Tibial tubercle osteotomy for access during revision knee arthroplasty: Ethibond suture repair technique

Background  

Tibial Tubercle Osteotomy has shown much promise in revision total knee replacement. Methods of repair previously described include screw and wire fixation. Both methods have significant complications.     

Professionals' views and experiences of using outcome measures in palliative care

In palliative care, outcome measures are increasingly used to aid clinical practice, conduct audit and research. The objective of this study was to elicit professionals' views and experiences of using outcome measures, paying special attention to the Palliative care Outcome Scale (POS). This article presents the results of a qualitative study of 26 professionals, experienced in using the POS, who were invited to participate in semi-structured telephone interviews. Of those invited, 22 people took part. Participants' comments were noted verbatim through the interviews and data subjected to content analysis. Analysis of data identified a number of key themes surrounding outcome measures, notably their reasons for use, application in clinical settings and a range of professionals' attitudes. The article concludes that understanding the process of outcome measures is important for improving their implementation. When undertaking further research, attention should be paid to the wider social, cultural and structural contexts, as factors that can influence the implementation of outcome measures. As the drive towards outcome measures continues, it is essential that measures are not developed in a vacuum. Instead they should always be informed by the needs and experiences of individuals and services.     

Considering the Vignette Technique and its Application to a Study of Drug Injecting and HIV Risk and Safer Behaviour

Vignettes are stories generated from a range of sources including previous research findings. They make reference to important factors in the study of perceptions, beliefs and attitudes. Vignettes have primarily been used by psychologists in North America and used in quantitative surveys but more recently they have been used in a small number of qualitative studies. Drawing from a range of studies in the social sciences this paper considers the value of vignettes together with the difficulties associated with the technique. It introduces the technique in a study that explores drug injectors' perceptions of human immunodeficiency virus (HIV) risk and safer behaviour inside and outside the prison system.     

'The reflections you get': an exploration of body image and cachexia

BACKGROUND: cachexia has a detrimental effect on quality of life and is an indicator of poor prognosis. The meanings people attach to their lived experiences of cachexia are unknown. AIMS: to explore the impact of cachexia on body image of people with advanced cancer, their emotions, relationships and social functioning. DESIGN: qualitative study using face-to-face in-depth interviews of a conversational style. Rich narrative data analysed by thematic content analysis. PARTICIPANTS: 12 participants recruited from two community palliative care teams in south east England. RESULTS: altered body image impacts on other aspects of embodiment: the emotions, spirituality, relationships and social functioning. Lives were restricted and isolated, which was compounded by emotional distancing by carers and health care professionals. Participants discussed their repeated attempts to re-adapt to disruptions of self caused by an altered body image. CONCLUSIONS: the key study implications focus on the need for (i) improved holistic care and support, and advice; (ii) training and awareness raising of care professionals; (iii) further research on the lived experiences of the condition and the development of effective measures of cachexia.     

Reliability evaluation of inter-eminence line,Akagi and Dalury lines for intraoperative tibial rotation: An osteology-based study

Background

This large osteology study examined the reliability, reproducibility and correlation between previously described tibial tray rotation alignment lines (including Akagi and Dalury lines). In addition, it described a novel inter-eminence line utilising the tibial plateau inter-condylar eminences as a landmark.

Synovial shelves of the knee: association with chondral lesions

The objectives of the present study were to evaluate whether synovial shelves of the knee are associated with increased incidence of chondral lesions and to determine which types of plica are associated with significant articular damage. Data were collected prospectively from 1,000 consecutive knee arthroscopies. Of these patients, 321 (32.1%) were found to have synovial shelves of the knee. Patients details (age, sex, duration of symptoms, injuries, and possible mechanism of injury), operative details (types and number of portals, equipment used), intra-articular findings (articular, meniscal and synovial lesions, and stability characteristics) and procedures performed were recorded on a special database. Synovial shelves of the knee were recorded using a modification of the Sakakibara classification. Articular lesions were noted on anatomic articular maps of the different functional zones using a functional zoning system that presaged the current ICRS system. An increased incidence of articular lesions was found in patients with synovial shelves, in comparison with patients without shelves (94.7 vs. 81% respectively; P < 0.001). Patients with larger and more fibrotic shelves were found to have increased incidence of cartilage lesions, in comparison with patients with type smaller and less fibrotic shelves (96.5 vs. 86.4%, respectively; P = 0.002), as well as cartilage lesions with bigger size (84 vs. 71.4%, respectively; P = 0.02). Patella (P < 0.001), and specific areas (P < 0.001) of the medial femoral condyle, were areas with increased incidence of cartilage lesions, in patients with synovial shelves. In conclusion, synovial shelves of the knee are associated with an increased incidence of cartilage lesions. Larger shelves, particularly with chronic inflammation are associated with more frequently occurring and larger articular lesions. Areas with increased incidence of chondral lesions, in patients with plicae, include particularly the lower patella and the non-weight-bearing medial femoral condyle.