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.

The Effect of Anteversion on Femoral Component Stability Assessed by Radiostereometric Analysis

Abstract: Internal rotation of a femoral stem within the femur, with posterior migration of the femoral head (PHM) relative to the femur, is an important mode of failure. The relationship between anteversion and rotational stability for the Exeter (Howmedica International Ltd, London, UK) and Charnley Elite (DePuy International Ltd, Leeds, UK) stems was investigated using radiostereometric analysis (RSA). For the Elite, there was a significant (P=.01) correlation between anteversion and PHM, whereas for the Exeter, there was no significant correlation (P=.6). Increasing anteversion of the Elite was associated with decreasing PHM and increased stability. Of stems, 20% of the Elite and none of the Exeter were classified as having reduced rotational stability because their PHM was >2 SDs from the mean. All reduced rotational stability implants had anteversion substantially <20 degrees. Polished collarless tapered stems such as the Exeter seem to have enhanced rotational stability. For conventional stems, increasing anteversion increases stability. It is recommended that these stems are anteverted 20 degrees.

Septic arthritis in haemophilia

Abstract: Septic arthritis has been regarded as rare in haemophiliacs, but its incidence may have increased since HIV infection has become widespread in these patients. We describe six cases treated at one haemophilia unit over a two-year period and discuss their investigation, diagnosis and treatment. Four of the patients were seropositive to anti-HIV.

Swallowing in motor neurone disease

Abstract: Ninety-two patients with motor neurone disease have been assessed clinically and radiologically for evidence of swallowing problems. At the time of examination, moderate or severe swallowing difficulty was present in 89% of those whose disease had presented as bulbar palsy, in 45% of those in whom the disease began many months before as progressive muscular atrophy and in 29% of those with amyotrophic lateral sclerosis. Patients with more severe swallowing symptoms appeared more likely to have abnormal findings on videofluoroscopy overall. However, not all patients with an abnormal radiological picture had swallowing difficulties. It is suggested that radiological signs should only be used within the context of clinical symptoms and signs in the selection of patients for palliative surgery. Thirteen patients with pseudobulbar symptoms and signs had a cricopharyngeal myotomy performed: two suffered major post-operative complications. However, the satisfaction rate was 89% and we recommend cricopharyngeal myotomy for such patients. Pharyngostomy was performed for seven patients unable to initiate swallowing, six had post-operative complications.

Avascular necrosis of bone: a review

Abstract: 'The power of reproduction which Nature possesses, displays itself in a great variety of morbid cases, but in none of them more remarkably than in a certain disease of bone termed necrosis', wrote James Russell, the first Professor of Clinical Surgery at the University of Edinburgh in 1794. This was the first description of bone necrosis which was clearly septic in origin. It was not until a century later that Axhausen (1928) realized that bone necrosis could occur in the absence ofinfection .The 20th century has seen an increase in the incidence ofaseptic necrosis of bone in deep sea divers, tunnel workers, and in patients given corticosteroids for a variety of conditions including organ transplantation. The four most common causes of hip pain in the adult are now osteoarthritis, inflammatory arthritis, trauma, and osteonecrosis. The terms osteonecrosis, ischaemic necrosis, aseptic necrosis and avascular necrosis are synonymous. Bone death appears to occur not as the result of a sudden occlusion or functional defect of the blood vessels to the bone or in the bone, but as a result of an imbalance between the metabolic requirements of the osteocyte and the ability of the circulation to meet those needs (Boettcher et al. 1970b). It is now possible to diagnose avascular necrosis of bone before destructive changes become obvious radiographically, yet avascular necrosis remains a problem of management. It may affect patients who would generally be considered too young for total joint replacement, and so efforts have been made to treat avascular necrosis of bone more aggressively from an early stage in the hope of preserving joint congruity; results, however, remain unpredictable. The early diagnosis of avascular necrosis of bone is dependent upon an awareness of the conditions in which it can occur.