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McCarthy I.D.,UCL Institute of Orthopaedics and Musculoskeletal Science | Bloomer Z.,UCL Institute of Orthopaedics and Musculoskeletal Science | Gall A.,London Spinal Cord Injuries Center | Keen R.,UCL Institute of Orthopaedics and Musculoskeletal Science | Ferguson-Pell M.,University of Alberta
Spinal Cord | Year: 2012

Study design: A cross-sectional study. Objectives: To measure the change of structural and material properties at different sites of the tibia in spinal cord-injured patients using peripheral quantitative computerised tomography (pQCT). Setting: Orthopaedic research centre (UK). Methods: Thirty-one subjects were measured - eight with acute spinal cord injury (SCI), nine with chronic SCI and fourteen able-bodied controls. pQCT scans were performed at 2% (proximal), 34% (diaphyseal) and 96% (distal) along the tibia from the tibial plateau. Structural measures of bone were calculated, and volumetric bone mineral density (vBMD) was also measured at all three levels. Muscle cross-sectional area was measured at the diaphyseal level. Results: Structurally, there were changes in the cortical bone; in the diaphysis, the shape of the cross-section changed to offer less resistance to AP bending, and the cross-sectional area of the cortical shell decreased both proximally and distally. There were corresponding changes in vBMD in the anterior aspect of the cortical diaphysis, as well as proximal and distal trabecular bone. Changes in muscle occurred more rapidly than changes in bone. Conclusion: There were clear changes of both structure and material at all three levels of the tibia in chronic SCI patients. These changes were consistent with specific adaptations to reduced local mechanical loading conditions. To assess fracture risk in SCI and also to monitor the effect of therapeutic interventions, the structure of the bone should be considered in addition to trabecular bone mineral density. © 2012 International Spinal Cord Society All rights reserved. Source


Wong J.M.,UCL Institute of Orthopaedics and Musculoskeletal Science
Journal of perioperative practice | Year: 2013

Since the introduction of modern implants in the 1970s, total knee replacement surgery has been a great clinical and commercial success. Implants and techniques have continued to evolve, driven by the desire for improved function and longevity. However, inaccurate insertion of these implants may cause them to loosen and fail. Computer navigation has been introduced as a modification to existing surgical techniques to improve the accuracy with which the bones are cut prior to inserting the knee replacement implants. Research continues to see if this potentially costly and time consuming technique can contribute to improved longevity of knee replacements. Source


O'Dowd-Booth C.J.,UCL Institute of Orthopaedics and Musculoskeletal Science
Journal of perioperative practice | Year: 2011

Bone cement has been increasingly used in orthopaedic surgery over the last 50 years. Since Sir John Charnley pioneered the use of polymethylmethacrylate cement in total hip replacements, there have been developments in cementing techniques and an expansion in the number of orthopaedic procedures that use cement. This review covers the perioperative issues surrounding bone cement including storage, cementing techniques and complications. It also discusses specific orthopaedic applications of bone cement and future developments. Source


White J.J.,UCL Institute of Orthopaedics and Musculoskeletal Science
Journal of perioperative practice | Year: 2011

Hip fracture is a major cause of morbidity, mortality and loss of independence for the elderly. Surgical fixation of the fractured hip remains the standard of care to allow for early mobilisation and a return to independence. Operative management in this population carries its own set of problems. The altered physiological state of the older person, often coupled with significant comorbidity, can present challenges for the anaesthetist, the surgeon and the rest of the perioperative team. This article provides an evidence-based review of the important perioperative factors associated with hip fractures in the older person and their management. Source


Dhinsa B.,UCL Institute of Orthopaedics and Musculoskeletal Science
Journal of perioperative practice | Year: 2011

With the increasing use of oral anticoagulation therapy the appropriate management of perioperative anticoagulation is of surgical importance. There is a delicate balance between the risk of a perioperative thromboembolic event and the risk of operative bleeding from anticoagulation. Whilst there are a range of options available to the clinician, there appears to be no precise agreement about how to best manage this problem. Source

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