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Institution

Nuffield Orthopaedic Centre

HealthcareOxford, United Kingdom
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.


Papers
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Journal ArticleDOI
TL;DR: Management of the failed total ankle replacement should be performed by experienced surgeons and ideally in units where multidisciplinary support is available, and a hindfoot fusion appears to be preferable to a revisiontotal ankle replacement.
Abstract: Advances in the design of the components for total ankle replacement have led to a resurgence of interest in this procedure. Between January 1999 and December 2004, 16 patients with a failed total ankle replacement were referred to our unit. In the presence of infection, a two-stage salvage procedure was planned. The first involved the removal of the components and the insertion of a cement spacer. Definitive treatment options included hindfoot fusion with a circular frame or amputation. When there was no infection, a one-stage salvage procedure was planned. Options included hindfoot fusion with an intramedullary nail or revision total ankle replacement. When there was suspicion of infection, a percutaneous biopsy was performed. The patients were followed up for a minimum of 12 months. Of the 16 patients, 14 had aseptic loosening, five of whom underwent a revision total ankle replacement and nine a hindfoot fusion. Of the two with infection, one underwent fusion and the other a below-knee amputation. There were no cases of wound breakdown, nonunion or malunion. Management of the failed total ankle replacement should be performed by experienced surgeons and ideally in units where multidisciplinary support is available. Currently, a hindfoot fusion appears to be preferable to a revision total ankle replacement.

147 citations

Journal ArticleDOI
TL;DR: It is concluded that persistent compression affects the growth plate by interference with the blood flow on one or both sides of the growth cartilage, which prepares the field for calcification and thus initiates the osteogenic process.
Abstract: From this work it may be concluded that persistent compression affects the growth plate by interference with the blood flow on one or both sides of the growth cartilage. Despite exertion of the same pressure upon both sides of the growth plate, only the metaphysial side was readily affected in the early stages, for, as long as no damage was caused to the epiphysial side of the growth cartilage, the lesions were fully reversible. Interference with growth was directly proportionate to the damage caused by compression to the epiphysial side of the growth plate and, in general, to the duration of compression. The first signs of interference with the metaphysial side of the plate were the lack of vascular progression and concomitant retardation of calcification. When severe degeneration was not present the growth cartilage recovered within four days. The matrix was ready for calcification all the time, as shown by the extremely rapid calcification occurring soon after the compression had ceased and the vessels were able to reach their proper place. It seems justified to believe that the first hypertrophic cell not to be calcified after removal of the clamp is the one around which the matrix has not yet changed sufficiently to have an affinity for the apatite crystals. As in moderate compression, the division of the proliferative cells continues and it seems it must be the age, or even more likely the distance from the transudate coming from the epiphysial side of the growth cartilage that conditions the maturity of the cell, which prepares the field for calcification and thus initiates the osteogenic process. Views similar to this have been advanced by Ham (1957) and his school.

147 citations

Journal ArticleDOI
31 Mar 2009-BMJ
TL;DR: This review aims to highlight cauda equina syndrome as a possible clinical diagnosis, review the evidence for an emergency surgical approach, and maintain an awareness of the medicolegal issues that surround the condition.
Abstract: #### Summary points An understanding of cauda equina syndrome is important not only to orthopaedic surgeons and neurosurgeons but also to general practitioners, emergency department staff, and other specialists to whom these patients present. Recognition of the syndrome by all groups of clinicians is often delayed as it presents with bladder, bowel, and sexual problems, which are common complaints and have a variety of causes. Patients may not mention such symptoms because of embarrassment or because the onset is slow and insidious. Cauda equina syndrome is a clinical area that attracts a high risk of litigation. Although symptoms have poor predictive value on their own for the syndrome, it is important to document the nature and timing of bladder, bowel, and sexual symptoms (along with any associated clinical findings), particularly if they are new, especially in those with a history of back pain and associated leg pain, and to make a timely referral for appropriate investigation and expert treatment. This review aims to highlight cauda equina syndrome as a possible clinical diagnosis, review the evidence for an emergency surgical approach, and maintain an awareness of the medicolegal issues that surround the condition. Cauda equina syndrome results from the dysfunction of multiple sacral and lumbar nerve roots in the lumbar vertebral canal. Such root dysfunction can cause a combination of clinical features, but the term cauda equina syndrome is used only when these include impairment of bladder, bowel, or sexual …

145 citations

Journal ArticleDOI
TL;DR: In this paper, the authors compared 96 siblings of 64 patients treated for primary femoroacetabular impingement with a spouse control group of 77 individuals, and found that the siblings of those patients with a cam deformity had a relative risk of 2.8 of having the same deformity (66 of 160 siblings versus 23 of 154 control hips, p < 0.00001).
Abstract: Femoroacetabular impingement causes pain in the hip in young adults and may predispose to the development of osteoarthritis. Genetic factors are important in the aetiology of osteoarthritis of the hip and may have a role in that of femoroacetabular impingement. We compared 96 siblings of 64 patients treated for primary impingement with a spouse control group of 77 individuals. All the subjects were screened clinically and radiologically using a standardised protocol for the presence of cam and pincer deformities and osteoarthritis. The siblings of those patients with a cam deformity had a relative risk of 2.8 of having the same deformity (66 of 160 siblings hips versus 23 of 154 control hips, p < 0.00001). The siblings of those patients with a pincer deformity had a relative risk of 2.0 of having the same deformity (43 of 116 sibling hips versus 29 of 154 control hips, p = 0.001). Bilateral deformity occurred more often in the siblings (42 of 96 siblings versus 13 of 77 control subjects, relative risk 2.6, p = 0.0002). The prevalence of clinical features in those hips with abnormal morphology was also greater in the sibling group compared with the control group (41 of 109 sibling hips versus 7 of 46 control hips, relative risk 2.5, p = 0.007). In 11 sibling hips there was grade-2 osteoarthritis according to Kellgren and Lawrence versus none in the control group (p = 0.002). Genetic influences are important in the aetiology of primary femoroacetabular impingement. This risk appears to be manifested through not only abnormal joint morphology, but also through other factors which may modulate progression of the disease.

144 citations

Journal ArticleDOI
TL;DR: Patients with GCA have a twofold increased risk of aortic aneurysm, and this should be considered within the range of other risk factors including male gender, age and smoking.
Abstract: Objectives To evaluate the risk of aortic aneurysm in patients with giant cell arteritis (GCA) compared with age-, gender- and location-matched controls Methods A UK General Practice Research Database (GPRD) parallel cohort study of 6999 patients with GCA and 41 994 controls, matched on location, age and gender, was carried out A competing risk model using aortic aneurysm as the primary outcome and non-aortic-aneurysm-related death as the competing risk was used to determine the relative risk (subhazard ratio) between non-GCA and GCA subjects, after adjustment for cardiovascular risk factors Results Comparing the GCA cohort with the non-GCA cohort, the adjusted subhazard ratio (95% CI) for aortic aneurysm was 192 (152 to 241) Significant predictors of aortic aneurysm were being an ex-smoker (264 (203 to 343)) or a current smoker (337 (261 to 437)), previously taking antihypertensive drugs (157 (123 to 201)) and a history of diabetes (032 (019 to 056)) or cardiovascular disease (198 (150 to 263)) In a multivariate model of the GCA cohort, male gender (210 (138 to 319)), ex-smoker (220 (122 to 398)), current smoker (379 (220 to 653)), previous antihypertensive drugs (162 (100 to 261)) and diabetes (019 (005 to 077)) were significant predictors of aortic aneurysm Conclusions Patients with GCA have a twofold increased risk of aortic aneurysm, and this should be considered within the range of other risk factors including male gender, age and smoking A separate screening programme is not indicated The protective effect of diabetes in the development of aortic aneurysms in patients with GCA is also demonstrated

143 citations


Authors

Showing all 2120 results

NameH-indexPapersCitations
Douglas G. Altman2531001680344
George Davey Smith2242540248373
Cyrus Cooper2041869206782
James J. Collins15166989476
Richard J.H. Smith118130861779
Andrew Carr11184254974
Paul Dieppe10561853529
Matthew A. Brown10374859727
David W. Murray9769943372
Ray Fitzpatrick9547740322
Derrick W. Crook9247429885
Richard W Morris9151935165
Richard J. K. Taylor91154343893
Sharon J. Peacock9049433352
Derick T Wade9039837413
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Performance
Metrics
No. of papers from the Institution in previous years
YearPapers
202315
202246
2021138
2020129
2019126
2018110