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Karthikeyan S.,University of Warwick | Roberts S.,Keele University | Roberts S.,Robert Jones and Agnes Hunt Orthopaedic Hospital | Griffin D.,University of Warwick
American Journal of Sports Medicine | Year: 2012

Background: Microfracture is a proven technique to treat articular cartilage defects in the knee. However, there is little evidence in the literature to confirm the ability of microfracture to produce repair tissue in the hip joint. Purpose: The purpose of this study was to report the macroscopic and microscopic appearances of repair tissue after microfracture performed at hip arthroscopic surgery for isolated full-thickness acetabular cartilage defects in patients with femoroacetabular impingement (FAI). Study Design: Case series; Level of evidence, 4. Methods: Twenty patients who underwent arthroscopic surgery for FAI had a localized full-thickness acetabular chondral defect treated by microfracture and then underwent a later second-look hip arthroscopic procedure. The size of the full-thickness defect was measured at the primary arthroscopic procedure. A visual assessment of the extent and quality of repair tissue was performed at second-look arthroscopic surgery. Two patients also had a biopsy of the repair tissue, which was studied histologically. Results: At an average follow-up of 17 months, 19 of the 20 patients had a mean fill of 96%±7% with macroscopically good quality repair tissue. One patient had only a 25% fill with poor quality repair tissue. Histologically, the tissue was found to be primarily fibrocartilage with some staining for type II collagen in the region closest to the bone. Conclusion: Microfracture in the hip appears to be an effective technique that produces excellent coverage of the defect with good quality repair tissue on visual inspection and microscopic examination at an average follow-up of 17 months. © 2012 The Author(s).


Morris G.E.,Robert Jones and Agnes Hunt Orthopaedic Hospital | Randles K.N.,Keele University | Randles K.N.,Hope Hospital
Biochemical Society Transactions | Year: 2010

The giant isoforms of nesprins 1 and 2 are emerging as important players in cellular organization, particularly in the positioning of nuclei, and possibly other organelles, within the cytoplasm. The experimental evidence suggests that nesprins also occur at the inner nuclear membrane, where they interact with the nuclear lamina. In this paper, we consider whether this is consistent with current ideas about nesprin anchorage and about mechanisms for nuclear import of membrane proteins. © The Authors Journal compilation.


Study design: A case report of a female patient who sustained injury to the thoracic spinal cord as a direct result of thoracolumbar selective nerve root block. Objective: To raise the awareness that selective nerve root infiltration, a very common procedure in a pre-existing deformity, may cause injury to the spinal cord with dire consequences, albeit rarely. Case report: An 82-year-old retired nurse (who had sustained osteoporotic compression fractures of the T12 vertebra) who presented with a 2-year history of continuous low back pain following a fall into a pothole. Immediately after image-guided, transforaminal infiltration of left side T12 root the patient developed sudden onset of complete motor and sensory T10 level flaccid paraplegia. No abnormality was noted on T2 magnetic resonance imaging (MRI) of the spine on the same day. Eleven days later, T2 MRI of the spine with gadolinium contrast revealed an increased fluid signal in conus medullaris. At 2-year follow-up, the neurological improvement has been good (L2 level American Spinal Injury Association/International Spinal Cord Society (ASIA/ISCoS) neurological standard scale (AIS) D paraplegia), urinary and sensory disorders are still present. Conclusion: Injury to the spinal cord is known to occur in interventions such as epidural steroid infiltrations. Over time, pain management in relation to the new and emerging interventions on spine have changed. What might not be appreciated is the awareness that such interventions may cause injury to the spinal cord with serious consequences. Despite potential occurrence, in the case reported here, the neurological and functional prognosis is good with an expert, early and appropriate management in a spinal injuries centre. © 2015 International Spinal Cord Society All rights reserved.


Carrothers A.D.,Robert Jones and Agnes Hunt Orthopaedic Hospital | Gilbert R.E.,Robert Jones and Agnes Hunt Orthopaedic Hospital | Richardson J.B.,Robert Jones and Agnes Hunt Orthopaedic Hospital
HIP International | Year: 2011

There is no published literature to support mid to long term results of hip resurfacing (HR) arthroplasty in patients over the age of 70 years. The purpose of our study was to evaluate the function HR in this age group (70 or older at the time of surgery) at medium to long term follow-up. Between July 1997 and November 2002, the Oswestry Outcome Centre independently and prospectively collected data on 5000 Birmingham Hip Resurfacings (BHRs). 106 had been implanted in elderly patients who were 70 years of age or older. The post-operative Harris and Merle D'Aubigné and Postel (MDP) hip scores and causes for revision were used to ascertain function and implant survival. Hip scores for the older BHR patients were compared with those from younger patients. The average age at surgery of the elderly BHR cohort was 73.2 years (range, 70.0 to 87.9 years) with a mean follow-up of 7.1 years (range, 0.5 to 10.9 years). Four patients had a femoral neck fracture and required conversion to a conventional total hip replacement. There were no patients lost to follow-up and no dislocations in this series. The median Harris hip score (HHS) was significantly better in the younger BHR group compared with the elderly BHR group, (96 vs. 94 p=0.008). There was no significant difference in recovery rates after surgery. There was a significantly higher rate of revision in women than men among the elderly patients (male= 1 of 65 (1.5%); women = 3 of 19 (15.8%), p=0.03). At latest follow-up the elderly patients continued to function well when compared with the younger BHR patients. There was a high mid to long term success rate after HR in patients who were 70 years of age or older, without the failure burden possibly anticipated. Elderly patients had a poorer functional outcome, but a difference in HHS of two points may be of only minor clinical significance. © 2011 Wichtig Editore.


Carrothers A.D.,Robert Jones and Agnes Hunt Orthopaedic Hospital | Gilbert R.E.,Robert Jones and Agnes Hunt Orthopaedic Hospital | Jaiswal A.,Robert Jones and Agnes Hunt Orthopaedic Hospital | Richardson J.B.,Robert Jones and Agnes Hunt Orthopaedic Hospital
Journal of Bone and Joint Surgery - Series B | Year: 2010

Despite the increasing interest and subsequent published literature on hip resurfacing arthroplasty, little is known about the prevalence of its complications and in particular the less common modes of failure. The aim of this study was to identify the prevalence of failure of hip resurfacing arthroplasty and to analyse the reasons for it. From a multi-surgeon series (141 surgeons) of 5000 Birmingham hip resurfacings we have analysed the modes, prevalence, gender differences and times to failure of any hip requiring revision. To date 182 hips have been revised (3.6%). The most common cause for revision was a fracture of the neck of the femur (54 hips, prevalence 1.1%), followed by loosening of the acetabular component (32 hips, 0.6%), collapse of the femoral head/avascular necrosis (30 hips, 0.6%), loosening of the femoral component (19 hips, 0.4%), infection (17 hips, 0.3%), pain with aseptic lymphocytic vascular and associated lesions (ALVAL)/metallosis (15 hips, 0.3%), loosening of both components (five hips, 0.1%), dislocation (five hips, 0.1%) and malposition of the acetabular component (three hips, 0.1%). In two cases the cause of failure was unknown. Comparing men with women, we found the prevalence of revision to be significantly higher in women (women = 5.7%; men = 2.6%, p < 0.001). When analysing the individual modes of failure women had significantly more revisions for loosening of the acetabular component, dislocation, infection and pain/ALVAL/metallosis (p < 0.001, p = 0.004, p = 0.008, p = 0.01 respectively). The mean time to failure was 2.9 years (0.003 to 11.0) for all causes, with revision for fracture of the neck of the femur occurring earlier than other causes (mean 1.5 years, 0.02 to 11.0). There was a significantly shorter time to failure in men (mean 2.1 years, 0.4 to 8.7) compared with women (mean 3.6 years, 0.003 to 11.0) (p < 0.001). ©2010 British Editorial Society of Bone and Joint Surgery.


Ockendon M.,Robert Jones and Agnes Hunt Orthopaedic Hospital
The journal of knee surgery | Year: 2012

Loss of full knee extension following anterior cruciate ligament surgery has been shown to impair knee function. However, there can be significant difficulties in accurately and reproducibly measuring a fixed flexion of the knee. We studied the interobserver and the intraobserver reliabilities of a novel, smartphone accelerometer-based, knee goniometer and compared it with a long-armed conventional goniometer for the assessment of fixed flexion knee deformity. Five healthy male volunteers (age range 30 to 40 years) were studied. Measurements of knee flexion angle were made with a telescopic-armed goniometer (Lafayette Instrument, Lafayette, IN) and compared with measurements using the smartphone (iPhone 3GS, Apple Inc., Cupertino, CA) knee goniometer using a novel trigonometric technique based on tibial inclination. Bland-Altman analysis of validity and reliability including statistical analysis of correlation by Pearson's method was undertaken. The iPhone goniometer had an interobserver correlation (r) of 0.994 compared with 0.952 for the Lafayette. The intraobserver correlation was r = 0.982 for the iPhone (compared with 0.927). The datasets from the two instruments correlate closely (r = 0.947) are proportional and have mean difference of only -0.4 degrees (SD 3.86 degrees). The Lafayette goniometer had an intraobserver reliability +/- 9.6 degrees. The interobserver reliability was +/- 8.4 degrees. By comparison the iPhone had an interobserver reliability +/- 2.7 degrees and an intraobserver reliability +/- 4.6 degrees. We found the iPhone goniometer to be a reliable tool for the measurement of subtle knee flexion in the clinic setting.


Roper H.,Birmingham Heartlands Hospital | Quinlivan R.,Robert Jones and Agnes Hunt Orthopaedic Hospital
Archives of Disease in Childhood | Year: 2010

The diagnosis of severe type 1 spinal muscular atrophy (SMA) should be confirmed by an expert in paediatric neuromuscular disease. Invasive investigations are not usually necessary as the diagnosis is confirmed with a DNA blood test. Care thereafter should be delivered close to home by a multidisciplinary team with a clear point of access during times of crisis. The aim of care is to keep the infant as well as possible with the best possible quality of life. There are many forms of active respiratory management which can help maintain the well-being of infants with severe type 1 SMA. These include approaches to reduce the risk of infection and aspiration and appropriate techniques of airway and secretion clearance. The use of non-invasive ventilation may be helpful for some, usually less-severely affected infants, particularly to assist extubation. Long-term invasive ventilation is not recommended. Active assessment of feeding and nutrition is vital, and most babies can be managed well with nasogastric feeds. Gastrostomy may be considered for some infants, but the benefits should be carefully weighed against the risks. It is vital to share information and formulate an anticipatory care plan with the infant's parents from the point of diagnosis.


Tins B.J.,Robert Jones and Agnes Hunt Orthopaedic Hospital | Butler R.,Robert Jones and Agnes Hunt Orthopaedic Hospital
Insights into Imaging | Year: 2013

Imaging in rheumatology was in the past largely confined to radiographs of the hands and sacroiliac joints (SIJs) helping to establish the diagnosis and then monitoring disease progression. Radiographs are not very sensitive for early inflammation in inflammatory rheumatic disorders and the demand on imaging services was therefore limited. However, over the last 10-15 years new drugs and new technologies have brought new challenges and opportunities to rheumatology and radiology as specialties. New drug treatments allow more effective treatment, preventing many complications. Early diagnosis and disease monitoring has become the challenge for the rheumatologist and radiologist alike. The best possible patient outcome is only achieved if the two specialties understand each other's viewpoint. This article reviews the role of imaging-in particular radiography, magnet resonance imaging, computer tomography, ultrasound and nuclear medicine-for the diagnosis and monitoring of rheumatological disorders, concentrating on rheumatoid arthritis, inflammatory spondylarthropathies and gout. Teaching Points • New drugs for the treatment of inflammatory disorders has led to greatly improved outcomes. • Imaging often allows for earlier diagnosis of inflammatory disorders. • Early diagnosis and treatment can often prevent the development of crippling disease manifestations. • Tailored imaging examinations are best achieved by consultation of rheumatologist and radiologist. © 2013 The Author(s).


Roberts A.,Robert Jones and Agnes Hunt Orthopaedic Hospital
Journal of Children's Orthopaedics | Year: 2013

Intractable and severe spasticity in childhood has the ability to impact on the quality of life, function and care of the child. Where medical and physical measures have proved insufficient, a surgical approach may be pursued. Irrespective of the underlying pathology, intrathecal baclofen will reduce spasticity in a controllable and reversible fashion, whereas selective dorsal rhizotomy is reserved for the management of bilateral cerebral palsy due to early birth. Owing to the potential for complications of intrathecal baclofen and the permanence of selective dorsal rhizotomy, careful selection and preparation are required to produce satisfactory results. © 2013 EPOS.


Roberts A.,Robert Jones and Agnes Hunt Orthopaedic Hospital
Paediatrics and Child Health (United Kingdom) | Year: 2012

Surgical management of cerebral palsy is a useful adjunct to physiotherapy and orthoses. Accurate management depends upon evaluation of the type of motor disorder present and a quantified assessment of function. The timing of surgery is dictated by growth and biology. Measures to manage spasticity need to be implemented before excessive deformity occurs whilst soft tissue deformity management is best deferred until there is less growth remaining. Excessive deformity in the middle years of childhood may require bony surgery to improve comfort, stability or function. Because of the complexity of the condition and the intimate relationship with growth, management has to be multidisciplinary and take a long-term view with the objective of the best functional and symptomatic outcome at skeletal maturity. © 2012 Elsevier Ltd.

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