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Ali A, Ahmed I, Shearman A, McCulloch R, Carrington R, Skinner J. Survival Rates and Patient-Reported Outcomes Support the Use of Custom Cement-Over Megaprosthesis (CCOM) in Complex Revision Lower Limb Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00029-9. [PMID: 38244641 DOI: 10.1016/j.arth.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/10/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Patients presenting with periprosthetic osteolysis or fracture between ipsilateral hip and knee arthroplasties are challenging to treat successfully. Long-stem implants, osteopenic bones, and patient comorbidities all represent considerable surgical challenges. Poor results of fracture fixation in this group, coupled with the desire to retain well-performing implants and minimize soft-tissue trauma led to the developmentof the custom cement-over megaprostheses (CCOM). The aims of the study were to evaluate implant survivals, complications, and patient outcomes in those undergoing CCOM within our institution. METHODS A retrospective analysis of patients undergoing CCOM between 2002 and 2022 was performed. We studied 34 cases, 33 patients, one patient underwent staged bilateral surgery with 26 women and 8 men. INDICATIONS trauma (16), failure of implants /aseptic loosening (9), or joint pathology. The mean Charlson comorbidity index was 3.5 (range, 0 to 8). All patients were followed up (mean 75 months [range, 9 to 170]) at 6 weeks, 6 months, 1 year, and annually thereafter. The VAS, EuroQol-5D-3L and MSTS scores were collected at 1 year. RESULTS Implant survival defined by the primary outcome (all-cause revision of the implant at any time point) at 12 months of 97% (32 of 33). In surviving patients, implant survival was 90% (18 of 20) and all 7 survived at 5 and 10 years, respectively. Implant survival including those in the primary outcome group and those free of infection at 12 months was 84.8% (28 of 33) and in surviving patients, implant survival was 70% (14 of 20) and 7 out of 7 at 5 and 10 years, respectively. CONCLUSIONS The CCOM technique demonstrates good implant survivorships and satisfactory patient-reported outcomes in complex, often frail patients who have compromised bone stock. This series confirms the technique as an established alternative to total femoral replacement in these cases.
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Affiliation(s)
- Asad Ali
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Iftikhar Ahmed
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alex Shearman
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Robert McCulloch
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Richard Carrington
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - John Skinner
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Snow M, Middleton L, Mehta S, Roberts A, Gray R, Richardson J, Kuiper JH, Smith A, White S, Roberts S, Griffiths D, Mohammed A, Moholkar K, Ashraf T, Green M, Hutchinson J, Bhullar T, Chitnis S, Shaw A, van Niekerk L, Hui A, Drogset JO, Knutsen G, McNicholas M, Bowditch M, Johnson D, Turner P, Chugh S, Hunt N, Ali S, Palmer S, Perry A, Davidson A, Hill P, Deo S, Satish V, Radford M, Langstaff R, Houlihan-Burne D, Spicer D, Phaltankar P, Hegab A, Marsh D, Cannon S, Briggs T, Pollock R, Carrington R, Skinner J, Bentley G, Price A, Schranz P, Mandalia V, O'Brien S. A Randomized Trial of Autologous Chondrocyte Implantation Versus Alternative Forms of Surgical Cartilage Management in Patients With a Failed Primary Treatment for Chondral or Osteochondral Defects in the Knee. Am J Sports Med 2023; 51:367-378. [PMID: 36661257 DOI: 10.1177/03635465221141907] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 01/21/2023]
Abstract
BACKGROUND There are limited randomized controlled trials with long-term outcomes comparing autologous chondrocyte implantation (ACI) versus alternative forms of surgical cartilage management within the knee. PURPOSE To determine at 5 years after surgery whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS In total, 390 participants were randomly assigned to receive either ACI or alternative management. Patients aged 18 to 55 years with one or two symptomatic cartilage defects who had failed 1 previous therapeutic surgical procedure in excess of 6 months prior were included. Dual primary outcome measures were used: (1) patient-completed Lysholm knee score and (2) time from surgery to cessation of treatment benefit. Secondary outcome measures included International Knee Documentation Committee and Cincinnati Knee Rating System scores, as well as number of serious adverse events. Analysis was performed on an intention-to-treat basis. RESULTS Lysholm scores were improved by 1 year in both groups (15.4 points [95% CI, 11.9 to 18.8] and 15.2 points [95% CI, 11.6 to 18.9]) for ACI and alternative, with this improvement sustained over the duration of the trial. However, no evidence of a difference was found between the groups at 5 years (2.9 points; 95% CI, -1.8 to 7.5; P = .46). Approximately half of the participants (55%; 95% CI, 47% to 64% with ACI) were still experiencing benefit at 5 years, with time to cessation of treatment benefit similar in both groups (hazard ratio, 0.97; 95% CI, 0.72 to 1.32; P > .99). There was a differential effect on Lysholm scores in patients without previous marrow stimulation compared with those with marrow stimulation (P = .03; 6.4 points in favor of ACI; 95% CI, -0.4 to 13.1). More participants experienced a serious adverse event with ACI (P = .02). CONCLUSION Over 5 years, there was no evidence of a difference in Lysholm scores between ACI and alternative management in patients who had previously failed treatment. Previous marrow stimulation had a detrimental effect on the outcome of ACI. REGISTRATION International Standard Randomised Controlled Trial Number: 48911177.
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Affiliation(s)
- Martyn Snow
- Orthopaedics Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK; School of Pharmacy and Bioengineering, Keele University, Staffordshire, UK
| | - Lee Middleton
- Birmingham Clinical Trials Unit, Birmingham University, Midlands, UK
| | - Samir Mehta
- Birmingham Clinical Trials Unit, Birmingham University, Midlands, UK
| | - Andrew Roberts
- Orthopaedics Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Richard Gray
- Nuffield Department of Population Health, Oxford University, Oxfordshire, UK
| | - James Richardson
- Orthopaedics Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK; School of Pharmacy and Bioengineering, Keele University, Staffordshire, UK
| | - Jan Herman Kuiper
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, UK
| | | | - Anthony Smith
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry
| | - Steve White
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry
| | - Simon Roberts
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry
| | - David Griffiths
- County Hospital, Stafford, University Hospitals of North Midlands NHS Trust, Stoke
| | - Aslam Mohammed
- Wrightington Wigan and Leigh teaching hospitals NHSFT, Wigan
| | | | | | - Marcus Green
- Royal Orthopaedic Hospital Birmingham, Birmingham
| | - James Hutchinson
- Edith Cavell Hospital Peterborough [now Peterborough City Hospital], NW Anglia NHSFT, Peterborough
| | - Tony Bhullar
- Edith Cavell Hospital Peterborough [now Peterborough City Hospital], NW Anglia NHSFT, Peterborough
| | | | - Andrew Shaw
- Royal Alexandra Hospital, Paisley; NHS Greater Glasgow and Clyde, Paisley
| | - Louw van Niekerk
- Friarage Hospital, South Tees; South Tees Hospitals NHSFT, Northallerton
| | - Anthony Hui
- The James Cook University Hospital, Middlesborough; South Tees Hospitals NHSFT, Middlesborough
| | | | | | | | - Mark Bowditch
- Ipswich Hospital, East Suffolk and North Essex NHSFT, Ipswich
| | | | | | - Sanjiv Chugh
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton
| | - Neil Hunt
- York Hospital, York and Scarborough Teaching Hospitals NHSFT, York
| | - Salman Ali
- Russels Hall Hospital, The Dudley Group NHSFT, Dudley
| | - Simon Palmer
- Worthing Hospital, University Hospitals Sussex NHSFT, Worthing
| | - Andrew Perry
- Frimley Park Hospital, Frimley Health NHSFT, Frimley Park
| | | | - Peter Hill
- Frimley Park Hospital, Frimley Health NHSFT, Frimley Park
| | - Sunny Deo
- The Great Western Hospitals NHSFT, Swindon
| | | | - Michael Radford
- Weston General Hospital, Weston Area Health NHS Trust, Weston-Super-Mare
| | - Ron Langstaff
- Hillingdon Hospital, The Hillingdon Hospitals NHSFT, Hillingdon
| | | | - Dominic Spicer
- St Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington
| | - Padman Phaltankar
- North Manchester General Hospital, Manchester University NHSFT, Manchester
| | - Ahmed Hegab
- Fairfield General Hospital, Northern Care Alliance NHSFT, Bury
| | - David Marsh
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - Steve Cannon
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - Tim Briggs
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - Rob Pollock
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | | | - John Skinner
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - George Bentley
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - Andrew Price
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHSFT, Oxford
| | | | | | - Shaun O'Brien
- Sunderland Royal Hospital, South Tyneside and Sunderland NHSFT, Sunderland.,Investigation performed at the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
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Madanipour S, Lemanu D, Jayadev C, Aston W, Donaldson J, Miles J, Carrington R, McCulloch R, Skinner J. Ischial screw fixation can prevent cup migration in 3D-printed custom acetabular components for complex hip reconstruction. Arthroplasty 2022; 4:52. [PMID: 36474284 PMCID: PMC9724270 DOI: 10.1186/s42836-022-00154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Custom acetabular components have become an established method of treating massive acetabular bone defects in hip arthroplasty. Complication rates, however, remain high and migration of the cup is still reported. Ischial screw fixation (IF) has been demonstrated to improve mechanical stability for non-custom, revision arthroplasty cup fixation. We hypothesize that ischial fixation through the flange of a custom acetabular component aids in anti-rotational stability and prevention of cup migration. METHODS Electronic patient records were used to identify a consecutive series of 49 custom implants in 46 patients from 2016 to 2022 in a unit specializing in complex joint reconstruction. IF was defined as a minimum of one screw inserted into the ischium passing through a hole in a flange on the custom cup. The mean follow-up time was 30 months. IF was used in 36 cups. There was no IF in 13 cups. No difference was found between groups in age (68.9 vs. 66.3, P = 0.48), BMI (32.3 vs. 28.2, P = 0.11) or number of consecutively implanted cups (3.2 vs. 3.6, P = 0.43). Aseptic loosening with massive bone loss was the primary indication for revision. There existed no difference in Paprosky grade between the groups (P = 0.1). 14.2% of hips underwent revision and 22.4% had at least one dislocation event. RESULTS No ischial fixation was associated with a higher risk of cup migration (6/13 vs. 2/36, X2 = 11.5, P = 0.0007). Cup migration was associated with an increased risk for all cause revision (4/8 vs. 3/38, X2 = 9.96, P = 0.0016, but not with dislocation (3/8 vs. 8/41, X2 = 1.2, P = 0.26). CONCLUSION The results suggest that failure to achieve adequate ischial fixation, with screws passing through the flange of the custom component into the ischium, increases the risk of cup migration, which, in turn, is a risk factor for revision.
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Affiliation(s)
- Suroosh Madanipour
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Daniel Lemanu
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Chethan Jayadev
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Will Aston
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - James Donaldson
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Jonathan Miles
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Richard Carrington
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Robert McCulloch
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - John Skinner
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
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Carrington R, Jordan S, Wong YJ, Pitchford SC, Page CP. A novel murine model of pulmonary fibrosis: the role of platelets in chronic changes induced by bleomycin. J Pharmacol Toxicol Methods 2021; 109:107057. [PMID: 33819606 DOI: 10.1016/j.vascn.2021.107057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a disease that causes scarring and destruction of lung tissue that is ultimately fatal. There is a need to develop improved treatments for IPF. One problem with identifying novel treatments of IPF is the poor predictability of current preclinical models. Few model investigate lung function changes, rather relying on histological changes which doesn't adequately reflect the complete clinical situation. The aim of this study was to establish a novel model of pulmonary fibrosis where we could investigate changes in lung function, and histology. We have also utilised this model to investigate the role of platelets in pulmonary fibrosis as platelets have been recognised as having a broader role than just facilitating haemostasis. Lung fibrosis was induced in male C57BL6/J mice by intranasal bleomycin on Days 0, 1, 2, 5, 6 and 7. Platelets were depleted by twice-weekly administration of anti-platelet antibodies. On Day 35 mice were assessed by examining lung function, platelet infiltration into lung tissues and bronchoalveolar lavage fluid (BAL), levels of BAL Tissue growth factor (TGF)-β levels, and the degree of fibrosis evaluated histologically. Repeated bleomycin administration caused loss of lung function associated with fibrosis assessed histologically. Platelet depletion resulted in a reduction in fibrosis and modest inhibition of lung function changes. We have established a novel model of pulmonary fibrosis that is associated with a decline in lung function similar to the clinical setting. Furthermore, platelet depletion resulted in a less severe fibrosis suggesting that targeting platelets maybe worth further investigation.
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Affiliation(s)
- R Carrington
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom; Department of Pharmacology, Covance Laboratories Ltd, Woolley Road, Alconbury, Huntingdon, Cambs PE28 4HS, United Kingdom.
| | - S Jordan
- Department of Pharmacology, Covance Laboratories Ltd, Woolley Road, Alconbury, Huntingdon, Cambs PE28 4HS, United Kingdom
| | - Y J Wong
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom
| | - S C Pitchford
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom
| | - C P Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom
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Kalson NS, Mathews JA, Alvand A, Morgan-Jones R, Jenkins N, Phillips JRA, Toms AD, Barrett D, Bloch B, Carrington R, Deehan D, Eyres K, Gambhir A, Hopgood P, Howells N, Jackson W, James P, Jeys L, Kerry R, Miles J, Mockford B, Murray J, Pavlou G, Porteous A, Price A, Sarungi M, Spencer-Jones R, Walmsley P, Waterson B, Whittaker J. Investigation and management of prosthetic joint infection in knee replacement: A BASK Surgical Practice Guideline. Knee 2020; 27:1857-1865. [PMID: 33202289 DOI: 10.1016/j.knee.2020.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/06/2020] [Revised: 07/23/2020] [Accepted: 09/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burden of knee replacement prosthetic joint infection (KR PJI) is increasing. KR PJI is difficult to treat, outcomes can be poor and it is financially expensive and limited evidence is available to guide treatment decisions. AIM To provide guidelines for surgeons and units treating KR PJI. METHODS Guideline formation by consensus process undertaken by BASK's Revision Knee Working Group, supported by outputs from UK-PJI meetings. RESULTS Improved outcomes should be achieved through provision of care by revision centres in a network model. Treatment of KR PJI should only be undertaken at specialist units with the required infrastructure and a regular infection MDT. This document outlines practice guidelines for units providing a KR PJI service and sets out: CONCLUSIONS: KR PJI patients treated within the NHS should be provided the best care possible. This report sets out guidance and support for surgeons and units to achieve this.
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Affiliation(s)
- N S Kalson
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - J A Mathews
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - A Alvand
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - R Morgan-Jones
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - N Jenkins
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - J R A Phillips
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - A D Toms
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland.
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- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
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Carrington R, Waiting J. Impact of short-acting vs. standard anaesthetic agents on obstructive sleep apnoea: a randomised controlled triple-blind trial. Anaesthesia 2020; 76:420-421. [PMID: 33169832 DOI: 10.1111/anae.15305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- R Carrington
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Waiting
- The Royal London Hospital, Barts Health NHS Trust, London, UK
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Kahan J, Carrington R, Cox S, Lewis G, Gwynne S. PD-0548: Quantitative Analysis of SCOPE 2 Trial 4DCT pre-accrual benchmark cases. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sugand K, Wescott RA, Carrington R, Hart A, van Duren BH. Training and Transfer Effect of FluoroSim, an Augmented Reality Fluoroscopic Simulator for Dynamic Hip Screw Guidewire Insertion: A Single-Blinded Randomized Controlled Trial. J Bone Joint Surg Am 2019; 101:e88. [PMID: 31483408 DOI: 10.2106/jbjs.18.00928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/01/2023]
Abstract
BACKGROUND FluoroSim, a novel fluoroscopic simulator, can be used to practice dynamic hip screw (DHS) guidewire insertion in a high-fidelity clinical scenario. Our aim was to demonstrate a training effect in undergraduate medical students who are not familiar with this operation and its simulation. METHODS Forty-five undergraduate medical students were recruited and randomized to either training (n = 23) or control (n = 22) cohorts. The training cohort had more exposure to FluoroSim (5 attempts each week) over a 2-week period (with a 1-week washout period in between) compared with the control cohort (a single attempt 1 week apart) over a 2-week period. Five real-time objective performance metrics were recorded: (1) tip-apex distance (TAD) (mm), (2) predicted cut-out rate (%), (3) total procedural time (sec), (4) total number of radiographs (n), and (5) total number of guidewire retries (n). RESULTS At baseline, there was no significant difference in the performance metrics, which confirmed the absence of a selection bias. The intragroup training effect demonstrated a significant improvement in all metrics for the training cohort only. A significant difference between groups was demonstrated as the training cohort significantly outperformed the control cohort in 3 metrics (procedural time [25%], number of radiographs [57%], and number of guidewire retries [100%]; p < 0.001). A learning curve showed an inversely proportional correlation between frequency of attempts and procedural time as well as the number of digital fluoroscopic radiographs that were made, indicating the development of psychomotor skills. There was also an improved baseline of the learning curve after the 1-week washout period, suggesting skill retention. CONCLUSIONS Skill acquisition with the FluoroSim system was demonstrated with repeat exposure in a safe, radiation-free high-fidelity clinical simulation with actual operating room equipment. The task of DHS guidewire insertion requires cognitive and psychomotor skills that take a variable number of attempts to acquire, as demonstrated on the learning curve. Additional work is required to demonstrate that the skill tested by the FluoroSim is the same skill that is required for intraoperative DHS guidewire insertion. However, use of the FluoroSim provides improvement in skills with extra-clinical training opportunities for orthopaedic trainees. CLINICAL RELEVANCE FluoroSim has demonstrated validity and training effect. It has the potential to be approved for possible use on patients in the operating room to help surgeons with the operation. Consequently, operating time, accuracy of TAD, and surgical outcomes may all be improved.
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Affiliation(s)
- Kapil Sugand
- MSk Lab, Imperial College London, London, United Kingdom.,Royal National Orthopedic Hospital, Stanmore, United Kingdom
| | - Robert A Wescott
- Institute of Orthopedics & Musculoskeletal Sciences, University College London, London, United Kingdom
| | | | - Alister Hart
- Royal National Orthopedic Hospital, Stanmore, United Kingdom.,Institute of Orthopedics & Musculoskeletal Sciences, University College London, London, United Kingdom
| | - Bernard H van Duren
- Institute of Orthopedics & Musculoskeletal Sciences, University College London, London, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Leeds, United Kingdom
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Carrington R, Jordan S, Pitchford S, Page C. Use of animal models in IPF research. Pulm Pharmacol Ther 2018; 51:73-78. [DOI: 10.1016/j.pupt.2018.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 01/10/2023]
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Sugand K, Wescott RA, Carrington R, Hart A, Van Duren BH. Teaching basic trauma: validating FluoroSim, a digital fluoroscopic simulator for guide-wire insertion in hip surgery. Acta Orthop 2018; 89:380-385. [PMID: 29745741 PMCID: PMC6066759 DOI: 10.1080/17453674.2018.1466233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Simulation is an adjunct to surgical education. However, nothing can accurately simulate fluoroscopic procedures in orthopedic trauma. Current options for training with fluoroscopy are either intraoperative, which risks radiation, or use of expensive and unrealistic virtual reality simulators. We introduce FluoroSim, an inexpensive digital fluoroscopy simulator without the need for radiation. Patients and methods - This was a multicenter study with 26 surgeons in which everyone completed 1 attempt at inserting a guide-wire into a femoral dry bone using surgical equipment and FluoroSim. 5 objective performance metrics were recorded in real-time to assess construct validity. The surgeons were categorized based on the number of dynamic hip screws (DHS) performed: novices (< 10), intermediates (10-39) and experts (≥ 40). A 7-point Likert scale questionnaire assessed the face and content validity of FluoroSim. Results - Construct validity was present for 2 clinically validated metrics in DHS surgery. Experts and intermediates statistically significantly outperformed novices for tip-apex distance and for cut-out rate. Novices took the least number of radiographs. Face and content validity were also observed. Interpretation - FluoroSim discriminated between novice and intermediate or expert surgeons based on tip-apex distance and cut-out rate while demonstrating face and content validity. FluoroSim provides a useful adjunct to orthopedic training. Our findings concur with results from studies using other simulation modalities. FluoroSim can be implemented for education easily and cheaply away from theater in a safe and controlled environment.
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Affiliation(s)
- Kapil Sugand
- Institute of Orthopaedics & Musculoskeletal Sciences, University College London, London, UK;; ,MSk Lab, Imperial College London, Charing Cross Hospital, London, UK;; ,Royal National Orthopaedic Hospital, Stanmore, London, UK,Correspondence:
| | - Robert A Wescott
- Institute of Orthopaedics & Musculoskeletal Sciences, University College London, London, UK;;
| | | | - Alister Hart
- Institute of Orthopaedics & Musculoskeletal Sciences, University College London, London, UK;; ,Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Bernard H Van Duren
- Institute of Orthopaedics & Musculoskeletal Sciences, University College London, London, UK;; ,Royal National Orthopaedic Hospital, Stanmore, London, UK
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van Duren B, Sugand K, Wescott R, Carrington R, Hart A. Augmented reality fluoroscopy simulation of the guide-wire insertion in DHS surgery: A proof of concept study. Med Eng Phys 2018; 55:52-59. [DOI: 10.1016/j.medengphy.2018.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 01/17/2018] [Accepted: 02/25/2018] [Indexed: 11/25/2022]
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Mandel R, Bruce G, Moss R, Carrington R, Gilbert A, Jaggi A. Hip precautions after primary total hip arthroplasty: ‘It's what we’ve always done’. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Gilbert A, Coltman A, Power A, Moss R, Miles J, Carrington R, Jaggi A. Prospectively testing the Stanmore Length of Stay tool to predict length of stay following primary total hip or knee arthroplasty. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Carrington R, Spezi E, Gwynne S, Staffurth J, Crosby T. PO-0711: Relating CT image heterogeneity to patient outcome in the SCOPE 1 oesophageal cancer trial. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31961-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Carrington R, Spezi E, Thomas B, Gwynne S, Crosby T, Staffurth J. EP-1794: Quantification of stomach movement using CBCT images. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Carrington R, Staffurth J, Warren S, Partridge M, Spezi E, Gwynne S, Hawkins M, Crosby T. SU-E-T-69: A Radiobiological Investigation of Dose Escalation in Lower Oesophageal Tumours with a Focus On Gastric Toxicity. Med Phys 2015. [DOI: 10.1118/1.4924430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
BACKGROUND AND PURPOSE Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time. PATIENTS AND METHODS We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23-83) years. The median time post-implantation was 83 (35-142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined. RESULTS The median blood cobalt was 6.84 (0.24-90) ppb and median chromium level was 4.42 (0.20-45) ppb. The median Oxford hip score was 34 (5-48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02). INTERPRETATION Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs.
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Affiliation(s)
- Reshid Berber
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
| | - Michael Khoo
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
| | - Erica Cook
- University of Bedfordshire,Park Square, Luton, Bedfordshire
| | - Andrew Guppy
- University of Bedfordshire,Park Square, Luton, Bedfordshire
| | - Jia Hua
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex,Middlesex University London, The Burroughs, London, UK
| | - Jonathan Miles
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
| | | | - John Skinner
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
| | - Alister Hart
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
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Carrington R, Spezi E, Gwynne S, Dutton P, Hurt C, Crosby T, Staffurth J. TH-AB-304-11: The Influence of Radiotherapy Treatment Method On Dose Distribution and Its Relation to Patient Outcome in the SCOPE 1 Oesophageal Cancer Trial Using Type B Algorithms. Med Phys 2015. [DOI: 10.1118/1.4926126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Berber R, Pappas Y, Khoo M, Miles J, Carrington R, Skinner J, Hart A. A New Approach to Managing Patients with Problematic Metal Hip Implants: The Use of an Internet-Enhanced Multidisciplinary Team Meeting. AAOS Exhibit Selection. J Bone Joint Surg Am 2015; 97:e42. [PMID: 25948527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Carrington R, Spezi E, Gwynne S, Dutton P, Hurt C, Crosby T, Staffurth J. PO-0986: Can radiotherapy dose distribution be related to outcome? An analysis of the SCOPE 1 oesophageal cancer trial data. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40978-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Berber R, Pappas Y, Khoo M, Miles J, Carrington R, Skinner J, Hart A. A new approach to managing patients with problematic metal hip implants: the use of an Internet-enhanced multidisciplinary team meeting: AAOS exhibit selection. J Bone Joint Surg Am 2015; 97:e20. [PMID: 25695991 DOI: 10.2106/jbjs.n.00973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 02/01/2023]
Abstract
BACKGROUND Over one million patients worldwide are estimated to have a metal-on-metal hip arthroplasty. To improve the management of these patients and reduce surgeon uncertainty regarding decision-making, we designed an Internet-enhanced multidisciplinary team (iMDT) working approach. METHODS From August 2012 to April 2014, the iMDT discussed 215 patients with 266 metal-on-metal hip arthroplasties. Of these, 236 primary arthroplasties (132 hip resurfacing and 104 total hip) were analyzed. The remaining thirty cases involved problematic revised hips and were therefore excluded. The possible recommendations of the iMDT were monitoring, further investigation, or surgery. The concordance between the recommendation and the actual management was used to assess the usefulness of this approach in reducing uncertainty in surgeon-level decision-making. RESULTS The median Oxford Hip Score was 35 (range, 4 to 48), and median cobalt and chromium levels in whole blood were 3.54 ppb (range, 0.18 to 161.46 ppb) and 3.17 ppb (range, 0.20 to 100.67 ppb), respectively. Magnetic resonance imaging revealed abductor muscle atrophy in ninety-two (39%) of the hips and a pseudotumor in eighty (34%). The iMDT recommended monitoring of 146 (61.9%) of the hips, further investigation of thirty (12.7%), and surgery in sixty (25.4%). The actual outcome was concordant with the recommendation in 211 (91.7%) of the hips. CONCLUSIONS Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes.
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Affiliation(s)
- Reshid Berber
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Putteridge Bury Campus, Hitchin Road, Luton, Bedfordshire, LU2 8LE, United Kingdom
| | - Michael Khoo
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Jonathan Miles
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Richard Carrington
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - John Skinner
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Alister Hart
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
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Carrington R, Spezi E, Gwynne S, Dutton P, Hurt C, Staffurth J, Crosby T. EP-1583: An analysis of the dose distribution in the SCOPE 1 oesophageal cancer trial data. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Malikian R, Maruthainar K, Stammers J, Cannon SR, Carrington R, Skinner JA, Maruthainar N, Dowd G, Briggs TWR, Blunn GW. In vivo roughening of retrieved total knee arthroplasty femoral components. Knee 2014; 21:278-82. [PMID: 23142273 DOI: 10.1016/j.knee.2012.09.008] [Citation(s) in RCA: 13] [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: 02/08/2012] [Revised: 09/02/2012] [Accepted: 09/06/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Joint registry data highlights the higher rates of cumulative revision for younger patients undergoing TKR. One of the reasons associated with this higher revision rate may be due to the wear of the UHMWPE leading to loosening. Alternate bearing surfaces have been developed to address this problem; however, roughening of the metal bearing surface has not been demonstrated in vivo. METHOD We recorded roughness measurements of retrieved femoral components. RESULTS Average lateral condyle roughness was 0.032 μm, compared to control values of 0.020 μm, p=0.002; average medial condyle roughness was 0.028 μm, compared to a control value of 0.019, p<0.001. CONCLUSION There was a small but statistically significant roughening of femoral components in vivo compared to controls. This may have important implications for aseptic loosening of knee arthroplasty components and the decision to use scratch resistant components.
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Affiliation(s)
- Raphael Malikian
- John Scales Centre for Biomedical Engineering, University College London, Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.
| | - Kunalan Maruthainar
- John Scales Centre for Biomedical Engineering, University College London, Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - John Stammers
- John Scales Centre for Biomedical Engineering, University College London, Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - Steve R Cannon
- Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - Richard Carrington
- Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - John A Skinner
- Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | | | - George Dowd
- Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom
| | - Tim W R Briggs
- Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - Gordon W Blunn
- John Scales Centre for Biomedical Engineering, University College London, Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
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Abstract
Osteochondral defects in the knee are difficult to repair because intrinsic healing of cartilage is poor and gradual progression to "early-onset" osteoarthritis leads to severe pain and disability. Of all methods tested to achieve regeneration of hyaline cartilage and long-lasting repair, autologous chondrocyte transplantation (ACI-C and MACI) has been the most successful with 80% of good results and graft survival in this unit in a very large series over 10 years. The repair mechanism is unclear but our work shows that the criteria for success are: young patient age, no previous operative procedures on the defect, no obesity, no smoking, defect on femoral condyles or trochlea and no pre-existing degenerative joint changes. Future research is aimed at non-transplantation, single-stage procedures aided by use of new scaffolds and growth factors and the extension of such techniques into arthritic joints.
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Affiliation(s)
- George Bentley
- The Joint Replacement and Cartilage Transplantation Unit, R.N.O.H, and The Institute of Orthopaedics, University College, London, UK
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Gikas PD, Morris T, Carrington R, Skinner J, Bentley G, Briggs T. A correlation between the timing of biopsy after autologous chondrocyte implantation and the histological appearance. ACTA ACUST UNITED AC 2009; 91:1172-7. [DOI: 10.1302/0301-620x.91b9.22490] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [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
Autologous chondrocyte implantation is an option in the treatment of full-thickness chondral or osteochondral injuries which are symptomatic. The goal of surgery and rehabilitation is the replacement of damaged cartilage with hyaline or hyaline-like cartilage, producing improved levels of function and preventing early osteoarthritis. The intermediate results have been promising in terms of functional and clinical improvement. Our aim was to explore the hypothesis that the histological quality of the repair tissue formed after autologous chondrocyte implantation improved with increasing time after implantation. In all, 248 patients who had undergone autologous chondrocyte implantation had biopsies taken of the repair tissue which then underwent histological grading. Statistical analysis suggested that with doubling of the time after implantation the likelihood of a favourable histological outcome was increased by more than fourfold (p < 0.001).
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Affiliation(s)
| | - T. Morris
- MRC Clinical Trials Unit, The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
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Dunstan E, Ladon D, Whittingham-Jones P, Carrington R, Briggs TWR. Chromosomal aberrations in the peripheral blood of patients with metal-on-metal hip bearings. J Bone Joint Surg Am 2008; 90:517-22. [PMID: 18310701 DOI: 10.2106/jbjs.f.01435] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [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: 02/01/2023]
Abstract
BACKGROUND Approximately one-third of patients undergoing joint replacement are under sixty years of age. Many of these patients may be exposed to wear debris from the orthopaedic implant for several decades. Clinical follow-up of this group of patients has been short compared with the lifetimes of the patients, and the long-term effects of this chronic exposure are unknown. METHODS By using cytogenetic biomarkers (twenty-four-color fluorescent in situ hybridization [FISH]), we analyzed the peripheral blood leukocytes for chromosomal aberrations in three groups of subjects: (1) six age and sex-matched control subjects who had no implant and did not smoke (control group), (2) five subjects in whom an implant with a metal-on-metal articulation had been in situ for an average of thirty-five years (metal-on-metal group), and (3) four subjects in whom a metal-on-metal implant had been revised to a metal-on-polyethylene articulation at an average of twenty-two years (revised group). RESULTS The number of chromosomal aberrations in the metal-on-metal group was greater than that in the control group. Specifically, the percentage of aneuploidy gain was three times greater (p = 0.01) in the metal-on-metal group. Structural aberrations were not seen in the control group, and this difference was highly significant (p = 0.003). Also, the number of chromosomal aberrations in the metal-on-metal group was greater than that in the revised group. Specifically, the percentage of structural aberrations was thirty-one-fold higher (p = 0.013). The percentage of aneuploidy gain in the metal-on-metal group was about twice that in the revised group, although this difference was not significant (p = 0.37). The percentage of aneuploidy gain in the revised group was about double that in the control group, although this difference was also not significant (p = 0.41). Translocations were seen only in subjects with a metal-on-metal articulation. CONCLUSIONS The clinical consequences of the chromosomal changes seen in this study are unknown, and it is unknown if the changes are present in other cells in the body. The results emphasize the need for additional investigations into the effect of chronic exposure to elevated levels of metal ions produced by orthopaedic implants.
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Affiliation(s)
- E Dunstan
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, England.
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Gooding CR, Bartlett W, Bentley G, Skinner JA, Carrington R, Flanagan A. A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered. Knee 2006; 13:203-10. [PMID: 16644224 DOI: 10.1016/j.knee.2006.02.011] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.9] [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] [Received: 12/19/2005] [Accepted: 02/20/2006] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The results for autologous chondrocyte implantation (ACI) in the treatment of full thickness chondral defects in the knee are encouraging. At present two techniques have been described to retain the chondrocyte suspension within the defect. The first involves using a periosteal cover (ACI-P) and the second involves using a type I/III collagen membrane (ACI-C). To the authors knowledge there are no comparative studies of these two techniques in the current literature. We have therefore undertaken such a study to establish if there is a difference between the 2 techniques based on a clinical and arthroscopic assessment. METHODS A total of 68 patients with a mean age of 30.52 years with symptomatic articular cartilage defects were randomised to have either ACI-P (33 patients) or ACI-C (35 patients). The mean defect size was 4.54 cm2. All patients were followed up at 24 months. RESULTS A clinical and functional assessment showed that 74% of patients had a good or excellent result following the ACI-C compared with 67% after the ACI-P at 2 years. Arthroscopy at 1 year also demonstrated similar results for both techniques. However, 36.4% of the ACI-P grafts required shaving for hypertrophy compared with none for the ACI-C grafts at 1 year. DISCUSSION This study has shown no statistical difference between the clinical outcome of ACI-C versus ACI-P at 2 years. A significant number of patients who had the ACI-P required shaving of a hypertrophied graft. We conclude that there is no advantage in using periosteum as a cover for retaining chondrocytes within an osteochondral defect; as a result we advocate the use of an alternative cover such as a manufactured type I/III collagen membrane.
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Affiliation(s)
- C R Gooding
- Institute of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
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Abstract
BACKGROUND Knee arthritis in the young patient is a challenging problem that may necessitate surgical treatment. We continue to perform hemiarthroplasty with a metallic tibial implant in selected young patients who, for various reasons, are not candidates for osteotomy, unicompartmental arthroplasty, or total knee arthroplasty. The purpose of the present study was to determine the minimum twelve-year results of this procedure in young patients. METHODS The original study group consisted of a consecutive series of twenty-four patients (twenty-six knees) who were managed with McKeever tibial hemiarthroplasty for the treatment of unicompartmental osteoarthritis of the knee. All patients were younger than sixty years of age at the time of the index procedure (average age, 44.6 years). During the study period, two patients died and one was lost to follow-up, leaving twenty-one patients (twenty-three knees) available for review. All patients were followed clinically for a minimum of twelve years or until revision. Knee Society knee and functional scores and Tegner scores were determined, and seven of the ten implants were evaluated radiographically. RESULTS Thirteen knees were revised at an average of eight years after the index procedures. All thirteen knees had an uncomplicated revision to either a unicompartmental arthroplasty or total knee arthroplasty. Ten retained implants were available for clinical review after an average duration of follow-up of 16.8 years. The mean Knee Society knee scores, functional scores, and Tegner scores, available for nine of these ten knees, were 80, 97, and 4.2, respectively. CONCLUSIONS We believe that the McKeever tibial hemiarthroplasty continues to be a reasonable surgical option for patients who are not candidates for osteotomy and are too young or too active for a unicompartmental or total knee arthroplasty.
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Affiliation(s)
- Bryan D Springer
- Department of Orthopaedic Surgery, New England Baptist Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Brumby SA, Carrington R, Zayontz S, Reish T, Scott RD. Tibial plateau stress fracture: a complication of unicompartmental knee arthroplasty using 4 guide pinholes. J Arthroplasty 2003; 18:809-12. [PMID: 14513460 DOI: 10.1016/s0883-5403(03)00330-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [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: 02/01/2023] Open
Abstract
Unicompartmental knee arthroplasty has gained popularity recently as a treatment for unicompartmental tibiofemoral non inflammatory arthritis. Tibial plateau stress fracture after unicompartmental knee arthroplasty (UKA) through guide pin holes placed in the proximal tibia has not been previously reported. In each case in this report, the compressive strength of the proximal tibia was reduced by the drilling of multiple holes for the placement of guide pins and holes for the lugs of the tibia component resulting in fracture through these holes between 3 and 18 weeks (median 8 weeks) post-operatively. In at least one case, the medial tibial cortex was violated by one pin. All cases required revision total knee arthroplasty (TKA). It is intuitive to caution against the use of multiple guide holes in the proximal tibia in UKA. If 3 or more hole pins are deemed necessary, surgeons must be aware of the potential for stress fracture and monitor patients accordingly. Peripheral pins that infract the medial tibial cortex should also be avoided.
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Shirota K, Kawaguchi O, Huang Y, Yuasa T, Carrington R, Brady PW, Hunyor SN. Ventricular remodeling after cardiomyoplasty in heart failure sheep: passive and dynamic effects. Ann Thorac Surg 2000; 70:2102-6. [PMID: 11156128 DOI: 10.1016/s0003-4975(00)01842-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/29/2022]
Abstract
BACKGROUND Recent reports claim that cardiomyoplasty (CMP) has a girdling effect on the left ventricle, to prevent dilatation and functional deterioration, but the mechanism of its long-term effects on the native heart is not known. We compared the relative role of CMP's active squeezing and passive girdling in chronically failing hearts. METHODS After induction of stable heart failure (left ventricular ejection fraction = 27% +/- 7%) by staged coronary microembolization, CMP was performed in 11 of 18 sheep. After 8 weeks pacing training of the latissimus dorsi muscle (LDM), cardiac assist was begun with 1:2 synchronous bursts in 6 sheep (d-CMP, n = 6), and the LDM in the passive group (p-CMP, n = 5) remained unstimulated. Four (base line) and 30 weeks after induction of heart failure, the pressure-volume relationship was derived. RESULTS After 30 weeks in d-CMP the slope (Emax) of the end-systolic pressure-volume relationship increased by 66% +/- 55% (p < 0.05) and external work efficiency by 48% +/- 41% (p < 0.01). In the passive CMP and control groups, slope and external work efficiency were unchanged. Conversely, left ventricular end-diastolic volume decreased (-14% +/- 12%, p < 0.05) in the dynamic CMP group compared with a static course in the passive CMP group (3% +/- 10%, p > 0.05) and an increase (18% +/- 15%, p < 0.05) in controls. CONCLUSIONS Dynamic CMP improved native heart's contractility and external work efficiency. In addition, whereas passive CMP has simply a girdling effect, dynamic CMP also induces reverse left ventricular chamber remodeling.
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Affiliation(s)
- K Shirota
- Cardiac Technology Centre, Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
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Cooper PG, Wilson GJ, Hardman DT, Kawaguchi O, Huang YF, Martinez-Coll A, Carrington R, Puchert E, Crameri R, Horam C, Hunyor SN. In situ measurements of skeletal muscle power output using new capacitive strain gauge. Med Biol Eng Comput 1999; 37:451-5. [PMID: 10696701 DOI: 10.1007/bf02513329] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Experiments are described in which a fatigue index is determined for the latissimus dorsi muscle of sheep in situ, using capacitive strain gauges. Parallel experiments for invasive and non-invasive measurements are conducted, measuring global contraction and relaxation rates and shortening duration for paced muscle. The results show that, above one pulse per burst (5 V, 100 microseconds pulsewidth), contraction rates (62 +/- 11 mm s-1) and relaxation rates (50 +/- 7 mm s-1) are constant for unloaded muscle. For one animal, fatigue testing with a 2.5 kg load at six pulses per burst shows shortening rates increasing to a maximum (80 mm s-1) after 30 s and reducing to 5 mm s-1 after 150 s. The decrease in shortening amplitude is used as a fatigue index, log displacement against time. Power output is load dependent, measuring 4.7 W kg-1 with a 2.5 kg load. There is good agreement between the invasive and non-invasive measurements, thus providing a method for monitoring changes in muscle parameters non-invasively during future pacing transformation.
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Affiliation(s)
- P G Cooper
- School of Indigenous Australian Studies, James Cook University, Queensland, Australia
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Bochner MA, Crameri R, Huang YF, Kawaguchi O, Carrington R, Horam C, Brady P, Hunyor SN. Thoracoscopic approach for biopsy of the latissimus dorsi cardiomyoplasty wrap. J Thorac Cardiovasc Surg 1998; 115:958-9. [PMID: 9576240 DOI: 10.1016/s0022-5223(98)70385-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M A Bochner
- Cooperative Research Centre for Cardiac Technology, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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Carrington R, Shaw G. Purines, pyrimidines, and imidazoles. Part XXX. Some further syntheses of N-glycyl-D-ribofuranosylamine 5-phosphate (GAR) and N-(N-formylglycyl)-D-ribofuranosylamine 5-phosphate (FGAR), intermediates in the biosynthesis de novo of purine nucleotides. ACTA ACUST UNITED AC 1968. [DOI: 10.1039/j39680001957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Carrington R, Shaw G, Wilson DV. 1268. Purines, pyrimidines, and imidazoles. Part XXIII. The use of 5-phospho-β-D-ribosyl azide in a new direct synthesis of nucleotides. ACTA ACUST UNITED AC 1965. [DOI: 10.1039/jr9650006864] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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