The feasibility of achieving Elective Care Framework targets for total hip arthroplasty and total knee arthroplasty in Northern Ireland.

Aims: Waiting times for arthroplasty surgery in Northern Ireland are among the longest in the NHS, which have been further lengthened by the onset of the COVID-19 global pandemic in March 2020. The Department of Health in Northern Ireland has announced a new Elective Care Framework (ECF), with the framework proposing that by March 2026 no patient will wait more than 52 weeks for inpatient/day case treatment. We aimed to assess the feasibility of achieving this with reference to total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Assessment of the effect of addition of 24 hours of oral tranexamic acid post-operatively to a single intraoperative intravenous dose of tranexamic acid on calculated blood loss following primary hip and knee arthroplasty (TRAC-24): a study protocol for a randomised controlled trial.

Background: While it is has been proven that tranexamic acid (TXA) reduces blood loss in primary total hip and knee arthroplasty (THA and TKA), there is little published evidence on the use of TXA beyond 3 h post-operatively. Most blood loss occurs after wound closure and the primary aim of this study is to determine if the use of oral TXA post-operatively for up to 24 h will reduce calculated blood loss at 48 h beyond an intra-operative intravenous bolus alone following primary THA and TKA. To date, most TXA studies have excluded patients with a history of thromboembolic disease.

A prospective evaluation of a largely cementless total knee arthroplasty cohort without patellar resurfacing: 10-year outcomes and survivorship.

Background: The theoretical benefits of a mobile bearing design in Total Knee Arthroplasty (TKA) include increased articular surface conformity with a reduction in both polyethylene wear and implant interface shear. However, to date these theoretical advantages have not been translated into published evidence of superior survivorship. This paper presents the results of a prospective, non-comparative study evaluating the performance of the mobile bearing Low Contact Stress LCS Complete Rotating Platform TKA in a largely cementless cohort without patellar resurfacing.

Sesamoid bone blocking fracture reduction in traumatic injury of first metatarsal.

We describe a patient who sustained an extra-articular, oblique and angulated first metatarsal fracture. The medial hallucal sesamoid bone was subsequently found to have entered the fracture gap preventing reduction. We describe treatment of this rare injury with a successful outcome.

Posterior hip dislocation and ipsilateral isolated femoral neck fracture: A novel fixation method.

It is accepted that a traumatic hip dislocation is a surgical emergency, this holds for the uncommon dislocation of the hip with femoral neck fracture however the surgical dilemma involves head salvage or replacement. This case report describes the method and technique for stabilisation of the rare and challenging isolated posterior hip dislocation with an ipsilateral femoral neck fracture. A 38-year-old gentleman was involved in a high-speed road traffic collision sustaining a posterior dislocation with ipsilateral femoral neck fracture.

Does a standard outpatient physiotherapy regime improve the range of knee motion after primary total knee arthroplasty?

The aim of this study was to investigate whether a standard course of outpatient physiotherapy improves the range of knee motion after primary total knee arthroplasty. One hundred and fifty patients were randomly assigned into one of 2 groups. One group received outpatient physiotherapy for 6 weeks (group A).

The use of two-stage exchange arthroplasty with depot antibiotics in the absence of long-term antibiotic therapy in infected total hip replacement.

We present a series of 114 patients with microbiologically-proven chronically-infected total hip replacement, treated between 1991 and 2004 by a two-stage exchange procedure with antibiotic-loaded cement, but without the use of a prolonged course of antibiotic therapy. The mean follow-up for all patients was 74 months (2 to 175) with all surviving patients having a minimum follow-up of two years. Infection was successfully eradicated in 100 patients (87.

The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability.

Ensuring the accuracy of the intra-operative orientation of the acetabular component during a total hip replacement can be difficult. In this paper we introduce a reproducible technique using the transverse acetabular ligament to determine the anteversion of the acetabular component. We have found that this ligament can be identified in virtually every hip undergoing primary surgery.

Secondary resurfacing of the patella in mobile-bearing total knee arthroplasty.

Objective: We aim to evaluate the impact of secondary patellar resurfacing in patients with patellar-related anterior knee pain who have undergone a mobile-bearing primary knee arthroplasty without resurfacing.

Materials: A total of 2950 primary Low Contact Stress (DePuy, Warsaw, Ind) mobile-bearing knee arthroplasties without patellar resurfacing were carried out between March 1992 and March 2003. Thirteen patients (0.

The early management of severe tibial pilon fractures using a temporary ring fixator.

Background: The management of pilon fractures of the distal tibia is fraught with complications. Poor initial management leads to a poorer outcome. Protection of the soft tissue envelope is paramount and to achieve this objective early fracture reduction, restoration of leg length and elevation are important principles in the management of severe injuries.

Carpal tunnel syndrome secondary to intratendinous infiltration by tophaceous gout.

Carpal tunnel syndrome caused by gout is rare. We describe a case of entrapment of the median nerve secondary to intratendinous infiltration by gouty tophi in a 54-year-old man. The tophus was excised from the profundus tendon but the superficialis was too infiltrated and destroyed to be saved.

Functional absence of flexor digitorum superficialis to the little finger and absence of palmaris longus--is there a link?

We examined 150 men and 150 women aged 18-40 years to assess flexor digitorum superficialis function to the little finger and the incidence of palmaris longus absence. All patients had flexor digitorum superficialis function to the little finger assessed by standard and modified tests. The presence or absence of palmaris longus was assessed by clinical inspection.

Absence of the palmaris longus muscle: a population study.

We examined 300 Caucasian subjects (150 males, 150 females) aged 18-40 years to assess the incidence of palmaris longus absence. The presence or absence of palmaris longus was assessed by clinical inspection. Forty-nine subjects had unilateral absence of palmaris longus (16%).