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1.
Musculoskelet Surg ; 103(3): 221-230, 2019 Dec.
Article in English | MEDLINE | ID: mdl-30937859

ABSTRACT

PURPOSE: The objective of this study is to evaluate the outcomes of total hip arthroplasty (THA) in patients with radiation-related changes to the bone, and specifically whether there is a difference in outcomes between cemented and uncemented acetabular components. METHODS: A database search was performed to identify available studies reporting adults undergoing THA who have previously had pelvic irradiation. Data were extracted and analysed with respect to the use of cemented versus uncemented acetabular components. Statistical analysis was performed using the Chi-square test for independence. RESULTS: The all-cause revision rate was 24% in the cemented THA group (27/111), compared with 15% of uncemented THAs (22/143) (p = 0.073). Revision for acetabular aseptic loosening occurred in 16% of cases (18/111) in the cemented group and 10% (15/143) in the uncemented group (p = 0.178). Acetabular aseptic loosening was reported in 24% of cemented THAs (27/111) and 14% of uncemented THAs (20/143), which was statistically significant (p = 0.035). Not all of these went on to have revision THA. The Incidence of prosthetic joint infection was similar in both groups. CONCLUSION: Overall outcomes appear to be better for uncemented THAs in post-radiotherapy patients, with a significantly lower rate of aseptic loosening and an appreciable (but not statistically significant) reduction in revision rate. The best outcomes seem to be associated with the use of acetabular reinforcement across both cemented and uncemented groups, but further work is needed to evaluate this.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Hip Joint/radiation effects , Prosthesis Failure , Reoperation/statistics & numerical data , Aged , Arthroplasty, Replacement, Hip/adverse effects , Hip Prosthesis/statistics & numerical data , Humans , Incidence , Pelvis/radiation effects , Postoperative Complications , Prosthesis-Related Infections/epidemiology , Treatment Outcome
2.
Bone Joint J ; 96-B(6): 817-22, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24891584

ABSTRACT

Conventional methods of treating ankle fractures in the elderly are associated with high rates of complication. We describe the results of treating these injuries in 48 frail elderly patients with a long calcaneotalotibial nail. The mean age of the group was 82 years (61 to 96) and 41 (85%) were women. All were frail, with multiple medical comorbidities and their mean American Society of Anaesthesiologists score was 3 (3 to 4). None could walk independently before their operation. All the fractures were displaced and unstable; the majority (94%, 45 of 48) were low-energy injuries and 40% (19 of 48) were open. The overall mortality at six months was 35%. Of the surviving patients, 90% returned to their pre-injury level of function. The mean pre- and post-operative Olerud and Molander questionnaire scores were 62 and 57 respectively. Complications included superficial infection (4%, two of 48); deep infection (2%, one of 48); a broken or loose distal locking screw (6%, three of 48); valgus malunion (4%, two of 48); and one below-knee amputation following an unsuccessful vascular operation. There were no cases of nonunion, nail breakage or peri-prosthetic fracture. A calcaneotalotibial nail is an excellent device for treating an unstable fracture of the ankle in the frail elderly patient. It allows the patient to mobilise immediately and minimises the risk of bone or wound problems. A long nail which crosses the isthmus of the tibia avoids the risk of peri-prosthetic fracture associated with shorter devices.


Subject(s)
Ankle Fractures , Ankle Injuries/surgery , Bone Nails , Fracture Fixation, Intramedullary/methods , Frail Elderly , Osteoporotic Fractures/surgery , Aged , Aged, 80 and over , Ankle Injuries/diagnostic imaging , Ankle Injuries/mortality , Cohort Studies , Female , Follow-Up Studies , Fracture Fixation, Intramedullary/instrumentation , Fracture Fixation, Intramedullary/mortality , Fracture Healing/physiology , Geriatric Assessment , Humans , Male , Middle Aged , Osteoporotic Fractures/diagnostic imaging , Osteoporotic Fractures/mortality , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Radiography , Retrospective Studies , Risk Assessment , Survival Rate , Treatment Outcome
3.
Bone Joint J ; 95-B(2): 250-3, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23365037

ABSTRACT

Local recurrence along the biopsy track is a known complication of percutaneous needle biopsy of malignant musculoskeletal tumours. In order to completely excise the track with the tumour its identification is essential, but this becomes increasingly difficult over time. In an initial prospective study, 22 of 45 patients (48.8%) identified over a three-month period, treated by resection of a musculoskeletal tumour, had an unidentifiable biopsy site at operation, with identification statistically more difficult after 50 days. We therefore introduced the practice of marking the biopsy site with India ink. In all 55 patients undergoing this procedure, the biopsy track was identified pre-operatively (100%); this difference was statistically significant. We recommend this technique as a safe, easy and accurate means of ensuring adequate excision of the biopsy track.


Subject(s)
Biopsy, Needle/methods , Bone Neoplasms/pathology , Carbon , Muscle Neoplasms/pathology , Humans , Prospective Studies
4.
J Bone Joint Surg Br ; 93(8): 1118-21, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21768639

ABSTRACT

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


Subject(s)
Bone Neoplasms/surgery , Osteochondroma/surgery , Adolescent , Adult , Aged , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/pathology , Child , Female , Humans , Male , Middle Aged , Osteochondroma/diagnostic imaging , Osteochondroma/pathology , Radiography , Recurrence , Retrospective Studies , Treatment Outcome
6.
Knee Surg Sports Traumatol Arthrosc ; 16(2): 148-51, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18000650

ABSTRACT

We report on a 67-year-old lady with multiple sclerosis (MS) who underwent bilateral total knee replacements using a fixed bearing posterior cruciate retaining prosthesis. Having initially achieved a satisfactory result, she developed recurrent dislocations of both knees necessitating bilateral revision surgery. Such complications are not previously described as a sequela of a neurological disease.


Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Knee Dislocation/complications , Multiple Sclerosis/complications , Prosthesis Failure , Aged , Female , Humans , Knee Dislocation/surgery , Osteoarthritis, Knee/surgery , Reoperation
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