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Biomedical subjects

I J Brenkel

Publications and source records attributed to I J Brenkel.

At least 19 recordsLinked to original sources
PubMed2006

The practice of bilateral, simultaneous total knee replacement in Scotland over the last decade. Data from the Scottish Arthroplasty Project.

The issue of the safety of performing simultaneous, bilateral total knee replacement (SBTKR) for patients with bilateral knee osteoarthritis remains controversial. Several small series have reported inconclusive findings and the few large series published are contradictory. We present data retrieved from the Scottish Arthroplasty Project on over 19,000 total knee replacements (TKR) performed in Scotland between 1989 and 1999. The trends in the practice of SBTKR are shown together with the associated mortality from the procedure compared with unilateral or staged, bilateral TKR. The data shows that there was no statistically significant difference in the 90-day mortality between unilateral TKR, staged TKR or SBTKR. In addition, the length of stay for SBTKR has reduced, equaling that of unilateral TKR since 1993. Despite an initial increase in the percentage of consultants performing SBTKR early in the decade, since 1993, only approximately 25% of knee arthroplasty surgeons in Scotland per year ever performed a SBTKR.

Arthritis↗
PubMed2006

Total knee replacement in morbidly obese patients. Results of a prospective, matched study.

The results of 41 consecutive total knee replacements performed on morbidly obese patients with a body mass index > 40 kg/m(2), were compared with a matched group of 41 similar procedures carried out in non-obese patients (body mass index < 30 kg/m(2)). The groups were matched for age, gender, diagnosis, type of prosthesis, laterality and pre-operative Knee Society Score. We prospectively followed up the patients for a mean of 38.5 months (6 to 66). No patients were lost to follow-up. At less than four years after operation, the results were worse in the morbidly obese group compared with the non-obese, as demonstrated by inferior Knee Society Scores (mean knee score 85.7 and 90.5 respectively, p = 0.08; mean function score 75.6 and 83.4, p = 0.01), a higher incidence of radiolucent lines on post-operative radiographs (29% and 7%, respectively, p = 0.02), a higher rate of complications (32% and 0%, respectively, p = 0.001) and inferior survivorship using revision and pain as end-points (72.3% and 97.6%, respectively, p = 0.02). Patients with a body mass index > 40 kg/m(2) should be advised to lose weight prior to total knee replacement and to maintain weight reduction. They should also be counselled regarding the inferior results which may occur if they do not lose weight before surgery.

Adult↗
PubMed2006

Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis?

A total of 370 consecutive primary total knee replacements performed for osteoarthritis were followed up prospectively at 6, 18, 36 and 60 months. The Knee Society score and complications (perioperative mortality, superficial and deep wound infection, deep-vein thrombosis and revision rate) were recorded. By dividing the study sample into subgroups based on the body mass index overall, the body mass index in female patients and the absolute body-weight. The outcome in obese and non-obese patients was compared. A repeated measures analysis of variance showed no difference in the Knee Society score between the subgroups. There was no statistically-significant difference in the complication rates for the subgroups studied. Obesity did not influence the clinical outcome five years after total knee replacement.

Aged↗
PubMed2005

Does body mass index affect the early outcome of primary total hip arthroplasty?

There is little evidence describing the influence of body mass index on the outcome of total hip arthroplasty (THA). Eight hundred patients undergoing primary cemented THA were followed for a minimum of 18 months. The Harris Hip Score (HHS) and Short Form 36 were recorded preoperatively and at 6 and 18 months postoperatively. In addition, other significant events were noted, namely death, dislocation, reoperation, superficial and deep infection, and blood loss. Multiple regression analysis was performed to identify whether body mass index (BMI) was an independently significant predictor of the outcome of THA. No relationship was seen between the BMI of an individual and the development of any of the complications noted. The HHS was seen to increase dramatically postoperatively in all patients. Body mass index did predict for a lower HHS at 6 and 18 months. This effect was small when compared with the overall improvements in these scores. There was no influence on the Short Form 36 component scores. On the basis of this study, we can find no justification for withholding THA solely on the grounds of BMI.

Aged↗
PubMed2005

Weight change following total hip replacement: a comparison of obese and non-obese patients.

BACKGROUND: Weight loss is desirable in obese patients prior to hip replacement but poor mobility secondary to hip dysfunction may limit attempts at weight reduction because of reduced exercise tolerance. METHODS: We followed 140 patients prospectively to investigate weight change and functional outcome in obese and non-obese patients following total hip arthroplasty. Weight and the Harris hip score was measured one week prior to surgery and three years post-operatively. RESULTS: Fifty nine patients were obese (BMI > or = 30). The mean weight of obese patients increased from 88 kg pre-operatively to 92 kg following surgery (p<0.001). In non-obese patients pre-operative weight was 69 kg and post-operative weight 70 kg (p=0.106). In the obese group 75% of patients gained a mean of 6.77 kg (p<0.001) and 19% of patients lost a mean of 4.8 kg (p<0.01). In the non-obese group, 60% of patients gained a mean of 4.2 kg (p<0.001) and 31% of patients lost an average of 4.7 kg (p<0.001). The mean Harris hip score was 90 in non-obese patients and 85 in obese patients three years post-operatively (p<0.01). CONCLUSION: Weight increase is common following total hip replacement despite improved function but the magnitude of weight increase appears to be greater in patients who are obese. Obesity was also associated with lower functional hip scores but the differences were small and unlikely to be of clinical significance.

Adult↗
PubMed2005

A postal survey of current thromboprophylactic practices of consultant orthopaedic surgeons in the treatment of fracture of the hip.

Despite increasing scientific investigation, the best method for preventing post-operative deep-vein thrombosis remains unclear. In the wake of the publication of the Pulmonary Embolism Prevention trial and the Scottish Intercollegiate Guidelines Network (SIGN) on the prevention of thromboembolism, we felt that it was timely to survey current thromboprophylactic practices. Questionnaires were sent to all consultants on the register of the British Orthopaedic Association. The rate of response was 62%. The survey showed a dramatic change in practice towards the use of chemoprophylaxis since the review by Morris and Mitchell in 1976. We found that there was a greater uniformity of opinion and prescribing practices in Scotland, consistent with the SIGN guidelines, than in the rest of the UK. We argue in favour of the use of such documents which are based on a qualitative review of current scientific literature.

Consultants↗
PubMed2005

Natural history of fixed flexion deformity following total knee replacement: a prospective five-year study.

We investigated fixed flexion deformity (FFD) after total knee replacement (TKR). Data relating to 369 cruciate-retaining unilateral TKRs performed at a single institution were collected prospectively. Fixed flexion was measured pre-operatively and at one week, six months, 18 months, three years and five years after surgery. Using binary logistic regression, pre-operative FFD was a predictor of post-operative FFD > 10 degrees at one week (p = 0.006) and six months (p = 0.003) following surgery. Gender was a predictor at one week (p = 0.0073) with 24% of women showing a FFD > 10 degrees compared with 37% of men. We have shown that a gradual improvement in knee extension can be expected up to three years after surgery in knees with FFD. By this time residual FFD is mild or absent in the majority of patients, including those who had a severe pre-operative FFD.

Adult↗
PubMed2004

Pre-operative predictors of the requirement for blood transfusion following total hip replacement.

We have reviewed prospective data on 1016 patients who underwent unilateral total hip replacement to establish the pre-operative risk factors associated with peri-operative blood transfusion. Most patients who required transfusion were older and were of lower weight, height, pre-operative haemoglobin level and body mass index than patients who were not transfused. Multivariate analysis revealed that only the pre-operative haemoglobin level and the patients weight were identified as significant independent factors increasing the need for transfusion (p < 0.001). A haemoglobin level below 12 g/dl was associated with a threefold increase in transfusion requirement.

Adolescent↗
PubMed2003

Thromboprophylaxis in patients undergoing total hip replacement.

Venous thromboembolism is a common complication following a hip replacement. It was the authors' impression that prophylaxis of deep vein thrombosis has changed in recent years. The authors felt that it was important to repeat a survey, done in 1997, on the use of thromboembolism prophylaxis among British orthopaedic surgeons.

Arthroplasty, Replacement, Hip↗
PubMed1999

The supracondylar intramedullary nail in elderly patients with distal femoral fractures.

From February 1994 until July 1997, a prospective study of all elderly patients with a displaced distal femoral fracture, who were treated with an intramedullary supracondylar nail, was made. The outcome of 31 fractures in 30 elderly patients was studied. The average age was 82 years (55-98). Two-thirds of the patients had had previous ipsilateral femoral pathology. Average acute hospital stay was 17 days. All patients were reviewed at 6 months and all cases have been followed for over 1 year. More than 90% of surviving fractures had healed within 6 months of the operation. Outcome scores were; 22 (85%) excellent or satisfactory, 2 (7.5%) unsatisfactory and 2 (7.5%) failures. The mortality rate was 17% at 6 months and 30% at 1 year, which is similar to patients with a fractured neck of femur. This nail is recommended for its versatility and favourable outcome scores in this age group.

Aged↗
PubMed1991

Slipped capital femoral epiphysis.

Although slipped capital femoral epiphysis is the most common disorder of the hip in adolescents, the diagnosis is often delayed. The subsequent development of degenerative joint disease is related to the severity of the slip, which in turn is usually related to the duration of the symptoms. This article summarizes the aetiology, epidemiology, clinical presentation and treatment of slipped capital femoral epiphysis.

Adolescent↗
PubMed1989

Hormone status in patients with slipped capital femoral epiphysis.

In 15 consecutive patients with slipped capital femoral epiphysis we recorded height, weight and skeletal maturity. Sexual maturity was assessed clinically and biochemically, and Harris's hypothesis that there is an increased ratio of serum growth hormone to oestrogen was tested in comparison with 15 age and sex matched controls. We found no difference in skeletal or sexual maturity between the groups, or any overt endocrine abnormality in the patients. However almost half the patients with slipped epiphysis were over the 90th weight percentile, suggesting that mechanical factors such as obesity are more important aetiologically than endocrine abnormalities.

Adolescent↗
PubMed1989

Patterns of union in fractures of the waist of the scaphoid.

Eighty-two of 85 patients who had sustained a fracture of the waist of the scaphoid in 1985 were reviewed more than one year after injury. The incidence of nonunion, defined as a clear gap at the fracture site one year after injury, was 12.3%. This was much higher than expected. Most of the patients with nonunion had symptoms and had appreciable restriction of wrist movement. In a further 25% of the patients at review, the site of the fracture could be easily identified although it appeared to have healed. These patients were older and more of them were women. Three-quarters of these patients had symptoms but their wrist movement was essentially normal.

Adolescent↗
PubMed1989

Total hip replacement and antithrombotic prophylaxis.

British orthopaedic surgeons were surveyed to assess the practice of prophylaxis against thromboembolism in patients undergoing total hip replacements. Of 690 surgeons, 348 (50.4%) do not routinely use pharmacological prophylaxis (190 use no prophylaxis while 158 use a mechanical form of prophylaxis), 289 (41.9%) surgeons use a single pharmacological agent (with or without a mechanical form of prophylaxis), and the remaining 53 (7.7%) use two or more pharmacological agents.

Antithrombins↗
PubMed1988

Articular fractures of the distal scaphoid.

We propose an anatomical classification of fractures involving the distal articular surface of the scaphoid. The predominant patterns, in the 37 patients reviewed, were avulsion fractures from the radio-volar tip of the tuberosity and impaction fractures of the radial half of the articular surface. The possible mechanisms of injury are discussed.

Adolescent↗
PubMed1988

Computerised tomographic assessment of the subtalar joint in calcaneal fractures.

Thirty-six patients with 39 fresh fractures of the calcaneus were investigated by standard radiography and by computerised tomography. It was found that the size and disposition of the fracture fragments and the degree of involvement of the posterior facet of the subtalar joint were more clearly shown by CT scanning. We recommend this technique for assessment and particularly for pre-operative planning.

Adolescent↗
PubMed1988

Radiographic signs of union of scaphoid fractures. An analysis of inter-observer agreement and reproducibility.

Inter-observer agreement and reproducibility of opinion were assessed for the radiographic diagnosis of union of scaphoid fractures on films taken 12 weeks after injury. Weighted kappa statistics were used to compare the opinions of eight senior observers reviewing 20 sets of good quality radiographs on two occasions separated by two months. There was poor agreement on whether trabeculae crossed the fracture line, whether there was sclerosis at or near the fracture and on whether the proximal part of the scaphoid was avascular. As a consequence, agreement on union also was poor; it appears that radiographs taken 12 weeks after a scaphoid fracture do not provide reliable and reproducible evidence of healing.

Carpal Bones↗