The Oxford mobile bearing unicompartmental knee replacement (UKR) is a validated, highly successful implant with an excellent ten-year survivorship. From November 2001 to September 2006 three hundred and eighty two patients who had a medial cemented Oxford Unicompartmental knee replacement (Biomet, Bridgend, UK) via a minimally invasive approach were prospectively entered into a database and followed up as per departmental policy in the specialist joint assessment clinic. We have noted a minority of patients have persistent postoperative pain and/or mechanical symptoms resistant to the standard postoperative therapies. We report the outcome of 22 patients who had an arthroscopy for persistent pain and/or mechanical symptoms a median of 15 months (range 4 months – 31 months) following medial unicompartmental knee replacement. The median follow up time following arthroplasty was 38 months (range 16 months – 63 months). Post arthroscopy we divided our study patients into two groups; those who had an improvement in symptoms and those who had none. These groups were then compared, with particular reference to demographics, check radiographs and arthroscopic findings. The results showed that patients with anterior or anteromedial symptoms in whom a medial rim of scar tissue was identified and debrided sixty seven percent had a significantly increased probability of symptomatic improvement (p<0.005). In addition men appeared to significantly improve more that women (p<0.043). When performed this therapeutic intervention many prevent or at least defer the need for early revision to total knee replacement in some cases and we have no complications as a result of the arthroscopic intervention. This observational study provides evidence for a role for arthroscopy in selected patients with pain following unicompartmental knee replacement.
In suspected scaphoid fracture the initial scaphoid series plain radiographs are 84-94% sensitive for scaphoid fractures. Patients are immobilised awaiting diagnosis. Unnecessary lengthy immobilisation leads to lost productivity and may leave the wrist stiff. Early accurate diagnosis would improve patient management. Although Magnetic Resonance Imaging (MRI) has come to be regarded as the gold standard in identifying occult scaphoid injury, recent evidence suggests Computer Tomography (CT) to be more accurate in identifying scaphoid cortical fracture. Additionally CT and USS are frequently a more available resource than MRI. We hypothesised that 16 slice CT is superior to high spatial resolution Ultrasonography (USS) in the diagnosis of radiograph negative suspected cortical scaphoid fracture and that a 5 point clinical examination will help to identify patients most likely to have sustained a fracture within this group. 100 patients with two negative scaphoid series and at least two out of five established clinical signs of scaphoid injury (anatomical snuffbox tenderness (AST), scaphoid tubercle tenderness (STT), effusion, pain on circumduction and pain on axial loading) were prospectively investigated with CT and USS. MRI was arranged for patient with persistent symptoms but negative CT/USS.Background
Methods
A number of measurements of patella height exist all of which use a position on the tibia as a reference. The Patellotrochlear Index has recently been proposed as a more accurate reflection of the functional height of the patella and described in normal knees. We aimed to compare patellar height measurements in patients with patellofemoral dysplasia. In a retrospective analysis of the MRI scans of 33 knees in 29 patients with patellofemoral dysplasia we assessed the inter- and intraobserver reliability of four patellar height measurements: the Patellotrochlear Index (PTI), Insall-Salvati (IS), Blackburne-Peel (BP) and Caton-Deschamps (CD) ratios. We also assessed the correlation between the different measurements in predicting patella alta. Three blinded observers on two separate occasions performed the measurements. There were 21 females and 8 males with a mean age of 21.4 years (13–33). Statistical analysis revealed good inter-observer reliability for all measurements (0.78 for PTI, 0.78 for IS, 0.73 for BP and 0.77 for CD). Intra-observer reliability was also good (0.80, 0.83, 0.75, 0.78 respectively). When comparing the different measurements for patella alta there was a weak correlation between the PTI and the others. There was a strong correlation between the CD and BP ratios (0.96) and a moderate correlation between IS and CD and IS and BP ratios (0.594 and 0.539 respectively). All measurements are reproducible. The PTI however suggests patella alta exists in different patients to that suggested by the established measures. We propose the PTI as a more clinically relevant measure.
A number of measurements of patellar height are in clinical use all of which reference from the tibia. The patellotrochlear index has been proposed recently as a more accurate reflection of the functional height of the patella and described in normal knees. We compared patellar height measurements in patients with patellofemoral dysplasia. In a retrospective analysis of the MRI scans of 33 knees in 29 patients with patellofemoral dysplasia we assessed the inter- and intraobserver reliability of four patellar height measurements: the recently described Patellotrochlear Index (PTI), Insall-Salvati (IS), Blackburne-Peel (BP) and Caton-Deschamps (CD) ratios. We also assessed the correlation between the different measurements in predicting patella alta. Three blinded observers on two separate occasions performed the measurements. There were 21 females and 8 males with a mean age of 21.4 years (13–33). Statistical analysis revealed good inter-observer reliability for all measurements (0.78 for PTI, 0.78 for IS, 0.73 for BP and 0.77 for CD). Intra-observer reliability was also good (0.80, 0.83, 0.75, 0.78 respectively). There was weak correlation between the PTI and the other ratios for patella alta. There was a strong correlation between the CD and BP ratios (0.96) and a moderate correlation between IS and CD and IS and BP ratios (0.594 and 0.539 respectively). We propose the PTI as a more clinically relevant measure.
Many radiographic techniques have been described for measuring patellar height. They can be divided into two groups: those that relate the position of the patella to the femur (direct) and those that relate it to the tibia (indirect). This article looks at the methods that have been described, the logic behind their conception and the critical analyses that have been performed to test them.
A number of measurements of patella height exist all of which use a position on the tibia as a reference. The Patellotrochlear Index has recently been proposed as a more accurate reflection of the functional height of the patella and described in normal knees.
Statistical analysis revealed good inter-observer reliability for all measurements (0.78 for PTI, 0.78 for IS, 0.73 for BP and 0.77 for CD). Intra-observer reliability was also good (0.80, 0.83, 0.75, 0.78 respectively). When comparing the different measurements for patella alta there was a weak correlation between the PTI and the others. There was a strong correlation between the CD and BP ratios (0.96) and a moderate correlation between IS and CD and IS and BP ratios (0.594 and 0.539 respectively).
The aim of this study was to find out whether distal radius fractures treated by K wire fixation loose reduction after wire removal and analyze the variables may influence this. Patients who underwent K wire fixation for unstable fractures of distal radius over a period of 3 years were included in this retrospective study. Fractures were classified according to AO classification. Radiographs taken just prior to removal of K wires and radiographs taken at least 1 month after wire removal were analyzed to study three radiological parameters; Palmar or dorsal tilt, radial inclination and ulnar variance. Loss of these angles was analyzed statistically against variables like age, sex, AO classification, type of K wires used, delay in fixation and duration of fixation. 59 fractures were analyzed with mean age of 56 years and male to female ratio of 1:2. Average loss of radial tilt was 2.6 deg, loss of palmar tilt was 2.6 deg and loss of ulnar variance was 1.3 mm. We found that distal radius fractures treated by percutaneous K wire fixation, do not suffer significant loss of reduction of fracture position after removal of wires. This remains true regardless of age, sex, fracture type according to AO type, type of wires used, delay in fixation or duration of wire fixation.
1) To determine the predictive value of a simple stability test in children’s wrist fractures treated with simple manipulation and plaster of Paris (PoP) cast immobilisation. 2) To determine the effect of cast quality as reflected in the skin cast distance (distance between the cast and the skin in the plane of major displacement or angulation) and the cast index (the inside diameter of the cast in the sagittal plane divided by the inside diameter in the coronal plane) on re-displacement rates in children’s wrist fractures treated with simple manipulation and plaster of Paris (PoP) cast immobilisation.
The management of patients with a painful total knee replacement requires careful assessment and a stepwise approach in order to diagnose the underlying pathology accurately. The management should include a multidisciplinary approach to the patient’s pain as well as addressing the underlying aetiology. Pain should be treated with appropriate analgesia, according to the analgesic ladder of the World Health Organisation. Special measures should be taken to identify and to treat any neuropathic pain. There are a number of intrinsic and extrinsic causes of a painful knee replacement which should be identified and treated early. Patients with unexplained pain and without any recognised pathology should be treated conservatively since they may improve over a period of time and rarely do so after a revision operation.
Evaluation of patients with painful total knee replacement requires a thorough clinical examination and relevant investigations in order to reach a diagnosis. Awareness of the common and uncommon problems leading to painful total knee replacement is useful in the diagnostic approach. This review article aims to act as a guide to the evaluation of patients with painful total knee replacement.
Age more than 65 years (p value 0.006), comminuted distal radius fracture [A3 or C3 in AO classification] (p value 0.049) and associated ulnar fracture (p value 0.013) were the variables found to have statistically significant correlation with poor radiological outcome.
Clinical improvement was better in the control group compared to the study group. Patients with isolated bone bruising were doing better than those with associated internal derangement. On radiological examination there was tendency for the bone bruise to progress in the first six weeks but majority started resolving by three months time. All isolated BB were resolved by six months, but there was delayed resolution of BB associated with ID. Weight-bearing status did not influence clinical or radiological course of bone bruising.
Clinical improvement was better in the control group compared to the study group. Patients with isolated bone bruising were doing better than those with associated ID. Radiololgically there was a tendency for the bone bruise (BB) to progress in the first six weeks but the majority started resolving by three months time. All isolated BB were resolved by six months but there was delayed resolution of BB associated with internal derangement. Weight bearing status did not influence clinical or radiological course of bone bruising.
The aim of this study was to evaluate the analgesic effect of extracorporeal shock wave lithotripsy (ESWL) in patients with refractory tennis elbow, golfer’s elbow and plantar fasciitis. Patients with tennis elbow (34), golfer’s elbow (11) and plantar fasciitis lesions (14) who had not responded to a minimum of six months’ conservative treatment were included in this three-year study of ESWL. Patients who were pregnant or had neurological problems, coagulation disorder and tumour in the area of treatment were excluded. Patients received 2 000 shock waves of 0.04 to 0.12 mj/mnf three times at monthly intervals. Patients were followed up for a minimum of six months and maximum of 36 months. The effectiveness of ESWL was assessed in terms of improvement in duration and severity of pain, functional disability, complication of treatment and recurrence. Good or excellent results were achieved in 67.65% of patients with tennis elbow, 45.45% with golfer’s elbow and 71.42% with plantar fasciitis. ESWL seems a useful treatment option, as effective administered monthly as weekly. Its effectiveness in cases of golfer’s elbow in questionable.
