1
|
Dick AG, Houghton JM, Bankes MJK. An approach to hip pain in a young adult. Br J Sports Med 2021; 55:290-294. [PMID: 33602751 DOI: 10.1136/bjsports-2018-k1086rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
2
|
Dick AG, Smith C, Bankes MJK, George M. The impact of mental health disorders on outcomes following hip arthroscopy for femoroacetabular impingement syndrome: a systematic review. J Hip Preserv Surg 2020; 7:195-204. [PMID: 33163204 PMCID: PMC7605775 DOI: 10.1093/jhps/hnaa016] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/15/2020] [Accepted: 02/24/2020] [Indexed: 01/11/2023] Open
Abstract
Hip arthroscopy for femoroacetabular impingement syndrome (FAI) has been shown to be beneficial in the short- to medium-term though outcomes vary between individuals. Multiple factors have been suggested to affect outcomes including pre-operative mental health disorders. We undertook a systematic review to assess the evidence relating to the effect of pre-existing mental health disorders on the outcomes following hip arthroscopy for FAI. Following PRISMA guidelines, a multi-database search was undertaken using three key concepts: 'mental health', 'FAI' and 'hip arthroscopy'. Results were screened and data extracted from relevant studies. A total of six studies met the inclusion criteria including 2248 hips, all published between 2017 and 2019. All studies were of evidence level III or IV with reasonable methodological quality. One study demonstrated pre-operative depression to be related to altered pain reduction in the short-term following surgery. Three studies reported inferior outcomes in the medium-term (1-2 years) in those with worse mental health. One study demonstrated an increased risk of persistent pain 2 years following surgery and one a reduced chance of returning to active military service following surgery in those with worse mental health. Despite inferior outcomes individuals with mental health disorders did still benefit from surgery in general. In conclusion, the presence of pre-existing poor mental health is associated with inferior outcomes in the medium-term following arthroscopic surgery for FAI. Surgeons should consider screening patients for mental health disorders before surgery and counselling them appropriately as to the potential for less satisfactory surgical outcomes.
Collapse
Affiliation(s)
- Alastair G Dick
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Christian Smith
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Marcus J K Bankes
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Marc George
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| |
Collapse
|
3
|
Dick AG, Pinder RJ, Lyle SA, Ember T, Mallinson C, Lucas J. Reducing Allogenic Blood Transfusion in Pediatric Scoliosis Surgery:: Reporting 15 Years of a Multidisciplinary, Evidence-Based Quality Improvement Project. Global Spine J 2019; 9:843-849. [PMID: 31819850 PMCID: PMC6882095 DOI: 10.1177/2192568219837488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
STUDY DESIGN Retrospective review of prospectively collected spinal surgery and transfusion databases. OBJECTIVES To evaluate the efficacy of a care pathway developed at our institution since 2003 with a focus on reducing the need for blood transfusions in children undergoing scoliosis correction surgery. The care pathway includes nurse-led clinics facilitating preoperative hemoglobin optimization, intraoperative cell salvage, the use of tranexamic acid, and a transfusion criteria awareness program. METHODS Retrospective review of our institution's prospectively recorded spinal surgery and transfusion databases including all cases of scoliosis surgery in patients 18 years and younger between 2001 and 2015. RESULTS A total of 1039 procedures were included in the analysis. Overall, 24.4% of patients received a transfusion. The proportion of patients transfused was 89.2% in 2001-2003, 39.6% in 2004-2006, 16.5% in 2007-2009, 15.6% in 2010-2012, and 20.1% in 2013-2015. The volume of blood products transfused in those undergoing transfusion was 9.1 units in 2001-2003, 4.8 units in 2004-2006, 5.0 units in 2007-2009, 2.3 units in 2010-2012, and 2.1 units in 2013-2015. A multivariate logistic regression demonstrated adjusted odds ratios for the probability of receiving any transfusion of 5.45 (95% confidence interval 3.62-8.11) for patients with neuromuscular diagnoses and 11.17 (5.02-24.86) for those undergoing combined anterior and posterior surgical approach. CONCLUSIONS We have demonstrated over a 15-year period that the introduction of a multifaceted, multidisciplinary pathway can dramatically and sustainably reduce the need for blood transfusions and their attendant risks in pediatric scoliosis surgery. This data lends weight to the adoption of such a care pathway in pediatric scoliosis surgery.
Collapse
Affiliation(s)
- Alastair G. Dick
- Guy’s & St Thomas’ NHS Foundation Trust, London, UK,Alastair G. Dick, Department of Spinal Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
| | | | | | - Tom Ember
- Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | | | | |
Collapse
|
4
|
Dhinsa BS, Saini A, Dick AG, Nash WJ, Nzeako O, Shah Z. Accuracy of the relationship between the centre of the femoral head and tip of greater trochanter. J Clin Orthop Trauma 2019; 10:674-679. [PMID: 31316238 PMCID: PMC6611959 DOI: 10.1016/j.jcot.2018.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/23/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION There have been many techniques described to measure limb length discrepancy and methods to correct this during total hip arthroplasty; preoperative and intraoperative. These techniques have been either inconsistent, cumbersome or not readily available due to expense. There is a lack of evidence to support one particular approach. The aim of this study is to assess the accuracy of the relationship between the centre of the femoral head and tip of the greater trochanter. METHODS A prospective observational cross-sectional study, with patients undergoing Positron emission tomography-CT (PET-CT) scan between 20th January 2016 to 31st December 2016. Exclusion criteria were patients undergoing PET-CT scan for musculoskeletal condition, those found to have existing pathology of the hip (including previous trauma) and those aged younger than 18 years and over 50 years. RESULTS There was a total of 116 participants, giving 232 hips for assessment and 184 hips were measured by two observers. The mean age of the sample was 40.51 years. The mean distance of the centre of the femoral head from the tip of the greater trochanter was 8.53 mm distal (with a standard deviation of 4.97). Analysis of the right and left hip measurements gave a Pearson correlation coefficient of 0.87, suggesting a good correlation. Interobserver analysis demonstrated fair agreement with intraclass correlation coefficient of 0.52. CONCLUSION The evidence of this study and that in literature suggests that this landmark is unreliable and should no longer be used.
Collapse
Affiliation(s)
- Baljinder S. Dhinsa
- William Harvey Hospital, Kennington Road, Willesborough, Ashford, TN24 0LZ, UK
- Corresponding author.
| | - Aaron Saini
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Alastair G. Dick
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - William J. Nash
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Obinna Nzeako
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Zameer Shah
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| |
Collapse
|
5
|
Abstract
Chlorhexidine-based skin preparations are frequently used in orthopaedic surgery. We report 2 recent cases of patients suffering significant allergic reactions to ChloraPrepTM complicating routine foot and ankle surgery. We advise vigilance for this possible issue and recommend thorough removal of all preparation at the end of the procedure.
Collapse
Affiliation(s)
- Alastair G Dick
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Baljinder Dhinsa
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Roland P Walker
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Samrendu Singh
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
6
|
|
7
|
Dick AG, Davenport D, Bansal M, Burch TS, Edwards MR. Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era? Geriatr Orthop Surg Rehabil 2017; 8:161-165. [PMID: 28835873 PMCID: PMC5557200 DOI: 10.1177/2151458517722104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/14/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.
Collapse
Affiliation(s)
- Alastair G Dick
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
| | - Dominic Davenport
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
| | - Mohit Bansal
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
| | - Therese S Burch
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
| | - Max R Edwards
- King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, United Kingdom
| |
Collapse
|
8
|
Abstract
In 1945, Fox developed the strategy for sequencing long proteins by using overlapping fragments. We show how the formal mathematical technique for the construction of interval graphs (Gilmore and Hoffman, 1964) is useful both pedagogically for understanding the underlying logic of sequencing linear molecules and is more amenable to automation because of its algorithmic nature. We also present a computer program, that employs the interval graph algorithm, which can be used to sequence proteins when given digest data. An example is given to illustrate all the steps involved in the algorithmic processing of the data. The need for such developments with respect to molecular evolution is discussed.
Collapse
|