J.K. Tucker

Norfolk and Norwich University Hospital

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C. Darrah

Norfolk and Norwich University Hospital

Simon Donell

University of East Anglia

John F. Nolan

Norfolk and Norwich University Hospital

C. Patrick Case

University of Bristol

T. Barker

Addenbrooke's Hospital

Andoni P. Toms

Norfolk and Norwich University Hospital

Caroline Hing

HollyFrontier (United States)

Richard Y. Ball

Norfolk and Norwich University Hospitals NHS Foundation Trust

J.A. Wimhurst

Norfolk and Norwich University Hospital

J. Morrisset Smith

British Medical Association

Cooperative Institutions

Norfolk and Norwich University Hospital

Norfolk and Norwich University Hospitals NHS Foundation Trust

Addenbrooke's Hospital

Norwich University

University of Cambridge

University of East Anglia

Royal College of Surgeons of England

Norwich Research Park

University College London

Royal Cornwall Hospital Trust

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Augmentation of Acetabular Cement Fixation in Revision Hip Arthroplasty with Titanium Screws

Hip International (2001)

Constant A. Busch J.K. Tucker A. Wooster

A method is described in which acetabular cement fixation is augmented by the use of specially designed titanium bone screws. In this analysis 22 elderly patients (24 hips) with severe acetabular bone loss at the time of revision have been prospectively studied both clinically and radiologically at a mean follow-up of 4.8 years. (Range 3 - 10.5 years). Three patients showed progression of peri-acetabular bone-cement lucent lines. In two patients a cement fracture occurred next to the bone screw. Two patients showed migration of the screw-cement unit of greater than 4mm at maximum follow-up. The post-operative Harris hip score was 81 (Range 68–96) There were no significant technical complications associated with the technique of screw insertion.

Hip Arthroplasty

10.1177/112070000101100204

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The value of MRI in the assessment of an elbow injury in a neonate

Journal of Bone and Joint Surgery - British Volume (2001)

Matthew L. Costa S. Owen-Johnstone J.K. Tucker T. Marshall

We describe the use of MRI to establish the exact diagnosis in a swollen elbow in a neonate. Urgent diagnosis was needed for medical and social reasons. We accomplished this without the use of an invasive procedure or anaesthesia for a fracture that is recognised to be difficult to diagnose in patients of this age group.

Medical assessment

Value (mathematics)

10.1302/0301-620x.83b4.10924

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Citations (13)

ILIAC APOPHYSITIS- A CAUSE OF HIP PAIN IN ADOLESCENTS

Orthopaedic Proceedings (2003)

H. Dabke J.K. Tucker

There are very few reports on apophysitis of the iliac crest although similar afflictions of the knee, heel, and elbow are well recognised conditions. Excesive forefoot pronation has been suggested as a contributory factor in the development of iliac apophysitis. We present our experience of this not so well known problem. Method: This is a prospective review of 8 patients (2- males, 6- females) between 12–16 years of age, who presented with pain in the hip of at least 3 months duration. They were prospectively reviewed over an average of 6 months (6–24 months). 7 of them were involved in some sort of sporting activity. 3 patients had to miss school due to pain. All of them had tenderness over the iliac crest, normal range of hip movements with pain on resisted hip abduction. None of them had any deformities in the lower limbs. Blood counts, ESR, CRP and radiographs were normal. 3 patients had persistent pain over 12 months hence had a bone scan which was normal. All patients had full symptomatic relief following rest, activity modification and anti-inflammatory medication. Conclusions: Unlike previous reports, our patients did not have characteristic radiographic changes thus the diagnosis of this condition seems to be mainly clinical. All pediatric patients with hip pain should be thoroughly investigated to rule out other sinister causes. None of our patients had any foot deformities questioning the hypothesis that iliac apophysitis develops secondary to excessive forefoot pronation. It is important to be aware of this condition, which causes considerable distress and can be relieved easily by conservative means.

Iliac crest

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METAL ON METAL HIP REPLACEMENT

Orthopaedic Proceedings (2008)

John F. Nolan C. Darrah Simon Donell J.A. Wimhurst Andrew Toms

60 out of total series of 643 metal-on-metal hip replacements, carried out over the last nine years, have so far required revision, 13 for peri-prosthetic fracture and 47 for extensive, symptomatic, peri-articular soft-tissue changes. Dramatic corrosion of generally solidly fixed, cemented stems has been observed and is believed to have resulted in the release of high levels of cobalt chrome ions from the stem surface. The contribution of the metal-to-metal articulation is, as yet, unclear. Not including the fracture cases, plain films have demonstrated little or no abnormality to account for patients’ progressive symptoms. MRI scanning, on the other hand, utilising a technique designed to minimise implant artefact, has correlated very closely with findings at the time of revision surgery. The histological changes, typified by extensive lymphocytic infiltration and a severe vasculitis leading to, in some cases, extensive tissue necrosis are demonstrated and discussed. The failure of any of the existing protective mechanisms or regulatory restrictions to identify and limit the exposure of large numbers of patients to unsatisfactory implants has again been demonstrated.

Infiltration (HVAC)

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CURRENT FLUID ADMINISTRATION IN LOWER LIMB ARTHROPLASTY LEADS TO HYPONATRAEMIA AND WEIGHT GAIN

Orthopaedic Proceedings (2008)

Patricia Nasr Ritu Chopra J.K. Tucker

Excessive perioperative administration of intravenous fluid during lower limb arthroplasty may be associated with postoperative complications. There have only been five randomised trials that have evaluated the effects of intraoperative fluid on recovery time, none of which have looked at Orthopaedic patients. Intravenous fluid overload has been shown to decrease muscular oxygen tension, produce general oedema, delay tissue healing, compromise cardiorespiratory function and can cause coma. This study assesses the current practice in the administration of fluid and sodium during and after lower limb arthroplasty in our hospital. A series of 68 patients who have undergone elective THR (57) and TKR (11) were included in this prospective study. Current fluid management includes the use of Hartmans solution at a rate of 125mL per hour together with fluid boluses to maintain blood pressure and urine output. We looked at the weight of the patients before and after surgery and compared this with their pre and post operative serum sodium level. Our findings were that patients gained an average of 1.84 Kilograms (Range −1.6 to +6.4) which was age dependent and there was a mean fall in Serum Sodium of 5.26 mmols/L (Range −15 to +2). Of note there was a mean fall in serum Haemoglobin of 3.69g/dL (Range −2.8 to −5.9) which may be due to blood loss perioperatively but haemodilution due to excessive fluid administration may also contribute. We propose responding aggressively to low urine output and low blood pressure can cause detrimental effects on Sodium Haemostasis. Factors such as preoperative Bendroflumethiazide and enthusiastic nursing regimes to encourage oral water intake were found to be contributory factors. Our results suggest that anaesthetists should be aware of post operative hyponatreamia in these patients and a more cautious approach to fluid management is required in the perioperative period.

Fluid Replacement

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Disseminated osteosarcoma arising in the pelvis after total hip arthroplasty

The Journal of Arthroplasty (2002)

Pancham Prasad J Latham J.K. Tucker Richard Y. Ball

Hip Arthroplasty

10.1054/arth.2002.30290

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Citations (14)

Roux loop drainage for post-traumatic biliary cyst.

BMJ (1975)

J.K. Tucker W G Everett J. Morrisset Smith

Biliary Drainage

10.1136/bmj.2.5961.22

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Citations (2)

Autobanking of femoral heads for revision total hip replacement, a preliminary report of a new surgical technique

The Surgeon (2004)

Caroline Hing Richard Y. Ball J.K. Tucker

10.1016/s1479-666x(04)80136-7

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Citations (8)

Radiographic appearances in lumbar disc prolapse

Journal of Bone and Joint Surgery - British Volume (1990)

JG MacLean J.K. Tucker JB Latham

The pre-operative lumbar spine radiographs of 200 consecutive patients who had undergone discectomy for prolapsed intervertebral disc were reviewed. Prolapse was recognized as bulging or sequestration of the disc with consequent root compromise. Measurement of the lumbar level of the interiliac line was shown to correlate with the level of disc prolapse and the incidence of transitional vertebrae at the lumbosacral junction was significantly higher than normal. A pathological value for the lumbosacral angle could not be identified.

Lumbosacral joint

Discectomy

Intervertebral Disc

10.1302/0301-620x.72b5.2145286

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Citations (12)

AUTOBANKING OF FEMORAL HEADS FOR TOTAL HIP REPLACEMENT

Orthopaedic Proceedings (2003)

Caroline Hing J.K. Tucker

Conventional banking of donated femoral heads has been well documented in the literature. It relies on screening potential donors, providing a storage facility and sterilisation techniques which are not standardised. Stored femoral heads have a finite lifetime and wastage does occur. Prion contamination and malignant potential are present with modern storage techniques. We report a technique of banking the donor’s femoral head in a surgically fashioned subperiosteal pouch, under iliacus. Young patients requiring a total hip replacement who are likely to need revision at a later date are suitable candidates. Patients who have signs of loosening of their total hip replacement and contralateral osteoarthritis are also suitable. The femoral head is retrieved and used for the donor’s own revision surgery. Interim clinical results for 12 patients with the head harvested at a maximum of 5 years from implantation are presented. We report no morbidity at the pouch site and present radiographic results showing good integration of the morselised femoral head bone graft in revision hip surgery. Histological results are also presented. Autobanking of the patient’s own femoral head has the advantage of providing a graft with a reduced risk of infection, rich in growth factors, with the potential of osteoinduction. It eliminates the need for a storage facility, screening programme and provides a portable storage facility if the patient moves area.

Pouch

Interim

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