J Bone Joint Surg Br
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J Bone Joint Surg Br · Feb 2009
ReviewThe management of patients with painful total knee replacement.
The management of patients with a painful total knee replacement requires careful assessment and a stepwise approach in order to diagnose the underlying pathology accurately. The management should include a multidisciplinary approach to the patient's pain as well as addressing the underlying aetiology. ⋯ There are a number of intrinsic and extrinsic causes of a painful knee replacement which should be identified and treated early. Patients with unexplained pain and without any recognised pathology should be treated conservatively since they may improve over a period of time and rarely do so after a revision operation.
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J Bone Joint Surg Br · Feb 2009
Medical negligence in orthopaedic surgery: a review of 130 consecutive medical negligence reports.
Payments by the NHS Litigation Authority continue to rise each year, and reflect an increase in successful claims for negligence against NHS Trusts. Information about the reasons for which Trusts are sued in the field of trauma and orthopaedic surgery is scarce. We analysed 130 consecutive cases of alleged clinical negligence in which the senior author had been requested to act as an expert witness between 2004 and 2006, and received information on the outcome of 97 concluded cases from the relevant solicitors. ⋯ Overall, 55% of cases were abandoned by the claimants' solicitors, and the remaining 45% were settled out of court. The cases were settled for sums ranging from pound 4500 to pound 2.7 million, the median settlement being pound 45,000. The cases that were settled out of court were usually the result of delay in treatment or diagnosis, or because of substandard surgical technique.
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J Bone Joint Surg Br · Feb 2009
Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing.
It has been noted that bony union of a pars defect can be achieved in children if they wear a trunk brace. Our aim was to evaluate how the stage of the defect on CT and the presence or absence of high signal change in the adjacent pedicle on T2-weighted MRI were related to bony healing. We treated 23 children conservatively for at least three months. ⋯ None of the seven terminal defects healed. Of the 26 high signal change-positive defects 20 (77%) healed after conservative treatment whereas none of the high signal change-negative defects did so. We concluded that an early-stage defect on CT and high signal change in the adjacent pedicle on a T2-weighted MR scan are useful predictors of bony healing of a pars defect in children after conservative treatment.