Fahad Hossain

The radiological assessment of total and unicompartmental knee replacements.

Radiological assessment of total and unicompartmental knee replacement remains an essential part of routine care and follow-up. Appreciation of the various measurements that can be identified radiologically is important. It is likely that routine plain radiographs will continue to be used, although there has been a trend towards using newer technologies such as CT, especially in a failing knee, where it provides more detailed information, albeit with a higher radiation exposure. The purpose of this paper is to outline the radiological parameters used to evaluate knee replacements, describe how these are measured or classified, and review the current literature to determine their efficacy where possible.

A performance based patient outcome score for active patients following total knee arthroplasty

OBJECTIVE The aim of this study was to develop and validate a user friendly performance based knee outcome score for use in active patients undergoing TKA surgery. DESIGN We prospectively studied a cohort of 50 subjects without any knee symptoms, and 50 patients who underwent TKA for osteoarthritis (OA). The patients were assessed pre- and postoperatively. SF-36 and WOMAC were concurrently administered for comparison. Patients completed seven physical tasks of the finalised outcome instrument which were objectively assessed and scored. RESULTS The mean functional score was 31.7 in the normal subjects. The mean functional score improved postoperatively from 10.0 to 17.7 (P < 0.001) in the TKA group. Our results confirm that the performance based score has a high test-retest reliability (intra-class correlation coefficient (ICC) of 0.89), internal consistency (Cronbachs alpha 0.84) and construct validity showing expected correlations with relevant components of the WOMAC and SF-36 scores. The responsiveness as measured by the effect size compared favourably with the same relevant components of the SF-36 and WOMAC. CONCLUSIONS Our performance based knee function score is a reliable dimension specific tool to detect change in musculoskeletal function after TKA. It complements existing self-reported outcome tools in facilitating a comprehensive assessment of patients following TKA.

Erratum to: A Cohort Study Predicts Better Functional Outcomes and Equivalent Patient Satisfaction Following UKR Compared with TKR

Background Total knee replacement (TKR) is considered the gold standard treatment for advanced osteoarthritis of the knee (Choong and Dowsey, Int J Rheum Dis 14:167–74, 2011; Satku, Singapore Med J 44:554–556, 2003). Unicompartmental disease can be treated with unicompartmental knee replacement (UKR) or TKR. Some surgeons prefer the proven track record of TKR, while others prefer the more normal joint kinematics, enhanced proprioception and range of movement achieved with UKR (Hopper and Leach, Knee Surg Sports Traumatol Arthrosc 16:973–9, 2008; Satku, Singapore Med J 44:554–556, 2003). However, there is reported low satisfaction amongst younger patients undergoing UKR (Robertson et al., Acta Orthop Scand 71:262–7, 2000).

The accuracy of primary care teams in diagnosing disorders of the shoulder

OBJECTIVE The aim of this retrospective, observational study was to determine the accuracy of diagnoses given by a multitude of primary care services to patients referred to an orthopaedic upper limb surgeon with a focus towards shoulder pathology. METHODS Records of all patients referred to a single upper limb surgeon over a 1-year period were reviewed. The diagnosis in the primary care setting was compared with the initial working diagnosis in the specialist clinic and against the final diagnosis following specialist investigation/intervention. RESULTS 114 eligible patients were identified. General practitioners referred 35% of patients, musculoskeletal triage services referred 63% of patients and independent physiotherapists referred 2% of patients. It was found that 37% of patients were not given a diagnosis by the primary care team. When a diagnosis was given, accuracy was 50% (κ = 0.28) when correlated against that given by an orthopaedic upper limb surgeon. CONCLUSIONS Our findings suggest that knowledge of shoulder conditions is limited amongst primary care practitioners. There does not appear to be any difference in accuracy between general practitioners and musculoskeletal triage services.

Factors Influencing Foundation Programme Choice among Medical Students

Objectives The advent of Modernising Medical Careers has replaced the traditional pre-registration house officer (PRHO) year and first year of senior house officer (SHO) training with a combined foundation programme. The aim of this study was to find out the factors influencing choice of foundation programme among medical students. Design Prospective survey. Setting Three medical schools based in England. Main outcome measures A questionnaire was formulated containing the reasons for choosing a foundation programme with students asked to rank their choices. Results There were 46 replies. The most important factors identified were geographical location (score 154) and combination of specialties (score 178). The least important factors was the reputation of consultants (score 525) and opportunities for research (score 530). Conclusions The factors influencing choice of foundation programme are not dissimilar to the choice of PRHO year despite the different emphasis in training which it offers.

Early performance-based and patient-reported outcomes of a contemporary taper fit bone-conserving short stem femoral component in total hip arthroplasty

Aims The aim of this study was to compare early functional and health related quality of life outcomes (HRQoL) in patients who have undergone total hip arthroplasty (THA) using a bone conserving short stem femoral component and those in whom a conventional length uncemented component was used. Outcome was assessed using a validated performance based outcome instrument as well as patient reported outcome measures (PROMs). Patients and Methods We prospectively analysed 33 patients whose THA involved a contemporary proximally porous coated tapered short stem femoral component and 53 patients with a standard conventional femoral component, at a minimum follow‐up of two years. The mean followup was 31.4 months (24 to 39). Patients with poor proximal femoral bone quality were excluded. The mean age of the patients was 66.6 years (59 to 77) and the mean body mass index was 30.2 kg/m2 (24.1 to 41.0). Outcome was assessed using the Oxford Hip Score (OHS) and the University College Hospital (UCH) hip score which is a validated performance based instrument. HRQoL was assessed using the EuroQol 5D (EQ‐5D). Results There were no major peri‐operative complications. There was no difference in the mean post‐operative OHS, EQ‐5D or function subscale of the UCH hip scores between the two groups. The mean pre‐operative OHS and EQ‐5D scores improved significantly (all p < 0.001). The mean functional component of the UCH hip score at final follow‐up was 42.5 and 40.6 in the short stem and conventional stem groups, respectively. There was no statistically significant difference between the groups (p = 0.42). A total of seven patients (21.2%) in the short stem group and nine (16.98%) in the conventional group achieved a ceiling effect using the OHS; none did using the function subscale of the UCH hip score. Conclusion The proximally porous coated tapered short stem femoral component achieves comparable short‐term functional outcomes when compared with a conventional longer stem uncemented femoral component when THA is undertaken in patients with good bone quality.

Prevention of limb length discrepancy in total hip arthroplasty

Total hip arthroplasty is a highly effective and cost-efficient procedure but postoperative limb length discrepancy is a common source of patient dissatisfaction and litigation. This article provides a systematic, stepwise approach for identifying and proactively managing risk factors associated with limb length discrepancy following total hip arthroplasty. This review explores preoperative history taking, clinical examination, radiological templating, implant positioning, soft tissue balancing, and intraoperative surgical techniques for minimizing leg length discrepancy while maintaining stability and restoring mechanical function following total hip arthroplasty. A comprehensive understanding of the multifactorial nature and methods for reducing postoperative limb length discrepancy is essential for optimizing patient satisfaction, clinical outcomes and long-term function following total hip arthroplasty.

Does the DVR® plate restore bony anatomy following distal radius fractures?

INTRODUCTION Fractures of the distal radius are common. Malreduced fractures are associated with residual functional deficiency. There has been a trend over the last few years for using fixed angle volar locking plates to surgically stabilise this injury. Our unit uses the DVR® plate (DePuy, Warsaw, IN, US). Nevertheless, it is unknown whether the normal bony anatomy is recreated or merely restored to acceptable limits with its usage. The aim of this study was to evaluate the reduction achieved compared with an uninjured population and pre-existing quoted ‘normal’ values. Furthermore, we wanted to identify the percentage of cases that were reduced to acceptable limits, and determine whether the grade of the surgeon and fracture type was a confounding influence on this reduction. METHODS A retrospective review of the 3-month postoperative radiography of 48 eligible patients who underwent open reduction and internal fixation of a distal radius fracture with a DVR® plate was undertaken. RESULTS Volar tilt, radial length and inclination were different to quoted normal values (p<0.01). Despite this, these parameters fell within acceptable limits in 46 cases; this was not influenced by fracture type or grade of operating surgeon. CONCLUSIONS The DVR® plate restores the bony anatomy to within acceptable limits in the majority of patients who have sustained a fracture of the distal radius although of all parameters investigated, the widest variability is seen in volar tilt.