Age at hip or knee joint replacement surgery predicts likelihood of revision surgery.

We compared revision and mortality rates of 4668 patients undergoing primary total hip and knee replacement between 1989 and 2007 at a University Hospital in New Zealand. The mean age at the time of surgery was 69 years (16 to 100). A total of 1175 patients (25%) had died at follow-up at a mean of ten years post-operatively. The mean age of those who died within ten years of surgery was 74.4 years (29 to 97) at time of surgery. No change in comorbidity score or age of the patients receiving joint replacement was noted during the study period. No association of revision or death could be proven with higher comorbidity scoring, grade of surgeon, or patient gender. We found that patients younger than 50 years at the time of surgery have a greater chance of requiring a revision than of dying, those around 58 years of age have a 50:50 chance of needing a revision, and in those older than 62 years the prosthesis will normally outlast the patient. Patients over 77 years old have a greater than 90% chance of dying than requiring a revision whereas those around 47 years are on average twice as likely to require a revision than die. This information can be used to rationalise the need for long-term surveillance and during the informed consent process.

The Morscher Press Fit acetabular component: a nine- to 13-year review.

We reviewed the results at nine to 13 years of 125 total hip replacements in 113 patients using the monoblock uncemented Morscher press-fit acetabular component. The mean age at the time of operation was 56.9 years (36 to 74). The mean clinical follow-up was 11 years (9.7 to 13.5) and the mean radiological follow-up was 9.4 years (7.7 to 13.1). Three hips were revised, one immediately for instability, one for excessive wear and one for deep infection. No revisions were required for aseptic loosening. A total of eight hips (7.0%) had osteolytic lesions greater than 1 cm, in four around the acetabular component (3.5%). One required bone grafting behind a well-fixed implant. The mean wear rate was 0.11 mm/year (0.06 to 0.78) and was significantly higher in components with a steeper abduction angle. Kaplan-Meier survival curves at 13 years showed survival of 96.8% (95% confidence interval 90.2 to 99.0) for revision for any cause and of 95.7% (95% confidence interval 88.6 to 98.4) for any acetabular re-operation.

Patellar resurfacing versus no resurfacing in Scorpio total knee arthroplasty.

This retrospective study compared the results of patellar resurfacing versus no resurfacing in 121 patients (142 knees) who underwent Scorpio total knee arthroplasty (TKA) between January 2002 and September 2004. Mean follow-up was 33 months in the nonresurfaced group and 18 months in the resurfaced group. The 2 groups were similar in age and gender. The incidence of anterior knee pain was 25% in the nonresurfaced group compared to 7% in the resurfaced group (P = 0.05), and the rate of revision was 10% in the nonresurfaced group compared to zero in the resurfaced group (P = 0.013). Mean Euroquol score was 91 in the nonresurfaced group compared to 95 in the resurfaced group (P = 0.26). Euroquol score, Knee Society score, knee instability, return to preoperative functional level, ability to kneel, use of a walking aid, and presence of limp were not significantly different between the 2 groups. The results of this study suggest a more consistent outcome can be achieved with patellar resurfacing in TKA with the Scorpio prosthesis.

Factors predicting outcome after whiplash injury in subjects pursuing litigation.

Records of 277 patients presenting for medicolegal reporting following isolated whiplash injury were studied retrospectively. A range of pre-accident, accident and response variables were recorded. Multivariate analysis was used to determine the main factors that predict physical and psychological outcome after whiplash injury. The factors that showed significant association with poor outcome on both physical and psychological outcome scales were pre-injury back pain, high frequency of General Practitioner attendance, evidence of pre-injury depression or anxiety symptoms, front position in the vehicle and pain radiating away from the neck after injury. The strongest associations were with factors that are present before impact. In this selected cohort of patients, there is a physical and a psychological vulnerability that may explain the widely varied response to low violence indirect neck injury.

Bilateral Achilles tendon rupture: a case report.

Bilateral Achilles tendon rupture is a rare injury. We present a case of a 59-year-old gentleman who sustained a bilateral Achilles tendon rupture when the tendon was subjected to normal physiological load. He was treated operatively with V-Y plasty and repair of the tendon with post-operative plaster immobilisation.

Sagittally split fracture of trapezium associated with subluxated carpo-metacarpal joint of thumb.

Trapezial fractures are uncommon, and require careful clinical and radiological assessment and treatment. Poor or inadequate treatment of displaced fractures of trapezium can lead to long-term morbidity. We report two displaced fractures of the trapezium. The clinical and radiological features are discussed. Both fractures were treated operatively and a good functional outcome was achieved.

The classification of outcome following whiplash injury--a comparison of methods.

There are many definitions and classifications of chronic neck pain and of neck pain following whiplash injury, many of them developed for a single study. This study compares three different outcome measures (neck disability index, Gargan and Bannister grade, general health questionnaire) in 277 patients who were examined for medicolegal reporting following isolated whiplash injury. There is significant correlation between the physical outcome scales and also between the physical and psychological outcome scales examined (both p <0.01). Definitions of chronic neck pain (with or without whiplash injury) and measures to assess and classify patients with chronic symptoms are reviewed. We recommend the use of a simple self-administered questionnaire that does not require physical measurement as the most useful tool in the evaluation of these patients and the most accurate method of classifying outcome.

Closing the loop: feedback to accident and emergency SHOs on their referrals to hospital specialists.

OBJECTIVES: To determine whether A&E SHOs in the Anglia and Oxford region receive regular case-specific feedback on their referrals to hospital specialists. METHODS: A telephone survey of an A&E SHO from each hospital in the region, using a semi-structured questionnaire and written protocol. The main questions asked were: (i) do you receive regular feedback about specific patients you refer to other specialties? If so, which one(s)? and (ii) do you think personal regular case-specific feedback about your referrals would be useful? RESULTS: Overall, 18 A&E SHOs and one staff grade were interviewed, one from each hospital (response rate 100%). Over the whole region, there were 106 hospital specialties to which A&E SHOs could directly refer out-patient cases. However, regular case-specific communication or feedback was received by the referring A&E SHO from only 5 (4.7%). There were 237 hospital specialties to which A&E SHOs could directly refer in-patients. However, regular case-specific feedback was received by the referring A&E SHO from only 3 specialities (1.3%). The A&E doctors at 18 of the 19 hospitals (95%) felt regular case-specific feedback would be useful. Of these, 13 (72%) would prefer written feedback - 5 (38%) would prefer a copy of the discharge summary or GP clinic letter, 6 (46%) a letter written specifically to the A&E SHO, 1 a letter to be sent via the A&E consultant, and 1 wished for 'any written feedback'. All 18 doctors wanted feedback from at least one of the specialties of general medicine, paediatrics, trauma and orthopaedics, and general surgery. CONCLUSIONS: A&E SHOs in the Anglia and Oxford region do not receive regular case-specific feedback on their referrals to hospital specialists. Almost all A&E SHOs in this study would welcome it. The situation could be rectified by routinely sending them copies of clinic letters or discharge summaries.

Cervical spondyloptosis caused by an aneurysmal bone cyst: a case report.

STUDY DESIGN: The case of an 11-year-old patient with an aneurysmal bone cyst at C7, cervical spondyloptosis, and scoliosis of the lumbar spine is reported. OBJECTIVE: To describe an unusual presentation of aneurysmal bone cyst causing painless cervical spondyloptosis. SUMMARY OF BACKGROUND DATA: Aneurysmal bone cysts of the cervical spine are rare. There has never been a reported case of cervical dislocation by an aneurysmal bone cyst. This case highlights the potentially devastating effects that can be caused by benign tumors in the vertebral column. METHODS: The history, clinical examination, imaging findings, and treatment are reviewed. RESULTS: The patient was treated with a single-stage combined posteroanteroposterior operation to resect the tumor, reduce the cervicothoracic dislocation, and create a three-column stabilization of the spine. The results were satisfactory, with an improvement in neurology. CONCLUSIONS: Aneurysmal bone cysts should be considered in the etiology of complicated scoliosis. Patients with a benign clinical history should be investigated at an early stage using appropriate imaging. Surgery is the treatment of choice when stability of the spine is compromised and neurologic signs are present.

Direct measurement of bacterial penetration through surgical gowns: a new method.

There is a paucity of data on the penetration of bacteria through surgical gowns during operations. A simple new method was developed, using Petri dishes filled with horse blood agar that were attached to the outside of the gown material. This was used to assess bacterial penetration through disposable spun-bonded polyester gowns and re-usable woven polyester gowns during normal use. There was a significant difference between the two gown types when tested in the axilla (P = 0.02), the groin (P = 0.02) and the peri-anal region (P < 0.01), with the disposable gowns performing to a higher standard. Re-usable gowns demonstrated variation in penetrability, and for this reason, may be unsuitable for use in orthopaedic implant surgery.