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Biomedical subjects

J P Hodgkinson

Publications and source records attributed to J P Hodgkinson.

At least 19 recordsLinked to original sources
PubMed2006

Bacteriology swab in primary total hip arthroplasty-- does it have a role?

Infection in joint replacement is a devastating complication, and in spite of the advances in surgery, it remains a challenge. The rate of deep infection following primary hip/knee arthroplasty is between 1% and 2%. The aim of this study was to determine whether obtaining bacteriology swabs at the time of surgery could help in further reducing the rate of infection following joint arthroplasty. A bacteriology swab of the synovial fluid was taken after opening the capsule of the hip joint and was sent for culture and sensitivity. Out of 142 swabs sent, four (2.1%) were found to be positive. Three of these patients were treated with antibiotics after obtaining sensitivities. None of the patients developed deep infection. Bacteriology swab in primary joint arthroplasty may have a role and may help in further reducing the incidence of deep infection in joint replacement surgery.

Antibiotic Prophylaxis↗
PubMed2006

Does salvage and tranexamic acid reduce the need for blood transfusion in revision hip surgery?

We carried out a retrospective case-control study in 80 patients who underwent a revision total hip replacement. Group A (40 patients) received tranexamic acid and intra-operative cell salvage. Group B (40 patients) was a matched control group and did not receive this management. Each group was divided into four subgroups: revision of both components, revision of both components with bone grafting, revision of the acetabular component with or without bone graft, and revision of the femoral component with or without bone graft. In group A the total number of units transfused was 52, compared with 139 in group B, representing a reduction in blood usage of 62.5%. The mean amount of blood transfused from cell salvage in each group was 858 ml (113 to 2100), 477 ml (0 to 2680), 228 ml (75 to 315) and 464 ml (120 to 1125), respectively. There was a significant difference in the amount of blood returned between the groups (p < 0.0001). In group A, 22 patients needed transfusion and in group B, 37 (p < 0.0001). A cost analysis calculation showed a total revenue saving of pounds sterling 70 000 and a potential saving throughout our facility of pounds sterling 318 288 per year. Our results show that a significant reduction in blood transfusion can be made using combined cell salvage and tranexamic acid in revision surgery of the hip.

Analysis of Variance↗
PubMed2006

Long-term survival of the acetabular component after total hip arthroplasty with cement in patients with developmental dysplasia of the hip.

BACKGROUND: Total hip arthroplasty with cement remains a difficult procedure in patients with osteoarthritis secondary to developmental dysplasia of the hip as it is associated with high rates of aseptic loosening of the acetabular component. The purpose of the present study was to evaluate the rate of revision of the acetabular component in this group of patients and the variables that are associated with it. METHODS: We retrospectively reviewed the records and radiographs of 292 hips in 206 patients who had undergone total hip arthroplasty with cement for the treatment of osteoarthritis secondary to developmental dysplasia of the hip. The average age of the patients at the time of the index procedure was 42.6 years, and the average duration of follow-up was 15.7 years (range, 2.2 to 31.2 years). Fourteen patients were lost to follow-up, and seven patients died from causes unrelated to surgery. A 22.25-mm head was used in all cases, and bone-grafting of the acetabulum was performed in forty-eight hips. Survival of the acetabular component was calculated with revision for aseptic loosening as the end point. Individual survival rates based on age, component type, previous surgery, and annual polyethylene wear also were calculated. RESULTS: The most common reason for revision was aseptic loosening of the acetabular component, which led to 87.2% of the revision procedures. The overall rate of survival of the acetabular component was 90.6% at ten years and 63% at twenty years. A higher rate of acetabular revision was noted in association with previous acetabular surgery, the offset-bore cup, younger age, and accelerated polyethylene wear (p < 0.05 for all comparisons). CONCLUSIONS: Aseptic loosening of the acetabular component affects the longevity of total hip replacements in patients with osteoarthritis secondary to developmental dysplasia of the hip. The present study identified the risk factors associated with the long-term survival of the acetabular component in this group of patients.

Acetabulum↗
PubMed2005

Severity of hip dysplasia and loosening of the socket in cemented total hip replacement. A long-term follow-up.

We have assessed the long-term results of 292 cemented total hip replacements which were performed for developmental dysplasia of the hip in 206 patients. The mean age of the patients at operation was 42.6 years (15.9 to 79.5) and most (202) were women. The severity of dysplasia was graded according to both the Crowe and the Hartofilakidis classifications. A 22.25-mm Charnley head was always used and the acetabular components were inserted with cement into the true acetabulum. Bone grafting of the acetabulum, using the patient's own femoral head, was performed on 48 occasions. At a mean follow-up of 15.7 years (2.2 to 31.2) the overall survival of the acetabular component was 78%. The main cause of revision was aseptic loosening (88.3%). The rate of survival at 20 years based on the Hartofilakidis classification was 76% in the dysplastic, 55% in the low-dislocation and 12% in the high-dislocation groups and on the Crowe classification, 72.7% for group I, 70.7% for group II, 36.7% for group III and 15.6% for group IV. There was no statistical correlation between bone grafting of the acetabulum and survival of the acetabular component. This study has shown a higher rate of failure of the acetabular component with increasing severity of hip dysplasia.

Adolescent↗
PubMed2004

Ankle sprain: an unexpected complication.

Blunt arterial injury is usually caused by high velocity trauma and can result in intimal dissection. We present a case of a professional footballer who sustained an intimal tear of the posterior tibial artery following a minor eversion injury of the ankle. The injury was noticed because of the physical demands of this patient's profession. This was confirmed by an arteriogram and was treated with bypass surgery using an arm vein. Arterial intimal injury has not been reported previously with this type of injury. A high index of suspicion is needed to diagnose these injuries and revascularisation either by primary anastomosis or vein interposition graft is suggested.

Adult↗
PubMed2000

Two-stage revision with pseudocapsular resection for recurrent dislocation of total hip prostheses.

Recurrent dislocation of the prosthesis is a problem with total hip arthroplasty. In the rare cases in which no identifiable cause can be found for the recurrent dislocation, we believe that the answer lies in addressing the large, sterile, fluid-filled cavity bounded by pseudocapsule, which we have noticed to form around the neck of the femoral implant in these cases. We report a 2-stage surgical technique that we have used successfully in 3 cases of recurrent dislocation without an identifiable cause, with an average follow-up of 3 years.

Arthroplasty, Replacement, Hip↗
PubMed1996

Acrylic bone-cement. Influence of mixer design and unmixed powder.

The effects of hand mixing with two different mechanical mixing systems (fixed versus rotating central axis) on unmixed powder content, macroporosity, density, and bending strength of acrylic bone-cement are compared. The effects of voids and unmixed powder on cement bending strength are also evaluated. In acrylic cement, both unmixed powder monomer and voids 1 mm and larger can be easily visualized and analyzed on radiographs of 3-mm-thick samples. Image analysis allowed demonstration of a significant increase in unmixed powder content (P < .0001), in cement prepared using a vacuum mixing system with a fixed central axis compared with both the rotating axis system and hand mixing. The rotating-axis system produced cement of higher density compared with hand mixing only (P = .004). There was a significant correlation between the number of voids measured per square centimeter and cement bending strength (P < .0001), as well as an independent and significant correlation between unmixed powder content and cement bending strength (P < .0001). Mechanical mixing using a fixed central axis produced significantly weaker cement compared with both hand mixing (P < .015) and the rotating-central-axis system (P < .0001). A 15% drop in strength between the two mechanical mixing systems was observed. It is therefore concluded that the use of different rotating systems in mechanical mixers can influence void and unmixed powder content and, consequently, the mechanical properties of acrylic cement, and that unmixed powder is an independent factor affecting the bending strength of the cement.

Acrylates↗
PubMed1995

The perceived relationship between back symptoms and preceding injury.

A questionnaire was used to gather information regarding the prevalence of minor back symptoms related to performing everyday tasks, including sitting, lifting, etc. in a population of hospital employees. We studied 175 subjects, of whom 111 had not suffered a back injury. Of this group, 68 (61.3 per cent) had suffered back discomfort during or after performing everyday tasks. Sixty-four reported a previous injury to their back, and of these 55 (85.9 per cent) described back discomfort during or after performing everyday tasks. Of the symptomatic cases, 46 (83.3 per cent) maintained that they had no back symptoms prior to their injury, and attributed all of their back symptoms to the injury. The chi 2 test was used to test the null hypothesis that the group attributing their symptoms to injury was derived from the same population as the group who had not suffered any definite injury, and yet had back symptoms. This hypothesis was rejected (P < 0.001), indicating that there was a significant difference between these two groups. We conclude that individuals who sustain a back injury sometimes do not recall that they suffered symptoms prior to their injury. This may be of medico-legal importance in cases where compensation is being sought.

Activities of Daily Living↗
PubMed1995

The perceived relationship between neck symptoms and precedent injury.

A questionnaire survey of 328 hospital employees was used to establish the general prevalence of neck symptoms related to everyday activities in a representative population of working society. The response rate was 92 per cent. Of the study population of 302, 54 had suffered neck injury, and of this group, 43 (80 per cent) had some neck discomfort during or after performing normal everyday tasks. Of the symptomatic cases, only seven (16 per cent) admitted that they had suffered from some neck symptoms before the injury, whilst 36 (84 per cent) attributed all of their neck symptoms to the injury sustained. Of the total population, 248 had not suffered a neck injury and of this group 84 (34 per cent) suffered some neck discomfort during or after performing normal everyday tasks. The chi 2 test was used to test the null hypothesis that the sub-group attributing their symptoms to injury, in whom only 16 per cent acknowledged pre-existent neck symptoms, was derived from the same population as the group who had not suffered any definite neck injury, and yet were still troubled with some neck symptoms in 34 per cent of cases. This hypothesis was rejected (P < 0.01), indicating that there was a significant difference between these two groups. We conclude that some individuals who suffer a neck injury do not recall that they suffered some minor neck symptoms before injury. The statistical analysis and alternative possible explanations are discussed. Our conclusions may be of medico-legal importance in cases where compensation is being sought.

Accidents, Occupational↗
PubMed1994

Activity and socket wear in the Charnley low-friction arthroplasty.

A clinical study was undertaken to assess the influence of patient-related factors on wear of the socket in Charnley low-friction arthroplasty. One hundred nine arthroplasties in 79 patients were reviewed at an average of 10.3 years. A new method of activity assessment was designed and used to estimate the distance walked by each patient. This method was validated by a pedometer that recorded the time taken by each patient to walk 20 m. Activity level was related to the amount of movement at the level of the prosthetic articulation by calculating the sliding distance of a point at the center of the surface of the head of the femoral component. Wear was found to correlate with patient activity, but not with the physical characteristics of the patient or the time since operation.

Activities of Daily Living↗
PubMed1993

Flanged acetabular components in cemented Charnley hip arthroplasty. Ten-year follow-up of 350 patients.

A flanged socket was introduced by Sir John Charnley for use in his low-friction hip arthroplasty in 1976. Experimental evidence has suggested that the flange offers an advantage in terms of cement pressurisation at the time of implantation. We have reviewed 302 primary Charnley arthroplasties followed for 9 to 11 years to determine the effect of the flanged socket on the radiological appearance. The incidence of radiological demarcation at the cement-bone interface is significantly reduced in early radiographs after the use of a flanged socket, and the advantage is maintained in the long-term results.

Bone Cements↗
PubMed1992

A new femoral cement restrictor.

The authors report on the clinical trial of a new femoral cement restrictor for use during hip arthroplasty. Instrumentation and technique are described. The restrictor has three components made of high-density polyethylene that fit one inside the other and is available in small, medium, and large sizes. The advantages of this new restrictor are ease of use and secure fixation in the femoral canal when deployed. Because of its inherent strength and design, small particles do not break off during insertion. The apex of the restrictor points proximally and is cupped. This helps in centralizing the stem. It also assists in obtaining good cement pressurization as it does not distally migrate in the femoral canal when pressurization is attempted. Also, no cement escapes distally beyond it. Furthermore, should revision surgery be required, the restrictor can be easily removed without the need for windowing the femoral cortex.

Cementation↗
PubMed1990

Patellar resurfacing in total condylar knee arthroplasty. Technique and results.

One hundred thirty-two total condylar knee arthroplasties with a 3-8-year follow-up period were studied prospectively with particular reference to the patellofemoral joint. All patients had significant patellofemoral disease and underwent primary patellar resurfacing. After operation 96% of patients had little or no pain and 98% had functional improvement. There were seven (5%) complications related to the patellofemoral joint. The importance of careful attention to preparation of the patella, the technique of prosthetic implantation and correct patellar tracking were emphasized. Routine patellar resurfacing proved highly successful with minimal complications.

Adult↗
PubMed1989

Symptomatic non-union of the carpal scaphoid: Matti-Russe bone grafting versus Herbert screw fixation.

We have reviewed 19 patients who have had Matti-Russe bone grafting and 16 patients who have had Herbert screw fixation for symptomatic non-union of the carpal scaphoid. The success rate in both groups was similar, 74 per cent in the Matti-Russe group and 71 per cent in the Herbert screw group. Only five patients in the Herbert screw group had bone grafts. The advantages and disadvantages of both methods of treatment are discussed.

Adolescent↗
PubMed1989

Treatment of displaced subcapital fractures with the Charnley-Hastings hemiarthroplasty.

Between December 1982 and June 1986, 98 displaced subcapital femoral neck fractures were treated using the Charnley-Hastings bipolar hemiarthroplasty. Although the patients were elderly, often with associated medical problems, the operation was well tolerated and the mortality at one and six months was 14.4% and 24.5% respectively. Fifty-four hips were reviewed after an average follow-up of 33 months; 64.8% of patients had a good or excellent result. The fair or poor results were seen mainly in patients with poor pre-operative mobility and multiple medical problems. A significant cause of morbidity was dislocation (two interprosthetic) which occurred in six hips. There were two cases of deep sepsis but neither patient was fit for further surgery. There were no cases of acetabular erosion requiring revision surgery.

Aged↗