To achieve expert clinical consensus in the delivery of hydrodilatation for the treatment of primary frozen shoulder to inform clinical practice and the design of an intervention for evaluation. We conducted a two-stage, electronic questionnaire-based, modified Delphi survey of shoulder experts in the UK NHS. Round one required positive, negative, or neutral ratings about hydrodilatation. In round two, each participant was reminded of their round one responses and the modal (or ‘group’) response from all participants. This allowed participants to modify their responses in round two. We proposed respectively mandating or encouraging elements of hydrodilatation with 100% and 90% positive consensus, and respectively disallowing or discouraging with 90% and 80% negative consensus. Other elements would be optional.Aims
Methods
Meniscal allograft transplantation (MAT) for patients with symptomatic meniscal loss has demonstrated good clinical results and survivorship. Factors that affect both functional outcome and survivorship have been reported in the literature. These are typically single-centre case series with relatively small numbers and conflicting results. Our aim was to describe an international, two-centre case series, and identify factors that affect both functional outcome and survival. We report factors that affect outcome on 526 patients undergoing MAT across two sites (one in the UK and one in Italy). Outcomes of interest were the Knee injury and Osteoarthritis Outcome Score four (KOOS4) at two years and failure rates. We performed multiple regression analysis to examine for factors affecting KOOS, and Cox proportional hazards models for survivorship.Aims
Methods
Pelvic tilt (PT) can significantly change the functional orientation of the acetabular component and may differ markedly between patients undergoing total hip arthroplasty (THA). Patients with stiff spines who have little change in PT are considered at high risk for instability following THA. Femoral component position also contributes to the limits of impingement-free range of motion (ROM), but has been less studied. Little is known about the impact of combined anteversion on risk of impingement with changing pelvic position. We used a virtual hip ROM (vROM) tool to investigate whether there is an ideal functional combined anteversion for reduced risk of hip impingement. We collected PT information from functional lateral radiographs (standing and sitting) and a supine CT scan, which was then input into the vROM tool. We developed a novel vROM scoring system, considering both seated flexion and standing extension manoeuvres, to quantify whether hips had limited ROM and then correlated the vROM score to component position.Aims
Methods
The Exeter V40 cemented polished tapered stem system has demonstrated excellent long-term outcomes. This paper presents a systematic review of the existing literature and reports on a large case series comparing implant fractures between the Exeter V40 series; 125 mm and conventional length stem systems. A systematic literature search was performed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In parallel, we performed a retrospective single centre study of Exeter V40 femoral stem prosthetic fractures between April 2003 and June 2020.Aims
Methods
We present the development of a day-case total hip arthroplasty (THA) pathway in a UK National Health Service institution in conjunction with an extensive evidence-based summary of the interventions used to achieve successful day-case THA to which the protocol is founded upon. We performed a prospective audit of day-case THA in our institution as we reinitiate our full capacity elective services. In parallel, we performed a review of the literature reporting complication or readmission rates at ≥ 30-day postoperative following day-case THA. Electronic searches were performed using four databases from the date of inception to November 2020. Relevant studies were identified, data extracted, and qualitative synthesis performed.Aims
Methods
To compare changes in gait kinematics and walking speed 24 months after conventional (C-MLS) and minimally invasive (MI-MLS) multilevel surgery for children with diplegic cerebral palsy (CP). A retrospective analysis of 19 children following C-MLS, with mean age at surgery of 12 years five months (seven years ten months to 15 years 11 months), and 36 children following MI-MLS, with mean age at surgery of ten years seven months (seven years one month to 14 years ten months), was performed. The Gait Profile Score (GPS) and walking speed were collected preoperatively and six, 12 and 24 months postoperatively. Type and frequency of procedures as part of MLS, surgical adverse events, and subsequent surgery were recorded.Aims
Methods
The aim of this study was to compare the surgical and quality-of-life outcomes of children with skeletal dysplasia to those in children with idiopathic early-onset scoliosis (EOS) undergoing growth-friendly management. A retrospective review of two prospective multicentre EOS databases identified 33 children with skeletal dysplasia and EOS (major curve ≥ 30°) who were treated with growth-friendly instrumentation at younger than ten years of age, had a minimum two years of postoperative follow-up, and had undergone three or more lengthening procedures. From the same registries, 33 matched controls with idiopathic EOS were identified. A total of 20 children in both groups were treated with growing rods and 13 children were treated with vertical expandable prosthetic titanium rib (VEPTR) instrumentation.Aims
Patients and Methods
The significance of the ‘clicky hip’ in neonatal and infant examination
remains controversial with recent conflicting papers reigniting
the debate. We aimed to quantify rates of developmental dysplasia
of the hip (DDH) in babies referred with ‘clicky hips’ to our dedicated
DDH clinic. A three-year prospective cohort study was undertaken between
2014 and 2016 assessing the diagnosis and treatment outcomes of
all children referred specifically with ‘clicky hips’ as the primary
reason for referral to our dedicated DDH clinic. Depending on their
age, they were all imaged with either ultrasound scan or radiographs.Aims
Patients and Methods
The aim of this study was to compare the outcomes of surgery
using growing rods in patients with severe A review of a multicentre EOS database identified 107 children
with severe EOS (major curve ≥ 90°) treated with growing rods before
the age of ten years with a minimum follow-up of two years and three
or more lengthening procedures. From the same database, 107 matched
controls with moderate EOS were identified.Aims
Patients and Methods
Meniscal allograft transplantation is undertaken to improve pain
and function in patients with a symptomatic meniscal deficient knee
compartment. While case series have shown improvements in patient
reported outcome measures (PROMs), its efficacy has not been rigorously
evaluated. This study aimed to compare PROMs in patients having
meniscal transplantation with those having personalized physiotherapy
at 12 months. A single-centre assessor-blinded, comprehensive cohort study,
incorporating a pilot randomized controlled trial (RCT) was performed
on patients with a symptomatic compartment of the knee in which
a (sub)total meniscectomy had previously been performed. They were
randomized to be treated either with a meniscal allograft transplantation
or personalized physiotherapy, and stratified for malalignment of
the limb. They entered the preference groups if they were not willing
to be randomized. The Knee injury and Osteoarthritis Outcome Score (KOOS),
International Knee Documentation Committee (IKDC) score and Lysholm
score and complications were collected at baseline and at four,
eight and 12 months following the interventions.Aims
Patients and Methods
The interaction between surgical lighting and laminar airflow
is poorly understood. We undertook an experiment to identify any
effect contemporary surgical lights have on laminar flow and recommend
practical strategies to limit any negative effects. Neutrally buoyant bubbles were introduced into the surgical field
of a simulated setup for a routine total knee arthroplasty in a
laminar flow theatre. Patterns of airflow were observed and the
number of bubbles remaining above the surgical field over time identified.
Five different lighting configurations were assessed. Data were analysed
using simple linear regression after logarithmic transformation.Aims
Materials and Methods
The aim of this study was to compare the effectiveness of a femoral
nerve block and a periarticular infiltration in the management of
early post-operative pain after total knee arthroplasty (TKA). A pragmatic, single centre, two arm parallel group, patient blinded,
randomised controlled trial was undertaken. All patients due for
TKA were eligible. Exclusion criteria included contraindications
to the medications involved in the study and patients with a neurological
abnormality of the lower limb. Patients received either a femoral
nerve block with 75 mg of 0.25% levobupivacaine hydrochloride around
the nerve, or periarticular infiltration with 150 mg of 0.25% levobupivacaine
hydrochloride, 10 mg morphine sulphate, 30 mg ketorolac trometamol
and 0.25 mg of adrenaline all diluted with 0.9% saline to make a
volume of 150 ml.Aims
Patients and Methods
We undertook a prospective non-randomised radiological study
to evaluate the preliminary results of using magnetically-controlled
growing rods (MAGEC System, Ellipse technology) to treat children
with early-onset scoliosis. Between January 2011 and January 2015, 19 children were treated
with magnetically-controlled growing rods (MCGRs) and underwent
distraction at three-monthly intervals. The mean age of our cohort
was 9.1 years (4 to 14) and the mean follow-up 22.4 months (5.1
to 35.2). Of the 19 children, eight underwent conversion from traditional growing
rods. Whole spine radiographs were carried out pre- and post-operatively:
image intensification was used during each lengthening in the outpatient
department. The measurements evaluated were Cobb angle, thoracic kyphosis,
proximal junctional kyphosis and spinal growth from T1 to S1.Aims
Patients and Methods
Subtotal or total meniscectomy in the medial or lateral compartment
of the knee results in a high risk of future osteoarthritis. Meniscal
allograft transplantation has been performed for over thirty years
with the scientifically plausible hypothesis that it functions in
a similar way to a native meniscus. It is thought that a meniscal
allograft transplant has a chondroprotective effect, reducing symptoms
and the long-term risk of osteoarthritis. However, this hypothesis has
never been tested in a high-quality study on human participants.
This study aims to address this shortfall by performing a pilot
randomised controlled trial within the context of a comprehensive
cohort study design. Patients will be randomised to receive either meniscal transplant
or a non-operative, personalised knee therapy program. MRIs will
be performed every four months for one year. The primary endpoint
is the mean change in cartilage volume in the weight-bearing area
of the knee at one year post intervention. Secondary outcome measures
include the mean change in cartilage thickness, T2 maps, patient-reported
outcome measures, health economics assessment and complications.Objectives
Methods
The clinical utility of routine cross sectional imaging of the
abdomen and pelvis in the screening and surveillance of patients
with primary soft-tissue sarcoma of the extremities for metastatic
disease is controversial, based on its questionable yield paired
with concerns regarding the risks of radiation exposure, cost, and
morbidity resulting from false positive findings. Through retrospective review of 140 patients of all ages (mean
53 years; 2 to 88) diagnosed with soft-tissue sarcoma of the extremity
with a mean follow-up of 33 months (0 to 291), we sought to determine
the overall incidence of isolated abdominopelvic metastases, their
temporal relationship to chest involvement, the rate of false positives, and
to identify disparate rates of metastases based on sarcoma subtype.Objectives
Methods
We performed a retrospective review of all patients
admitted to two large University Hospitals in the United Kingdom
over a 24-month period from January 2008 to January 2010 to identify
the incidence of atypical subtrochanteric and femoral shaft fractures
and their relationship to bisphosphonate treatment. Of the 3515 patients
with a fracture of the proximal femur, 156 fractures were in the
subtrochanteric region. There were 251 femoral shaft fractures.
The atypical fracture pattern was seen in 27 patients (7%) with
29 femoral shaft or subtrochanteric fractures. A total of 22 patients
with 24 atypical fractures were receiving bisphosphonate treatment at
the time of fracture. Prodromal pain was present in nine patients
(11 fractures); 11 (50%) of the patients on bisphosphonates suffered
12 spontaneous fractures, and healing of these fractures was delayed
in a number of patients. This large dual-centre review has established
the incidence of atypical femoral fractures at 7% of the study population,
81% of whom had been on bisphosphonate treatment for a mean of 4.6
years (0.04 to 12.1). This study does not advocate any change in the use of bisphosphonates
to prevent fragility fractures but attempts to raise awareness of
this possible problem so symptomatic patients will be appropriately
investigated. However, more work is required to identify the true
extent of this new and possibly increasing problem.
