Pes cavovarus is a foot deformity that can be idiopathic (I-PC) or acquired secondary to other pathology. Charcot-Marie-Tooth disease (CMT) is the most common adult cause for acquired pes cavovarus deformity (CMT-PC). The foot morphology of these distinct patient groups has not been previously investigated. The aim of this study was to assess if morphological differences exist between CMT-PC, I-PC and normal feet (controls) using weightbearing computed tomography (WBCT). A retrospective analysis of WBCT scans performed between May 2013 and June 2017 was undertaken. WBCT scans from 17 CMT-PC, 17 I-PC and 17 healthy normally-aligned control feet (age-, side-, sex- and body mass index-matched) identified from a prospectively collected database, were analysed. Eight 2-dimensional (2D) and three 3-dimensional (3D) measurements were undertaken for each foot and mean values in the three groups were compared using one-way ANOVA with the Bonferroni correction.Introduction
Methods
The National Joint Registry (NJR) was established in 2003, and was extended to include ankle arthroplasty on 1st April 2010, and shoulder and elbow arthroplasty in April 2012. The aim of this study was to evaluate the uptake of the NJR for ankle arthroplasty over its first 3 years. This is compared to the first 3 years of hip and knee data, and the first year of shoulder and elbow data. The methods of measuring compliance are also evaluated. NJR compliance is measured by comparing the number of procedures submitted to the NJR, against the number of levies raised through implant sales. This applies to all of the UK, and both independent and NHS providers. However, compliance can also be measured by comparing NJR submissions with data submitted to the Hospital Episode Statistics (HES) database. This only relates to NHS institutions in England. The NJR ankle data was compared to implant data, and adjusted to compare to HES data, to evaluate the different methods of measuring compliance. We also compared these figures with the first 3 years for hip and knee arthroplasties and the first year for shoulder and elbow arthroplasties. In 2011 there were 493 arthroplasties and the compliance was 64% against industry data. In 2012 there were 590 procedures with compliance improved to 77% against industry data. When adjusting NJR to compare with HES data, the compliance was 87% in 2012., with 507 ankle arthroplasties registered with the NJR and 582 on HES data. The reasons for this discrepancy are discussed. The specific difficulties of capturing ankle revisions are discussed, as some get revised to arthrodeses. The uptake is significantly higher than the first year for all other joints (shoulders 52%, hips 57%, knees 57%, and elbows 60%).Results:
Venous thromboembolism (VTE) represents a major cause of morbidity, mortality and financial burden to the NHS. Acquired risk factors are well documented, including immobilisation, lower limb plaster cast and surgery. NICE guidance on VTE prophylaxis within orthopaedics currently excludes operative ankle fracture fixation (ankle ORIF). Ascertain the local incidence of VTE; compare our local VTE rates with published data from other institutions; review guidelines, scientific literature and other hospitals policies; formulate a local policy for VTE prophylaxis.Introduction
Aims
Survival of patients with high-grade osteosarcoma has significantly improved with combined multi-agent chemotherapy and aggressive local surgical control. However, despite modern therapy, approximately one-third recur and those that do recur are difficult to treat successfully. The recurrence of osteosarcoma is rare. Local recurrence occurs in 4–10% of patients following effective treatment. This report details a lady with local recurrence of osteosarcoma seventeen years following initial presentation. She was diagnosed with an osteosarcoma with both chondroblastic and osteoblastic differentiation of the right ilium in November 1989 (aged 41). There were no distant metastases. She received one cycle of neo-adjuvant chemotherapy (PIA) prior to a right hemipelvectomy in April 1990. Six weeks post excision, she underwent a hemipelvic and proximal femoral replacement. She received 5 cycles of adjuvant (PIA) chemotherapy. Post-operative recovery was complicated by infection leading to formation of a discharging sinus. Despite exploration and an external oblique rotation graft, the sinus continued to discharge and the femoral and pelvic prostheses were removed in March 1994. She mobilised with the use of two crutches and functioned extremely well. She was not keen for reinsertion of a prosthesis and remained on yearly follow-up until 2000. In June 2007, she presented to her general practitioner with dull right iliac fossa pain. She was referred back to our service and examination revealed a mass in the right iliac fossa. This was biopsied and demonstrated locally recurrent osteosarcoma. Staging investigations revealed no metastatic disease. She had excision of the osteosarcoma in September 2007 followed by re-excision local re-recurrence within psoas in April 2008. To our knowledge, this is the first time that locally recurrent intramedullary osteosarcoma, 17 years from initial diagnosis and treatment, is described in the literature. This case serves as a useful clinical reminder.
