The Exeter Knee Infection Multi Disciplinary Team approach to managing prosthetic knee infections: A qualitative analysis.

BACKGROUND: A Knee Infection Multi-Disciplinary Team meeting was established in Exeter. This study was designed to qualitatively evaluate the impact of the MDT on those involved. MATERIALS AND METHODS: Semi-structured interviews of all members of the MDT at Exeter were undertaken and analysed using Nvivo software. Data was coded to identify common patterns and trends. RESULTS: The common themes identified were improved communication and standardisation of care. The main challenges identified were the timing of the meetings and funding. CONCLUSION: This study has used established qualitative techniques to evaluate the impact of the Exeter Knee Infection MDT.

Ten-year results for a single-surgeon series of Scorpio non-restrictive geometry (NRG) posterior stabilised (PS) total knee replacement.

BACKGROUND: To report the long-term results for a single-surgeon consecutive series of Scorpio non-restrictive geometry (NRG) posterior stabilised (PS) total knee replacement (TKR). MATERIALS AND METHODS: Forty-six consecutive patients who underwent 53 Scorpio NRG PS were identified. Change in range of motion (ROM) and Oxford Knee Score (OKS) over time were recorded. Radiographs were evaluated for alignment and radiolucent lines. Survival analysis for the prosthesis was calculated. RESULTS: At a mean of 10.1 years (range 9.1-10.9) following exclusions thirty-seven (69.8%) knees in thirty-one (67.4%) patients (6 bilateral) were available for review. None of the patients required revision surgery. Mean OKS score at 10 years was 37.8. The mean ROM significantly improved from 95° pre-operative to 117.5° at 5 years and 115° at 10 years (p = < 0.001). This equates to a value-added range of motion (VAROM) of 19° at 5 years and 15.6° at 10 years. There was a correlation between OKS and VAROM at 5 and 10 years. Radiological assessment did not reveal any evidence of progressive cement radiolucent lines nor component migration. CONCLUSION: In this series the Scorpio NRG PS showed 100% 10-year survivorship. We found a significant improvement in ROM and VAROM over time. This was not associated with increased signs of loosening.

The effect of coal and diesel particulates on the weathering loss of Portland Limestone in an urban environment.

Due to reductions in domestic usage, legislation and changes in fuel use, coal derived particulates in the UK urban atmosphere have been significantly reduced. However, a large increase in road usage and an expansion in the use of diesel engines, has meant that the majority of particulates, now present in the urban atmosphere, originate from vehicle exhausts. Particulate matter, resulting from coal combustion, has been recorded as being present in black patinas observed on some historic stone buildings and monuments and has been associated with accelerated weathering of stone surfaces as a result of enhanced gypsum formation. In contrast, the effects of particulates resulting from vehicle exhaust on stone are much less understood. To investigate this, a comparative study was undertaken using the technique of microcatchments under ambient atmospheric conditions. This compared the elemental composition and volume of precipitation runoff from Portland Limestone coated with three different particulate treatments. Treatments consisted of coal and diesel particulates, both separately and in combination. Combining these treatments attempts to investigate any synergistic effects that may occur when coal derived particulates are overlain by layers formed by particulates from more contemporary sources. It was found that diesel-coated samples were much darker in appearance and showed a significant reduction (P<0.05) in the overall rate of weathering loss when compared to untreated samples. Microcatchment runoff volume was reduced from diesel-coated Portland Limestone compared to untreated stone. Enhanced surface temperatures may be increasing the rate of moisture loss from the pore network between rainfall events. Since, generally, the pores must be full before runoff can occur, the reduction may be due to the differential volume of empty pore space between diesel-coated and untreated Portland Limestone.