Functional outcome of total hip arthroplasty after a previous hip arthroscopy: a retrospective comparative cohort study.

BACKGROUND: Despite patients demonstrating significant short-term clinical improvement from a hip arthroscopy (HA), a number of patients progress to significant osteoarthritis of the hip requiring total hip arthroplasty (THA). This study aims to evaluate if there is any difference in the functional outcome of patients undergoing THA after a previous hip arthroscopy compared to patients undergoing THA for primary osteoarthritis of the hip. METHODS: Between 2010 and 2013, in a group of 414 patients who underwent hip arthroscopy, we identified 18 patients who underwent a subsequent uncemented THA. These formed the study group. During the same period, 625 patients underwent an uncemented THA performed for primary OA, of which 63 patients were matched to the study group for age, follow-up and implants used. These formed the control group. Pre-op and post-op Oxford Hip Scores (OHS) were recorded for all patients. RESULTS: A mean follow-up of 26.5 and 26.3 months was observed in the study and control groups respectively. The median (interquartile ranges) preoperative OHS were 14 (8.25, 17.0) and 18.5 (13.25, 24.75) in the 2 groups. Corresponding postoperative scores were 40 (31.25, 45) and 46 (43, 48). Median difference between the preoperative and postoperative OHS was 27 (19, 31) and 25 (18.25, 31). Adjusting for the pre-treatment scores, the postoperative scores in the study arm were significantly lower than for the control arm with an estimate (SE) of -0.464 (p = 0.012). Post-hoc power analysis showed that the study was sufficiently powered to detect a meaningful difference in scores. CONCLUSION: Total hip arthroplasty after hip arthroscopy leads to satisfactory functional outcomes. However, the functional outcome in this group is significantly worse than in a matched cohort of patients undergoing THA for osteoarthritis. There was no difference in the rate of complications between the 2 groups.

Trauma theatre productivity - Does the individual surgeon, anaesthetist or consultant presence matter?

INTRODUCTION: With rising NHS clinical and financial demands, improving theatre efficiency is essential to maintain quality of patient care. Consistent teams and consultant presence have been shown to improve outcomes and productivity in elective orthopaedic surgery. The aim of this study was to investigate the impact on trauma theatre productivity of different surgeons and anaesthetists working together in a Major Trauma Centre. The influence of consultant presence and weekend operating on productivity was also considered. METHODS: Data relating to a single orthopaedic trauma theatre was gathered retrospectively for a two-year period. Variables including orthopaedic and anaesthetic consultant presence, number and complexity of operations performed and procedure start times were collected for daily trauma lists. Individual anaesthetic and orthopaedic consultants were compared by productivity outcomes. The impact of surgeons operating more frequently with one anaesthetist was also examined. RESULTS: Data relating to 2384 patients undergoing a total of 2787 procedures was collected. Orthopaedic consultant presence at the first surgical case (p < 0.05) and for 50% or greater of cases (p < 0.05) lead to higher mean number of cases performed per list and reduced turnaround time. Despite working with a significantly higher number of different consultant anaesthetists (p < 0.001) in year two, the productivity of surgeons as judged by list start time, total cases per list and total operating time was not significantly affected. Significantly earlier start times (p < 0.001) and shorter turnaround times (p < 0.001) at weekends led to maintained productivity despite shorter theatre time. No significant difference in productivity was found when comparing individual anaesthetic and orthopaedic consultants. Productivity was not significantly increased by surgeons operating more frequently with one individual anaesthetist. CONCLUSION: In the setting of an acute trauma theatre, orthopaedic consultant presence led to increased productivity. Furthermore, individual surgeon and anaesthetist pairings had no effect on overall productivity. Future efforts to improve productivity should focus on achieving earlier start times, consultant supervision of lists and reduced turnaround times between cases.

Traumatic isolated coracoid fractures in the adolescent.

Coracoid fractures are rare injuries in themselves. Even rarer are isolated fractures of the coracoid in the skeletally immature patient. Due to the low numbers of these fractures, there is no true consensus on how to treat them. We report two cases of an isolated fracture of the coracoid. Case A is a 13-year-old boy who sustained the coracoid fracture following a skiing injury; case B is a 15-year-old boy who fell onto the right shoulder during a wheelbarrow race at school. Initial radiographs in case A suggested a displaced fracture; however, a CT scan taken after a short period of conservative treatment showed minimal displacement. In case B both the radiographs and CT scan showed no displacement. Both injuries were treated conservatively and united uneventfully with a full return to function. We advocate conservative management for these injuries in the skeletally immature patient.

Talonavicular dislocation with associated cuboid fracture following low-energy trauma.

Isolated talonavicular dislocations are uncommon injuries, usually occurring as a result of high-energy trauma. As a result extensive disruption of the midfoot ligamentous structures commonly occur with these injuries, often resulting in a poor outcome. Due to its rarity these injuries remain poorly understood, and several opinions exist on the probable mechanisms of injury and the optimal treatment. Five main injury types have been classified based on the deforming forces and direction of displacement; medial, lateral, longitudinal, plantar, and crush. However new mechanisms and injury patterns continue to be reported. We report a case of a medial swivel type talonavicular dislocation, associated with a cuboid body fracture, which is previously undescribed.