Hugh English

St Vincent's Hospital

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Ross Crawford

Prince Charles Hospital

Sarah L. Whitehouse

Queensland University of Technology

Graham A. Gie

Princess Elizabeth Orthopaedic Centre

William J. Donnelly

White River Junction VA Medical Center

A. John Timperley

Royal Devon & Exeter NHS Foundation Trust

Mayur Chawda

Ysbyty Gwynedd Hospital NHS Trust

Brett Halliday

Royal Brisbane and Women's Hospital

R. S. M. Ling

Princess Elizabeth Orthopaedic Centre

Sameer Viswanathan

Camden and Campbelltown Hospitals

P. Hucker

Prince Charles Hospital

Cooperative Institutions

Prince Charles Hospital

Queensland University of Technology

Princess Elizabeth Orthopaedic Centre

Holy Spirit Northside Private Hospital

Royal Devon and Exeter Hospital

St James's University Hospital

Nuffield Orthopaedic Centre

University of Queensland

University of Hull

NHS Blood and Transplant

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COMPARISON OF THE ACCURACY OF TOTAL HIP ARTHROPLASTY COMPONENT PLACEMENT BETWEEN CEMENTED AND UNCEMENTED IMPLANTS

Faculty of Built Environment and Engineering; Institute of Health and Biomedical Innovation (2011)

Mayur Chawda P. Hucker Sarah L. Whitehouse Ross Crawford Hugh English

Data from recent AOANJRR shows a higher incidence of acetabular revision for dislocation of THA in uncemented compared to cemented THA (RR 1.59). We hypothesized that a difference in accuracy of component placement may be a factor. We aimed to assess any difference in accuracy between these 2 types of THA. Patients undergoing navigated THA were prospectively recruited. Choice of uncemented or cemented THA was based on individual surgeon’s routine practice and preference and no adjustments were made for this study. All THAs (Cemented Exeter-21 and uncemented Trident/Secur fit-20) were performed through a posterior approach. Statistical analysis: the mean and 95% confidence intervals (or median and interquartile range (IQR) for non parametric data) for each measure in both groups. ANOVA and nonparametric Mann-Whitney U test (significance level 5%). Levene’s test for homogeneity, Comparison of frequencies with chi-squared test or Fishers Exact test. Bonferroni correction where necessary. We demonstrated a significant difference in reproducibility between components. Four of 20 (20%) uncemented cups deviated from the target inclination by 5 degrees or more compared to none of 21 in the cemented group (p=0.048). Seven of the 20 (35%) of the uncemented cups deviated from the target version by 5 degrees or more compared to none of 21 in the cemented group (p=0.003). There was a significant difference between the groups with regard to deviation from planned leg length (p Statistically significant reduced accuracy of cup placement is demonstrated with uncemented compared to cemented implants. It is harder to control implant positioning in uncemented implants than cemented implants.

Bonferroni correction

Interquartile range

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Stripping torque as a predictor of successful internal fracture fixation

ANZ Journal of Surgery (2005)

Thomas R. Edwards Greg Tevelen Hugh English Ross Crawford

Background: Internal fixation of fractures using plates and screws is a common method of treatment. Occasionally the internal fixation fails prior to fracture healing. This often requires revision surgery. Determining the force that internal fixation needs to withstand postoperatively would enable this force to be applied intraoperatively as a test to predict successful fixation. The purpose of the present paper was to determine the minimum stripping torque needed to predict successful internal fixation strength. Methods: The pull‐out strength and stripping torque relationships of 4.5‐mm cortical bone screws in Sawbones polyurethane foam were determined. Screw forces were directly measured using an LCM load cell washer on a model intertrochanteric neck of femur fracture fixed with 135° 4‐hole pin and plate loaded to single leg stance conditions. Additionally a 135° 4‐hole pin and plate was mounted on foam blocks and loaded until failure of the shaft screws from the foam occurred. Predicted stripping torque/yield load was determined. Results: Pull‐out strength and stripping torque of 4.5‐mm cortical bone screws in polyurethane foam have a high degree of linear correlation R 2 = 0.95. Direct measurement of shaft screw forces at single leg stance conditions were 585−686 N. This correlated with a stripping torque of 0.9 Nm. Load to yield testing at single leg stance conditions corresponded to a stripping torque of 1.8 Nm. Conclusion: Withstanding 0.9−1.8 Nm of torque during insertion of the femoral shaft screws of a 135° 4‐hole pin and plate predicts that the construct will successfully withstand single leg stance.

Washer

Load cell

Stripping (fiber)

Femoral shaft

10.1111/j.1445-2197.2005.03497.x

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Citations (22)

The use of ABO-compatible mismatched livers in the UK

Transplant International (1994)

Hugh English S. Pollard C. Flamank Mark Belger R. Y. Calne

Waiting list

ABO incompatibility

10.1111/j.1432-2277.1994.tb01321.x

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Does use of a “rim cutter” improve quality of cementation of the acetabular component of cemented exeter total hip arthroplasty?

Faculty of Built Environment and Engineering; Institute of Health and Biomedical Innovation (2009)

Jon Conroy Mayur Chawda Rishi Kaushal Sarah L. Whitehouse Ross Crawford

Cementation (geology)

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Femoral impaction grafting with cement in revision total hip replacement. Evolution of the technique and results.

PubMed (2003)

Brett Halliday Hugh English A. John Timperley Graham A. Gie R. S. M. Ling

We report the results of cancellous femoral impaction grafting with cement in revision hip arthroplasty in all patients from one centre who had undergone surgery more than five years previously. A total of 32 surgeons undertook femoral impaction grafting in 207 patients (226 hips). There were no deaths attributable to the revision surgery; 33 patients with 35 functioning hips died with less than five years' follow-up. One patient was lost to follow-up. Two hips (1%) developed early postoperative infection. Of the 12 stems which underwent a further surgical procedure for aseptic failure, ten were for femoral fracture and two for loosening. Survivorship with any further femoral operation as the endpoint was 90.5% (confidence intervals, 82 to 98) and using femoral reoperation for symptomatic aseptic loosening as the endpoint, the survivorship was 99.1% (confidence intervals, 96 to 100) at 10 to 11 years. As a consequence of the experience in this series, we have modified our technique with an increased use of longer stems with impacted allograft. Long stems are indicated when the host bone around the tip of a short stem is compromised, in patients with major loss of bone stock, or when a femoral fracture occurs.

Impaction

Aseptic processing

Bone grafting

Cancellous bone

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Citations (223)

FEMORAL IMPACTION GRAFTING WITH CEMENT IN REVISION TOTAL HIP REPLACEMENT, RESULTS BEYOND A MINIMUM OF FIVE YEARS FOLLOW-UP

Orthopaedic Proceedings (2004)

Brett Halliday Graham A. Gie Hugh English A. John Timperley R. S. M. Ling

Introduction We report the results of cancellous femoral impaction grafting with cement in revision hip arthroplasty in all patients from the above centre, who had their surgery more than five years previously. Methods Up to December 1994, 226 hips underwent femoral impaction grafting in 207 patients. No deaths were attributable to the revision surgery. Thirty-three patients with 35 functioning hips died with less than five years follow-up. Only one patient was lost to follow-up. All other patients have had clinical review by two of the authors (BH and HE) and a combined panel undertook radiological review. Results Two hips (one percent) became infected at the time of their revision surgery. Twelve stems underwent a further surgical procedure for aseptic failure; 10 for treatment of fracture and two for mechanical loosening in the absence of fracture. Survivorship with any femoral re-operation for any cause as the end point was 90.5% (confidence interval 82 to 98% (Peto equation)) at 10 to 11 years. Using femoral re-operation for symptomatic aseptic mechanical loosening as the endpoint the survivorship was 99.1% (CI= 96–100) at the same follow-up. The technique used in our centre has been modified since this series with an increased use of longer stems with impacted allograft. The technique used in Exeter has evolved and there has been an increased awareness of the fundamental importance of gaining stability of the implant within the graft at the time of surgery. Conclusion These results provide evidence of a successful technique in the intermediate to long term. In relation to the conduct of this study, one or more the authors have received, or are likely to receive direct material benefits.

Impaction

Bone grafting

Cancellous bone

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Citations (1)

Impaction grafting of the femur in two-stage revision for infected total hip replacement

Journal of Bone and Joint Surgery - British Volume (2002)

Hugh English A. John Timperley D. Dunlop Graham A. Gie

We report the mid-term results of femoral impaction grafting which was used in 53 patients during the second stage of a two-stage revision for an infected total hip replacement. We reviewed all cases performed between 1989 and 1998. All patients underwent a Girdlestone excision arthroplasty, received local and systemic antibiotics and subsequently underwent reconstruction, using femoral impaction grafting. Four patients had further infection (7.5%), and four died within 24 months of surgery. One patient underwent revision of the stem for a fracture below its tip at ten months. This left 44 patients with a mean follow-up of 53 months (24 to 122). All had improved clinical scores and a satisfactory radiological outcome.

Impaction

Bone grafting

10.1302/0301-620x.84b5.0840700

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Citations (26)

Laparoscopic repair of cholecystoduodenal fistulae.

PubMed (1994)

Anant Sharma Mackenzie W. Sullivan Hugh English R J E Foley

Since the first laparoscopic cholecystectomy in 1987 by Mouret, the scope of biliary surgery available to a laparoscopic surgeon has increased. In the early days of the procedure there were several accepted contraindications. Some of these were acute cholecystitis, morbid obesity, adherent gallbladder, jaundiced patients, ductal calculi, and biliary tract anomalies. In a series of 300 laparoscopic cholecystectomies we encountered five cholecystoduodenal fistulae. It was possible to deal with four fistulae laparoscopically. Two patients underwent a laparotomy, one for a failed laparoscopic repair of cholecystoduodenal fistula and the other for several common bile duct (CBD) stones, which could not be removed laparoscopically via the cystic duct. We maintain that with increasing expertise and improved instrumentation, most cases of cholecystoduodenal fistula could be dealt with laparoscopically.

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Impaction grafting of the femur in two-stage revision for infected total hip replacement

Journal of Bone and Joint Surgery - British Volume (2002)

Hugh English A. John Timperley D. Dunlop Graham A. Gie

Impaction

Bone grafting

10.1302/0301-620x.84b5.12504

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Citations (53)

Use of a Cement-Loaded Kuntscher Nail in First-Stage Revision Hip Arthroplasty for Massive Femoral Bone Loss Secondary to Infection: A Report of Four Cases

Journal of orthopaedic surgery (2010)

Corey J. Richards Chris J Bell Sameer Viswanathan Hugh English Ross Crawford

A 2-stage revision total hip replacement (THR) is the standard treatment for a chronically infected THR with severe metadiaphyseal bone loss. A long-stem cemented prosthesis as part of a temporary articular spacer is commonly used during the first-stage procedure. Nonetheless, this option is expensive and can pose difficulties for patients with a small medullary canal. A construct using an antibiotic cement-loaded Kuntscher nail cemented with a highly polished Exeter stem has been devised and used in 4 patients.

Bone cement

10.1177/230949901001800124

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Citations (17)