Richard Field - Academia.edu (original) (raw)
Papers by Richard Field
The Journal of Bone and Joint Surgery. British volume, 2012
Using general practitioner records and hospital notes and through direct telephone conversation w... more Using general practitioner records and hospital notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications gathered from a self-completed questionnaire after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with a mean age of 71.8 years (34 to 93). A total of 319 reported complications (79.4%; 95% confidence interval 75.4 to 83.3) were confirmed to be correct. High rates of correct reporting were demonstrated for infection (94.5%) and the need for further surgery (100%), whereas the rates of reporting deep-vein thrombosis (DVT), pulmonary embolism, myocardial infarction and stroke were lower (75% to 84.2%). Dislocation, peri-prosthetic fractures and nerve palsy had modest rates of correct reporting (36% to 57.1%). More patien...
The Journal of bone and joint surgery. British volume, 2012
We obtained information from the Elective Orthopaedic Centre on 1523 patients with baseline and s... more We obtained information from the Elective Orthopaedic Centre on 1523 patients with baseline and six-month Oxford hip scores (OHS) after undergoing primary hip replacement (THR) and 1784 patients with Oxford knee scores (OKS) for primary knee replacement (TKR) who completed a six-month satisfaction questionnaire. Receiver operating characteristic curves identified an absolute change in OHS of 14 points or more as the point that discriminates best between patients' satisfaction levels and an 11-point change for the OKS. Satisfaction is highest (97.6%) in patients with an absolute change in OHS of 14 points or more, compared with lower levels of satisfaction (81.8%) below this threshold. Similarly, an 11-point absolute change in OKS was associated with 95.4% satisfaction compared with 76.5% below this threshold. For the six-month OHS a score of 35 points or more distinguished patients with the highest satisfaction level, and for the six-month OKS 30 points or more identified the hi...
Acta orthopaedica Belgica, 2013
This study aimed to assess if patient-matched cutting blocks reduce operating time, blood loss an... more This study aimed to assess if patient-matched cutting blocks reduce operating time, blood loss and length of stay on top of improving implant alignment and offer operational or economic benefits, as claimed by manufacturers. We retrospectively reviewed patients undergoing TKA using patient matched technology and compared them with patients undergoing TKA using standard instrumentation; all were operated on between September 2010 and June 2012. All procedures were performed by a single surgeon at a single centre using the same implants. We collected data on operating time, length of stay and blood loss and also measured component alignment. Thirty-nine patients underwent TKA using patient-matched technology during the study period. Data was compared with that from 50 patients undergoing TKA using standard instrumentation during the same period. We found no significant difference in operating time, length of stay or blood loss between the two groups. There was also no difference in fe...
Journal of Orthopaedic Surgery and Research, 2019
Background With over 2.35 million records, the National Joint Registry (NJR) is the largest arthr... more Background With over 2.35 million records, the National Joint Registry (NJR) is the largest arthroplasty registry in the world. It provides a powerful tool to monitor implant survivorship and influence different surgical strategies. To date, little work has been undertaken to investigate the validity of the ‘Reason for Revision’ recorded in Consultant Outcome Reports on the NJR. Methods The NJR was queried to identify all revisions on the THR performed at a single centre over an 11-year period. Review and validation of ‘Reason for Revision’ for each case was undertaken using radiological imaging studies, pathology, histology, microbiology and electronic medical records. Results Of the 22,046 primary total hip replacements (THR) and total knee replacements (TKR) undertaken by 23 surgeons at our hospital, over an 11-year period, 1.35% (297) were subsequently reported to the NJR as revised. Discrepancies in reporting to the NJR were identified for 41 cases (25.63%) for THR and 28 (20.4...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
Seventeen (43%) FAI cases did not require surgery. Within this group, all patients received forma... more Seventeen (43%) FAI cases did not require surgery. Within this group, all patients received formal physical therapy (PT). None of these athletes had sports limitations. Three of these cases required at least 1 corticosteroid injection. One athlete opted to retire from sport for FAI and other injuries without surgery. Conclusions: In a large collegiate athletic program the prevalence of hip injuries was 10% of all MSK injuries, and 9% of those were diagnosed with FAI. There was a preponderance of females, and more than half the patient underwent surgery with 96% return to sports at the same or higher level. Half the subjects were treated non-operatively with PT, functional progression, and temporary activity modification and returned to sports at the same level. Two athletes retired from sports, 1 with and 1 without surgery. There was a trend toward more significant chondral damage for those that waited longer for surgery.
Arthritis, 2015
Synovial tissue can display an inflammatory response in the presence of OA. There is increasing i... more Synovial tissue can display an inflammatory response in the presence of OA. There is increasing interest to better understand the role of inflammation in OA, particularly with regard to those who require joint replacement. A systematic review of inflammatory synovitis in OA of literature databases was undertaken from their inception until October 14, 2014. Independent critical appraisal of each study was undertaken using the CASP appraisal tool. From a total of sixty-six identified citations, twenty-three studies were deemed eligible for review. The studies presented moderate to strong methodological quality. Strong correlation was identified between histological and imaging synovitis severity. Correlation was weaker between clinical symptoms and imaging and/or histological synovitis severity. There was little consensus, with regard to expressed cytokines and chemokines at the different stages of OA disease progression. Few studies investigated the influence of inflammatory synoviti...
Clinical Orthopaedics & Related Research, 2014
Background Experimental disruption of the labrum has been shown to compromise its sealing functio... more Background Experimental disruption of the labrum has been shown to compromise its sealing function and alter cartilage lubrication. However, it is not known whether pathological changes to the labrum secondary to femoroacetabular impingement (FAI) have a similar impact on labral function. Questions/purposes Does damage to the labrum occurring in association with abnormal femoral morphology affect the labral seal? Methods Using 10 fresh cadaveric specimens (mean age 50 years, ± 8), we measured the capacity of the central Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that all investigations were conducted in conformity with ethical principles of research.
Hip international : the journal of clinical and experimental research on hip pathology and therapy
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2011
We describe a case of arthroscopic reconstruction of the ligamentum teres using a novel technique... more We describe a case of arthroscopic reconstruction of the ligamentum teres using a novel technique. This technique is both simple and reproducible. We believe it to be a useful addition to the procedures available to the arthroscopic hip surgeon.
HSS Journal ®, 2012
Background: Surgeons undertaking total hip arthroplasty (THA) routinely perform a distal femoral ... more Background: Surgeons undertaking total hip arthroplasty (THA) routinely perform a distal femoral neck resection. It has been argued that retaining the femoral neck during THA can provide mechanical and biological advantages. Purposes: The objectives of this study were to review: (1) the current evidence on the advantages of femoral neck preservation during THA and (2) the clinical and radiological outcome of neck-preserving femoral stems. Methods: A search of the English-language literature on neck-preserving THA and on the individual neck-preserving implants was performed using PubMed, Ovid SP and Science Direct. Results: Studies have indicated that neck preservation offers superior tri-planar implant stability and allows more accurate restoration of the hip geometry and biomechanics. The trend towards tissue sparing surgery has contributed to the development of bone-conserving short-stem implants that offer variable levels of neck preservation. Despite an initial learning curve, these implants have generated promising early clinical results, with low revision rates and high outcome scores. However, radiological evaluation of some neck-preserving implants has detected a characteristic pattern of proximal femoral bone loss with distal cortical hypertrophy. The long-term implications of this finding are not yet known. Conclusions: Preserving the femoral neck during THA has biomechanical advantages. However, long-term outcome data are needed on neck-preserving femoral stems to evaluate ongoing bone remodelling and assess implant performance and survival.
The Annals of The Royal College of Surgeons of England, 2008
INTRODUCTION The fast-track assessment clinic (FTAC) is a process to select patients who are very... more INTRODUCTION The fast-track assessment clinic (FTAC) is a process to select patients who are very likely to require primary total hip replacement. Selected patients can then be seen in a one-off clinic reducing the number of hospital visits, cost to primary care trusts and delay between referral and treatment. PATIENTS AND METHODS Fifty patients on the waiting list for hip replacement were analysed to see if there were common parameters that led to their inclusion. From these data, fast-track selection criteria (FTSCs) were generated. These FTSCs were used to make a dual comparison of outcomes between 52 patients seen in a traditional clinic. Finally, a pilot study was conducted in which patients fulfilling FTSCs were seen in a designated clinic. RESULTS An Oxford hip score (OHS) of 34 and above combined with severe loss of joint space, severe marginal osteophytes, or both was common to most patients on the waiting list (84%). FTSCs correctly predicted the outcome of the orthopaedic...
Rheumatology (Oxford, England), 2012
To identify pre-operative predictors of patient-reported outcomes of primary total knee replaceme... more To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery. The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee Score (OKS). To classify whether patients had a clinically important outcome, we calculated a patient acceptable symptom state (PASS) for the 6-month OKS related to satisfaction with surgery. Potential predictor variables were pre-operative OKS, age, sex, BMI, deprivation, surgical side, diagnosis, operation type, American Society of Anesthesiologists grade and EQ5D anxiety/depression. Regression modelling was used to identify predictors of outcome. The strongest determinants of outcome include pre-operative pain/function-those with less severe pre-operative disease obtain the best outcomes; diagnosis in relation to pain outcome-patients with RA did better than ...
International …, 2009
Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate ... more Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate alignment of prostheses. We aimed to compare the outcome of computer-navigated and conventional TKA and to analyse the radiologically malaligned knees. We analysed 637 primary TKA, carried out by a single surgeon, over five consecutive years and divided them into two cohorts: group 1 = STA (standard instrumentation) and group 2 = CAS (computer-assisted surgery). There was no significant difference between the average Oxford Knee Scores (OKS) of the two groups at any time from one to five years. However, the malaligned TKA at three years had a worse OKS. At medium term there is no difference in clinical outcome measures that can be attributed to the surgeon having used computer-assisted navigation for TKA. But group 1, having a higher proportion of malaligned TKA, might show worsening of OKS at long term.
Surgical and Radiologic Anatomy, 2014
This study aimed at describing the anatomy of the zona orbicularis (ZO), based on magnetic resona... more This study aimed at describing the anatomy of the zona orbicularis (ZO), based on magnetic resonance arthrography (MRA) and magnetic resonance imaging (MRI) scans and to assess the presence of synovial folds in relation to the ZO. A retrospective review was performed using consecutive hip and pelvic MRA and MRI examinations from our institution. We identified 25 normal scans of each variety. Patients were scanned in a neutral hip position and 3D FIESTA sequence images were included in a number of cases. Using electronic callipers, measurements were obtained of the ZO thickness and of the location of the ZO with respect of the femoral head and neck. On MRA, the ZO appeared as a horseshoe in 18/25 patients, being absent anteriorly. On MRI the ZO was less consistent and absent in 12/25 posteriorly, in 8/25 inferiorly and in 2/25 anteriorly. Where present, the ZO usually coincided with the boundary of femoral head sphericity and the narrowest point of the isthmus of the femoral neck. The medial synovial fold was identified in all MRA studies (25/25). The ZO of the hip is most consistently identified when the joint is distended and in approximately 75% of cases appears as a horseshoe-shaped structure. Superiorly, the ZO is aligned perpendicular to the long axis of the femoral neck. The ZO twists from postero-lateral to antero-medial as it moves inferiorly. Our findings are consistent with the hypothesis that the ZO functions as a ring that resists femoral head distraction and contributes to dynamic circulation of synovial fluid.
Hip International, 2014
Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outco... more Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outcome programme at our centre achieves a preoperative data capture rate of 99%. This falls to 90.6%, 89%, 83% and 79% at the six-week, six-month, one-year and two-year time points, respectively. The study aims were to determine factors associated with patients who did not respond to outcome questionnaires following total hip replacement (THR), and the potential implications this may have when assessing patients following THRs. During the first year of the PROMs programme, 1,322 patients underwent unilateral primary THR at our institution. Of these, 1,311 completed preoperative questionnaires. Thirty-eight patients (2.9%) died within two years of surgery and have been excluded. For the remaining 1,273 patients, we identified those who did not return postoperative questionnaires at each of our review time points. Younger age, lower baseline EQ5D and Oxford Hip scores (OHS) were significantly ...
Hip International, 2014
Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outco... more Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outcome programme at our centre achieves a preoperative data capture rate of 99%. This falls to 90.6%, 89%, 83% and 79% at the six-week, six-month, one-year and two-year time points, respectively. The study aims were to determine factors associated with patients who did not respond to outcome questionnaires following total hip replacement (THR), and the potential implications this may have when assessing patients following THRs. During the first year of the PROMs programme, 1,322 patients underwent unilateral primary THR at our institution. Of these, 1,311 completed preoperative questionnaires. Thirty-eight patients (2.9%) died within two years of surgery and have been excluded. For the remaining 1,273 patients, we identified those who did not return postoperative questionnaires at each of our review time points. Younger age, lower baseline EQ5D and Oxford Hip scores (OHS) were significantly associated with non-response (p<0.001). Patients with lower satisfaction scores, OHS and EQ5D scores, were less likely to respond to subsequent questionnaires. A significant association between non-response and deprivation (p<0.001) was demonstrated. Our findings suggest that the more satisfied patients are over-represented and our reported outcome results are better than they would have been if all patients had responded. This phenomenon may apply to studies where those categorised as "lost to follow-up" represent a subset of patients who have disengaged due to poor outcome or satisfaction.
The Journal of Bone and Joint Surgery. British volume, 2012
Using general practitioner records and hospital notes and through direct telephone conversation w... more Using general practitioner records and hospital notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications gathered from a self-completed questionnaire after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with a mean age of 71.8 years (34 to 93). A total of 319 reported complications (79.4%; 95% confidence interval 75.4 to 83.3) were confirmed to be correct. High rates of correct reporting were demonstrated for infection (94.5%) and the need for further surgery (100%), whereas the rates of reporting deep-vein thrombosis (DVT), pulmonary embolism, myocardial infarction and stroke were lower (75% to 84.2%). Dislocation, peri-prosthetic fractures and nerve palsy had modest rates of correct reporting (36% to 57.1%). More patien...
The Journal of bone and joint surgery. British volume, 2012
We obtained information from the Elective Orthopaedic Centre on 1523 patients with baseline and s... more We obtained information from the Elective Orthopaedic Centre on 1523 patients with baseline and six-month Oxford hip scores (OHS) after undergoing primary hip replacement (THR) and 1784 patients with Oxford knee scores (OKS) for primary knee replacement (TKR) who completed a six-month satisfaction questionnaire. Receiver operating characteristic curves identified an absolute change in OHS of 14 points or more as the point that discriminates best between patients' satisfaction levels and an 11-point change for the OKS. Satisfaction is highest (97.6%) in patients with an absolute change in OHS of 14 points or more, compared with lower levels of satisfaction (81.8%) below this threshold. Similarly, an 11-point absolute change in OKS was associated with 95.4% satisfaction compared with 76.5% below this threshold. For the six-month OHS a score of 35 points or more distinguished patients with the highest satisfaction level, and for the six-month OKS 30 points or more identified the hi...
Acta orthopaedica Belgica, 2013
This study aimed to assess if patient-matched cutting blocks reduce operating time, blood loss an... more This study aimed to assess if patient-matched cutting blocks reduce operating time, blood loss and length of stay on top of improving implant alignment and offer operational or economic benefits, as claimed by manufacturers. We retrospectively reviewed patients undergoing TKA using patient matched technology and compared them with patients undergoing TKA using standard instrumentation; all were operated on between September 2010 and June 2012. All procedures were performed by a single surgeon at a single centre using the same implants. We collected data on operating time, length of stay and blood loss and also measured component alignment. Thirty-nine patients underwent TKA using patient-matched technology during the study period. Data was compared with that from 50 patients undergoing TKA using standard instrumentation during the same period. We found no significant difference in operating time, length of stay or blood loss between the two groups. There was also no difference in fe...
Journal of Orthopaedic Surgery and Research, 2019
Background With over 2.35 million records, the National Joint Registry (NJR) is the largest arthr... more Background With over 2.35 million records, the National Joint Registry (NJR) is the largest arthroplasty registry in the world. It provides a powerful tool to monitor implant survivorship and influence different surgical strategies. To date, little work has been undertaken to investigate the validity of the ‘Reason for Revision’ recorded in Consultant Outcome Reports on the NJR. Methods The NJR was queried to identify all revisions on the THR performed at a single centre over an 11-year period. Review and validation of ‘Reason for Revision’ for each case was undertaken using radiological imaging studies, pathology, histology, microbiology and electronic medical records. Results Of the 22,046 primary total hip replacements (THR) and total knee replacements (TKR) undertaken by 23 surgeons at our hospital, over an 11-year period, 1.35% (297) were subsequently reported to the NJR as revised. Discrepancies in reporting to the NJR were identified for 41 cases (25.63%) for THR and 28 (20.4...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
Seventeen (43%) FAI cases did not require surgery. Within this group, all patients received forma... more Seventeen (43%) FAI cases did not require surgery. Within this group, all patients received formal physical therapy (PT). None of these athletes had sports limitations. Three of these cases required at least 1 corticosteroid injection. One athlete opted to retire from sport for FAI and other injuries without surgery. Conclusions: In a large collegiate athletic program the prevalence of hip injuries was 10% of all MSK injuries, and 9% of those were diagnosed with FAI. There was a preponderance of females, and more than half the patient underwent surgery with 96% return to sports at the same or higher level. Half the subjects were treated non-operatively with PT, functional progression, and temporary activity modification and returned to sports at the same level. Two athletes retired from sports, 1 with and 1 without surgery. There was a trend toward more significant chondral damage for those that waited longer for surgery.
Arthritis, 2015
Synovial tissue can display an inflammatory response in the presence of OA. There is increasing i... more Synovial tissue can display an inflammatory response in the presence of OA. There is increasing interest to better understand the role of inflammation in OA, particularly with regard to those who require joint replacement. A systematic review of inflammatory synovitis in OA of literature databases was undertaken from their inception until October 14, 2014. Independent critical appraisal of each study was undertaken using the CASP appraisal tool. From a total of sixty-six identified citations, twenty-three studies were deemed eligible for review. The studies presented moderate to strong methodological quality. Strong correlation was identified between histological and imaging synovitis severity. Correlation was weaker between clinical symptoms and imaging and/or histological synovitis severity. There was little consensus, with regard to expressed cytokines and chemokines at the different stages of OA disease progression. Few studies investigated the influence of inflammatory synoviti...
Clinical Orthopaedics & Related Research, 2014
Background Experimental disruption of the labrum has been shown to compromise its sealing functio... more Background Experimental disruption of the labrum has been shown to compromise its sealing function and alter cartilage lubrication. However, it is not known whether pathological changes to the labrum secondary to femoroacetabular impingement (FAI) have a similar impact on labral function. Questions/purposes Does damage to the labrum occurring in association with abnormal femoral morphology affect the labral seal? Methods Using 10 fresh cadaveric specimens (mean age 50 years, ± 8), we measured the capacity of the central Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that all investigations were conducted in conformity with ethical principles of research.
Hip international : the journal of clinical and experimental research on hip pathology and therapy
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2011
We describe a case of arthroscopic reconstruction of the ligamentum teres using a novel technique... more We describe a case of arthroscopic reconstruction of the ligamentum teres using a novel technique. This technique is both simple and reproducible. We believe it to be a useful addition to the procedures available to the arthroscopic hip surgeon.
HSS Journal ®, 2012
Background: Surgeons undertaking total hip arthroplasty (THA) routinely perform a distal femoral ... more Background: Surgeons undertaking total hip arthroplasty (THA) routinely perform a distal femoral neck resection. It has been argued that retaining the femoral neck during THA can provide mechanical and biological advantages. Purposes: The objectives of this study were to review: (1) the current evidence on the advantages of femoral neck preservation during THA and (2) the clinical and radiological outcome of neck-preserving femoral stems. Methods: A search of the English-language literature on neck-preserving THA and on the individual neck-preserving implants was performed using PubMed, Ovid SP and Science Direct. Results: Studies have indicated that neck preservation offers superior tri-planar implant stability and allows more accurate restoration of the hip geometry and biomechanics. The trend towards tissue sparing surgery has contributed to the development of bone-conserving short-stem implants that offer variable levels of neck preservation. Despite an initial learning curve, these implants have generated promising early clinical results, with low revision rates and high outcome scores. However, radiological evaluation of some neck-preserving implants has detected a characteristic pattern of proximal femoral bone loss with distal cortical hypertrophy. The long-term implications of this finding are not yet known. Conclusions: Preserving the femoral neck during THA has biomechanical advantages. However, long-term outcome data are needed on neck-preserving femoral stems to evaluate ongoing bone remodelling and assess implant performance and survival.
The Annals of The Royal College of Surgeons of England, 2008
INTRODUCTION The fast-track assessment clinic (FTAC) is a process to select patients who are very... more INTRODUCTION The fast-track assessment clinic (FTAC) is a process to select patients who are very likely to require primary total hip replacement. Selected patients can then be seen in a one-off clinic reducing the number of hospital visits, cost to primary care trusts and delay between referral and treatment. PATIENTS AND METHODS Fifty patients on the waiting list for hip replacement were analysed to see if there were common parameters that led to their inclusion. From these data, fast-track selection criteria (FTSCs) were generated. These FTSCs were used to make a dual comparison of outcomes between 52 patients seen in a traditional clinic. Finally, a pilot study was conducted in which patients fulfilling FTSCs were seen in a designated clinic. RESULTS An Oxford hip score (OHS) of 34 and above combined with severe loss of joint space, severe marginal osteophytes, or both was common to most patients on the waiting list (84%). FTSCs correctly predicted the outcome of the orthopaedic...
Rheumatology (Oxford, England), 2012
To identify pre-operative predictors of patient-reported outcomes of primary total knee replaceme... more To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery. The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee Score (OKS). To classify whether patients had a clinically important outcome, we calculated a patient acceptable symptom state (PASS) for the 6-month OKS related to satisfaction with surgery. Potential predictor variables were pre-operative OKS, age, sex, BMI, deprivation, surgical side, diagnosis, operation type, American Society of Anesthesiologists grade and EQ5D anxiety/depression. Regression modelling was used to identify predictors of outcome. The strongest determinants of outcome include pre-operative pain/function-those with less severe pre-operative disease obtain the best outcomes; diagnosis in relation to pain outcome-patients with RA did better than ...
International …, 2009
Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate ... more Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate alignment of prostheses. We aimed to compare the outcome of computer-navigated and conventional TKA and to analyse the radiologically malaligned knees. We analysed 637 primary TKA, carried out by a single surgeon, over five consecutive years and divided them into two cohorts: group 1 = STA (standard instrumentation) and group 2 = CAS (computer-assisted surgery). There was no significant difference between the average Oxford Knee Scores (OKS) of the two groups at any time from one to five years. However, the malaligned TKA at three years had a worse OKS. At medium term there is no difference in clinical outcome measures that can be attributed to the surgeon having used computer-assisted navigation for TKA. But group 1, having a higher proportion of malaligned TKA, might show worsening of OKS at long term.
Surgical and Radiologic Anatomy, 2014
This study aimed at describing the anatomy of the zona orbicularis (ZO), based on magnetic resona... more This study aimed at describing the anatomy of the zona orbicularis (ZO), based on magnetic resonance arthrography (MRA) and magnetic resonance imaging (MRI) scans and to assess the presence of synovial folds in relation to the ZO. A retrospective review was performed using consecutive hip and pelvic MRA and MRI examinations from our institution. We identified 25 normal scans of each variety. Patients were scanned in a neutral hip position and 3D FIESTA sequence images were included in a number of cases. Using electronic callipers, measurements were obtained of the ZO thickness and of the location of the ZO with respect of the femoral head and neck. On MRA, the ZO appeared as a horseshoe in 18/25 patients, being absent anteriorly. On MRI the ZO was less consistent and absent in 12/25 posteriorly, in 8/25 inferiorly and in 2/25 anteriorly. Where present, the ZO usually coincided with the boundary of femoral head sphericity and the narrowest point of the isthmus of the femoral neck. The medial synovial fold was identified in all MRA studies (25/25). The ZO of the hip is most consistently identified when the joint is distended and in approximately 75% of cases appears as a horseshoe-shaped structure. Superiorly, the ZO is aligned perpendicular to the long axis of the femoral neck. The ZO twists from postero-lateral to antero-medial as it moves inferiorly. Our findings are consistent with the hypothesis that the ZO functions as a ring that resists femoral head distraction and contributes to dynamic circulation of synovial fluid.
Hip International, 2014
Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outco... more Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outcome programme at our centre achieves a preoperative data capture rate of 99%. This falls to 90.6%, 89%, 83% and 79% at the six-week, six-month, one-year and two-year time points, respectively. The study aims were to determine factors associated with patients who did not respond to outcome questionnaires following total hip replacement (THR), and the potential implications this may have when assessing patients following THRs. During the first year of the PROMs programme, 1,322 patients underwent unilateral primary THR at our institution. Of these, 1,311 completed preoperative questionnaires. Thirty-eight patients (2.9%) died within two years of surgery and have been excluded. For the remaining 1,273 patients, we identified those who did not return postoperative questionnaires at each of our review time points. Younger age, lower baseline EQ5D and Oxford Hip scores (OHS) were significantly ...
Hip International, 2014
Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outco... more Patient reported outcome measures (PROMs) are used to gauge clinical performance. The PROMs outcome programme at our centre achieves a preoperative data capture rate of 99%. This falls to 90.6%, 89%, 83% and 79% at the six-week, six-month, one-year and two-year time points, respectively. The study aims were to determine factors associated with patients who did not respond to outcome questionnaires following total hip replacement (THR), and the potential implications this may have when assessing patients following THRs. During the first year of the PROMs programme, 1,322 patients underwent unilateral primary THR at our institution. Of these, 1,311 completed preoperative questionnaires. Thirty-eight patients (2.9%) died within two years of surgery and have been excluded. For the remaining 1,273 patients, we identified those who did not return postoperative questionnaires at each of our review time points. Younger age, lower baseline EQ5D and Oxford Hip scores (OHS) were significantly associated with non-response (p<0.001). Patients with lower satisfaction scores, OHS and EQ5D scores, were less likely to respond to subsequent questionnaires. A significant association between non-response and deprivation (p<0.001) was demonstrated. Our findings suggest that the more satisfied patients are over-represented and our reported outcome results are better than they would have been if all patients had responded. This phenomenon may apply to studies where those categorised as "lost to follow-up" represent a subset of patients who have disengaged due to poor outcome or satisfaction.