Steroid Infiltration into arthritic joints is a common means of treating pain. It is also sometimes done to differentiate pain in the hip from that in the low back or knee. We performed a retrospective review of the notes of all patients who had undergone hip replacements in Wrightington Hospital under the care of the senior author (V.R.) from 1997 to 2004. We identified all patients who had at least 1 year follow up after the procedure. The infection rates in the patients who had received an injection of steroid into the joint prior to hip replacement and in a matched cohort who had received no such intervention were compared. In the injected group there was no incidence of infection during the period of follow up. There was one case of infection in a patient who had not had an injection prior to the arthroplasty. There was also a case of superficial infection in a patient who had no steroid infiltration prior to surgery, which responded to antibiotics. Steroid injections are a valuable adjunct in the management of patients with arthritic joints. This review clearly identifies no increased risk of infection in patients who had received the injection prior to the operation.
Introduction Four-corner arthrodesis with excision of the scaphoid is an accepted salvage procedure for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) and has been performed in our unit for over 20 years. We have undertaken a retrospective review of 116 of these procedures performed in 110 patients between 1992 and 2009. Fifty-eight patients attended for a clinical evaluation, and 29 responded by postal questionnaire. Methods The surgical technique undertaken was standard. That is, through a dorsal approach the scaphoid and tip of the radial styloid were excised. The capitate, lunate, triquetrum, and hamate articular surfaces were then prepared down to bleeding bone. Bone grafts from the scaphoid and radial styloid were then inserted and fixation undertaken. For the latter, various methods were used, including Kirschner (K-)wires, staples, bone screws, but predominantly the Spider plate (Integra Life Sciences, USA). Thereafter the wrist was immobilized for a minimum period of 2 weeks prior to rehabilitation. Results Follow-up was done at a mean of 9 years and 4 months (range 3-19 years). All patients reported a significant improvement in pain relief and $50% of flexion extension, although only 40% of radioulnar deviation. Grip strength was again $50% of the contralateral side. Most patients reported a significant improvement in function with 87% returning to work. In addition, radiologic evaluation identified 28 patients (31%) who demonstrated ongoing signs of nonunion, particularly around the triquetrum. Fourteen of these (15%) underwent a further procedure, generally with success. Finally, none of the patients demonstrated any arthritic changes in the lunate fossa on follow-up X-ray, and all secondary procedures were undertaken within 2 years of the primary. Discussion This research has demonstrated that four-corner fusion fixed with a circular plate can result in a satisfactory outcome with a reduction in pain, a functional range of motion, and a satisfactory functional outcome. The bulk of the complications appear to occur in the first 2 years after surgery. Thereafter, analysis shows long-term satisfaction with little deterioration. Nonunion, particularly around the triquetrum, continues to be a problem, but it may be that this bone should be excised along with the scaphoid, resulting in a three-part fusion only. Alternatively, a simple capitolunate fusion may be satisfactory.
Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options like plantaris, extensor Hallucis longus, flexor carpi radialis are readily available. Advantages of autografts include easy availability, satisfactory biomechanical properties and the human body tends to accept its own tendons than from a donor. This review highlights the various options available and their anatomical and surgical considerations in procuring grafts for upper limb reconstructive work.
Ann R Coll Surg Engl 2010; 92: 27-30 27The number of patients requiring revision hip arthroplasty is constantly rising. This is a significant orthopaedic challenge due to the extensive bone loss associated with revision surgery which often requires bone grafting. Acetabular reconstruction using bone graft and a cemented polyethylene cup is a reliable and durable technique for revision situations with acetabular bone stock defects. 1It is accepted that all acetabular components will fail in time. 2If extensive areas of bone lysis are not addressed with bone graft during revision, subsequent revisions will be extremely difficult. It is important to attempt reconstruction of the skeleton biologically during revision surgery by using bone graft. Slooff and colleagues 2 published results of impaction grafting demonstrating a stable graft in 79% of cases at 15 years and Ornstein et al.3 produced 71% stable graft at 2-year follow-up. Slooff et al.7 used pure cancellous graft alone whereas Brewster et al.12 used the corticocancellous portion of the femoral head allograft after removing the articular cartilage. There have been no reports in the literature of using the whole femoral head while retaining the articular cartilage. The aim of this paper was to assess the initial mechanical stability and the capacity for biological incorporation and remodelling after impaction grafting using the whole femoral head including residual articular cartilage. Extensive bone loss associated with revision hip surgery is a significant orthopaedic challenge. Acetabular reconstruction with the use of impaction bone grafting and a cemented polyethylene cup is a reliable and durable technique in revision situations with cavitatory acetabular bone defects. Some use cancellous graft alone whilst others morselise the whole femoral head after removal of articular cartilage. This paper asks, if it really necessary to use pure cancellous graft? PATIENTS AND METHODS Forty-two acetabular revisions using impacted morselised bone graft without removal of articular cartilage and a cemented cup were studied retrospectively. The mean follow-up was 3 years (range, 2-5.6 years). Clinical and radiographic assessment was made using the Oxford hip score, Hodgkinson's criteria (1988) for socket loosening and the Gie classification (1993) for evaluation of allograft consolidation and remodelling. RESULTS Forty (95%) sockets were considered radiologically stable (type 0, 1, 2 demarcations) and two (5%) sockets were radiologically loose (Type 3 demarcation). There was no socket migration in our series. Twenty-seven(64%) cases showed good trabecular remodelling (grade 3). Twelve (29%) cases showed trabecular incorporation (grade 2). Only three (7%) cases showed poor allograft incorporation (grade 1). Average pre-operative Oxford hip score was 41 and postoperative hip score was 27. There have been no socket re-revisions (100% survival) at an average of 3 years. CONCLUSIONS Early radiological and clinical survival results with retaining articular cartilage of femo...
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