapel, London, E1 1BB, UK
| | - M A Imam
- South West London Elective Orthopaedic Centre, Epsom, UK
| | - A Eifert
- Department of Biomedical Engineering, University of Florida, Florida, USA
| | | | | | - R E Field
- St Georges University of London, Director of Research, South West London Elective Orthopaedic Centre, Epsom, UK
| | - J Skinner
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - S A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Florida, USA
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Williams DP, Price AJ, Beard DJ, Hadfield SG, Arden NK, Murray DW, Field RE. The effects of age on patient-reported outcome measures in total knee replacements. Bone Joint J 2013; 95-B:38-44. [PMID: 23307671 DOI: 10.1302/0301-620x.95b1.28061] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a comparison of patient-reported outcomes (PROMs) in relation to patient age, in patients who had received a total (TKR) or unicompartmental knee replacement (UKR). The outcome was evaluated using the Oxford knee score (OKS), EuroQol (EQ-5D) and satisfaction scores. Patients aged 65 to 84 years demonstrated better pre-operative function scores than those aged < 65 years (OKS, p = 0.03; EQ-5D, p = 0.048) and those aged ≥ 85 years (OKS, p = 0.03). Post-operative scores were comparable across age groups, but a linear trend for greater post-operative improvement in OKS and EQ-5D was seen with decreasing age (p < 0.033). The overall mean satisfaction score at six months was 84.9, but those aged < 55 years exhibited a lower mean level of satisfaction (78.3) compared with all other age groups (all p < 0.031). The cumulative overall two-year revision rate was 1.3%. This study demonstrates that good early outcomes, as measured by the OKS and EQ-5D, can be anticipated following knee replacement regardless of the patient's age, although younger patients gain greater improvement. However, the lower satisfaction in those aged < 55 years is a concern, and suggests that outcome is not fully encapsulated by the OKS and EQ-5D evaluation, and raises the question whether the OKS alone is an appropriate measure of pain and function in younger, more active individuals.
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Affiliation(s)
- D P Williams
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Windmill Road, Oxford OX3 7LD, UK.
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5
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Abstract
The Oxford knee score (OKS) is a validated and widely accepted disease-specific patient-reported outcome measure, but there is limited evidence regarding any long-term trends in the score. We reviewed 5600 individual OKS questionnaires (1547 patients) from a prospectively-collected knee replacement database, to determine the trends in OKS over a ten-year period following total knee replacement. The mean OKS pre-operatively was 19.5 (95% confidence interval (CI) 18.8 to 20.2). The maximum post-operative OKS was observed at two years (mean score 34.4 (95% CI 33.7 to 35.2)), following which a gradual but significant decline was observed through to the ten-year assessment (mean score 30.1 (95% CI 29.1 to 31.1)) (p < 0.001). A similar trend was observed for most of the individual OKS components (p < 0.001). Kneeling ability initially improved in the first year but was then followed by rapid deterioration (p < 0.001). Pain severity exhibited the greatest improvement, although residual pain was reported in over two-thirds of patients post-operatively, and peak improvement in the night pain component did not occur until year four. Post-operative OKS was lower for women (p < 0.001), those aged < 60 years (p < 0.003) and those with a body mass index > 35 kg/m(2) (p < 0.014), although similar changes in scores were observed. This information may assist surgeons in advising patients of their expected outcomes, as well as providing a comparative benchmark for evaluating longer-term outcomes following knee replacement.
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Affiliation(s)
- D P Williams
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
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Alazzawi S, Bardakos NV, Hadfield SG, Butt U, Beer ZH, Field RE. Patient-reported complications after elective joint replacement surgery: are they correct? ACTA ACUST UNITED AC 2012; 94:1120-5. [PMID: 22844056 DOI: 10.1302/0301-620x.94b8.29040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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
Using general practitioner records and hospital notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications gathered from a self-completed questionnaire after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with a mean age of 71.8 years (34 to 93). A total of 319 reported complications (79.4%; 95% confidence interval 75.4 to 83.3) were confirmed to be correct. High rates of correct reporting were demonstrated for infection (94.5%) and the need for further surgery (100%), whereas the rates of reporting deep-vein thrombosis (DVT), pulmonary embolism, myocardial infarction and stroke were lower (75% to 84.2%). Dislocation, peri-prosthetic fractures and nerve palsy had modest rates of correct reporting (36% to 57.1%). More patients who had knee surgery delivered incorrect reports of dislocation (p = 0.001) and DVT (p = 0.013). Despite these variations, it appears that post-operative complications may form part of a larger patient-reported outcome programme after elective joint replacement surgery.
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Affiliation(s)
- S Alazzawi
- University College Hospital, 235 Euston Road, London NW1 2BU, UK
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Judge A, Arden NK, Kiran A, Price A, Javaid MK, Beard D, Murray D, Field RE. Interpretation of patient-reported outcomes for hip and knee replacement surgery: identification of thresholds associated with satisfaction with surgery. ACTA ACUST UNITED AC 2012; 94:412-8. [PMID: 22371552 DOI: 10.1302/0301-620x.94b3.27425] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [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
We obtained information from the Elective Orthopaedic Centre on 1523 patients with baseline and six-month Oxford hip scores (OHS) after undergoing primary hip replacement (THR) and 1784 patients with Oxford knee scores (OKS) for primary knee replacement (TKR) who completed a six-month satisfaction questionnaire. Receiver operating characteristic curves identified an absolute change in OHS of 14 points or more as the point that discriminates best between patients' satisfaction levels and an 11-point change for the OKS. Satisfaction is highest (97.6%) in patients with an absolute change in OHS of 14 points or more, compared with lower levels of satisfaction (81.8%) below this threshold. Similarly, an 11-point absolute change in OKS was associated with 95.4% satisfaction compared with 76.5% below this threshold. For the six-month OHS a score of 35 points or more distinguished patients with the highest satisfaction level, and for the six-month OKS 30 points or more identified the highest level of satisfaction. The thresholds varied according to patients' pre-operative score, where those with severe pre-operative pain/function required a lower six-month score to achieve the highest levels of satisfaction. Our data suggest that the choice of a six-month follow-up to assess patient-reported outcomes of THR/TKR is acceptable. The thresholds help to differentiate between patients with different levels of satisfaction, but external validation will be required prior to general implementation in clinical practice.
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Affiliation(s)
- A Judge
- University of Oxford, Oxford NIHR Musculoskeletal Biomedical Research Unit, Windmill Road, Headington, Oxford OX3 7LD, UK.
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Judge A, Arden NK, Price A, Glyn-Jones S, Beard D, Carr AJ, Dawson J, Fitzpatrick R, Field RE. Assessing patients for joint replacement. ACTA ACUST UNITED AC 2011; 93:1660-4. [DOI: 10.1302/0301-620x.93b12.27046] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [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
We obtained pre-operative and six-month post-operative Oxford hip (OHS) and knee scores (OKS) for 1523 patients who underwent total hip replacement and 1784 patients who underwent total knee replacement. They all also completed a six-month satisfaction question. Scatter plots showed no relationship between pre-operative Oxford scores and six-month satisfaction scores. Spearman’s rank correlation coefficients were -0.04 (95% confidence interval (CI) -0.09 to 0.01) between OHS and satisfaction and 0.04 (95% CI -0.01 to 0.08) between OKS and satisfaction. A receiver operating characteristic (ROC) curve analysis was used to identify a cut-off point for the pre-operative OHS/OKS that identifies whether or not a patient is satisfied with surgery. We obtained an area under the ROC curve of 0.51 (95% CI 0.45 to 0.56) for hip replacement and 0.56 (95% CI 0.51 to 0.60) for knee replacement, indicating that pre-operative Oxford scores have no predictive accuracy in distinguishing satisfied from dissatisfied patients. In the NHS widespread attempts are being made to use patient-reported outcome measures (PROMs) data for the purpose of prioritising patients for surgery. Oxford hip and knee scores have no predictive accuracy in relation to post-operative patient satisfaction. This evidence does not support their current use in prioritising access to care.
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Affiliation(s)
- A. Judge
- Oxford NIHR Musculoskeletal Biomedical
Research Unit, University of Oxford, Windmill Road, Headington, Oxford
OX3 7LD, UK
| | - N. K. Arden
- Oxford NIHR Musculoskeletal Biomedical
Research Unit, University of Oxford, Windmill Road, Headington, Oxford
OX3 7LD, UK
| | - A. Price
- Oxford NIHR Musculoskeletal Biomedical
Research Unit, University of Oxford, Windmill Road, Headington, Oxford
OX3 7LD, UK
| | - S. Glyn-Jones
- Oxford NIHR Musculoskeletal Biomedical
Research Unit, University of Oxford, Windmill Road, Headington, Oxford
OX3 7LD, UK
| | - D. Beard
- Oxford NIHR Musculoskeletal Biomedical
Research Unit, University of Oxford, Windmill Road, Headington, Oxford
OX3 7LD, UK
| | - A. J. Carr
- Oxford NIHR Musculoskeletal Biomedical
Research Unit, University of Oxford, Windmill Road, Headington, Oxford
OX3 7LD, UK
| | - J. Dawson
- Department of Public Health, University
of Oxford, Rosemary Rue Building, Old
Road Campus, Roosevelt Drive, Headington, Oxford
OX3 7LF, UK
| | - R. Fitzpatrick
- Department of Public Health, University
of Oxford, Rosemary Rue Building, Old
Road Campus, Roosevelt Drive, Headington, Oxford
OX3 7LF, UK
| | - R. E. Field
- Elective Orthopaedic Centre, Dorking
Road, Epsom, Surrey KT18
7EG, UK
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Abstract
Developmental dysplasia of the hip predisposes to premature degenerative hip disease. A number of operations have been described to improve acetabular cover and have achieved varying degrees of success. We present the case of an 84-year-old woman, who underwent a shelf procedure to reconstruct a dysplastic hip 75 years ago. To date, the shelf remains intact and the hip is asymptomatic. We believe this represents the longest documented outcome of any procedure to stabilise the hip.
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Affiliation(s)
- K Rajakulendran
- South West London Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey KT18 7EG, UK.
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Abstract
Long-term surveillance of patients is necessary to ascertain the outcome of medical interventions. The rate of 'loss to follow-up' is the largest controllable variable in long-term follow-up studies. Such surveillance programmes are of particular importance to surgical interventions as differences between techniques or implants may take years to become apparent.
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Affiliation(s)
- LC Biant
- Consultant Trauma and Orthopaedic Surgeon, The Royal Infirmary of Edinburgh
| | | | - RE Field
- Consultant Orthopaedic Surgeon and Director of Research, South West London Elective Orthopaedic Centre
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Blakey CM, Eswaramoorthy VK, Hamilton LC, Biant LC, Field RE. Mid-term results of the modular ANCA-Fit femoral component in total hip replacement. ACTA ACUST UNITED AC 2009; 91:1561-5. [PMID: 19949117 DOI: 10.1302/0301-620x.91b12.22638] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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
We report the minimum five-year follow-up of 352 primary total hip replacements using the uncemented hydroxyapatite-coated ANCA-Fit femoral component with a modular neck and head. The series comprised 319 patients (212 men, 107 women) with a mean age at operation of 64.4 years (28 to 97). The principal diagnosis was osteoarthritis. A total of 18 patients (21 hips) died before their follow-up at five years, nine patients (11 hips) were lost to follow-up, and four (four hips) declined further follow-up. Patient-reported outcomes have been recorded for 288 patients (316 hips). Their mean Oxford Hip Score improved significantly from 41 points (16 to 57) pre-operatively to 20 points (12 to 44) at five-year follow-up. Radiological assessment showed good bony stability in 98% of implants. There were two cases of aseptic loosening of the femoral component. There were no clinical or radiological complications related to modularity. In our series we did not see the high rate of intra-operative fracture previously reported for this implant. This medium-term follow-up study demonstrates that the clinical outcome of the ANCA-Fit femoral component is, to date, comparable with that of other metaphyseal loading femoral components.
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Affiliation(s)
- C. M. Blakey
- Research and Education South West London Elective Orthopaedic Centre, Epsom, Surrey KT18 7EG, UK
| | - V. K. Eswaramoorthy
- Research and Education South West London Elective Orthopaedic Centre, Epsom, Surrey KT18 7EG, UK
| | - L. C. Hamilton
- 3rd Floor, Plastic Surgery Department Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - L. C. Biant
- Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - R. E. Field
- Research and Education South West London Elective Orthopaedic Centre, Epsom, Surrey KT18 7EG, UK
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Eswaramoorthy VK, Biant LC, Field RE. Clinical and radiological outcome of stemmed hip replacement after revision from metal-on-metal resurfacing. ACTA ACUST UNITED AC 2009; 91:1454-8. [DOI: 10.1302/0301-620x.91b11.22651] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [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
We report the outcome of total hip replacement in 29 failed metal-on-metal resurfacing hip replacements in which the primary surgery was performed between August 1995 and February 2005. The mean length of follow-up was five years (1.7 to 11.7). Of the 29 hip resurfacings, 19 acetabular components and all the femoral components were revised (28 uncemented stems and one cemented stem). There were no deaths and none of the patients was lost to follow-up. None of the hips underwent any further revision. The results of the revision resurfacing group were compared with those of a control group of age-matched patients. In the latter group there were 236 primary total hip replacements and 523 resurfacings performed during the same period by the same surgeons. The outcome of the revision resurfacing group was comparable with that of the stemmed primary hip replacement group but was less good than that of the primary hip resurfacing group. Long-term follow-up is advocated to monitor the outcome of these cases.
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Affiliation(s)
- V. K. Eswaramoorthy
- Research & Education South West London Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey KT18 7EG, UK
| | - L. C. Biant
- Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - R. E. Field
- Research & Education South West London Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey KT18 7EG, UK
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Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. ACTA ACUST UNITED AC 2009; 91:776-83. [DOI: 10.1302/0301-620x.91b6.22393] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [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
Tranexamic acid is a fibrinolytic inhibitor which reduces blood loss in total knee replacement. We examined the effect on blood loss of a standardised intravenous bolus dose of 1 g of tranexamic acid, given at the induction of anaesthesia in patients undergoing total hip replacement and tested the potential prothrombotic effect by undertaking routine venography. In all, 36 patients received 1 g of tranexamic acid, and 37 no tranexamic acid. Blood loss was measured directly per-operatively and indirectly post-operatively. Tranexamic acid reduced the early post-operative blood loss and total blood loss (p = 0.03 and p = 0.008, respectively) but not the intraoperative blood loss. The tranexamic acid group required fewer transfusions (p = 0.03) and had no increased incidence of deep-vein thrombosis. The reduction in early post-operative blood loss was more marked in women (p = 0.05), in whom this effect was dose-related (r = −0.793). Our study showed that the administration of a standardised pre-operative bolus of 1 g of tranexamic acid was cost-effective in reducing the blood loss and transfusion requirements after total hip replacement, especially in women.
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Affiliation(s)
- K. Rajesparan
- The Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey KT18 7EG, UK
| | - L. C. Biant
- The Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - M. Ahmad
- The Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey KT18 7EG, UK
| | - R. E. Field
- The Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey KT18 7EG, UK
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Cristofolini L, Juszczyk M, Taddei F, Field RE, Rushton N, Viceconti M. Stress shielding and stress concentration of contemporary epiphyseal hip prostheses. Proc Inst Mech Eng H 2009; 223:27-44. [PMID: 19239065 DOI: 10.1243/09544119jeim470] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
After the first early failures, proximal femoral epiphyseal replacement is becoming popular again. Prosthesis-to-bone load transfer is critical for two reasons: stress shielding is suspected of being responsible for a number of failures of early epiphyseal prostheses; stress concentration is probably responsible of the relevant number of early femoral neck fractures in resurfaced patients. The scope of this work was to experimentally investigate the load transfer of a commercial epiphyseal prosthesis (Birmingham Hip Replacement (BHR)) and an innovative prototype proximal epiphyseal replacement. To investigate bone surface strain, ten cadaveric femurs were instrumented with 15 triaxial strain gauges. In addition the cement layer of the prototype was instrumented with embedded gauges to estimate the strain in the adjacent trabecular bone. Six different loading configurations were investigated, with and without muscles. For the BHR prosthesis, significant stress shielding was observed on the posterior side of the head-neck region (the strain was halved); a pronounced stress concentration was observed on the anterior surface (up to five times in some specimens); BHR was quite sensitive to the different loading configurations. For the prototype, the largest stress shielding was observed in the neck region (lower than the BHR; alteration less than 20 per cent); some stress concentration was observed at the head region, close to the rim of the prosthesis (alteration less than 20 per cent); the different loading configurations had similar effects. Such large alterations with respect to the pre-operative conditions were found only in regions where the strain level was low. Conversely, alterations were moderate where the strain was higher. Thus, prosthesis-to-bone load transfer of both devices has been elucidated; the prototype preserved a stress distribution closer to the physiological condition.
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Affiliation(s)
- L Cristofolini
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy.
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15
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Abstract
Idiopathic calcium pyrophosphate deposition disease (pseudogout) has a variable presentation. Many joints are usually affected; single joint disease is uncommon. We present a case report of primary monoarticular pseudogout affecting the hip. The diagnosis was made on the appearance and analysis of specimens obtained at arthroscopy. Monoarticular pseudogout is rare, but should be considered in the differential diagnosis of any presentation of joint pain.
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Affiliation(s)
- L C Hamilton
- South West London Elective Orthopaedic Centre, UK
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16
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Eswaramoorthy V, Moonot P, Kalairajah Y, Biant LC, Field RE. The Metasul metal-on-metal articulation in primary total hip replacement: clinical and radiological results at ten years. ACTA ACUST UNITED AC 2008; 90:1278-83. [PMID: 18827235 DOI: 10.1302/0301-620x.90b10.20378] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [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
We report the clinical and radiological outcome at ten years of 104 primary total hip replacements (100 patients) using the Metasul metal-on-metal bearing. Of these, 52 had a cemented Stuehmer-Weber polyethylene acetabular component with a Metasul bearing and 52 had an uncemented Allofit acetabular component with a Metasul liner. A total of 15 patients (16 hips) died before their follow-up at ten years and three were lost to follow-up. The study group therefore comprised 82 patients (85 hips). The mean Oxford score at ten years was 20.7 (12 to 42). Six of 85 hips required revision surgery. One was performed because of infection, one for aseptic loosening of the acetabular component and four because of unexplained pain. Histological examination showed an aseptic lymphocytic vasculitis associated lesion-type tissue response in two of these. Continued follow-up is advocated in order to monitor the long-term performance of the Metasul bearing and tissue responses to metal debris.
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Affiliation(s)
- V Eswaramoorthy
- Research and Education, South West London Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey KT18 7EG, UK.
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17
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Johnson SA, Kalairajah Y, Moonot P, Steele N, Field RE. Fast-track assessment clinic: selection of patients for a one-stop hip assessment clinic. Ann R Coll Surg Engl 2008; 90:208-12. [PMID: 18430334 DOI: 10.1308/003588408x242024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The fast-track assessment clinic (FTAC) is a process to select patients who are very likely to require primary total hip replacement. Selected patients can then be seen in a one-off clinic reducing the number of hospital visits, cost to primary care trusts and delay between referral and treatment. PATIENTS AND METHODS Fifty patients on the waiting list for hip replacement were analysed to see if there were common parameters that led to their inclusion. From these data, fast-track selection criteria (FTSCs) were generated. These FTSCs were used to make a dual comparison of outcomes between 52 patients seen in a traditional clinic. Finally, a pilot study was conducted in which patients fulfilling FTSCs were seen in a designated clinic. RESULTS An Oxford hip score (OHS) of 34 and above combined with severe loss of joint space, severe marginal osteophytes, or both was common to most patients on the waiting list (84%). FTSCs correctly predicted the outcome of the orthopaedic clinic in 38 patients out of a total of 52. During the pilot stage, positive FTSCs were shown to have a positive predictive value of 92% for joint replacement being carried out and a negative predictive value of 46%. CONCLUSIONS An OHS of 34 or above combined with complete loss of joint space and/or severe marginal osteophyte formation can be used to select patients who are very likely to need total hip replacement. These patients can be seen in a clinic that combines assessment of surgical indication with medical fitness for surgery.
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Affiliation(s)
- S A Johnson
- Department of Orthopaedics, St Helier Hospital, Carshalton, Surrey, UK
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18
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Abstract
Hip resurfacing is a bone-conserving procedure with respect to proximal femoral resection, but there is debate in the literature as to whether the same holds true for the acetabulum. We have investigated whether the Birmingham hip resurfacing conserves acetabular bone. Between 1998 and 2005, 500 Birmingham hip resurfacings were performed by two surgeons. Between 1996 and 2005 they undertook 700 primary hip replacements, with an uncemented acetabular component. These patients formed the clinical material to compare acetabular component sizing. The Birmingham hip resurfacing group comprised 350 hips in men and 150 hips in women. The uncemented total hip replacement group comprised 236 hips in men and 464 hips in women. Age- and gender-matched analysis of a cohort of patients for the sizes of the acetabular components required for the two types of replacement was also undertaken. Additionally, an analysis of the sizes of the components used by each surgeon was performed. For age-matched women, the mean outside diameter of the Birmingham hip resurfacing acetabular components was 2.03 mm less than that of the acetabular components in the uncemented total hip replacements (p < 0.0001). In similarly matched men there was no significant difference (p = 0.77). A significant difference was also found between the size of acetabular components used by the two surgeons for Birmingham hip resurfacing for both men (p = 0.0015) and women (p = 0.001). In contrast, no significant difference was found between the size of acetabular components used by the two surgeons for uncemented total hip replacement in either men or women (p = 0.06 and p = 0.14, respectively). This suggests that variations in acetabular preparation also influence acetabular component size in hip resurfacing.
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Affiliation(s)
- P. Moonot
- South West London Elective Orthopaedic Centre, Denbies Wing, Dorking Road, Epsom, Surrey KT18 7EG, UK
| | - P. J. Singh
- South West London Elective Orthopaedic Centre, Denbies Wing, Dorking Road, Epsom, Surrey KT18 7EG, UK
| | - M. D. Cronin
- South West London Elective Orthopaedic Centre, Denbies Wing, Dorking Road, Epsom, Surrey KT18 7EG, UK
| | - Y. E. Kalairajah
- South West London Elective Orthopaedic Centre, Denbies Wing, Dorking Road, Epsom, Surrey KT18 7EG, UK
| | - T. G. Kavanagh
- South West London Elective Orthopaedic Centre, Denbies Wing, Dorking Road, Epsom, Surrey KT18 7EG, UK
| | - R. E. Field
- South West London Elective Orthopaedic Centre, Denbies Wing, Dorking Road, Epsom, Surrey KT18 7EG, UK
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Changulani M, Kalairajah Y, Peel T, Field RE. The relationship between obesity and the age at which hip and knee replacement is undertaken. ACTA ACUST UNITED AC 2008; 90:360-3. [PMID: 18310761 DOI: 10.1302/0301-620x.90b3.19782] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [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
We audited the relationship between obesity and the age at which hip and knee replacement was undertaken at our centre. The database was analysed for age, the Oxford hip or knee score and the body mass index (BMI) at the time of surgery. In total, 1369 patients were studied, 1025 treated by hip replacement and 344 by knee replacement. The patients were divided into five groups based on their BMI (normal, overweight, moderately obese, severely obese and morbidly obese). The difference in the mean Oxford score at surgery was not statistically significant between the groups (p > 0.05). For those undergoing hip replacement, the mean age of the morbidly obese patients was ten years less than that of those with a normal BMI. For those treated by knee replacement, the difference was 13 years. The age at surgery fell significantly for those with a BMI > 35 kg/m2 for both hip and knee replacement (p > 0.05). This association was stronger for patients treated by knee than by hip replacement.
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Affiliation(s)
- M. Changulani
- William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent TN24 0LZ, UK
| | - Y. Kalairajah
- Luton and Dunstable Hospital NHS Trust, Lewsey Road, Luton LU4 0DZ, UK
| | - T. Peel
- South West London Elective Orthopaedic Centre, Dorking Road, Epsom KT18 7EG, UK
| | - R. E. Field
- South West London Elective Orthopaedic Centre, Dorking Road, Epsom KT18 7EG, UK
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20
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Abstract
The effects of the method of fixation and interface conditions on the biomechanics of the femoral component of the Birmingham hip resurfacing arthroplasty were examined using a highly detailed three-dimensional computer model of the hip. Stresses and strains in the proximal femur were compared for the natural femur and for the femur resurfaced with the Birmingham hip resurfacing. A comparison of cemented versus uncemented fixation showed no advantage of either with regard to bone loading. When the Birmingham hip resurfacing femoral component was fixed to bone, proximal femoral stresses and strains were non-physiological. Bone resorption was predicted in the inferomedial and superolateral bone within the Birmingham hip resurfacing shell. Resorption was limited to the superolateral region when the stem was not fixed. The increased bone strain observed adjacent to the distal stem should stimulate an increase in bone density at that location. The remodelling of bone seen during revision of failed Birmingham hip resurfacing implants appears to be consistent with the predictions of our finite element analysis.
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Affiliation(s)
- K L Ong
- Exponent Incorporated, Philadelphia, Pennsylvania 19104, USA.
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21
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Field RE, Singh PJ, Latif AMH, Cronin MD, Matthews DJ. Five-year prospective clinical and radiological results of a new cannulated cemented polished Tri-Taper femoral stem. J Bone Joint Surg Br 2006; 88:315-20. [PMID: 16498003 DOI: 10.1302/0301-620x.88b3.17314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
We describe the results at five years of a prospective study of a new tri-tapered polished, cannulated, cemented femoral stem implanted in 51 patients (54 hips) with osteoarthritis. The mean age and body mass index of the patients was 74 years and 27.9, respectively. Using the anterolateral approach, half of the stems were implanted by a consultant orthopaedic surgeon and half by six different registrars. There were three withdrawals from the study because of psychiatric illness, a deep infection and a recurrent dislocation. Five deaths occurred prior to five-year follow-up and one patient withdrew from clinical review. In the remaining 51 hips the mean pre-operative Oxford hip score was 47 points which decreased to 19 points at five years (45 hips). Of the stems 49 (98%) were implanted within 1 degrees of neutral in the femoral canal. The mean migration of the stem at five years was 1.9 mm and the survivorship for aseptic loosening was 100%. There was no significant difference in outcome between the consultant and registrar groups. At five years, the results were comparable with those of other polished, tapered, cemented stems. Long-term surveillance continues.
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Affiliation(s)
- R E Field
- South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, and St Helier University Hospitals NHS Trust, Surrey KT18 7EG, UK.
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22
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Field RE, Rushton N. Five-year clinical, radiological and postmortem results of the Cambridge Cup in patients with displaced fractures of the neck of the femur. ACTA ACUST UNITED AC 2005; 87:1344-51. [PMID: 16189305 DOI: 10.1302/0301-620x.87b10.16559] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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
The Cambridge Cup has been designed to replace the horseshoe-shaped articular cartilage of the acetabulum and the underlying subchondral bone. It is intended to provide physiological loading with minimal resection of healthy bone. The cup has been used in 50 women with displaced, subcapital fractures of the neck of the femur. In 24 cases, the cup was coated with hydroxyapatite. In 26, the coating was removed before implantation in order to simulate the effect of long-term resorption. The mean Barthel index and the Charnley-modified Merle d’Aubigné scores recovered to their levels before fracture. We reviewed 30 women at two years, 21 were asymptomatic and nine reported minimal pain. The mean scores deteriorated slightly after five years reflecting the comorbidity of advancing age. Patients with the hydroxyapatite-coated components remained asymptomatic, with no wear or loosening. The uncoated components migrated after four years and three required revision. This trial shows good early results using a novel, hydroxyapatite-coated, physiological acetabular component.
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Affiliation(s)
- R E Field
- Epsom and St Helier University Hospital NHS Trust, Wrythe Lane, Carshalton, Surrey SM5 1AA, UK.
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23
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Abstract
We have used the Oxford hip score to monitor the progress of 1908 primary and 279 revision hip replacements undertaken since the start of 1995. Our review programme began in early 1999 and has generated 3900 assessments. The mean pre-operative scores for primary and revision cases were 40.95 and 40.11, respectively. The mean annual score for primary replacement at between 12 and 84 months ranged between 20.60 and 22.57. A comparison of cross-sectional and longitudinal data showed no significant differences. All post-operative reviews showed a significant improvement (p ≤ 0.0001). The 50- to 60-year-old group scored significantly better than the patients over 80 years of age up to 48 months (p < 0.01). A subgroup of 826 National Health Service (NHS) and 397 private patients, treated by the senior author (2292 Oxford assessments), had a higher (i.e. worse) mean pre-operative score for the NHS patients (p ≤ 0.001). The private patients scored better than the NHS group up to 84 months (p < 0.05). Patients treated by a surgeon performing more than 100 replacements each year had a significantly better outcome up to five years than those operated on by surgeons performing fewer than 20 replacements each year. The age of the patients at the time of operation, and their pre-operative level of disability, have both been identified as affecting the long-term outcome. Awareness of the influence of these factors should assist surgeons to provide balanced advice.
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Affiliation(s)
- R E Field
- Epson and St Helier Hospital NHS Trust, Carshalton, Surrey SM5 1AA, UK
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24
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25
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Abstract
The results of patellar fracture fixation using metal wire and non-absorbable polyester (5 Ethibond) are presented. In group 1 (21 cases), the standard "AO" technique using stainless steel wire was used, and in group 2 (16 cases) we used 5 Ethibond. Patients were assigned to the two groups on surgeon preference. Post-operative management in the two groups was similar, with patients being allowed to mobilise as comfort allowed, under the supervision of the physiotherapists. All patients were followed-up until union of the fractures or until further surgical intervention was carried out. At a mean of 2 years and 6 months (range 1-4 years), we reviewed the notes and X-rays of all 37 cases. In group 2 there were no cases of infection but there were three cases of post-operative infections in group 1. Re-operation rate was 6/21 (38%) in group 1 and 1/6 (6%) in group 2. Therefore, the relative risk of re-operation in the metal group is six times that in the non-absorbable polyester group. The risk of infection in the metal group is also higher. These have implication on patient morbidity associated with the operative treatment of patellar fractures. Non-absorbable polyester appears to compare favourably with the use of metallic wire to fix patellar fractures.
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Affiliation(s)
- H S Gosal
- Department of Orthopaedic Surgery, St. Helier Hospital, Wrythe Lane, Carshalton, Surrey SM5 1AA, UK
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26
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Phillips DL, Field RE, Broughton NS, Menelaus MB. Reciprocating orthoses for children with myelomeningocele. A comparison of two types. J Bone Joint Surg Br 1995; 77:110-3. [PMID: 7822365] [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: 01/27/2023]
Abstract
Since 1987, 22 children with myelomeningocele have been fitted with reciprocating orthoses. The level of the spinal lesions ranged from T10 to L4 and 13 had associated spinal deformities. Twelve of the patients currently use a Reciprocating Gait Orthosis, seven use a Hip Guidance Orthosis or Parawalker, one has progressed to a Knee Ankle Foot Orthosis, one has died and one has been lost to follow-up. The reciprocating orthoses are worn for a mean of 3.5 hours per day (1 to 6.5); daily usage by girls is almost twice that by boys. The mean daily usage by community walkers is 4.2 hours (13 children) as against 2.8 hours by household ambulators (8 children). Active hip flexion is not essential and fixed-flexion contractures up to 35 degrees can be accommodated. The average breakdown rate is 0.45 per year with an average of 1.5 adjustments each year. The average annual cost of a reciprocating orthosis is Aus$750 (375 pounds, US$570); this includes fabrication, adjustments and repairs.
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27
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Phillips DL, Field RE, Broughton NS, Menelaus MB. Reciprocating orthoses for children with myelomeningocele. A comparison of two types. ACTA ACUST UNITED AC 1995. [DOI: 10.1302/0301-620x.77b1.7822365] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Since 1987, 22 children with myelomeningocele have been fitted with reciprocating orthoses. The level of the spinal lesions ranged from T10 to L4 and 13 had associated spinal deformities. Twelve of the patients currently use a Reciprocating Gait Orthosis, seven use a Hip Guidance Orthosis or Parawalker, one has progressed to a Knee Ankle Foot Orthosis, one has died and one has been lost to follow-up. The reciprocating orthoses are worn for a mean of 3.5 hours per day (1 to 6.5); daily usage by girls is almost twice that by boys. The mean daily usage by community walkers is 4.2 hours (13 children) as against 2.8 hours by household ambulators (8 children). Active hip flexion is not essential and fixed-flexion contractures up to 35 degrees can be accommodated. The average breakdown rate is 0.45 per year with an average of 1.5 adjustments each year. The average annual cost of a reciprocating orthosis is Aus$750 (375 pounds, US$570); this includes fabrication, adjustments and repairs.
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28
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Abstract
Between 1980 and 1988, displacement bone-marrow transplantation was performed on 25 children with Hurler's syndrome (type-1 mucopolysaccharidosis). We describe the musculoskeletal development of 11 of the 12 surviving children and the orthopaedic procedures undertaken to treat progressive thoracolumbar kyphosis, hip subluxation and carpal tunnel syndrome. We found abnormal bone modelling, focal failures of ossification and an avascular disorder of the femoral head in every patient and offer an explanation for these phenomena. Increasing valgus deformity of the knees and progressive generalised myopathy caused loss of mobility as the children entered adolescence. The benefit of bone-marrow transplantation as a treatment for the skeletal disorders of Hurler's syndrome is limited by the poor penetration of the musculoskeletal tissues by the enzyme derived from the leucocytes.
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Field RE, Buchanan JA, Copplemans MG, Aichroth PM. Bone-marrow transplantation in Hurler's syndrome. Effect on skeletal development. J Bone Joint Surg Br 1994; 76:975-81. [PMID: 7983131] [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: 01/28/2023]
Abstract
Between 1980 and 1988, displacement bone-marrow transplantation was performed on 25 children with Hurler's syndrome (type-1 mucopolysaccharidosis). We describe the musculoskeletal development of 11 of the 12 surviving children and the orthopaedic procedures undertaken to treat progressive thoracolumbar kyphosis, hip subluxation and carpal tunnel syndrome. We found abnormal bone modelling, focal failures of ossification and an avascular disorder of the femoral head in every patient and offer an explanation for these phenomena. Increasing valgus deformity of the knees and progressive generalised myopathy caused loss of mobility as the children entered adolescence. The benefit of bone-marrow transplantation as a treatment for the skeletal disorders of Hurler's syndrome is limited by the poor penetration of the musculoskeletal tissues by the enzyme derived from the leucocytes.
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Affiliation(s)
- R E Field
- Chelsea and Westminster Hospital, London, England
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30
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Abstract
On 18 February 1991 a bomb exploded on Victoria station, London. A total of 51 people were injured including one fatally. Of the most seriously wounded, 30 were treated at The Westminster Hospital. The majority of injuries were to the lower limbs, but serious wounds were also sustained to the chest, abdomen, forearm, orbit and cranium. Almost all injuries were caused by shrapnel. The low incidence of infection was attributed to thorough early surgical débridement. The administration of antibiotics was varied and uncoordinated, reflecting a lack of a common policy. The exhaustion of common external fixators necessitated the use of equipment unfamiliar to the surgeons and underlined the need for the rapid transfer of equipment between hospitals at the time of major incidents.
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31
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Mann D, Field RE, Viskanta R. Determination of specific heat and true thermal conductivity of glass from dynamic temperature data. ACTA ACUST UNITED AC 1992. [DOI: 10.1007/bf01589920] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Field RE, Dixon AK, Lawrence JP, Rushton N. Bone density distribution within the femoral head and neck. An examination by high-resolution computed tomography. Skeletal Radiol 1990; 19:319-25. [PMID: 2377898 DOI: 10.1007/bf00193084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The upper portions of three cadaveric femora were examined by high-resolution computed tomography. Analysis of the resulting images provided both quantitative and spatial distributions of bone density within the femoral head and neck. The information obtained provides new insights into aspects of proximal femoral architecture for both normal and osteoporotic bone. The study also points the way towards a clinical technique for measuring the material properties of proximal femoral bone.
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Affiliation(s)
- R E Field
- Orthopaedic Research Unit, University of Cambridge Clinical School, Addenbrooke's Hospital, UK
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33
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Abstract
We present a mathematical analysis of trabecular bone which may be applied to develop dynamic computer simulations of the musculoskeletal system. We have derived an algorithm which can be used to study the genetic limitations within which skeletal articulations may function successfully. We believe that our model will help other workers to advance the understanding of the interplay between genetic and environmental influences in the growth, modelling and degeneration of osseous tissues.
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Affiliation(s)
- R E Field
- Orthopaedic Research Unit, Cambridge University, UK
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34
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Abstract
This paper describes a new type of proximal femoral, replacement arthroplasty and its preliminary, pre-clinical, evaluation. The prosthesis was designed as a replacement for the femoral capital epiphysis. It comprises a thin, metal, articular shell and an underlying 'epiphyseal' replacement which is modulus-matched to adjacent proximal femoral bone. Surface strain gauge analysis of the proximal femur under conditions simulating static single leg stance demonstrated that the new prosthesis maintains an essentially normal femoral strain distribution. It is hoped that selective load transmissions across the prosthesis-bone interface should result in less post-implantation proximal bone resorption.
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Affiliation(s)
- R E Field
- Orthopaedic Research Unit, University of Cambridge Clinical School, UK
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35
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Field RE, Romanus RJ. A decerebrate patient: eighteen years of care. Conn Med 1981; 45:717-23. [PMID: 6895616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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36
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Koos L, Field RE. Metastatic carcinoma of breast simulating Crohn's disease. Int Surg 1980; 65:359-62. [PMID: 6262268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A 52-year-old female had radical surgery on both breasts in 1971 and 1973 for infiltrating lobular carcinoma of the breast. One year later, multiple metastases simulating Crohn's disease were found radiologically and intraoperatively in the colon and small bowel. The pathological examination revealed multiple areas of linitis plastica type carcinoma in the colon and small bowel. Review of the breast slides showed that the original breast carcinoma was morphologically identical to the metastatic lesions. The literature is reviewed and arguments are presented to attest that signet-ring-cell carcinoma of the breast is a distinct entity, which not too infrequently metastasizes to the gastrointestinal tract.
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37
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Romanus RJ, Field RE. Ventral herniorrhaphy using Marlex mesh inlay graft. Int Surg 1977; 62:460-1. [PMID: 143458] [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: 12/13/2022] Open
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38
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Field RE, Romanus RJ. A decerebrate patient: eighteen years of care. IMJ Ill Med J 1977; 151:121-3. [PMID: 16841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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39
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Field RE, Romanus RJ. An improved gastrostomy technique. IMJ Ill Med J 1975; 148:610-1. [PMID: 316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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40
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