The Exeter technique can lead to a lower incidence of leg-length discrepancy after total hip arthroplasty

We evaluated an operative technique, described by the Exeter Hip Unit, to assist accurate introduction of the femoral component. We assessed whether it led to a reduction in the rate of leg-length discrepancy after total hip arthroplasty (THA). A total of 100 patients undergoing THA were studied retrospectively; 50 were undertaken using the test method and 50 using conventional methods as a control group. The groups were matched with respect to patient demographics and the grade of surgeon. Three observers measured the depth of placement of the femoral component on post-operative radiographs and measured the length of the legs. There was a strong correlation between the depth of insertion of the femoral component and the templated depth in the test group (R = 0.92), suggesting accuracy of the technique. The mean leg-length discrepancy was 5.1 mm (0.6 to 21.4) pre-operatively and 1.3 mm (0.2 to 9.3) post-operatively. There was no difference between Consultants and Registrars as primary surgeons. Agreement between the templated and post-operative depth of insertion was associated with reduced post-operative leg-length discrepancy. The intra-class coefficient was R ≥ 0.88 for all measurements, indicating high observer agreement. The post-operative leg-length discrepancy was significantly lower in the test group (1.3 mm) compared with the control group (6.3 mm, p < 0.001). The Exeter technique is reproducible and leads to a lower incidence of leg-length discrepancy after THA.

Randomized controlled trial of intubation with the McGrath Series 5 videolaryngoscope by inexperienced anaesthetists

BACKGROUND

The McGrath Series 5 videolaryngoscope might reduce the incidence of unexpected difficult tracheal intubation. If it also performs as well as a standard laryngoscope during uncomplicated intubations, there would be an argument for the McGrath to become the laryngoscope of choice in higher risk settings, such as rapid sequence induction by inexperienced anaesthetists. Therefore, we compared the McGrath and the Macintosh laryngoscopes during routine tracheal intubation performed by inexperienced anaesthetists.

METHODS

Single-blind randomized controlled trial with 120 adult patients allocated to intubation by first-year anaesthetic trainees, using a McGrath or Macintosh laryngoscope. The primary outcome was time to intubation. Secondary outcomes were quality of view at laryngoscopy and evidence of differential learning between using the two laryngoscopes. A Cox proportional hazards model was used to determine the effect of the laryngoscopes on time to intubation.

RESULTS

Duration of intubation was significantly longer (P<0.001) in the McGrath group [median (IQR); 47.0 (39.0-60.0) vs 29.5 (23.0-36.8) s]. There were no significant differences in other outcomes, including grade of laryngoscopy view, visual confirmation of tube placement, number of laryngoscopies, or complications (oesophageal intubation, hypoxaemia, and airway trauma). There was no differential learning effect.

CONCLUSIONS

There were no advantages to using the McGrath laryngoscope for uncomplicated tracheal intubation and duration of intubation was longer, so it should not be used as a first-line laryngoscope instrument by inexperienced anaesthetists.