Benedict A. Rogers

The Reconstruction of Periprosthetic Pelvic Discontinuity

The surgical techniques and outcomes of acetabular reconstruction for periprosthetic pelvic discontinuity cases are reported. The mean time to surgery for 9 patients with acute pelvic discontinuity was 16.3 days, with 8 patients (88%) having posterior column plating and a porous metal acetabular cup. No cases required revision surgery, with a mean follow-up of 34 months (range, 24-67 months). Of the 62 chronic pelvic discontinuity cases, 20 had an ilioischial cage, with a revision rate of 29%. There were 42 cup-cage reconstructions with an 8-year survivorship of 86.3%, with a mean follow-up of 35 months (range, 24-93 months). Stable reconstruction of chronic pelvic discontinuity was achievable by distraction using a cup-cage acetabular reconstruction; however, satisfactory stability of acute pelvic discontinuity was achieved with compression of the posterior column using screw augmentation of the acetabular shell supplemented by posterior column plating.

Proximal femoral allograft in revision hip surgery with severe femoral bone loss: a systematic review and meta-analysis.

This study provides an objective appraisal of available evidence regarding the outcome of proximal femoral allograft for reconstruction of massive proximal femoral bone loss. The primary outcomes were rates of success, structural failure, and infection. A systematic literature review identified 16 studies with a minimum 2-year follow-up. Estimated pooled effect analysis performed with heterogeneity quantified using I(2) and τ(2). The total cohort included 498 patients with a mean follow-up of 8.1 years. The pooled success rate was 81%, pooled structural failure rate of 15%, and pooled infection rate of 8%. Significant heterogeneity was observed in structural failure rates (I(2) = 47.9, τ(2) = 0.29, P < .05). Proximal femoral allografts afford viable reconstruction for massive femoral bone loss when performed by experienced.

Proximal Femoral Allograft for Major Segmental Femoral Bone Loss: A Systematic Literature Review

As the indications for total hip arthroplasty increase, the prevalence of extensive proximal femoral bone loss will increase as a consequence of massive osteolysis, stress shielding and multiple revisions. Proximal femoral bone stock deficiency provides a major challenge for revision hip arthroplasty and is likely to account for a significant future caseload. Various surgical techniques have been advocated included impaction allografting, distal press-fit fixation and massive endoprosthetic reconstruction. This review article provides a systematic review of the current literature to assess the outcome of revision hip arthroplasty using allograft to reconstruction massive proximal femoral bone loss.

Is there adequate information on operation notes? The application of the Royal College of Surgeons of England guidelines.

An audit was performed to review the compliance and applicability of the Royal College of Surgeons of England (RCSEng) guidelines for operation notes in a regional plastic surgery department. 137 operation notes were initially audited revealing a variable quality when compared to the guidelines. An aide-memoire (Figure 1) was used to detail each of the ten guidelines and allowed the surgeon to record if any of the guidelines were not applicable. 151 operation notes were subsequently reviewed, and showed an improvement in the recording of the operative note and the varied applicability of the guidelines to this particular speciality. It is concluded that the RCSEng guidelines are not universally applicable to plastic surgery. The difference between ‘not applicable’ and ‘failure to record’ is potentially important if these guidelines are used by non-clinical audit staff in a target driven environment.

The Use of Structural Allograft in Primary and Revision Knee Arthroplasty with Bone Loss

Bone loss around the knee in the setting of total knee arthroplasty remains a difficult and challenging problem for orthopaedic surgeons. There are a number of options for dealing with smaller and contained bone loss; however, massive segmental bone loss has fewer options. Small, contained defects can be treated with cement, morselized autograft/allograft or metal augments. Segmental bone loss cannot be dealt with through simple addition of cement, morselized autograft/allograft, or metal augments. For younger or higher demand patients, the use of allograft is a good option as it provides a durable construct with high rates of union while restoring bone stock for future revisions. Older patients, or those who are low demand, may be better candidates for a tumour prosthesis, which provides immediate ability to weight bear and mobilize.

Thromboprophylaxis in orthopaedic surgery: a clinical review.

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common cause of cardiovascular mortality and morbidity. Patients undergoing major orthopaedic surgery, including hip and knee arthroplasty, represent a group that is at particularly high risk for VTE, especially patients with risk factors (age >60 years, cancer, prior VTE).

Blunt chest trauma: bony injury in the thorax.

The management of blunt chest trauma is an evolving concept with no clear current guidelines. This article explores the bony injuries associated with this, focusing on rib fractures and flail segments and the themes around investigation and best management.

The management of rotator cuff tears in the elderly.

Rotator cuff tears occur commonly in the elderly causing significant pain and disability. In light of new treatment options developed over recent years, this article reviews the diagnosis and operative options available for this condition.

Blunt chest trauma: soft tissue injury in the thorax

The management of blunt chest trauma is evolving. This article discusses the soft tissue injuries associated with blunt chest trauma.

The use of freedom of information requests in medical audit and research

T he ability to evaluate and audit clinical activity throughout the UK is difficult for a variety of logistical, practical and political reasons. As a public organization, the effective and efficient working of the NHS is of societal interest. The Freedom of Information Act 2000 affords a mechanism to collect data that are of public interest and this article examines how these can be used for medical audit and research.