The management of peri-prosthetic distal femur fractures following TKR (Total Knee Replacement) in the elderly remains a challenge with little or no consensus on the best available treatment. Various methods have been described in the management of these complex fractures. Our study compares the outcome and cost of distal femoral arthroplasty to that of Fixation (Plating/Retrograde Nailing). We retrospectively reviewed our database for patients admitted with peri-prosthetic distal femoral fractures between 2005–2013 (n=61). The patients were stratified into 2 groups based on method of management. The Distal Femoral Arthroplasty group (Group A) had 21 patients, with a mean age of 78 years (68–90. The Fixation group (Group B) had 40 patients, with a mean age of 74 years, 23 of those had plating of the fracture, while 17 had a retrograde nail inserted. Pain scores, Length of stay, intra-operative blood loss, and weight bearing status, were compared. Functional outcomes were also assessed using Oxford knee scores, KSS scores, VAS pain assessment and range of motion from last follow up appointment. Minimum follow-up was 2 years. Cost analysis was done for both groups, which included implant costs, consumable costs (man power included), theatre utilisation time and length of hospital stay. The calculation was done based on the PbR (payment by results) system and “best practise tariffs 2010–11” utilised by the NHS (National Health Service) in England.Introduction
Methods
Hospital acquired MRSA is globally endemic and is a leading cause of surgical site infection (SSI). Of great concern is the emergence of community acquired MRSA (CA MRSA) with its unique virulence characteristics. Infected hip or knee prostheses due to MRSA are associated with multiple reoperations and prolonged hospital stay. Few studies have been done to assess for risk of SSI in MRSA carriers undergoing elective orthopaedic surgery following decolonisation. However in these studies, the eradication status was not confirmed prior to proceeding for surgical intervention. The purpose of the study was to evaluate the incidence of SSI in MRSA carriers undergoing elective hip and knee arthroplasty, who had confirmed eradication of MRSA carrier status and to compare it with incidence of SSI in non MRSA carriers.Background
Aim
Avulsion of abductors from hip is a debilitating complication after total hip arthroplasty performed through a trans-gluteal approach. It results in intractable pain, Trendelenberg limp and instability of the hip. Techniques described for repairing these abductor tears including direct trans osseous repairs, endoscopic repair techniques, Achilles tendon allograft, Gluteus Maximus and Vastus Lateralis muscle transfers. The aim of our study was to assess improvement in pain, limp and abductor strength in patients operated upon surgically for confirmed abductor avulsion using a modified trans osseous repair and augmentation of repair with a Graft Jacket allograft acellular human dermal matrix (Graft jacket; Wright Medical Technology, Arlington, TN). In this prospective study we include 18 consecutive patients with hip abductor avulsions following a primary total hip arthroplasty through Hardinge approach for osteoarthritis. All the patients presented with pain around lateral aspect of hip, walking with a significant Trendelenberg limp and used a crutch or a stick in the opposite hand. Diagnosis was made by clinical examination and confirmed by MRI scans.Introduction
Patients and Methods
