Crichton J.,University of Manchester |
Jones D.R.,London Wasps Rugby Football Union Club |
Funk L.,Wrightington Hospital
British Journal of Sports Medicine | Year: 2012
Background: Shoulder injuries in rugby players are common, but the mechanisms of injury are less well understood. This study aims to elucidate common mechanisms of injury and identify the patterns of injury they produce. Materials and methods: Twenty-four elite rugby players, referred to the senior author for diagnosis and management of shoulder injuries, were selected. Videos of the injuries were independently reviewed by rugby-medical experts to describe the mechanisms of injury. The mechanisms reported were collated and analysed to determine the level of agreement between reviewers and conclude an overall description of injury mechanisms. Results: The authors identified three mechanisms of shoulder injury from the video analysis. These are the 'Try-Scorer', characterised by hyperflexion of the outstretched arm such as when scoring a try; the 'Tackler', extension of the abducted arm behind the player while tackling; and the 'Direct Impact', a direct blow to the arm or shoulder when held by the side in neutral or slight adduction. The Try Scorer and Tackler mechanisms both involve a levering force on the glenohumeral joint (GHJ). These mechanisms predominantly cause GHJ dislocation, with Bankart, reverse Bankart and superior labrum anterior-posterior tears. The Try-Scorer Mechanism also caused the majority (83%) of rotator cuff tears. The Direct Hit mechanism resulted in GHJ dislocation and labral injury in 37.5% of players and was most likely to cause acromioclavicular joint dislocation and scapula fractures, injuries that were not seen with the other mechanisms. Conclusion: Greater understanding of the mechanisms involved in rugby shoulder injury is useful in understanding the pathological injuries, guiding treatment and rehabilitation and aiding the development of injury-prevention methods.
Stevenson H.L.,Wrightington Hospital
The Journal of hand surgery, European volume | Year: 2013
Patients managed with upper limb cast immobilization often seek advice about driving. There is very little published data to assist in decision making, and advice given varies between healthcare professionals. There are no specific guidelines available from the UK Drivers and Vehicles Licensing Agency, police, or insurance companies. Evidence-based guidelines would enable clinicians to standardize the advice given to patients. Six individuals (three male, three female; mean age 36 years, range 27-43 years) were assessed by a mobility occupational therapist and driving standards agency examiner while completing a formal driving test in six different types of upper limb casts (above-elbow, below-elbow neutral, and below-elbow cast incorporating the thumb [Bennett's cast]) on both left and right sides. Of the 36 tests, participants passed 31 tests, suggesting that most people were able to safely drive with upper limb cast immobilization. However, driving in a left above-elbow cast was considered unsafe.
Parkinson R.W.,Park University |
Kay P.R.,Wrightington Hospital |
Rawal A.,Park University
Knee | Year: 2011
Infection in total knee replacement is a rare but devastating complication. The current literature tends to support a two-stage revision as definitive treatment of established deep infection. Despite the fact that single stage revision is a well recognised treatment for the infected hip replacement, it has not gained the same level of support in the knee.This article reviews the literature of two-stage and single stage revision and reports the senior author's experience with the latter. © 2010 Elsevier B.V.
Cash D.J.W.,Wrightington Hospital |
Khanduja V.,Addenbrookes Hospital
HIP International | Year: 2014
The optimum choice of bearing surfaces in total hip arthroplasty, particularly in the younger and more active patient, remains controversial. Despite several studies demonstrating good long-term results for the metal-on-polyethylene articulation, there has been a recent vogue towards the utilisation of hard-on-hard bearings for younger patients due, in part, to concerns regarding polyethylene induced osteolysis. However, well-documented complications concerning metal-on-metal bearings and the risk of fracture in ceramic-on-ceramic bearings have raised concerns regarding the principle of the hard-on-hard bearing in the active patient. With recent technological advancements in the manufacture of both polyethylene and alumina ceramics, the in vitro properties of each material with regards to strength and toughness have been significantly improved. In addition, ceramic femoral heads have consistently been shown to produce less in vivo polyethylene wear than similar sized metal heads. This paper aims to critically review the biomechanical, in vivo and clinical studies related to the use of the ceramic on polyethylene bearing, and highlights its potential use as the preferred bearing for a young adult hip replacement. © 2014 Wichtig Publishing-ISSN 1120-7000.
Ng C.Y.,Wrightington Hospital |
Watts A.C.,Wrightington Hospital
Journal of Bone and Joint Surgery - Series B | Year: 2012
Bone loss involving articular surface is a challenging problem faced by the orthopaedic surgeon. In the hand and wrist, there are articular defects that are amenable to autograft reconstruction when primary fixation is not possible. In this article, the surgical techniques and clinical outcomes of articular reconstructions in the hand and wrist using nonvascularised osteochondral autografts are reviewed. ©2012 British Editorial Society of Bone and Joint Surgery.
Funk L.,Wrightington Hospital
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2016
Rugby is a high-impact collision sport, with impact forces. Shoulder injuries are common and result in the longest time off sport for any joint injury in rugby. The most common injuries are to the glenohumeral joint with varying degrees of instability. The degree of instability can guide management. The three main types of instability presentations are: (1) frank dislocation, (2) subluxations and (3) subclinical instability with pain and clicking. Understanding the exact mechanism of injury can guide diagnosis with classical patterns of structural injuries. The standard clinical examination in a large, muscular athlete may be normal, so specific tests and techniques are needed to unearth signs of pathology. Taking these factors into consideration, along with the imaging, allows a treatment strategy. However, patient and sport factors need to be also considered, particularly the time of the season and stage of sporting career. Surgery to repair the structural damage should include all lesions found. In chronic, recurrent dislocations with major structural lesions, reconstruction procedures such as the Latarjet procedure yields better outcomes. Rehabilitation should be safe, goal-driven and athlete-specific. Return to sport is dependent on a number of factors, driven by the healing process, sport requirements and extrinsic pressures. Level of evidence V. © 2016, The Author(s).
Smith A.J.,University of Bristol |
Dieppe P.,University of Exeter |
Vernon K.,University of Bristol |
Porter M.,Wrightington Hospital |
Blom A.W.,University of Bristol
The Lancet | Year: 2012
Background: Total hip replacement (THR) is extremely common. Some prostheses fail, particularly in younger patients, and need to be revised, most commonly for loosening secondary to wear or dislocation. Surgeons have tried to address these problems by implanting large diameter metal-on-metal bearing surfaces. Our aim was to assess if metal-on-metal bearing surfaces lead to increased implant survival compared with other bearing surfaces in stemmed THR and, additionally, if larger head sizes result in improved implant survival. Methods: We analysed the National Joint Registry of England and Wales for primary hip replacements (402 051, of which 31 171 were stemmed metal-on-metal) undertaken between 2003 and 2011. Our analysis was with a multivariable flexible parametric survival model to estimate the covariate-adjusted cumulative incidence of revision adjusting for the competing risk of death. Findings: Metal-on-metal THR failed at high rates. Failure was related to head size, with larger heads failing earlier (3·2 cumulative incidence of revision [95 CI 2·5-4·1] for 28 mm and 5·1 [4·2-6·2] for 52 mm head at 5 years in men aged 60 years). 5 year revision rates in younger women were 6·1 (5·2-7·2) for 46 mm metal-on-metal compared with 1·6 (1·3-2·1) for 28 mm metal-on-polyethylene. By contrast, for ceramic-on-ceramic articulations larger head sizes were associated with improved survival (5 year revision rate of 3·3 [2·6-4·1] with 28 mm and 2·0 [1·5-2·7] with 40 mm for men aged 60 years). Interpretation: Metal-on-metal stemmed articulations give poor implant survival compared with other options and should not be implanted. All patients with these bearings should be carefully monitored, particularly young women implanted with large diameter heads. Since large diameter ceramic-on-ceramic bearings seem to do well we support their continued use. Funding: National Joint Registry of England and Wales. © 2012 Elsevier Ltd.
Wood P.L.R.,Wrightington Hospital |
Karski M.T.,Wrightington Hospital |
Watmough P.,Royal Bolton Hospital
Journal of Bone and Joint Surgery - Series B | Year: 2010
We describe the early results of a prospective study of 100 total ankle replacements (96 patients) at a single centre using the Mobility Total Ankle Replacement. At final review, six patients had died and five ankles (5%) had been revised, two by fusion and three by exchange of components. All remaining patients were reviewed at a minimum of three years. The mean follow-up was 43 months (4 to 63). The three-year survival was 97% (95% confidence interval (CI) 91 to 99). The four-year survival was 93.6% (95% CI 84.7 to 97.4). The portion of bony interface that was visible on plain radiograph was divided into 15 zones and a radiolucent line or osteolytic cavity was seen in one zone in 14 ankles. It was not seen in more than one zone. In five ankles it was > 10 mm in width. This study suggests that the early outcome of ankle replacement is comparable to that of other total joint replacements. ©2010 British Editorial Society of Bone and Joint Surgery.
Patel K.,Wrightington Hospital |
Raut V.,Wrightington Hospital
International Orthopaedics | Year: 2011
The aim of this study was to assess medium term results of patellar resurfacing in total knee arthroplasty, specifically looking at anterior knee pain, patellofemoral function and need for reoperation. A prospective cohort study was conducted with patients undergoing staged bilateral knee arthroplasty with the patella being resurfaced only on one side. This was due to change in the clinical practice of the senior author. Sixty patients were reviewed clinically and radiologically on a regular basis. The surgery was either performed or supervised by the senior author in all cases. All patients received the cemented press-fit condylar© prosthesis. The Knee Society clinical rating system was used. Scores were recorded pre-operatively and post-operatively at three months, one year, two years and three yearly thereafter. The mean age of patients in the study group was 75 years (range: 62-89 years). There were 42 women and 18 men in the study. The mean duration of follow-up was 4.5 years (range: 2-12 years). There was no significant difference in the pre-operative scores in both groups. There were significantly better scores (p<0.05) on the resurfaced side as compared to the non-resurfaced side at final follow-up. No revision was carried out for patellofemoral complications on the resurfaced side. Four patients required revision in the form of patellar resurfacing on the non-resurfaced side for persistent anterior knee pain. Patellar resurfacing is recommended in total knee arthroplasty for better functional outcome with regards to anterior knee pain and patellofemoral function. © Springer-Verlag 2010.
Nuttall D.,Wrightington Hospital |
Haines J.F.,Wrightington Hospital |
Trail I.A.,Wrightington Hospital
Journal of Shoulder and Elbow Surgery | Year: 2012
Background: Radiostereometric analysis measures the position of rigid bodies in 3 dimensions with very high precision and can be used to measure early micromotion of glenoid implants. Materials and methods: Radiostereometric analysis was used to measure migration of 11 partially cemented fluted pegged glenoid components in patients with osteoarthritis who underwent shoulder arthroplasty during a 2-year period. Patients were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores and by a computed tomography (CT) scan at the 2-year follow-up. Results: Migration patterns could be classified into 2 groups: The first group showed little if any migration, the second group rotated by 4° or more as early as 3 months after operation. The maximum total point motion reached up to 2 mm by the 6-month follow-up. At 12 months, the 2 groups could be identified by the presence or absence of focal lucency around the central peg. At the end of 2 years, CT scans were able to classify the same 2 migration patterns by the presence or absence of osseointegration around the cementless central peg of the glenoid implant. The clinical effect of the absence of osseointegration in this novel glenoid component is unknown because both groups had similar clinical results at 2 years. Conclusion: Rapid early migration associated with focal lucency and absence of osseointegration was observed in 6 of 11 components. We postulate that lack of initial fixation leads to early movement of the glenoid component and failure of osseointegration. © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.