Purpose. To investigate consultant surgeons' knowledge about the costs of implants for various joint surgeries. Methods. Questionnaires were distributed to consultant orthopaedic surgeons at 2 hospitals. Respondents were asked to estimate the implant costs of any brand for low-demand and high-demand total hip replacement (THR), total knee replacement (TKR), uni-compartmental knee replacement, arthroscopy shaver blade, total anterior cruciate ligament (ACL) fixation, and meniscal repair. The actual cost of each implant was obtained from the manufacturer. Results. 16 consultant surgeons completed the questionnaires. The respective mean estimated and actual costs for a low-demand THR implant were £1714 (range, £600-3000) and £1448 (range, £985-2335), with an overestimation of 18.4%. The respective costs for a high-demand THR implant were £2172 (range, £600-6000) and £1737 (range, £1192-2335), with an overestimation of 25%. The respective costs for a TKR implant were £1550 (range, £600-6000) and £1316 (range, £995-1535), with an overestimation of 17.8%. The respective costs for a uni-compartmental knee replacement implant were £1040 (range, £600-2000) and £1296 (range, £698-1470), with an
Licox offers new insights into cerebral pathology and physiology. The continuous bedside monitoring provides real-time data that can be used to improve patient management and prognosis in specialist units by trained and experienced staff. More research is required to understand the limitations of this technology and why it is not in widespread use. RELEVENCE TO CLINICAL PRACTICE: A clinical tool that could be utilized more often in the right setting to improve care to patients suffering from TBI by disseminating more information on this unique tool.
Poor tendon to bone healing following rotator cuff repair has led to the continued interest and investigation into biological augmentation. The biology of tendinopathy is not fully understood and consequently the availability of disease modifying therapeutic targets is limited. A ceiling of benefit has been reached by mechanical optimisation of rotator cuff repair and thus, in order to improve healing rates, a biological solution is required. This review focuses on the strategies to biologically augment rotator cuff disorders with an emphasis on rotator cuff repair. Leucocyte rich platelet rich plasma has been shown to improve healing rates without clinically relevant improvements in outcome scores. Similarly, improved healing rates have also been reported with bone marrow stimulation and in long-term follow-up with bone marrow concentrate. Extracellular matrix (ECM) and synthetic scaffolds can increase healing through mechanical and or biological augmentation. A potential third category of scaffold is bioinductive and has no mechanical support. Studies involving various scaffolds have shown promising results for augmentation of large to massive tears and is likely to be most beneficial when tendon quality is poor, however level I evidence is limited.
Acute comparment syndrome (ACS) is a surgical emergency, in which tissue pressure becomes greater than perfusion pressure leading to tissue ischaemia. It is typically a consequence of trauma. We present a case in which a patient suffers blunt trauma to the thigh, but develops ACS 2 years after this injury and consequently endures 10-episodes of ACS (no perciptating event or cause) in the same thigh over 10 years. On the 10th presentation the patient was found to have arteriovenous malformation on MR angiography which were embolised and the fasciotomy wound closed with a split-thickness skin graft. A thorough literature search deemed this case to be the first reported recurrent spontaneous ACS of the thigh. Prompt recognition and treatment of ACS is vital. Clinicians should thoroughly investigate such patients postoperatively and involve vascular/plastic surgeons and interventianal radiologist to provide optimum care and prevent recurrence.
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
Importance of specimen length during temporal artery biopsy (Br J Surg 2011; 98: 1556-1560)
SirWe read with great interest the article by Ypsilantis and colleagues, raising the question of optimum temporal artery biopsy (TAB) length. This is a large cohort yet the positive rate remains only 21 per cent. Allison et al. 1 and others have also demonstrated an average biopsy length of 0·7 cm, with higher positive rates. However, Achkar and colleagues 2 reviewed 535 patients with an average biopsy length of 3·6 cm and obtained a positive rate of 33 per cent; thus there continues to remain great heterogeneity in findings, possibly due to skip lesions, length of biopsy, previous steroid treatment and atypical presentation.Our own experience is of a low positive rate, with similar TAB lengths and with more junior surgeons taking longer biopsies. As surgical technique influences specimen length, have the authors investigated this variable?Finally, should we be doing TAB at all? It has been suggested that TAB makes little difference to treatment and is not without risks 3,4 . Is it not purely academic, given that a score of at least 3 on the American College of Rheumatology criteria is very accurate (sensitivity 93·5 per cent and specificity 91·2 per cent) 5 and, irrespective of TAB result, these patients will receive the same treatment?
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