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Tribe H.,Royal National Orthopaedic Hospital NHS Trust
Annals of the Royal College of Surgeons of England | Year: 2013

Oxinium™ (Smith & Nephew, Memphis, TN, US) has been used in hip arthroplasty since 2003. The surface coating is hard and provides low wear rates but if this surface coating is damaged, the soft metal core is at risk of accelerated wear. Previous reports have described accelerated wear following intra and postoperative hip dislocation. We report a case of advanced wear of an in situ Oxinium™ femoral head implant following a cracked acetabular liner. The liner had disengaged from the titanium shell, allowing the Oxinium™ head to articulate directly with the shell. The disengaged liner led to dislocation of the Oxinium™ head, with associated pronounced wear of the head and the acetabular cup. The patient had a successful revision procedure. We advise close follow-up of patients with Oxinium™ implants, especially if associated with dislocation and closed reduction.

Zaidi R.,Royal National Orthopaedic Hospital NHS Trust
The Journal of bone and joint surgery. American volume | Year: 2012

The focus on evidence-based medicine has led to calls for increased levels of evidence in surgical journals. The purpose of the present study was to review the levels of evidence in articles published in the foot and ankle literature and to assess changes in the level of evidence over a decade. All of the articles in the literature from the years 2000, 2005, and 2010 in Foot & Ankle International and Foot and Ankle Surgery, as well as all foot and ankle articles from The Journal of Bone and Joint Surgery (JBJS, American [A] and British [B] Volumes) were analyzed. Animal, cadaver, and basic science articles; editorials; surveys; special topics; letters to the editor; and correspondence were excluded. Articles were ranked by a five-point level-of-evidence scale, according to guidelines from the Centre for Evidence-Based Medicine. A total of 720 articles from forty-three different countries were analyzed. The kappa value for interobserver reliability showed very good agreement between the reviewers for types of evidence (κ = 0.816 [p < 0.01]) and excellent agreement for levels of evidence (κ = 0.869 [p < 0.01]). Between 2000 and 2010, the percentage of high levels of evidence (Levels I and II) increased (5.2% to 10.3%) and low levels of evidence (Levels III, IV, and V) decreased (94.8% to 89.7%). The most frequent type of study was therapeutic. The JBJS-A produced the highest proportion of high levels of evidence. There has been a trend toward higher levels of evidence in foot and ankle surgery literature over a decade, but the differences did not reach significance.

Datir A.,Jackson Memorial Hospital | Connell D.,Royal National Orthopaedic Hospital NHS Trust
Clinical Radiology | Year: 2010

Aim: To evaluate the role of computed tomography (CT) in needle placement for ganglion impar blocks, and to determine the efficacy of CT-guided ganglion impar blocks in the management of coccydynia. Materials and methods: The results of ganglion impar blockade in eight patients with coccydynia secondary to trauma or unknown cause were reviewed. The diagnosis of coccydynia was based on clinical history, location of pain, and response to previous diagnostic and therapeutic procedures. The eight patients were treated with CT-guided ganglion impar blocks to manage their coccyx pain after conservative procedures, including oral medication and cushions, failed to provide relief. All patients were subjected to ganglion impar blocks under a thin-section CT-guided technique for needle placement, using a mixture of bupivacaine and triamcinolone. The patients were followed-up for a period of 6-months. Results: Eight patients were treated in this study with a total of 11 injections. A technical success of 100% was achieved in all cases with accurate needle placement without any complications and all the patients tolerated the procedure well. Out of eight, three patients (37%) had complete relief of pain on the follow-up intervals up to 6 months. Three out of eight patients (37%), had partial relief of symptoms and a second repeat injection was given at the 3 month interval of the follow-up period. At the end of the 6-month follow-up period, six out of eight patients (75%) experienced symptomatic relief (four complete relief and two partial relief) without any additional resort to conventional pain management. Twenty-five percent (two out of eight) did not have any symptomatic improvement. The mean visual analogue score (VAS) pre-procedure was 8 (range 6-10) and had decreased to 2 (range 0-5) in six out of eight patients. Conclusion: CT can be used as an imaging method to identify the ganglion and guide the needle in ganglion impar blockade. The advantages of CT-guided injection over those performed under fluoroscopy may include accurate and confident needle placement in the sacro-coccygeal region, ease of wide area coverage, lesser risk of complications due to inadvertent injections into the major pelvic structures, and increased likelihood of reaching the ganglion impar, especially in cases with anatomical variation in the ganglion impar location. These factors may have implications in the overall success rate of ganglion impar blockade. © 2009 The Royal College of Radiologists.

Kampa R.J.,Sunnybrook Health science Center | Connell D.A.,Royal National Orthopaedic Hospital NHS Trust
International Journal of Clinical Practice | Year: 2010

Background:- Chronic tendinopathies are a common source of disability and can be recalcitrant to conservative measures, which once exhausted may necessitate operative intervention. Blood and platelets, in particular, are a rich source of factors necessary for tissue healing. Autologous blood injections (ABI) are thought to promote tendon healing, but have been explored clinically in only a few limited studies. However, recently they have attracted media attention in relation to the world of professional athletes and sports-related injuries. Method:- We review the evidence base for this technique using the available literature on PubMed. Conclusion:- Refractory chronic tendinopathy may be responsive to ABIs, but the data available to date are limited by quality and size of study, as well as length of follow up, and are currently insufficient to recommend this modality for routine clinical use. © 2010 Blackwell Publishing Ltd.

Douis H.,Royal National Orthopaedic Hospital NHS Trust | Saifuddin A.,Royal National Orthopaedic Hospital NHS Trust
Skeletal Radiology | Year: 2013

Chondrosarcoma is the third most common primary malignant bone tumour. There are various histological subtypes of chondrosarcomas, of which conventional intramedullary chondrosarcoma is by far the most common. Rarer sub-types include clear cell chondrosarcoma, myxoid chondrosarcoma, mesenchymal chondrosarcoma and dedifferentiated chondrosarcoma. Chondrosarcoma is also classified into central, peripheral and periosteal, dependent upon the lesion site, and into primary chondrosarcoma if the lesion arises de novo and secondary chondrosarcoma if the tumour arises in a pre-existing lesion. The various subtypes of chondrosarcoma have characteristic imaging features that may aid diagnosis and may guide biopsy, therefore potentially preventing misdiagnosis. The aim of this article is to provide an overview of the pertinent clinical and imaging findings of the different forms of chondrosarcoma. © 2012 ISS.

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