Survivorship of the C-Stem total hip replacement using the "French Paradox" technique.

BACKGROUND: This study evaluates the survivorship of the C-Stem total hip replacement, using the "French Paradox" method, at medium-term follow-up. METHODS: 321 cemented total hip replacements in 307 patients were performed, using the canal-filling technique for the femoral stem. Survival analysis was performed for all-cause revision. The secondary outcome was aseptic loosening of the stem. RESULTS: Revision rate for all reasons was 2%. Overall ten-year survival was 95%. There were no revisions for femoral stem aseptic loosening. CONCLUSION: This is a unique study demonstrating successful outcomes of total hip replacement using the "French Paradox" technique with a triple-tapered stem.

Hospital accreditation and patient care, a dilemma?

There are concerns that increased BMI is associated with a greater length of stay (LOS) and perioperative complications following total knee (TKR) and total hip replacements (THR). We analysed data from a six-month period to see if there was a correlation between BMI and LOS. We performed a subgroup analysis for patients with morbid obesity (BMI >40) looking at perioperative complications. 285 TKRs and 195 THRs were analysed. For TKRs, the average length of stay was 2.7 days. The average BMI was 32.4. There was no significant correlation between BMI and LOS (r=-0.0447, p=0.2267). The morbidly obese category (n=33) had the shortest LOS (2.5 days) compared to other BMI categories. 30- day readmission rate was 6%. 90-day re-admission rate was 12%. Six patients had minor wound issues requiring no intervention or antibiotics only. The was one prosthetic joint infection, one stitch abscess, one DVT and one patellar tendon injury. For THRs, the average LOS was 2.9 days. The average BMI was 29.9. There was no significant correlation between BMI and LOS (r=0.007, p=0.4613). The morbid obese category (n=9) had the shortest LOS (1.9 days) compared to other BMI categories. No patients were readmitted within 90 days or had documented complications. We have shown that for TKRs and THRs, increased BMI is not associated with increased LOS. The morbidly obese were found to have the shortest LOS. Re-admission rates and complications were commendable for patients with morbid obesity. BMI >40 is not a contraindication to TKR or THR.

Performance anxiety amongst trauma and orthopaedic surgical trainees.

BACKGROUND: This study aims to assess performance anxiety amongst orthopaedic trainees. Operating is equivalent in its skill level, both dexterous and mental, to that of elite sport. This study uses a slightly altered version of the validated Sports Competition Anxiety Test (SCAT), making it relevant to operating, rather than to sport, to evaluate peri-operative stress and anxiety in orthopaedic surgeons. METHODS: The SCAT questionnaire was sent to trainees across 3 UK. deaneries via email. A score of <17 suggests low-levels of anxiety, 17-24 suggests medium-levels of anxiety and >24 suggest high-levels of anxiety. Data was anonymised except from training grade and sex. RESULTS: 109 of 273 (40%) responded to the survey, 71% of respondents were male (n = 77). The mean SCAT score amongst Core Surgical Trainees was 16.9 (n = 21, range 12-23), Specialist Trainees years 3-5 was 18.7 (n = 51, range 12-28), Specialist Trainees years 6-8 was 16.8 (n = 26, range 11-24) and consultants was 16 (n = 11, range 11-28). Across all groups, when sub-divided by sex, females had higher mean scores, this was statistically significant for Specialist Trainees years 3-5 (p = 0.029) and Specialist Trainees years 6-8 (p = 0.042) groups. DISCUSSION: Surgical performance anxiety exists amongst orthopaedic surgeons, with females scoring higher than males. Five respondents scored "high-levels of anxiety" including 2 consultants level surgeons, suggesting experience does not entirely eliminate anxiety. Stress and anxiety are known to lead to surgical mistakes and "burnout" amongst surgeons which is highly topical at present. It is important to highlight this significant issue and it could be taken forward as a national survey to evaluate further.

A simple technique to position patients with bilateral above-knee amputations for operative fixation of intertrochanteric fractures of the femur: a case report.

INTRODUCTION: Intertrochanteric fractures of the femur are common fractures in the elderly, and management includes operative fixation after patient positioning on the fracture table. Patients with bilateral above-knee amputations are challenging in terms of positioning on the table. We describe a simple technique to overcome this special problem. CASE PRESENTATION: A 75-year-old wheelchair-bound Caucasian man with bilateral above-knee amputations presented to our hospital after a fall. Plain radiographs showed an intertrochanteric fracture of the femur, and operative fixation with a dynamic hip screw was planned. His positioning on the table posed a particular problem, and therefore we developed a technique to overcome this problem. CONCLUSION: Positioning of patients for fixation of intertrochanteric fractures of the femur poses a particular problem that can be solved by using our simple technique.

The long-term effectiveness of steroid injections in primary acromioclavicular joint arthritis: a five-year prospective study.

We evaluated the long-term benefits of steroid injection in 25 shoulders in 20 consecutive patients (average age, 55 years) with primary acromioclavicular arthritis. Minimum follow-up was 5 years. The mean preinjection Constant score (61 points) improved at 6 months to 81 points, (mean difference, 19.36; P < .01). Improvement at 12 months (mean, 86 points) was also significant vs the 6-month score (P = .001). The mean score at 5 years (81 points) was a significant deterioration vs the 12-month score (P = .01) but still a significant improvement vs the preinjection scores (P < .0005). Younger patients had greater improvement in the objective score (range of movement and power; r = -0.47; P = .01), as did women (r = 0.405; P = .05). Local steroid injection is an effective treatment for primary isolated acromioclavicular arthritis. Improvement continues for at least 12 months. The benefit is felt up to 5 years. Pain relief tends to diminish long-term.

3M Capital hip arthroplasty: 3-8-year follow-up of 208 primary hip replacements.

We reviewed 267 Capital hip replacements. Patients were recalled in 1998 after reports of failure of this prosthesis. 208 hips (200 patients) were followed-up (average 6 years). 9 hips (4%) had been revised for aseptic loosening and 10 stems (5%) were radiographically loose. Males and both varus and valgus stems showed a higher incidence of loosening. The failure rate, however, was considerably lower than the published figures. The reason for this is not clear, but obviously design is not the only factor contributing to loosening. Therefore, a continuous routine registration of clinical data and relevant outcome parameters on a large scale seems desirable.

Eight-year prospective targeted ultrasound screening program for instability and at-risk hip joints in developmental dysplasia of the hip.

The use of targeted ultrasound screening for at-risk hips to reduce the rate of surgery in developmental dysplasia of the hip is unproven. A prospective trial was undertaken in an attempt to clarify this matter. This study was undertaken between May 1992 and April 2000. There were 28,676 live births. Unstable and at-risk hips were routinely targeted for ultrasound examination. One thousand eight hundred six infants underwent ultrasound examination (6.3% of the birth population). Twenty-five children (18 with dislocations, 7 with dysplasia) required surgical intervention in the form of open reduction of the hip or pelvic or femoral osteotomy (0.87 per 1,000 births for dysplasia, 0.63 per 1,000 births for dislocation). Targeted ultrasound screening does not reduce the overall rate of surgery compared with the best conventional clinical screening programs. The development of a national targeted ultrasound screening program for at-risk hips cannot be justified on a cost or result basis.