Early experience of a local pathway on the waiting time for MRI in patients presenting to a UK district general hospital with suspected cauda equina syndrome.

AIM: This study evaluated the impact of the Salisbury Protocol for Assessment of Cauda Equina Syndrome (SPACES) on the waiting time for MRI in patients presenting with suspected Cauda Equina Syndrome (sCES) within a UK district general hospital. PATIENTS AND METHODS: All consecutive patients undergoing an MRI scan in our hospital, for sCES, over a 12 month period, prior to and following the introduction of SPACES, were identified. Patient's gender, age, MRI diagnosis, time from MRI request to imaging and outcome were recorded. RESULTS: In the year prior to the introduction of SPACES, 66 patients underwent MRI for sCES, out of which 10.6% had cauda equina compression (CEC), 63.5% had other spinal pathology and 25% had a normal scan. In the year after introduction of SPACES, 160 patients underwent MRI for sCES out of which 6.2% had CEC, 70.7% had other spinal pathology and 23% had a normal scan. Despite the referrals for sCES increasing by more than 2-fold following the introduction of SPACES, the median time from MRI request to scan decreased from 9.1 to 4.2 hours (p = 0.106, Mann-Whitney-U) and the number of patients transferred to the regional hub hospital decreased from 7 to 3. CONCLUSION: Implementation of SPACES for patients with sCES resulted in a substantial reduction in waiting time for MRI and decreased the number of transfers to the regional hub hospital. Based on our early experience, we encourage other centres within the UK to introduce such a pathway locally, to improve the management of patients with sCES.

Hearing Evaluation of ARthroplasty Surgeons: results from the HEARS study.

AIMS: The aim of this study was to investigate whether the prevalence of hearing loss among arthroplasty surgeons was comparable to clinicians from other medical specialties and to explore the factors associated with hearing loss. METHODS: A cross-sectional prevalence study was carried out. Arthroplasty surgeons and non-surgical clinicians were recruited from orthopaedic and medical conferences. All participants were given a paper questionnaire including demographic details, hearing history and the Tinnitus and Hearing Survey. All participants were screened for hearing loss in a quiet room using the HearCheck Screener™ (HCS; Siemens, Munich, Germany). Logistic regression was used to identify factors associated with hearing loss. All statistical models were adjusted for age, gender, smoking status and personal noise exposure. RESULTS: The HEARS (Hearing Evaluation of ARthroplasty Surgeons) study recruited 188 participants (106 arthroplasty surgeons; 82 non-surgical clinicians). Prevalence of hearing loss identified by the HCS was 31% for arthroplasty surgeons vs 11% for non-surgical clinicians. The odds of failing the HCS were 3.7 times higher in arthroplasty surgeons compared to their non-surgical colleagues (p < 0.004). The odds of self-reported hearing using the Tinnitus and Hearing Survey were 2.79 times higher among arthroplasty surgeons (p < 0.003). CONCLUSION: The prevalence of hearing loss among arthroplasty surgeons is significantly higher than in their non-surgical colleagues. Noise generated during arthroplasty surgery should be recognised and managed to create safer working conditions.

Intra-pelvic migration of femoral head trial in total hip arthroplasty, a rare intra-operative complication: a systematic literature review.

Trial reduction while performing total hip replacement is an essential step of the procedure. This is to check the stability of the hip joint with the selected implant sizes and to assess the leg length to avoid discrepancy. Disengagement of the femoral head trial from the femoral rasp stem with subsequent migration of the trial head into the pelvic cavity is a rare occurrence, but can be a very frustrating complication to both the surgeon and occasionally the patient. We present our experience with this exceptional situation and different management options, together with systematic review of the literature.