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Biomedical subjects

M G Hullin

Publications and source records attributed to M G Hullin.

11 recordsLinked to original sources
PubMed2005

Long-term results of the uncemented low contact stress total knee replacement in patients with rheumatoid arthritis.

We analysed the long-term clinical and radiological results of 63 uncemented Low Contact Stress total knee replacements in 47 patients with rheumatoid arthritis. At a mean follow-up of 12.9 years (10 to 16), 36 patients (49 knees) were still alive; three patients (five knees) were lost to follow-up. Revision was necessary in three knees (4.8%) and the rate of infection was 3.2%. The mean clinical and functional Knee Society scores were 90 (30 to 98) and 59 (25 to 90), respectively, at final follow-up and the mean active range of movement was 104 degrees (55 degrees to 120 degrees ). The survival rate was 94% at 16 years but 85.5% of patients lost to follow-up were considered as failures. Radiological evidence of impending failure was noted in one knee.

Aged↗
PubMed2001

Audit of orthopaedic bed utilisation.

Blockage of beds on an orthopaedic ward causes multiple problems; it can result in cancellation of patients or elective surgery, longer waiting lists and a crisis with emergency admissions. This often necessitates 'boarding out' of patients, which is not ideal for optimal patient care. Not all patients on an orthopaedic ward need continuing orthopaedic medical or nursing care and it may be more appropriate for these patients to be managed in a rehabilitation environment. From 1/09/98-30/11/98 data were collected on all patients admitted to an adult orthopaedic ward. Information recorded included the reason for admission, age, diagnosis, surgical procedure, family and social circumstances. In addition, the date when discharge was deemed appropriate was recorded as well as the actual date of discharge. We defined the length of overstay as the time spent in an orthopaedic bed after discharge had been deemed appropriate. There were 621 patients admitted for a total of 3159 bed days. There were 253 elective admissions and 368 emergency admissions. A total of 255 bed days were blocked by 46 patients (41 emergency and 5 elective) accounting for eight per cent of the total bed days. Of these 236 (93%) were due to emergency admissions and 19 (7%) were due to elective admissions, most blocked beds were due to patients who required rehabilitation in either a unit for the young disabled or a geriatric rehabilitation ward.

Adult↗
PubMed2000

Wound infection in hip and knee arthroplasty.

We have studied prospectively the outcome of wound discharge in patients after arthroplasty of the hip and knee. Over a period of 3.5 years 530 primary arthroplasties were carried out in one hospital. Postoperative wound infections developed in 82. At a mean follow-up of two years a comparison was made between these patients and 82 with healthy wounds, in terms of symptoms and signs of deep infection. There was an incidence of 1.1% of early deep infection, within six weeks in all cases. The rate of 'superficial' infection was 17.3% in the hips, 10.5% in the knees and 14.3% in total. At a mean follow-up of 26 months, there were no significant differences between the patients with infected wounds and a matched group of patients with healthy wounds in terms of the ESR, level of C-reactive protein, white cell count and radiological scores, but clinical scores were significantly worse in the patients with infected knees (p < 0.05). The length of stay was also significantly longer in this group (mean 14.6 days in the healthy wound group, 19 days in the problem group; p < 0.005). There was, however, no convincing evidence that these wound infections led to deep infection and early revision in the early to medium follow-up period. A larger and longer prospective trial would be necessary to shed more light on this potential problem.

Arthroplasty, Replacement, Hip↗
PubMed1996

Gait patterns in children with hemiplegic spastic cerebral palsy.

Twenty-six nonoperated spastic hemiplegic children underwent three-dimensional kinetic gait analysis. We identified five patterns based on sagittal plane kinetics. Group I had a minimal gait disturbance, a drop foot pattern, and normal kinetics, Group II had a flexed knee but normal hip extension, Group III a flexed knee and hip, Group IV knee hyperextension and tibial arrest, and Group V knee hyperextension and persistent ankle dorsiflexion. We concluded that Group I had weak anterior tibial muscles, and in stance Group II a functionally tight gastrocnemius, Group III a functionally tight gastrocnemius and hip flexors, and Group IV a functionally tight soleus, and in Group V the patients generated an abnormally large fore-aft shear force and the gastrocnemius and soleus were not tight. Kinetics help in the understanding of gait aberrations in spastic hemiplegia.

Biomechanical Phenomena↗
PubMed1994

Lower limb amputation following injury: a survey of long-term functional outcome.

Although there have been significant advances in surgical methods of limb preservation and various injury scores produced to predict the outcome after severe lower limb injury, there is common belief amongst surgeons that patients rehabilitate rapidly and well after amputation. There is however little evidence in the literature supporting this view of functional outcome of amputation following injury. A subjective assessment of post-injury lower limb amputees implied that there was a similar functional outcome in above- and below-knee amputations. Furthermore, there was little functional difference between early and delayed amputations, the delayed group being more satisfied with the end result.

Adolescent↗
PubMed1991

The effect of Luque segmental sublaminar instrumentation on the rib hump in idiopathic scoliosis.

The change in back shape after Luque segmental sublaminar instrumentation was assessed in the frontal, sagittal, and transverse planes in 61 patients with adolescent idiopathic scoliosis using the Integrated Shape Investigation System (ISIS) and standard radiographic techniques. Luque instrumentation was found to be an effective method of correcting thoracic and thoracolumbar curves in the frontal plane with a 59% and 63% respective reduction in the size of the preoperative Cobb angle. Despite the frontal plane correction, however, the ISIS scan showed that of the 40 single thoracic curves, the rib hump was reduced in only 6 patients, was unchanged in 27 patients, and was worsened slightly in 7 patients. By contrast, thoracolumbar and lumbar curves were corrected in all three planes with a significant cosmetic improvement.

Adolescent↗
PubMed1991

Biomechanical effects of rockers on walking in a plaster cast.

Rockers are applied to lower limb casts to assist walking but there is little information on their biomechanical effects. The performances of 10 commercially available rockers were compared. They were applied to a below-knee cast worn by a normal subject who was also tested walking in the cast alone. Gait analysis was used to evaluate kinematic and kinetic data. The design of rocker had no effect upon the kinematics of walking. However, using new criteria for kinetic assessment of rocker function (tibial floor angular velocity and centre of pressure progression), most designs had a deleterious effect on the biomechanics of gait. Only two rockers approached the ideal kinetic criteria.

Biomechanical Phenomena↗
PubMed1986

Wrist arthrodesis as part of composite surgery of the hand.

A simple, quick and reliable method of arthrodesis of the wrist joint enables other surgical procedures to be carried out at the same time under the same tourniquet, thus reducing strain upon the patient and the hospital services.

Arthritis, Rheumatoid↗
PubMed1986

Modified instruments for wrist fusion.

A technique and new instruments for intramedullary fixation of the wrist arthrodesis is described, based on the technique of Clayton, popularized by Nalebuff and Millender. This allows early mobilisation, secure fixation and simplicity of the technique. It also allows other surgical procedures to be performed under the same anaesthetic and tourniquet due to the reduction in operative time.

Arthrodesis↗
PubMedDate not supplied

Ankle-foot orthosis function in low-level myelomeningocele.

Six children with low-level myelomeningocele underwent gait analysis. All showed excessive ankle dorsiflexion and knee flexion when walking barefoot. A rigid thermoplastic ankle-foot orthosis (AFO) improved gait by preventing ankle dorsiflexion and reducing knee flexion. Biomechanically, the AFO caused a reduction in external knee moment by aligning the knee with the ground reaction force. Small changes in the foot-shank angle of the orthosis had profound effects on knee mechanics. Knee hyperextension could be controlled by a rocker sole. Kinetic gait analysis permits understanding of the biomechanical effects of orthoses.

Biomechanical Phenomena↗