Staff education compared with active real-time waste segregation to reduce the environmental impact of hip and knee arthroplasty.

Aims: Arthroplasty has been shown to generate the most waste among all orthopaedic subspecialties, and it is estimated that hip and knee arthroplasty generate in excess of three million kg of waste annually in the UK. Infectious waste generates up to ten times more CO2 compared with recycled waste, and previous studies have shown that over 90% of waste in the infectious stream is misallocated. We assessed the effect of real-time waste segregation by an unscrubbed team member on waste generation in knee and hip arthroplasty cases, and compared this with a simple educational intervention during the 'team brief' at the start of the operating list across two sites.

The ROSA robotic-arm system reliably restores joint line height, patella height and posterior condylar offset in total knee arthroplasty.

Introduction: There is growing interest in the use of robotic TKA to improve accuracy of component positioning in Total Knee Arthroplasty (TKA). The aim of this study was to investigate the accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Patella Height and Posterior Condylar Offset (PCO).

Methods: This was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system.

Mako versus ROSA: comparing surgical accuracy in robotic total knee arthroplasty.

There is increasing adoption of robotic surgical technology in Total Knee Arthroplasty. The ROSA® knee system can be used in either image-based mode (using pre-operative calibrated radiographs) or imageless modes (using intra-operative bony registration). The Mako knee system is an image-based system (using a pre-operative CT scan).

The Environmental Impact and Sustainability of Total Hip and Knee Arthroplasty.

Background: Operating room waste is disposed of in landfill sites, recycled, or undergoes costly, energy-intensive incineration processes. By assessing the quantity and recyclability of waste in primary hip (THA) and knee arthroplasty (TKA), we aim to identify strategies to improve sustainability.

Methods: A prospective waste audit of 15 primary THA and 16 primary TKA cases was conducted at a tertiary orthopedic hospital between April and July 2022.

The Linear Coronal Knee Offset (LCKO)-Preliminary Study of New Method of Measuring Knee Varus/Valgus Malalignment.

 Considerable attention is focused on preoperative templating of radiological images in patients undergoing total knee arthroplasty to obtain optimal alignment and outcome. Several radiological measurements have been described.  In this study, we illustrate a new linear measurement: The linear coronal knee offset (LCKO) that can be used to analyze the coronal configuration on long leg alignment radiographs commonly undertaken during preoperative templating.

Robotic technology in total knee arthroplasty.

Key factors for successful total knee arthroplasty include accurate implant positioning with precise tibial and femoral resection, combined with appropriate soft tissue balancing to achieve the desired alignment. Robotic-assisted total knee arthroplasty allows surgeons to execute pre-planned strategies with precision, with growing evidence suggesting that robotic-assisted-total knee arthroplasty reduces radiological outliers. This has yet to be proven to translate into long-term improvements in patient-reported outcomes and implant survivorship.

Deep infection after hip hemiarthroplasty: risk factors for infection and outcome of treatments.

Aims: Deep surgical site infection (SSI) remains an unsolved problem after hip fracture. Debridement, antibiotic, and implant retention (DAIR) has become a mainstream treatment in elective periprosthetic joint infection; however, evidence for DAIR after infected hip hemiarthroplaty is limited.

Methods: Patients who underwent a hemiarthroplasty between March 2007 and August 2018 were reviewed.

Methicillin-resistant in hip fracture.

Aims: Infection after surgery increases treatment costs and is associated with increased mortality. Hip fracture patients have historically had high rates of methicillin-resistant (MRSA) colonization and surgical site infection (SSI). This paper reports the impact of routine MRSA screening and the "cleanyourhands" campaign on rates of MRSA SSI and patient outcome.

Outcomes of distally un-threaded screw fixation of slipped capital femoral epiphysis at skeletal maturity: a matched cohort study.

The most common treatment for slipped capital femoral epiphysis worldwide is in situ fixation with a threaded screw. Un-threaded screws are designed to prevent slip progression without hindering residual growth of the proximal femur. This study aimed to compare growth, remodelling and long-term outcomes after fixation with un-threaded screws and a matched cohort of patients treated with a standard screw.

Review of total hip arthroplasty in patients younger than 30 years: mid- to long-term results.

Background: Data on the outcome of THA in patients under the age of 30 years is sparse. There is a perceived reluctance to offer surgery to young patients on the basis of potential early failure of the implant. The aim of this study was to review clinical and radiological outcomes of THA in patients under the age of 30 years in a high-volume specialist arthroplasty unit.

Landmark Technique for a Wrist Block.

Effective anesthesia of the hand and wrist has many uses inside and outside the operating room. In the emergency department or fracture clinic, a wrist block may be used for closed reductions of dislocations and fractures or for effective inspection and treatment of wounds. In the operating room, surgery may be carried out under a wrist block alone or a wrist block may be used as an adjunct to general anesthesia as the block is an opiate-sparing option to facilitate outpatient surgery and to provide many hours of postoperative analgesia, particularly if administered prior to the commencement of surgery.

Outcome following use of the Achillon jig for the repair of acutely ruptured Achilles tendons.

We report a series of 143 patients who underwent limited open Achilles tendon repair using the Achillon device at a mean follow-up of 25 months. All patients attending our institution with a diagnosis of acute Achilles tendon rupture were considered for operative repair using the Achillon jig unless they declined surgery or met the exclusion criteria. Following surgery patients were contacted and asked to complete an Achilles Tendon Rupture Score (ATRS).

Scarf-Akin osteotomy for hallux valgus in juvenile and adolescent patients.

Hallux valgus (HV) has been reported to affect 22-36% of adolescents, with a recurrence rate of around 30-40%. Operative treatment may be indicated in symptomatic deformities where conservative management has failed to halt progression of the deformity. There remains genuine concern with respect to high complication rates including recurrence and stiffness of the metatarsophalangeal joint following operative treatment in adolescents.

Type II Monteggia injury in a toddler: an unusual presentation.

Monteggia type fracture dislocations of the elbow are a common occurrence in children. Bado types I and III are the most common types comprising 70 and 23%, respectively, and type II injuries account only for 6%. We present an interesting case of Monteggia type II fracture dislocation in an 11-month-old child, which has not been described before in a child younger than 11 years of age.

A unique orthogeriatric model: a step forward in improving the quality of care for hip fracture patients.

Background: In August 2010, a unique model of shared care for hip fracture patients was implemented in our hospital. In this model, patients are allocated to an orthogeriatric team within 48 h of surgery, who review patients daily to manage medical complications and coordinate multidisciplinary rehabilitation, with orthopaedic input if necessary.

Aim: To compare the new model to the previous model of care as perceived by members of staff and compare clinical outcomes.

Lateral sesamoid position in hallux valgus: correlation with the conventional radiological assessment.

Background: We aimed to quantify the severity of the hallux valgus based on the lateral sesamoid position and to establish a correlation of our simple assessment method with the conventional radiological assessments.

Methods: We reviewed one hundred and twenty two dorso-plantar weight bearing radiographs of feet. The intermetatarsal and hallux valgus angles were measured by the conventional methods; and the position of lateral sesamoid in relation to first metatarsal neck was assessed by our new and simple method.

Traction splint: to use or not to use.

Traction splints are widely used for immobilisation of fractures of the lower limb. There is brevity of evidence-based research on their efficacy. We present a case of skin complication following traction splint for spiral fracture of femur.

Medial and lateral rotatory dislocations of the ankle after trivial trauma--pathomechanics and management of two cases.

Pure frontal plane rotatory dislocation of the ankle joint without an associated fracture is an extremely rare injury. We report one such case of an eversion rotatory dislocation and one case of an inversion rotatory dislocation. To our knowledge, this is the first report of an eversion injury resulting in dislocation of the ankle without fracture.