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Burston B.J.,Avon Orthopaedic Center | Barnett A.J.,Avon Orthopaedic Center | Amirfeyz R.,Avon Orthopaedic Center | Amirfeyz R.,Royal Infirmary | And 3 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2012

We prospectively followed 191 consecutive collarless polished tapered (CPT) femoral stems, implanted in 175 patients who had a mean age at operation of 64.5 years (21 to 85). At a mean follow-up of 15.9 years (14 to 17.5), 86 patients (95 hips) were still alive. The fate of all original stems is known. The 16-year survivorship with re-operation for any reason was 80.7% (95% confidence interval 72 to 89.4). There was no loss to follow-up, with clinical data available on all 95 hips and radiological assessment performed on 90 hips (95%). At latest follow-up, the mean Harris hip score was 78 (28 to 100) and the mean Oxford hip score was 36 (15 to 48). Stems subsided within the cement mantle, with a mean subsidence of 2.1 mm (0.4 to 19.2). Among the original cohort, only one stem (0.5%) has been revised due to aseptic loosening. In total seven stems were revised for any cause, of which four revisions were required for infection following revision of the acetabular component. A total of 21 patients (11%) required some sort of revision procedure; all except three of these resulted from failure of the acetabular component. Cemented acetabular components had a significantly lower revision burden (three hips, 2.7%) than Harris Galante uncemented components (17 hips, 21.8%) (p < 0.001). The CPT stem continues to provide excellent radiological and clinical outcomes at 15 years following implantation. Its results are consistent with other polished tapered stem designs. ©2012 British Editorial Society of Bone and Joint Surgery.


Thomas W.,Royal Devon and Exeter Hospital | Gheduzzi S.,Avon Orthopaedic Center | Packham I.,University of Bath
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2015

Purpose: Pectoralis major tendon avulsion injury benefits from surgical repair. The technique used and speed of rehabilitation in this demanding population remains subject to debate. We performed a biomechanical study comparing suture button (Pec Button™, Arthrex, Naples, FL) with a transosseous suture technique (FibreWire, Arthrex, Naples, FL). Methods: Freshly slaughtered porcine humeri were prepared to model a single transosseous suture or suture button repair. A static, tensile load to failure experiment and a cyclic, tensile load experiment to model standard (10,000 cycles) and accelerated rehabilitation (20,000 cycles) philosophies were tested. The mode of failure, yield and ultimate failure load, extension (clinical failure >10 mm) and the resistance to cyclic loading was measured. Results: The mode of failure was suture fracture in all the static load experiments with 10/11 occurring as the suture passed through the button and 7/11 as the suture passed through the bone tunnels. There was a significant difference in yield load, favouring transosseous suture [p = 0.009, suture button (SB) 673.0 N (647.2–691.7 N), transosseous suture (TOS) 855.0 N (750.0–891.4 N)] and median extension, favouring suture button [p = 0.009, SB 8.8 mm (5.0–12.4 mm), TOS 15.2 mm (13.2–17.1 mm)]. 2/3 transosseous suture and 0/3 suture buttons failed before completing 20,000 cycles. The difference in mean number of cycles completed was non-significant. The difference in mean extension was 5.1 mm (SB 6.7 mm, TOS 11.7 mm). Conclusions: Both techniques show advantages. The difference in extension is likely to be more clinically relevant than load tolerated at failure, which is well above physiological levels. The findings do not support an accelerated rehabilitation model. © 2014, Springer-Verlag Berlin Heidelberg.


Avery P.P.,Royal Infirmary | Avery P.P.,Avon Orthopaedic Center | Baker R.P.,Royal Infirmary | Baker R.P.,Avon Orthopaedic Center | And 8 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2011

We reviewed the seven- to ten-year results of our previously reported prospective randomised controlled trial comparing total hip replacement and hemiarthroplasty for the treatment of displaced intracapsular fracture of the femoral neck. Of our original study group of 81 patients, 47 were still alive. After a mean follow up of nine years (7 to 10) overall mortality was 32.5% and 51.2% after total hip replacement and hemiarthroplasty, respectively (p = 0.09). At 100 months postoperatively a significantly greater proportion of hemiarthroplasty patients had died (p = 0.026). Three hips dislocated following total hip replacement and none after hemiarthroplasty. In both the total hip replacement and hemiarthroplasty groups a deterioration had occurred in walking distance (p = 0.02 and p < 0.001, respectively). One total hip replacement required revision compared with four hemiarthroplasties which were revised to total hip replacements. All surviving patients with a total hip replacement demonstrated wear of the cemented polyethylene component and all hemiarthroplasties had produced acetabular erosion. There was lower mortality (p = 0.013) and a trend towards superior function in patients with a total hip replacement in the medium term. ©2011 British Editorial Society of Bone and Joint Surgery.


Artz N.,University of Bristol | Artz N.,Avon Orthopaedic Center | Dixon S.,University of Bristol | Wylde V.,University of Bristol | And 4 more authors.
Musculoskeletal Care | Year: 2013

Background: Total hip replacement (THR) and total knee replacement (TKR) are two common elective orthopaedic procedures, and the provision of physiotherapy for patients after discharge is variable, with evidence for best practice remaining uncertain. Aims and objectives: To determine the standard physiotherapy service offered to patients following discharge after THR and TKR. Methods: A telephone survey was carried with clinicians at 24 high-volume NHS orthopaedic centres in England and Wales. Information was gathered on standard physiotherapy provision and categorized into; no routine physiotherapy, outpatient physiotherapy (including one-to-one and group), home-based physiotherapy or other physiotherapy (including telephone consultation and drop-in services). Results: No centres surveyed referred patients to outpatient physiotherapy as a routine pathway of care following THR. Eleven centres provided group physiotherapy to patients after discharge following TKR compared with five centres providing one-to-one outpatient physiotherapy. Conclusion: The provision of physiotherapy following discharge after TKR is a more common practice than after THR, where ongoing physiotherapy is provided depending upon clinical need. Group exercises are the favoured destination for patients following TKR in high-volume centres. © 2012 John Wiley & Sons, Ltd.


Blackburn J.,Avon Orthopaedic Center | Qureshi A.,Avon Orthopaedic Center | Amirfeyz R.,Avon Orthopaedic Center | Bannister G.,Avon Orthopaedic Center
Knee | Year: 2012

Background and purpose: Approximately one fifth of patients are not satisfied with the outcome of total knee arthroplasty (TKA). Preoperative variables associated with poorer outcomes are severity and chronicity of pain, psychological disease, poor coping strategies and pain catastrophisation. Psychological disease may be expressed as anxiety and depression. It is unclear whether anxiety and depression before TKA are constitutional or result from knee pain. The aim of this study was to explore the association of anxiety and depression with knee pain and function using specific outcome measures. Methods: Forty consecutive patients undergoing TKA completed Hospital Anxiety and Depression Scale (HAD) and Oxford Knee Scores (OKS) preoperatively and at 3 and 6. months postoperatively. Results: The HAD and OKS significantly improved post-operatively (p<0.001). There was a greater change between the preoperative and postoperative scores in the OKS than the HAD. The severity of preoperative anxiety and depression was associated with higher levels of knee disability (coefficient -0.409, p=0.009). Postoperatively reduction in anxiety and depression was associated with improvement in knee disability after 3 (coefficient -0.459, p=0.003) and 6. months (coefficient - 0.428, p=0.006). Interpretation: The difficulty in interpreting preoperative anxiety and depression and the outcome of TKA is establishing whether they are the cause or effect of pain in the knee. As anxiety and depression improve with knee pain and function, this study suggests that knee pain contributes to the psychological symptoms and that a successful TKA offers an excellent chance of improving both. © 2011 Elsevier B.V.


Tucker D.,Avon Orthopaedic Center | Acharya M.,Avon Orthopaedic Center
BMJ Case Reports | Year: 2014

A 68-year-old man with a previous right total hip arthroplasty presented with acute pain in the right hip, and no associated trauma was reported. The previous hybrid arthroplasty consisted of a ceramic femoral head articulating on an ultra-high-molecular-weight polyethylene liner. The unusual diagnosis of fractured ceramic femoral head was made and an urgent revision arthroplasty was performed to remove the ceramic bearing as well as all implants that may have come into contact with the ceramic. This case report highlights the material properties of ceramics in total hip arthroplasties as well as the importance of regular follow-up in these patients.©2014 BMJ Publishing Group. All rights reserved.


Hassaballa M.,Avon Orthopaedic Center | Artz N.,Avon Orthopaedic Center | Weale A.,Avon Orthopaedic Center | Porteous A.,Avon Orthopaedic Center
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2012

Purpose: Disturbance in skin sensation is a recognised, often unpleasant consequence of knee replacement for many patients and may affect function especially kneeling. The aim of this study was to compare post-operative changes in skin sensation following total (TKA) and unicompartmental knee (UKA) arthroplasties using three different incision types and its effect on kneeling ability. Methods: Skin sensation was recorded using a purpose-designed grid over the front of the knee in 72 patients (78 knees) following knee arthroplasty. Surface area of sensory change, length of incision, and kneeling ability were recorded and compared between three different types of incision; long antero-medial and midline for TKA, and short medial for UKA. Results: The average length of the long antero-medial incision was 19 ± 5 cm with an average area of sensory alteration of 88 ± 56 cm2. The average length of the midline incision was 18 ± 3 cm with an average area of sensory alteration of 57 ± 52 cm2. The short medial incision used for UKA averaged 11 ± 3 cm in length with an average area of sensory alteration of 54 ± 45 cm2. Long antero-medial produced a significantly greater area of sensory alteration than standard short medial (P = 0. 017), but not the midline incision. There was a significant positive correlation of incision length with reduced sensation. Patients unable to kneel demonstrated a significantly larger area of hypersensitivity than patients who could kneel (P = 0. 002). Conclusions: Increased length of incision results in a greater surface area of sensory change in the front of the knee. This finding was greatest in the long antero-medial incisions used in TKA. The inability to kneel following knee arthroplasty is associated with increased area of hypersensitivity of the anterior knee. Level of evidence: Prospective comparative study, Level II. © 2011 Springer-Verlag.


Howells N.R.,Avon Orthopaedic Center | Brunton L.R.,Avon Orthopaedic Center | Robinson J.,Avon Orthopaedic Center | Porteus A.J.,Avon Orthopaedic Center | And 2 more authors.
Injury | Year: 2011

Traumatic knee dislocations are uncommon yet serious injuries that historically have had variable prognosis. The evaluation and management of traumatic knee dislocations remains controversial. Appropriate early management has been shown to have a significant impact on long term functional outcome. A comprehensive review of the recent literature is presented alongside our current approach to management. The dislocated knee is an under diagnosed injury which relies on a high index of clinical suspicion on presentation of any knee injury. There is now a degree of consensus regarding need for surgery, timing of surgery, vascular investigations, surgical techniques and rehabilitation protocols. Vigilant monitoring for neurovascular complications, appropriate investigations and early involvement of surgeons with a specialist interest in knee ligament surgeries is the key to successful management of these difficult injuries. © 2010 Elsevier Ltd. All rights reserved.


PubMed | Osaka Rosai Hospital, MVZ Oberstdorf, Ghent University, Avon Orthopaedic Center and 4 more.
Type: | Journal: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA | Year: 2016

Many studies have reported satisfactory clinical outcomes and low redislocation rates after reconstruction of the medial patellofemoral ligament (MPFL) for the treatment of lateral patellar instability. Despite uncorrected severe trochlear dysplasia (Dejour type B to D) being acknowledged as a major reason for less favourable clinical outcomes and a higher incidence of patellar redislocations after an isolated MPFL reconstruction, the evidence for a deepening trochleoplasty procedure remains scarce in the current literature. The hypothesis of this systematic review and meta-analysis was that a deepening trochleoplasty in combination with an a la carte extensor apparatus balancing procedure provides lower redislocation rates and superior clinical outcomes than isolated MPFL reconstruction in patients with lateral patellar instability caused by severe trochlear dysplasia.A systematic review of the literature was conducted using specific inclusion and exclusion criteria for clinical studies reporting index operations (trochleoplasty and MPFL reconstruction) for the treatment of patellar instability caused by severe trochlear dysplasia. The Kujala score was analysed as the primary clinical outcome parameter in a random effects meta-analysis.Ten uncontrolled studies with a total of 407 knees (374 patients) were included in this analysis. The MPFL group comprised 4 studies with a total of 221 knees (210 patients), and the trochleoplasty group comprised 6 studies with a total of 186 knees (164 patients). The mean preoperative Kujala score ranged between 50.4 and 70.5 in the MPFL group and between 44.8 and 75.1 in the trochleoplasty group. The pooled Kujala score increased significantly by 26.4 (95% CI 21.4, 31.3; P<0.00001) points in the MPFL group and by 26.2 (95% CI 19.8, 32.7; P<0.00001) points in the trochleoplasty group. The post-operative patellar redislocation/subluxation rate was 7% in the MPFL group and 2.1% in the trochleoplasty group.This analysis found significant post-operative improvements in patient-reported outcomes for patients undergoing both an MPFL reconstruction and in those undergoing a trochleoplasty plus an individual extensor apparatus balancing procedure when assessed using the Kujala score. The likelihood of preventing the patella from subsequent post-operative redislocation/subluxation was, however, greater in patients who underwent trochleoplasty plus extensor balancing.IV.


Berstock J.R.,Avon Orthopaedic Center | Bunni J.,Great Western Hospital | Thorpe P.L.,Musgrove Park Hospital
Journal of Minimally Invasive Gynecology | Year: 2012

Anterior sacral meningocele is a rare cause of a pelvic mass. Herein the authors describe the case of a young patient presenting with chronic pelvic pain undergoing diagnostic laparoscopy. She was found to have a retrorectal mass confirmed as an anterior sacral meningocele on subsequent MRI. The authors explore the case, describe a method of intraoperative management to minimize the risk of severe complications and include a discussion of the differential diagnosis. Central to this is an emphasis on advocating a cautious approach when confronted with an incidental unknown pelvic mass, as deleterious consequences may occur from biopsy of such a lesion. © 2012 AAGL.

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