Nuffield Orthopaedic Centre

About: Nuffield Orthopaedic Centre is a healthcare organization based out in Oxford, United Kingdom. It is known for research contribution in the topics: Population & Arthroplasty. The organization has 2082 authors who have published 2920 publications receiving 145718 citations.

Is clopidogrel stopped prior to hip fracture surgery--A survey of current practice in the United Kingdom.

Abstract: Summary Background Clopidogrel is an anti-platelet agent which causes an increase in bleeding time. An increasing number of patients presenting with an acute femoral neck fracture take clopidogrel in combination with other anti-platelet agents as regular prescription medication. Such patients may be at higher risk of increased peri-operative bleeding. No guidelines or recommendations currently exist regarding the routine discontinuation of clopidogrel in patients with fracture of the femoral neck awaiting surgery. Methods A telephone questionnaire was undertaken to examine the current practice amongst 110 orthopaedic departments in the UK regarding the discontinuation of clopidogrel prior to trauma surgery for femoral neck fractures. This was compared to the practice of discontinuing aspirin and warfarin in the same patient groups in these departments. Results There appears to be significant variation in practice amongst orthopaedic departments with 43.6% having a policy of discontinuing clopidogrel. This compares to 37.3% of trusts having a policy of stopping aspirin and 97.3% stopping warfarin. Conclusion There is wide variation in practice regarding the discontinuation of clopidogrel preoperatively in patients due to undergo surgery for femoral neck fractures. These findings highlight the need to develop guidelines for the preoperative management of these patients.

Localization of gastrinomas by selective intra-arterial calcium injection

Abstract: BACKGROUND Preoperative localisation is important for successful surgical treatment of gastrinomas. However, a satisfactory method that achieves this has not been defined, and at present somatostatin receptor scintigraphy and selective intra-arterial stimulation testing with secretin have the greatest sensitivities. As secretin is now difficult to obtain, we decided to explore the use of calcium gluconate as a secretagogue. High extracellular calcium concentrations cause degranulation of neuroendocrine cells and subsequent release of hormone. METHODS Two patients with biochemically proven gastrinomas were investigated pre-operatively. Under angiographic control calcium gluconate was injected into the arteries supplying the pancreas and duodenum, gastrin levels were then determined in hepatic vein samples obtained before and 30, 60, 90, 120 and 180 seconds after each injection. One of the patients had also previously undergone selective intra-arterial stimulation testing with secretin. RESULTS Calcium gluconate produced sharp peaks of gastrin which unequivocally localised the tumour to a specific vascular territory in each case. Furthermore, surgery confirmed the localisations of the gastrinomas. Calcium injection, unlike secretin, into vascular territories without gastrinomas caused no rise in gastrin, thereby demonstrating calcium's greater specificity. CONCLUSIONS Calcium gluconate is a highly sensitive and specific alternative secretagogue to secretin for localisation of pancreatic and duodenal gastrinomas. Furthermore calcium gluconate was found to demonstrate the territory of the tumour more accurately than secretin.

Total arthroplasty in Paget's disease of the hip. A clinical review and review of the literature.

Abstract: The results in 30 Paget's disease patients with 37 affected hips treated with total hip arthroplasty (THA) for symptomatic coxarthrosis were compared with the results of previously reported series. Metabolic activity of the disease subsequent to surgery seemed to have no effect on the clinical outcome during 7.8 years of follow-up study; location of the disease (acetabulum only, femur only, or both) or the presence of protrusio alone also had no effect. For the femur, failure rates were similar for prostheses implanted in Pagetic or non-Pagetic bone. Good results can be anticipated for patients with Paget's disease treated with cemented THA.

Cementless fixation in medial unicompartmental knee arthroplasty: a systematic review.

Abstract: The aim of this study was to evaluate clinical outcome, failures, implant survival, and complications encountered with cementless fixation in unicompartmental knee arthroplasty (UKA). A systematic review of the literature on cementless fixation in UKA was performed according to the PRISMA guidelines. The following database was comprehensively searched: PubMed, Cochrane, Medline, CINAHL, Embase, and Google Scholar. The keywords “unicompartmental”, “unicondylar”, “partial knee arthroplasty”, and “UKA” were combined with each of the keyword “uncemented”, “cementless” and “survival”, “complications”, and “outcome”. The following data were extracted: demographics, clinical outcome, details of failures and revisions, cumulative survival, and complications encountered. The risk of bias of each study was estimated with the MINORS score and a further scoring system based on the presence of the primary outcomes. From a cohort of 63 studies identified using the above methodology, 10 papers (1199 knees) were included in the final review. The mean follow-up ranged from 2 to 11 years (median 5 years). The 5-year survival ranged from 90 to 99 % and the 10-year survival from 92 to 97 %. There were 48 revisions with an overall revision rate of 0.8 per 100 observed component-years. The most common cause of failure was progression of osteoarthritis in the retained compartment (0.9 %). The cumulative incidence of complications and revisions was comparable to that reported in similar studies on cemented UKAs. The advantages of cementless fixation include faster surgical time, avoidance of cementation errors, and lower incidence of radiolucent lines. Cementless fixation is a safe and effective alternative to cementation in medial UKA. Clinical outcome, failures, reoperation rate, and survival are similar to those reported for cemented implants with lower incidence of radiolucent lines. IV.