Early to mid-term outcome of Oxinium on Verilast highly cross-linked polyethylene bearing surface in uncemented total hip arthroplasty

INTRODUCTION

We report 5- to 10-year clinical and radiological outcomes of a series of uncemented Oxinium on Verilast (highly cross-linked polyethylene liners) total hip replacements (THAs) using the Anthology stem and R3/Reflection cup system.

METHODS

116 THAs were performed by 2 senior authors in 104 patients from 2005 to 2009. The mean age at time of operation was 63.8 (45-80) years. The average length of follow-up was 8.8 years. At final data collection 12 patients had died (13 THAs) and 3 patients (3 THAs) were lost to follow-up.

RESULTS

In the remaining 100 THAs, the preoperative Harris Hip Score of 39 improved to 91 and Oxford Hip Score improved from 16 to 44 (mean at 5 to 10 years). 100 THAs were available for radiographic analysis: all had stable bony ingrowth of both the stem and cup. Dorr's methods for wear in the 100 THAs showed an average wear <0.01 mm/year and no osteolysis; only 1 case showed 0.22 mm/year with some proximal femoral osteolysis but no cup lesions. There were no dislocations or revisions, survivorship in this series for both components for any cause as an endpoint was 100%. 1 intraoperative calcar fracture was sustained and treated with a cerclage wires, 2 peri-prosthetic fractures occurred and were treated with open reduction and fixation, both healed well with excellent outcomes.

DISCUSSION

The study has shown good clinical and radiological outcomes at 5-10 years and supports existing data on the potential benefits of this bearing performance in literature.

Assessment and management of adult spinal deformities

Adult spinal deformity is a complex condition, increasing in prevalence, and occurring in a patient population in which it poses unique challenges. This review provides an overview of adult spinal deformity with a particular focus on its clinical evaluation, radiological assessment and classification, reviewing the current literature and amalgamating this with the authors' clinical experience.

Blunt vertebral vascular injury in trauma patients: ATLS® recommendations and review of current evidence

Blunt cerebrovascular injury (BCVI) encompasses two distinct clinical entities: traumatic carotid artery injury (TCAI) and traumatic vertebral artery injury (TVAI). The latter is the focus of our review. These are potentially devastating injuries which pose a diagnostic challenge in the acute trauma setting. There is still debate regarding the optimal screening criteria, diagnostic imaging modality and treatment methods. In 2012 the American College of Surgeons proposed criteria for investigating patients with suspected TVAI and subsequent treatment methods, caveated with the statement that evidence is limited and still evolving. Here we review the historical evidence and recent literature relating to these recommendations.

STROKE: CRITICAL APPRAISSAL OF INTENSIVE CARE MANAGEMENT

BACKGROUND

Stroke is a common medical condition in the medical units. Stroke patients are usually managed on the medical wards while some that needs organ support are admitted into the intensive care unit. However there is conflicting data on the benefits or otherwise of admitting stroke patients into the intensive care unit. This necessitated this study to know how much benefit is derived from admitting stroke patients into the intensive care unit.

AIM AND OBJECTIVE

The study aims at the benefits of admitting stroke patients into the intensive care unit. The objective included studying the prognostic factors that determines the outcome of stroke patients admitted into the intensive care unit.

METHODOLOGY

The case files of all patients admitted and managed in the intensive care unit of LAUTECH teaching hospital between 2002 and 2014 were retrieved and were analysed. The factors used in analyzing included the type of stroke, the age of the patients, the Glasgow Coma scale at admission, the need for intubation and mechanical ventilation as well as the percentage mortality in each subsets.

RESULTS

A total of 48 patients were admitted over the study period of which 19 were males and 29 were females. The percentage mortality in females was 78.95 while mortality in males was 62.5%. The higher the age the worse the prognosis, the higher the GCS the better the prognosis. Patients that were intubated and ventilated had percentage mortality of 68.8% and better than non ventilated patients. The hemorrhagic strokes also carries worse prognosis.

CONCLUSION

The admission of stroke patients to the intensive care unit should be individualized considering the above mentioned prognostic factors. However patients that are likely to benefit from intensive care unit should be admitted early for them to derive the maximum benefits.

Surgical vs general practitioner assessment: diagnostic accuracy in 2-week-wait colorectal cancer referrals

AIM

It has been recommended that patients with suspected colorectal cancer should proceed straight to an endoscopic test to increase speed of diagnosis, using only the information in the general practitioner's referral letter. This study aims to establish whether the diagnostic accuracy of the first surgical outpatient assessment is significantly greater than the general practitioner's assessment and if so by what means.

METHOD

Demographic variables, symptoms and signs were collected from the first surgical outpatient assessment letters and the general practitioners' referral letters in 2-week-wait colorectal cancer referrals made between 2002 and 2005. Multiple logistic regression models derived from both the surgeons' and the general practitioners' letters were compared with receiver operator characteristic curves.

RESULTS

Variables were collected from 978 2-week-wait colorectal cancer referrals. The median age was 69 years (range 19-98) and the male to female ratio was 1:2. Seventy-eight referrals were diagnosed with colorectal cancer. Surgeons' models demonstrated significantly greater diagnostic accuracy than general practitioners' models (area under the curve, 0.84 vs 0.73; P < 0.003). General practitioners' letters contained significantly less information than surgeons' letters (P < 0.001), but correcting for this did not account for the difference in diagnostic accuracy. The single variable that accounted for the difference in diagnostic accuracy was examination of the rectum by rigid sigmoidoscopy.

CONCLUSION

Rigid sigmoidoscopy significantly improves the diagnostic accuracy of clinical assessment in patients with suspected colorectal cancer. If rigid sigmoidoscopy were omitted in a straight-to-test pathway, some patients would be denied the opportunity for immediate diagnosis.