Baker P.N.,Northumbria University |
Petheram T.,Wansbeck General Hospital |
Avery P.J.,Newcastle University |
Gregg P.J.,James Cook University |
Deehan D.J.,Royal Infirmary
Journal of Bone and Joint Surgery - Series A | Year: 2012
Background: Unicompartmental knee arthroplasty has been associated with consistently worse implant survival rates than total knee arthroplasty in worldwide arthroplasty registers. The rate of revision and the proportion of revisions performed for unexplained knee pain after either a unicompartmental or total knee arthroplasty were studied to assess if there is evidence to support the hypothesis that the numbers of revisions performed for unexplained knee pain differ between these two implant types. Methods: Using data from the National Joint Registry (NJR) of England and Wales, we identified 402,714 primary knee arthroplasties (366,965 total knee arthroplasties and 35,749 unicompartmental knee arthroplasties) that were consecutively entered from April 2003 to December 2010. The status of all implants was assessed as of December 2010, at which time 6075 implants (4503 total knee implants and 1572 unicompartmental knee implants) had been revised at a maximum of eight years. Survival analysis and Cox regression analysis with adjustment of differences in age, sex, American Society of Anesthesiologists (ASA) grade, and indication for arthroplasty were performed with use of the end points of revision for any reason, revision for unexplained pain, and revision for other reasons. Results: Revision for unexplained pain was more common after unicompartmental knee arthroplasty than after total knee arthroplasty (representing 23% of revisions as compared with 9% of revisions; p < 0.001). The five-year rate of revision for unexplained pain was 1.6% for the unicompartmental knee arthroplasty group and 0.2% for the total knee arthroplasty group. With use of Cox regression, the hazard ratio (HR) for unicompartmental knee arthroplasty relative to total knee arthroplasty with the end points of revision for any reason, revision for unexplained pain, and revision for all other reasonswere 2.82 (95% confidence interval [CI], 2.66 to 2.99; p < 0.001), 6.76 (95% CI, 5.84 to 7.83; p < 0.001), and 2.39 (95% CI, 2.24 to 2.56; p < 0.001), respectively. The mean time from primary implantation to revision was similar for both implant types. Conclusions: While more unicompartmental knee implants than total knee implants were revised for unexplained pain, when these revisions for unexplained pain were discounted, unicompartmental knee arthroplasty still had a significantly greater risk of revision from other reasons than did total knee arthroplasty. The revision rate in isolation may not be a reliable way to compare different implant designs and should instead be considered in the context of the reason for failure. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2012 By The Journal of Bone and Joint Surgery, Incorporated.
Baker P.,Northumbria University |
Jameson S.,James Cook University |
Critchley R.,Wansbeck General Hospital |
Reed M.,Wansbeck General Hospital |
And 2 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2013
Background: Revision rates following unicondylar knee replacement vary among reporting institutions. Revision rates from institutions involved in the design of these implants and independent single-center series are comparable with those following total knee replacement, suggesting that higher operative volumes and surgical enthusiasm improve revision outcomes. Methods: This registry-based cohort study involved the analysis of 23,400 medial cemented Oxford unicondylar knee replacements for the treatment of osteoarthritis. Total center and surgeon operative volumes were calculated over an eight-year time span since the inception of the registry (April 2003 to December 2010). The revision rate was calculated according to center volume and surgeon volume, each of which was grouped into five categories. The groups were compared with use of life tables, Kaplan-Meier plots, and Cox regression models that adjusted for variations in age, sex, and American Society of Anesthesiologists (ASA) grade among the groups. Results: A total of 919 surgeons and a total of 366 centers performed at least one replacement, with the majority performing a small number of procedures. The revision rate for the centers with the lowest volume (fifty or fewer procedures over the eight-year study period) was 1.62 (95% confidence interval [CI], 1.42 to 1.82) revisions per 100 component years; this was significantly higher than the rate for the centers with the highest volume (more than 400 procedures), which was 1.16 (95% CI, 0.97 to 1.36) revisions per 100 component years. The five-year implant survival rate of 92.3% (95% CI, 91.2% to 93.3%) for the lowest-volume centers was significantly lower than the rate of 94.1% (95% CI, 93.0% to 95.2%) for the highest-volume centers. Similarly, the revision rate for the surgeons with the lowest volume (twenty-five or fewer procedures), 2.16 (95% CI, 1.91 to 2.41) revisions per 100 component years, was significantly higher than that for the surgeons with the highest volume (more than 200 procedures), 0.80 (95% CI, 0.62 to 0.98) revisions per 100 component years. The five-year survival rate of 90.1% (95% CI, 88.8% to 91.3%) for the lowest-volume surgeons was also significantly lower than the rate of 96.0% (95% CI, 95.0% to 97.0%) for the highest-volume surgeons. When center and surgeon volume were considered simultaneously, the hazard of revision was greater for lower-volume surgeons at lowervolume centers compared with higher-volume surgeons at higher-volume centers (hazard ratio = 1.87 [95% CI, 1.58 to 2.22], p < 0.001). Conclusions: High-volume centers and surgeons specializing in such procedures had superior results following unicondylar knee replacement compared with their low-volume counterparts. These results suggest that centers and surgeons should undertake a minimum of thirteen such procedures per year to achieve results comparable with the high-volume operators. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 By The Journal Of Bone And Joint Surgery, Incorporated.
Chummun S.,Frenchay Hospital |
Chummun S.,Wansbeck General Hospital |
McLean N.R.,Wansbeck General Hospital
Surgeon | Year: 2013
Introduction: This study describes our experience on the management of patients with PIP (Poly Implant Prothèse) breast implants between 2000 and 2008. Materials and methods: The medical records of patients were reviewed. Data was collected on clinical presentation, investigations, management and outcome. Results: 44 patients, with bilateral breast implants, and a median age of 33 years (18-54 years), were reviewed, and of these, 31 patients were asymptomatic. Symptoms at presentation included lymphadenopathy, capsule formation, breast lump, seroma and breast pain. Patients underwent mammography, ultrasound and MRI scanning of the breasts as part of the imaging investigations.5 patients declined explantation. Reasons for explantation included patient anxiety, silent rupture, aesthetic breast change, palpable nodes and breast lump.17 out of a total of 78 implants (21.8%) were noted to have ruptured; 2 had a simple tear and 15 were totally disintegrated. 1 patient underwent removal of the implants, 18 underwent exchange of implants, and 20 patients had a capsulotomy and exchange of implants. Postoperative complications included wound infection, seroma, axillary lymphadenopathy, hypersensitive scar and overgranulation of the wound. Conclusion: Our series confirms the high rate of PIP implant rupture (21.8%), the majority of which were asymptomatic. The main reasons for explantation were patient anxiety and silent rupture of implants. It is imperative that patients should be appropriately counselled, prior to surgery with regards to removal of the implants, given the increased rupture rates noted. © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland.
Malviya A.,Richard Villar Practice |
Malviya A.,Wansbeck General Hospital |
Stafford G.H.,Spire Cambridge Lea Hospital |
Villar R.N.,Spire Cambridge Lea Hospital
Journal of Bone and Joint Surgery - Series B | Year: 2012
The benefit of arthroscopy of the hip in the treatment of femoroacetabular impingement (FAI) in terms of quality of life (QoL) has not been reported. We prospectively collected data on 612 patients (257 women (42%) and 355 men (58%)) with a mean age at the time of surgery of 36.7 years (14 to 75) who underwent arthroscopy of the hip for FAI under the care of a single surgeon. The minimum follow-up was one year (mean 3.2 years (1 to 7)). The responses to the modified Harris hip score were translated using the Rosser Index Matrix in order to provide a QoL score. The mean QoL score increased from 0.946 (-1.486 to 0.995) to 0.974 (0.7 to 1) at one year after surgery (p < 0.001). The mean QoL score in men was significantly higher than in women, both before and one year after surgery (both p < 0.001). However, the mean change in the QoL score was not statistically different between men and women (0.02 (-0.21 to 0.27) and 0.04 (-0.16 to 0.87), respectively; p = 0.12). Linear regression analysis revealed that the significant predictors of a change in QoL score were pre-operative QoL score (p < 0.001) and gender (p = 0.04). The lower the pre-operative score, the higher the gain in QoL post-operatively (ñ = -0.66; p < 0.001). One year after surgery the QoL scores in the 612 patients had improved in 469 (76.6%), remained unchanged in 88 (14.4%) and had deteriorated in 55 (9.0%). ©2012 British Editorial Society of Bone and Joint Surgery.
Malviya A.,Wansbeck General Hospital |
Paliobeis C.P.,Hereford Hospital |
Villar R.N.,Spire Cambridge Lea Hospital
Clinical Orthopaedics and Related Research | Year: 2013
Background: Although a large number of athletes' returns to sports after hip arthroscopic surgery for femoroacetabular impingement (FAI), it is not clear if they do so to the preinjury level and whether professional athletes (PA) are more likely to return to the preinjury level compared with recreational athletes (RA). Questions/purposes: We therefore compared (1) the time taken to return to the preinjury level of sport between professional and recreational athletes; (2) the degree of improvement in time spent in training and competitive activities after arthroscopic surgery for FAI; and (3) the difference in trend of improvement in hip scores. Methods: We prospectively followed 80 athletes (PA = 40, RA = 40; mean age, 35.7 years; males = 50, females = 30; mean followup, 1.4 years; range, 1-1.8 years) who underwent hip arthroscopy for FAI. We measured the time to return to sports; training time and time in competition; and the modified Harris hip score and the nonarthritic hip score. Results: There was a 2.6-fold improvement in the training time (from 7.8 to 20 hours per week) and a 3.2-fold increase in time in competition (from 2.5 to 7.9 hours per week) 1 year after surgery. The mean time to return to sporting activities was 5.4 months, which was lower for PA (4.2) as compared with RA (6.8). Eighty-two percent (66) (PA = 88%  versus RA = 73% ) returned to their preinjury level of sport within 1 year of surgery. Conclusions: The data suggest PA may show quicker return to sports than RA but the hip scores and rate of return to sports are similar. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.
Abbas G.,Wansbeck General Hospital
Journal of orthopaedic surgery (Hong Kong) | Year: 2011
To assess periods required for resuming car driving in 130 patients who had undergone total hip replacement (THR). 80 men and 50 women aged 39 to 80 years who had been driving automatic (n=49) or manual (n=81) cars in the previous 3 months and underwent unilateral primary THR of the right (n=85) or left (n=45) hip were recruited. Patients were advised to resume driving after 6 weeks if they felt comfortable to do so. 105 (81%) patients were able to resume driving at week 6 to 8; 67 (64%) had had a right THR and 65 (62%) were manual car drivers. 22 (17%) patients were able to do so at week 12. The remaining 3 (2%) patients were not confident to drive even at week 12. No patient reported deterioration in driving ability, whereas 48 (38%) felt a subjective improvement in their driving ability. The time to resume driving varies in different patients. The advice should be individualised, depending on the patient's recovery and confidence level.
Raghavendra G.K.G.,Wansbeck General Hospital
Indian Journal of Surgery | Year: 2012
Peripheral arterial disease (PAD) is an important cause of morbidity and mortality in the world affecting up to 20% in people over 70 years of age. The prevalence is increasing in India due to combined effects of increased life expectancy, increased tobacco smoking and increased prevalence of diabetes mellitus. The aim of the study was to examine the hypothesis whether squatting posture reduces blood flow to lower limbs resulting in worsening of symptoms of lower limb ischemia in patients with PAD. 10 patients with arterial disorders due to thromboangiitis obliterans (TAO), atherosclerosis and diabetic macro vascular disease were selected for patients and were compared with 10 healthy volunteers as controls. Clinical examination and duplex scan of posterior tibial artery (PTA) and dorsalis pedis artery (DPA) performed in standing and squatting position in a clinical environment. They were asked about symptoms of numbness, ischemic pain and the results were noted. Results were tabulated and analysed using Microsoft Excel®. Members in the control group complained of numbness of both the limbs after a period of 30 min on an average. In the patients group, members while squatting complained of numbness in the involved limb within 5 min. They complained of ischemic pain in the involved limb within 10 min and developed numbness in the opposite limb in within 15 min. Posterior tibial artery and dorsalis pedis artery pulsations disappeared for the entire duration of squatting in both groups as confirmed by duplex scanning. It may be recommended that patients with established peripheral vascular disease should avoid squatting position, even if it is for a very short period of time. It is desirable to advice such patients to use appropriate structures as supports which will allow them to work without squatting. This may also necessitate a change in occupation. © 2011 Association of Surgeons of India.
Lakshmanan P.,Wansbeck General Hospital
Journal of orthopaedic surgery (Hong Kong) | Year: 2010
PURPOSE: To review the infection rate in 43 patients who underwent percutaneous Kirschner wire fixation for distal radius fractures. METHODS: Records of 13 men and 30 women aged 25 to 86 (mean, 49) years who underwent closed reduction and percutaneous Kirschner wire fixation for unstable distal radius fractures were reviewed. Each fracture was fixed with 2 to 3 wires of 1.6-mm diameter. Kirschner wires were left protruding through the skin for easy removal, with their ends bent outside the skin to prevent migration. Wounds were cleaned and dressed with gauze and a plaster-of-Paris cast was applied. The severity of the pin tract infection was graded according to the modified Oppenheim classification. RESULTS: Nine (21%) of the patients developed pin tract infection (3 grade 1, 3 grade 2, 2 grade 3, and one grade 4). Three patients underwent early removal of the Kirschner wires at week 3. CONCLUSION: The infection rate after percutaneous Kirschner wire fixation is unacceptable. Kirschner wires should be buried under the skin to decrease the infection rate.
Walker R.W.,North Tyneside General Hospital |
Chaplin A.,Wansbeck General Hospital |
Hancock R.L.,Northumbria University |
Rutherford R.,Northumbria University |
Gray W.K.,North Tyneside General Hospital
Movement Disorders | Year: 2013
The incidence of hip fracture and outcomes from hip surgery for people with Parkinson's disease (PD) are thought to be poorer than for people without PD. The aim of this audit of a prospective hip-fracture database was to establish the incidence of, and outcomes from, hip fracture in people with and without PD living in North East England. The number of people with PD living in the study area was estimated using data from two previous prevalence studies in the same geographical area. Using data collected prospectively for the National Hip Fracture Database for Northumbria Healthcare National Health Service Foundation Trust in the UK, the annual incidence of hip fracture in people with and without PD was calculated. Type of fracture, time to surgery, time to discharge, and 30-day outcomes from surgery were compared. Annual incidence of hip fracture was significantly higher in people with PD across all age bands. In those 60 years of age and over, it was 2,171 (95% confidence interval [CI]: 2,082-2,264) per 100,000 in people with PD and 551 (95% CI: 506-598) in people without PD. The experience of PD and non-PD patients within hospital was remarkably similar. However, PD patients had poorer mobility before hip fracture, took longer to be discharged to the community, and were less mobile postsurgery. Specific guidelines for managing people with PD who sustain a hip fracture may help to improve awareness of the potential complications of the condition and improve outcomes. © 2012 Movement Disorder Society.
Jensen C.D.,Wansbeck General Hospital |
Steval A.,Northumbria University |
Partington P.F.,Wansbeck General Hospital |
Reed M.R.,Wansbeck General Hospital |
Muller S.D.,Wansbeck General Hospital
Journal of Bone and Joint Surgery - Series B | Year: 2011
Rivaroxaban has been recommended for routine use as a thromboprophylactic agent in patients undergoing lower-limb arthroplasty. However, trials supporting its use have not fully evaluated the risks of wound complications. This study of 1048 total hip/knee replacements records the rates of return to theatre and infection before and after the change from a low molecular weight heparin (tinzaparin) to rivaroxaban as the agent of chemical thromboprophylaxis in patients undergoing lower-limb arthroplasty. During a period of 13 months, 489 consecutive patients undergoing lower-limb arthroplasty received tinzaparin and the next 559 consecutive patients received rivaroxaban as thromboprophylaxis. Nine patients in the control (tinzaparin) group (1.8%, 95% confidence interval 0.9 to 3.5) returned to theatre with wound complications within 30 days, compared with 22 patients in the rivaroxaban group (3.94%, 95% confidence interval 2.6 to 5.9). This increase was statistically significant (p = 0.046). The proportion of patients who returned to theatre and became infected remained similar (p = 0.10). Our study demonstrates the need for further randomised controlled clinical trials to be conducted to assess the safety and efficacy of rivaroxaban in clinical practice, focusing on the surgical complications as well as the potential prevention of venous thromboembolism. ©2011 British Editorial Society of Bone and Joint Surgery.