Aims

In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this. The secondary aim of this study was to describe the barriers to making sustainable changes within orthopaedic surgery.

Aims

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common orthopaedic procedures requiring postoperative radiographs to confirm implant positioning and identify complications. Artificial intelligence (AI)-based image analysis has the potential to automate this postoperative surveillance. The aim of this study was to prepare a scoping review to investigate how AI is being used in the analysis of radiographs following THA and TKA, and how accurate these tools are.

Aims

The aims of this study were to assess mapping models to predict the three-level version of EuroQoL five-dimension utility index (EQ-5D-3L) from the Oxford Knee Score (OKS) and validate these before and after total knee arthroplasty (TKA).

This is a prospective study looking at 116 consecutive total hip replacements in 110 patients using the C-Stem total hip replacement system (Depuy International, Leeds, UK) between March 2000 and October 2002. This is the first documented study of results of the C-Stem outside Wrightington Hospital where it was developed.

There were 69 females and 41 male patients. Average age was 66 years (Range 32 – 89 years). 64 patients had a right hip replacement, 52 patients had a left hip replacement and 6 were bilateral. The duration of follow up was from 24 to 55 months, with an average of 38.75 months.

All patients had a cemented C-stem via a posterior approach. 107 with a metal head and 9 with a ceramic head. Cemented, all polyethylene cups were used. 82 hips had an Opera cup inserted and 34 had an Ogee cup inserted. Palacos R with Gentamicin was used for the cement.

103 femoral stems were neutral.12 stems were in varus (5–10 degrees) and 1 stem was in valgus (5–10degrees). No stems were greater than 10 degrees in either direction. There were no lucencies in any of the zones described by Gruen. The average amount of subsidence of the stem was 0.86mm (range 0–4mm).

The average cup angle was 44.29 degrees (SD = +/− 4.85). 8 acetabular components had a 0.5mm lucent area in zone 1 and 2 acetabular components had 1mm lucent area in zone 1. All of these lucencies were present on the immediate postoperative x-ray and none were progressive.

There were no lucencies in the other zones. There have been no incidences of deep infection, fatal P.E, dislocation or revision.

We conclude that the C-Stem has produced excellent results in the short term in keeping with the criteria of the NICE guidelines.

Bladder catheterisation following joint arthroplasty is not uncommon but delaying catheterisation in the postoperative period until the patient is symptomatic can produce an atonic bladder due to the distension. This can prolong catheterisation and increase the risk of urinary tract infection. We prospectively determined if we could identify patients needing pre-operative catheterisation.

Method: 150 consecutive patients undergoing knee and hip arthroplasty were recruited. Pre-operative symptoms of frequency, nocturia, retention, incontinence and previous bladder or prostate surgery along with prior history of catheterisation were recorded. The type of anaesthesia and post-operative analgesia was noted. Details of catheterisation included duration, antibiotic administration, and reason for catheterisation and incidence of urinary tract infection.

Results: Patients mean age was 67.7 years. 47 patients required catheterisation of which 56.6% were female. The mean age of patients catheterised was 70.6 years in comparison to 66.3 years (Mann-Whitney P< 0.01). The frequency of catheterisation was unrelated to the surgical procedure.

Nocturia was significantly more common in-patients requiring catheterisation (Kruskal Wallis P=0.04) and its combination with pre-operative symptoms of frequency, retention or incontinence increased the significance further to P=0.001.

Patient age of greater then 66 years had a 76.6% predictive value for the subsequent need of catheterisation. This further increased to 91.5% when combined with a previous history of either catheterisation or nocturia. The type of anaesthesia or the post-operative analgesia did not significantly influence catheterisation frequency.

Conclusion: Patients aged greater then 66 years undergoing joint arthroplasty with previous history of catheterisation or nocturia may benefit from pre-operative bladder catheterisation. Peri-operative catheterisation of high-risk patients in theatre reduces patient discomfort caused by the observation period and avoids bladder atonia consequent of the distention, which may subsequently prolong catheterisation.

Aims: As part of the guidelines recommended by NICE (National Institute of Clinical Excellent), we are presenting the early results of this new hip replacement component.

Methods: We reviewed 65 consecutive primary total hip replacements in 59 patients in which the Opera Flanged cemented acetabular component (smith & nephew) had been used. The mean follow-up was 47 months (36 to 63). In all cases a Charnley femoral prosthesis had been used. There were 39 women and 26 men with a mean age at operation of 67.4 years (33 to 90). Survival analysis of the acetabular components was performed.

Results: Two components were revised due to deep infection, and one of these cups was discovered to be well fixed at operation. None of the acetabular components required revision for aseptic loosening. After 5 years survival was 97% using the worst-case scenario. Radiological analysis of all acetabular components at 12 months post-operation and at yearly intervals revealed no cases of aseptic loosening. Radiolucencies around the cemented socket were noted in five patients, but were not progressive on sequential radiographs.

Conclusions: The early results are encouraging and the follow-up will be continued to assess the 10 years results.

We have studied the relationship between movements of the foot and ankle and venous blood flow from the lower limb using colourflow Duplex ultrasound to determine the optimum type of exercise for promoting venous return. Studies of both active and passive movements were carried out on 40 limbs in 20 subjects (18 men; 2 women), with a median age of 27 years (20 to 54). We assessed ankle dorsiflexion and plantar flexion, subtalar inversion and eversion, and a combination of all movements.

There was no difference in venous flow when comparing opposite limbs in a single subject (p > 0.5), but active exercises produced higher peak and mean velocities of blood flow than passive ones. The active combined movement produced the highest velocities with an increase of 38% in mean and of 58% in peak flow velocities, which were significantly greater than the peak and mean flow rates produced by passive movements. The active combined exercise would therefore be the most effective in eliminating stasis and could contribute to the prevention of deep-vein thrombosis.

Between 1981 and 1986 two groups of patients received either Charnley low-friction arthroplasties or the Wrightington Frusto-Conical hip replacement with otherwise identical management before and after operation. There were 260 consecutive replacements in 215 patients in the first group and 260 consecutive procedures in 211 patients in the second. Both components of each design were cemented and featured a 22.25 mm femoral head, but the geometry of the stems differed.

Of the patients lost to follow-up, 16 (18 hips) were in the Wrightington series and 24 (36 hips) in the Charnley series, and of those who have died 20 (23 hips) were Wrightington and 14 (16 hips) were Charnley. All surviving patients have been followed up clinically and radiologically or until revision was necessary. The mean length of follow-up for original surviving components in both series was 140 months (120 to 180).

Pain, function and movement were measured by the grading system of Merle D’Aubign′e and Postel and showed a marked improvement in both groups. There was little or no pain in 98% of patients in the Wrightington series and 96% in the Charnley series, while 93% and 85%, respectively, were entirely painfree. Trochanteric osteotomy was used in 292 cases overall, with a complication rate of 13% due to wire breakage, trochanteric bursitis or trochanteric detachment, requiring a further operation in 5.8% (17 hips). Heterotopic ossification was seen in 40% of cases in which trochanteric osteotomy had been performed (117 hips) but only 3% (10 hips) had clinically significant changes. After the direct lateral approach heterotopic ossification was seen in 24% (42 hips) with only 2% in class 3 or 4 (4 hips). Femoral osteolysis was more common in the Charnley series, occurring in 7.6% of cases (17 hips) as opposed to 2.1% (5 hips) in the Wrightington series.

Ten acetabular and seven femoral components have been revised in the Wrightington series and 16 acetabular and 11 femoral implants in the Charnley series. Survivorship based on revision for aseptic loosening using the Kaplan-Meier technique showed survival of the femoral implant at 5, 10 and 15 years of 100%, 99% and 98%, respectively in the Wrightington and 100%, 99% and 87% in the Charnley series. The survival of the acetabular component at 10, 12 and 15 years respectively, was 100%, 99% and 95% for the Wrightington, and 99%, 98% and 84% for the Charnley.

The survival of both the acetabular and femoral components of the Wrightington system at a mean of 11.7 years was better than that of the Charnley system, with a lower incidence of radiological loosening of unrevised components.