Nimalan Maruthainar

The importance of correct patient positioning in theatres and implications of mal-positioning.

Patient positioning in theatre pertains to how a patient is transferred and positioned for a specific procedure. Patient safety is a central focus of care within the NHS and every healthcare practitioner must ensure that patients are protected from harm where possible. Mal-positioning of the patient has important implications in terms of associated problems of pressure sores, nerve compressions, deep vein thrombosis and compartment syndrome, and should be avoided.

In vivo roughening of retrieved total knee arthroplasty femoral components

BACKGROUND Joint registry data highlights the higher rates of cumulative revision for younger patients undergoing TKR. One of the reasons associated with this higher revision rate may be due to the wear of the UHMWPE leading to loosening. Alternate bearing surfaces have been developed to address this problem; however, roughening of the metal bearing surface has not been demonstrated in vivo. METHOD We recorded roughness measurements of retrieved femoral components. RESULTS Average lateral condyle roughness was 0.032 μm, compared to control values of 0.020 μm, p=0.002; average medial condyle roughness was 0.028 μm, compared to a control value of 0.019, p<0.001. CONCLUSION There was a small but statistically significant roughening of femoral components in vivo compared to controls. This may have important implications for aseptic loosening of knee arthroplasty components and the decision to use scratch resistant components.

Advanced trauma life support radiographic trauma series: Part 3--The pelvis radiograph.

The chest radiograph is used as a screening test to exclude significant thoracic injuries in cases of major trauma. A systematic approach to reviewing chest radiographs is necessary for accurate interpretation. Radiographic findings should be considered together with clinical assessment.

Gaucher disease: outcome following total hip replacements and effect of enzyme replacement therapy in a cohort of UK patients.

Only a limited number of reports of total hip replacements (THRs) in patients with Gaucher disease (GD) have been published, with the majority showing high rates of early aseptic loosening as well as an increased number of peri-operative complications. We present a series of twelve THRs in nine affected patients, with a mean age of 39 years at the time of surgery (median 37 years; range 27–60 years). We examine the medium- to long-term results and present the outcome scores, survival, and assess the effect of enzyme replacement therapy (ERT). Four hips (33.3%) required revision for aseptic loosening at a mean time of 11.5 years. There was no significant difference in survival between the group on ERT at the time of surgery and group not on ERT. Those on ERT did, however, have fewer peri-operative complications and there was a trend to better outcome scores. Five of the 12 THRs were performed when the diagnosis of GD was unknown and all of these had early complications. Our results show better survival of THRs in patients with GD than previously thought. The use of ERT pre-operatively did not have an effect on survival, nor outcome scores, but did reduce the peri-operative complication rate. Those not on ERT at the time of surgery were commenced on it at some point in their treatment (at an average of 8.6 years following THR) and we believe the use of ERT, at any time in the treatment, could have contributed to the improved survival seen in our series compared to historical results in the literature.

Perioperative blood transfusion: the role of allogenous and autologous transfusions, and pharmacological agents.

The decision to transfuse patients perioperatively is made on an individual basis and should consider factors such as duration and severity of anaemia, symptoms, physiological parameters and comorbidities. Autologous blood transfusion has the benefit of avoiding some of the immunological and infective complications associated with allogenic blood transfusion. Pharmacological agents as well as anaesthetic and surgical techniques have a role in avoiding the need for blood transfusion.

Advanced trauma life support radiographic trauma series: part 1--The cervical spine radiograph

Plain cervical spine radiographs are the first line investigation in trauma patients to exclude cervical spine fractures and dislocations. Adequate views are essential to reduce the risk of missing diagnoses. Injuries may however not be visible on plain cervical spine radiographs despite adequate views. Additional imaging such as computer tomography scanning is indicated in the event of a normal plain radiograph if there is any clinical suspicion of injury.