Revision Following Cemented and Uncemented Oxford-III Primary Medial Unicompartmental Knee Replacements: A 19-Year Analysis from the New Zealand Joint Registry.

Background: Oxford-III unicompartmental knee replacements (UKRs) are among the most commonly used prostheses to treat isolated medial compartment osteoarthritis (OA). However, the best mode of implant fixation for primary UKRs remains a source of debate. The hypothesis of this study was that the biologically superior fixation of uncemented Oxford-III primary UKRs would translate into a lower revision rate when compared with cemented Oxford-III primary UKRs used to treat isolated medial compartment OA.

An analysis of the Oxford Shoulder Score and its relationship to early joint revision in the New Zealand Joint Registry.

Background: Primary shoulder arthroplasties significantly improve shoulder function and have acceptable prosthesis survival for various indications. Currently, no validated shoulder questionnaire exists that can anticipate the early failure of primary shoulder arthroplasties. This study hypothesized that the Oxford Shoulder Score (OSS) after primary shoulder arthroplasty at 6 months would be significantly associated with early revision procedures.

Pretubercular Subcutaneous Thickness Is a Protective Factor for Superficial Wound Complications After Total Knee Arthroplasty in Nonmorbidly Obese Patients.

Background: Anterior knee subcutaneous thickness has been associated with increased risk of early reoperation for surgical site infection after primary total knee arthroplasty (TKA) in morbidly obese patients. However, most patients undergoing TKA are not morbidly obese. The aims of this study were to (1) assess the association between anterior knee subcutaneous thickness and early superficial wound complications and (2) determine a threshold value for anterior knee subcutaneous thickness measures that can assist in preoperative risk stratification in nonmorbidly obese TKA patients.

Arthroscopic assessment of patella tracking correlates with recurrent patellar instability.

Purpose: For recurrent lateral patellar instability surgical algorithm, an arthroscopic assessment of patellar tracking can aid with the decision of adding a tibial tubercle transfer procedure based on knee flexion angle at which patella centrally engages in its groove. Tibial tubercle-trochlear groove distance is variable in normal values and has discrepancies between imaging modalities. The aims of our study were to assess correlation of arthroscopic patellar tracking technique with recurrent patellar instability, and to assess the accuracy and reproducibility of this technique.

Efficacy of the Adductor Canal Approach to Saphenous Nerve Block for Anterior Cruciate Ligament Reconstruction With Hamstring Autograft: A Randomized Controlled Trial.

Background: For reconstruction of the anterior cruciate ligament (ACL) with hamstring autograft, perioperative analgesia can be achieved with multimodal analgesia and intra-articular local anesthesia infiltration with or without additional regional blocks. Saphenous nerve block (SNB) via the adductor canal is commonly used in our practice, but its benefit has not been well established in the literature.

Purpose: To assess the efficacy of SNB in ACL reconstruction with hamstring autograft.

Is radiograph glenopolar angle accurate for extraarticular scapular neck fractures?

Background: Plain radiographs still play a role in management of extraarticular scapular neck fractures. Glenopolar angle (GPA) is one of the radiograph measurements that is used to determine the necessity for surgery. Our aim was to establish reliability of GPA on plain radiograph in patients with extraarticular scapular neck fractures.

Single versus triple injection ultrasound-guided infraclavicular block: confirmation of the effectiveness of the single injection technique.

Background: The optimal site for local anesthetic placement during ultrasound-guided infraclavicular block remains controversial.

Methods: Patients were randomized to receive lidocaine 2% 30 mL as a single injection posterior to the axillary artery (n = 51) or a triple injection ideally adjacent to each brachial plexus cord (n = 49). Pinprick sensory and motor block (3 = no block, 0 = complete block) were assessed to 20 minutes in the 4 distal nerve territories.

Time to definitive care for patients with moderate and severe traumatic brain injury--does a trauma system matter?

Aim: The presence of a trauma system has been associated with improved outcomes in patients with traumatic brain injury (TBI) by speeding up transfers to a neurosurgical centre. Improved outcomes are associated with time to neurosurgical intervention for those with significant extradural and subdural haemorrhages of less than 4 hours. To compare the outcomes for patients with TBI transferred directly from the scene of injury to Auckland City Hospital (ACH) with those transferred from other hospitals, transfer times and outcomes were evaluated in a consecutive cohort of patients recorded on the ACH trauma registry.

A survey of surgical techniques for catheterising the cerebral lateral ventricles.

The objective of this paper is to characterise the frequency of different surgical techniques for targeting the lateral ventricle in shunt surgery and the attitudes of Australasian neurosurgeons and advanced neurosurgical trainees to stereotactic adjuncts. Secondarily, we aim to learn from and collate the practical experiences of neurosurgeons for those attempting to improve their operative success. A survey of all practising and training members of the Neurosurgical Society of Australasia (NSA) was conducted.

Is it possible to distribute a scarce resource equitably? Access to invasive procedures for patients with acute myocardial infarction.

Aims: To compare waiting times for inpatient cardiac catheterisation between a hospital with on-site cardiac catheterisation facility (Auckland City Hospital, ACH) and one of its referring hospitals (North Shore Hospital, NSH).

Methods: Patients were included if they were admitted ACH or NSH with a myocardial infarction, and subsequently underwent inpatient coronary angiography.

Results: 853 patients were identified from NSH and 600 from ACH.

Surgical inclination and anatomy teaching at the University of Auckland.

Background: Medical graduate interest in surgery has declined and medical students are less capable in anatomy than they once were. Declining interest in surgery is because of factors, including growing number of women entering medical school. There has been less emphasis in teaching anatomy at various medical schools in recent years.

Surgical inclination in senior medical students from the University of Auckland: results of the 2005 Senior Students Survey.

Aims: To determine the proportion of senior medical students who are surgically inclined and to assess whether gender differences exist in surgical inclination.

Study Design: Cross-sectional survey. Twenty-five point questionnaire.

Magnetic resonance imaging of the common bile duct to exclude choledocholithiasis.

Background: Prior to cholecystectomy it is important to assess the common duct for choledocholithiasis. Given that a proportion of common duct stones will pass without incident and that methods of removal of these stones are potentially morbid, it would be very useful to have a test that identified only those stones that need intervention. The present study was designed to assess whether a negative magnetic resonance cholangiopancreaticogram (MRCP) is able to reliably exclude clinically relevant common duct stones.