Henry Wynn Jones

Wrightington, Wigan and Leigh NHS Foundation Trust

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Nikhil Shah

Wrightington Hospital

Tim Board

Wrightington Hospital

Anthony Clayson

Wrightington Hospital

G Marsh

Croydon College

Sunil Panchani

Wrightington Hospital

Amol Chitre

Lancashire Teaching Hospitals NHS Foundation Trust

William J. Harrison

University of Liverpool

A.K. Gambhir

Wrightington Hospital

R Macnair

Morriston Hospital

Hiren Divecha

Wrightington Hospital

Cooperative Institutions

University of Birmingham

1,765

Institut de Virologie

1,616

NIHR Birmingham Biomedical Research Centre

1,133

Yorkshire Cancer Research

1,029

Urology Foundation

956

Association for Cancer Surgery

862

AstraZeneca (Brazil)

744

Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie

718

Stryker (United Kingdom)

643

Pfizer (United Kingdom)

513

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Femoral Component Revision Using Impaction Bone Grafting and a Cemented Stem

Nuthan Jagadeesh Henry Wynn Jones B Purbach Nikhil Shah

The main problem in revision hip arthroplasty is bone loss. Every attempt should be made to conserve the existing bone and restore the missing bone where possible during reconstruction of the acetabulum and femur. Femoral impaction grafting is a demanding but powerful technique to restore the bone loss and prepare for any further revisions in future. It allows the use of a cemented stem which loads the cancellous bed of the graft and helps in neo-osteogenesis. We report our technique of using this technique in femoral revisions.

Impaction

Bone grafting

10.1007/978-981-99-5517-6_53

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Reconstruction of Acetabular Bone Defects in Primary Total Hip Replacement Using Bone Graft

Jaypee Brothers Medical Publishers (P) Ltd. eBooks (2012)

Henry Wynn Jones Nikhil Shah Anthony Clayson Peter Kay

10.5005/jp/books/11713_27

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Custom triflange revision acetabular components for significant bone defects and pelvic discontinuity: Early UK experience

Journal of Orthopaedics (2020)

Hosam E. Matar Veenesh Selvaratnam Nikhil Shah Henry Wynn Jones

Pelvic fracture

10.1016/j.jor.2020.01.053

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Shoe Raises for Symptomatic Leg Length Discrepancy after Total Hip Replacement: Do Patients Find Them Useful?

The Internet Journal of Orthopedic Surgery (2014)

Bola Akinola Henry Wynn Jones Tim Harrison Keith Tucker

Leg-length discrepancy (LLD) is a well-recognised complication after total hip replacement (THR). It is one of the commonest sources of litigation against orthopaedic surgeons in North America [1]. LLD may cause generalised patient dissatisfaction as well as an abnormal gait, back pain and sciatica [2 – 6]. A small true LLD is common, with published mean discrepancies ranging from 1 to 15.9mm [7 – 9; 10 – 15]. Not all patients are aware of a true leg length discrepancy after THR. The perception of a leg length discrepancy ranges from 6 to 32% in the published literature [15 – 16]. Some authors have stated that most patients are unaware of a leg length discrepancy after THR [17], whereas Sarangi et al found that patients with a true lengthening of greater than 6mm universally perceived a LLD [10]. True LLD occurs as a result of the limb being lengthened or shortened by the position of the prosthesis at the time of surgery. Patients may also have a functional LLD. This can be caused by scoliosis, pelvic obliquity or soft tissue tightness around the hip [12]. The limb is usually lengthened when a THR is performed, as the arthritis causes loss of length at the hip joint [11, 18]. This relative lengthening may also be perceived as a LLD.

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Clinical effectiveness

Age and Ageing (2013)

Adonis Abdullah Abdullah Omar R. Mulcahy Alison Clapp Ellen Tullo

Introduction: Although older individuals are more prone to hypoglycaemia, it is not known if they have sufficient understanding of the risks of hypoglycaemia or the factors that predispose to it. We evaluated the effectiveness of hypoglycaemia education and examined the factors that increased susceptibility to hypoglycaemia among older people with diabetes. Methods: Forty-five patients (male/female) aged >65 years and known to have diabetes were identified through outpatient clinics at a secondary care hospital. Information relating to education received, awareness of hypoglycaemia and associated risk factors was collected using a standard questionnaire. Additionally, data regarding demographics, treatment regimes, patient attitudes, hypoglycaemic awareness and risks and barriers to self-management of diabetes was collected. Patients were categorised as low, moderate and high risk based on their responses. Independent sample t-tests and Analysis of Variance were carried out to identify factors contributing to high hypoglycaemic risk. Results: Overall, 70% of the patients reported receiving education about hypoglycaemia from health professionals and 95% of them reported good understanding of hypoglycaemia and were able to self-test. Proportion of women receiving education was, however, lower than men (52% women versus 88% men). Compared with men, women were less likely to recognise (59 versus 73%), or act appropriately to a hypoglycaemic episode (59 versus 78%). The mean number of hypoglycaemic episodes per year (41 versus 12) and the duration of hypoglycaemia (9.9 versus 6.3 min) was also greater among women compared with men. The duration of diabetes (P = 0.018), female gender, type 1 diabetes (0.002) and lack awareness of medications causing hypos (P = 0.006) were strong predictors of hypoglycaemia risk. Conclusions: There are significant gaps in education around hypoglycaemia in older people with diabetes. Women, people with longer duration and type 1 diabetes in particular, need additional attention and future educational initiatives need to address these issues.

10.1093/ageing/aft096

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Wear rate and medium-term survival of a cemented, moderately cross-linked polyethylene acetabular prosthesis

Hip International (2017)

Bilal M. Barkatali Dinesh Alexander A.K. Gambhir Henry Wynn Jones Tim Board

Introduction: The moderately cross-linked Depuy Marathon® cemented acetabular component was introduced into the UK in 2007. The wear rate for the previously introduced Marathon® uncemented acetabular component has been reported to range from 0.06 to 0.01 mm/year. The aim of this study was to present the medium-term results and wear rate of the Marathon® cemented prosthesis used in primary total hip arthroplasty. Methods: 103 Marathon® cemented acetabular components were implanted between 2008 and 2009 in primary arthroplasty, who were eligible for this study. All patients received a metal 28-mm head. Mean age was 68 years (range 27-87). Mean clinical follow-up was 55 months (range 50-61). Mean radiological follow-up was 46 months (range 24-57). Wear was calculated on AP radiographs using computer-assisted uni-radiographic technique. Results: The mean wear was 0.37 mm (range 0.0-0.78 mm). The wear rate was calculated as 0.03 mm/year (95% confidence interval 0.02-0.06). Postoperative complications included deep vein thrombosis (2%) and dislocation (0.8%); there were no deep infections. There were no revisions for failure of the Marathon® cemented acetabular component. Conclusions: The Marathon® cemented acetabular component demonstrates satisfactory wear rates and survivorship at medium-term follow-up.

10.5301/hipint.5000521

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SELECTIVE USE OF SYNOVASURE IN PATIENTS WITH AN EQUIVOCAL DIAGNOSIS OF PERIPROSTHETIC JOINT INFECTION

Journal of Bone and Joint Surgery-british Volume (2017)

Gavin White Henry Wynn Jones Tim Board

Synovasure has been designed and validated for use in the diagnosis of periprosthetic joint infection (PJI). It has a reported sensitivity of 97.4% (CI 86.1–99.6%) and specificity of 95.8% (CI 90.5–98.6%), higher than the variable results reported for aspiration by most units. At a cost of £500 per test, we aimed to establish cost-effectiveness and diagnostic accuracy, to determine its role in routine practice. We developed a protocol for pre-operative aspiration or intra-operative use. Prerequisites for entry were a high index of clinical suspicion for PJI and equivocal standard investigations. All cases were discussed at the lower limb arthroplasty MDT and approved only if use would change clinical management. Over 15 months, 36 tests were approved for 22 aspirations (5 hip, 17 knee) and 14 intra-operative cases (7 hip, 7 knee). 10/36 had undergone previous revision surgery. 35/36 cases complied with the protocol. All 22 Synovasure aspirations were negative, corresponding to the microbiology in all but one case; thought to be a contaminant. In the intra-operative group there was one true positive and 12 true negative tests, giving a sensitivity of 100% (95% CI 2.5–100%) and a specificity of 100% (95% CI 73.5–100%). Synovasure influenced decision making in 34/36 procedures. One test failed and in another there was evidence of frank infection. In 11 cases no surgery was performed versus a potential two-stage revision and in 21 cases a single rather than two-stage revision was performed. Resulting in estimated savings of £686,690, offset against a cost of £18,000. The Synovasure test was found to be sensitive and specific and can aid decision-making particularly in complex cases with an equivocal diagnosis of PJI. The use of this test through a robust protocol driven peer review MDT process not only reduces patient morbidity but drives significant efficiency savings.

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Evaluation of optical methods of detecting dental pulp vitality

Journal of Biomedical Optics (1997)

Michael E. Fein Alan Gluskin William W.Y. Goon Bradford B. Chew Willem A. Crone

An attempt to develop an optical probe to assess dental pulp vitality led to the conclusion that it would be difficult to construct an effective optical probe for the middle-aged and older patient who is a common candidate for pulpal assessment. In such patients, vascularity of the gingiva is so much greater than that of the pulp that signals originating in the gingiva overwhelm pulpal effects. This conclusion applies to photoplethysmography, pulse oximetry, and laser Doppler flowmetry, and probably to spectrophotometry as well. The effect of the gingiva was first demonstrated by placing opaque plastic film in the gingival sulcus, which caused attenuation of light passing through molar and bicuspid teeth. More dramatically, the remaining pulsatile signal could be much further attenuated by vasoconstricting the gingiva. An unusually sensitive photoplethysmograph was developed (noise floor, with signal averaging, was near 10 fA), as were a variety of optical probes (including two that approached the tooth below the gingival margin). The tools, methods, and conceptual models that were developed are intended also to be of use to investigators who are developing optical probes for use in younger subjects, in whom such probes appear to be useful.

Photoplethysmogram

10.1117/12.261679

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ARTHROSCOPIC SUBACROMIAL DECOMPRESSION USING AN ELECTROSURGICAL ABLATOR: ARE SAFE TEMPERATURES MAINTAINED?

Orthopaedic Proceedings (2008)

Henry Wynn Jones Thomas De Smedt Søren Sjølin

There is concern that intra-articular electrosurgical ablation may cause thermal soft tissue damage, particularly chondrolysis, if excessive temperatures are reached. The aim of this study was to determine whether the intra-articular temperature during arthroscopic subacromial decompression using a monopolar electrosurgical ablator remains below a safe level. Data was collected prospectively from consecutive shoulder arthroscopic subacromial decompressions performed at our institution. Shoulder arthroscopy was performed using three standard portals. Evaluation of the glenohumeral joint and subacromial space was performed in a standard manner. Soft tissue resection of the subacromial bursa was performed using a monopolar electrosurgical ablator probe with continuous integral suction. Additional procedures such as acromioclavicular joint excision and rotator cuff debridement or repair were performed as appropriate. Bone resection, if required was performed using an arthroscopic burr. The temperature of the fluid within the shoulder and subacromial space was continuously monitored using a sterile digital temperature probe. The surgeon performing the procedure was blinded the collection of data. Data from thirty subacromial decompressions has been collected. 8 patients had full thickness cuff tears of which 6 were debrided, and 2 repaired arthroscopically. 13 patients had acromioclavicular joint excision. Mean operating time was 46 minutes (30–107). The infusion pressure ranged from 40 to 65 mmHg. The median volume of infused fluid was 3900 ml (1500 to 9000). The starting temperature ranged from 18.3 to 21.9. The mean maximum temperature reached was 27.6 (range 22.7 to 41.8 °C). The results suggest that the intra-articular temperature is maintained within safe levels when a monopolar electrosurgical ablator with integral suction is used to perform soft tissue subacromial decompression.

Electrosurgery

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Effects of honey and sugar dressings on wound healing

Journal of Wound Care (2007)

A.N.G. Mphande C. Killowe S. Phalira Henry Wynn Jones William J. Harrison

Objective: To investigate whether there is a difference between the efficacy of honey and sugar as wound dressings. Method: Patients with open or infected wounds were randomised to receive either honey or sugar dressings. Bacterial colonisation, wound size, wound ASEPSIS score and pain were assessed at the start of treatment and at weekly intervals until full healing occurred. Results: Forty patients were enrolled; 18 received sugar dressings and 22 honey dressings. In the honey group, 55% of patients had positive wound cultures at the start of treatment and 23% at one week, compared with 52% and 39% respectively in the sugar group. The median rate of healing in the first two weeks of treatment was 3.8cm2/week for the honey group and 2.2cm2/week for the sugar group. After three weeks of treatment 86% of patients treated with honey had no pain during dressing changes, compared with 72% treated with sugar. Conclusion: Honey appears to be more effective than sugar in reducing bacterial contamination and promoting wound healing, and slightly less painful than sugar during dressing changes and motion. Declaration of interest: None.

Aseptic processing

10.12968/jowc.2007.16.7.27053

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Citations (127)