SP Morapudi, R Zhou, K Barnes: Bone and Joint Journal of Orthopaedics: 2014

Another publication from the Orthopaedics Dept, this time in The Bone and Joint Journal of Orthopaedics


SP Morapudi, R Zhou, K Barnes – Bone & Joint Journal Orthopaedic Proceedings …, 2014

Abstract. Summary There is little knowledge in surgeons about the guidelines for prophylactic antibiotics in patients with prosthetic joints when undergoing a dental procedure. read more 

RJ Macfarlan, TD Donnelly, Y Khan, S Morapundi, M Waseem, J Fischer: Biomed Research 2014

Congratulations to the staff of the Dept of Trauma and Orthopaedics for having the following article published.

Clinical Outcome and Wound Healing following Carpal Tunnel Decompression: A Comparison of Two Common Suture Materials

RJ MacFarlane, TD Donnelly, Y Khan, S Morapudi… – BioMed Research …, 2014

Department of Trauma and Orthopaedics, Macclesfield District General Hospital,
East Cheshire NHS Trust, Victoria Road, Macclesfield SK10 3BL, UK.

Published 7 August 2014


Donnelly TD; Macfarlane RJ; Nagy MT; Ralte P; Waseem M; The Open Orthopaedics Journal 2013

Fractures of the clavicle: an overview.

Citation: The open orthopaedics journal, 2013, vol./is. 7/(329-33), 1874-3250 (2013)
Author(s):  Donnelly TD; Macfarlane RJ; Nagy MT; Ralte P; Waseem M

Abstract: Fractures of the clavicle are a common injury and most often occur in younger individuals. For the most part, they have been historically treated conservatively with acceptable results. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the
appropriate management. A thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted. The majority of recent data suggests that operative treatment may be more appropriate as it improves
functional outcome and reduces the risk of complications such as non-union. This is particularly evident in mid shaft fractures, although more high grade evidence is needed to fully recommend this, especially regarding certain fractures of the medial and lateral clavicle.

Full Text: Available from National Library of Medicine, The  Open Orthopaedics Journal


Ahsan Akhtar*, Robert J. MacFarlane and Mohammad Waseem; The Open Orthopaedics Journal, 2013

Pre-Operative Assessment and Post-Operative Care in Elective Shoulder
The Open Orthopaedics Journal, 2013, 7, (Suppl 3: M4) 316-322
East Cheshire NHS Trust, Victoria Rd, Macclesfield, SK10 3BL, UK

Abstract: Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately.

This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common postoperative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and postoperative analgesia following shoulder surgery.


Health Matters – 2 July 2013

The latest ‘Health Matters’ talk will be looking at the Rapid Recovery Joint Replacement Programme the trust adopted earlier this year. The talk, ‘Knee and Hip Replacements, working together for a quicker, better and happier recovery’, will be led by Mr Graham Keys, Consultant Orthopaedic Surgeon & Project Lead.

Other speakers at the lecture include Dr Mick Rothwell, Consultant Anaesthetist and the author of the Anaesthesia and Analgesic Protocol; Christine Jackson, Occupational Therapist; Shirley Jones, Perioperative Specialist Practitioner; Selena King, Ward Six Manager; Sarah Clubley, Physiotherapist and Dot Pearson, Acute Pain Nurse and Project Co-ordinator. Several patients who have already been through the programme will also be on hand at the event.

For further information on ‘Health Matters’ and to book your place at the 2 July lecture, from 7-8pm, in the Lecture Theatre, Macclesfield District General Hospital, please contact The Communications and Engagement Department on 01625 661560 or email ecntstaff.comms@nhs.net

Arthroplasty: critical review.

Provisional PDF file published in Open Access Orthopaedics


[PDF] arthroplasty: A critical review. OA Orthopaedics 2013 Jun 01; 1 (1): 4.

SG Kini, SS Sathappan
Unicompartmental knee arthroplasty (UKA) is an effective surgical treatment for unicompartmental arthritis. Although results can be optimized with careful patient selection and use of a sound implant design, the most important determinants of success of UKA is 

Orthopaedics News

[HTML] Titanium Alloys in Orthopaedics

W Wang, CK Poh – 2013
Schematic figure of a hip implant. The femoral neck is the region at risk of compromised vascularity. Arrows indicate area of compromised vascularity where osseiointegration fails to take place. Figure 2. Schematic figure of a hip implant. The femoral neck is the region at


EVIDENCE-BASED ORTHOPAEDICS 940 Intra-Articular Infusion with Bupivacaine Decreased Pain and Opioid Consumption After Total Knee Arthroplasty

MJ Bolesta
EVIDENCE-BASED ORTHOPAEDICS 940 Intra-Articular Infusion with Bupivacaine Decreased Pain and Opioid Consumption After Total Knee Arthroplasty 941 Hemiarthroplasty Did Not Confer Any Benefit in Older Patients with Four-Part Humeral Fractures

Naveed M.A.; Khan Y.; Ratnam K.R.; Fischer J; European Orthopaedics and Traumatology

European Orthopaedics and Traumatology
March 2013, Volume 4, Issue 1, pp 59-61

Keep it blunt: Aberrations in the course of the superficial peroneal nerve during lateral ankle approach

Author(s): Naveed M.A.; Khan Y.; Ratnam K.R.; Fischer J.
Language: English
Publication Type:   Journal: Article
Source:  EMBASE

Prophylactic Wound Drainage in Orthopaedics

[PDF] Prophylactic Wound Drainage in Orthopaedics:
A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital

IA Ikpeme, NE Ngim, IU Ilori, E Oku, AM Udosen – 2013
ABSTRACT :  Surgical wound drainage is practised routinely by many orthopaedic surgeons despite studies that challenge the practice. Among proponents, the  advantages of drainage include prevention of haematoma and/or seroma formation which

Mahmood A; Fountain J; Vasireddy N; Waseem M; The Open Orthopaedics Journal; 2012;

Wrist MRI Arthrogram v Wrist Arthroscopy: What are we Finding?

Citation: The Open Orthopaedics Journal, 2012, vol./is. 6/(194-8), 1874-3250 (2012)

Author(s): Mahmood A; Fountain J; Vasireddy N; Waseem MS Evidence | library.nhs.uk

Institution: Macclesfield District General Hospital, Victoria Road, Macclesfield, SK10 3BL, UK.

Abstract: The aim of the study was to compare the radiological findings of wrist arthrogram with wrist arthroscopy. This allowed us to establish the accuracy (sensitivity, specificity) of MRI arthrogram as a diagnostic tool. Thirty patients (20 female and 10 male) have undergone both wrist MRI arthrogram and wrist arthroscopy over the last 3 years at a District General Hospital. The mean age at arthrogram was 42.4 years with an average 6.7 month interval between the two procedures.The MRI arthrogram was reported by a consultant radiologist with an interest in musculoskeletal imaging and the arthroscopies performed by two upper limb surgeons. Patients who underwent both procedures were identified. The arthrogram reports and operation notes were examined for correlation.

Three main areas of pathology were consistently examined: TFCC (triangular fibrocartilage complex), scapholunate and lunotriquetral ligament tears. The sensitivity and specificity of arthrogram was calculated for each. Other areas of pathology were also noted. In the case of TFCC tears MRI arthrogram had 90% sensitivity and 75% specificity. The lunotriquetral ligament examination with this technique was 100% sensitivity and specificity. However for scapholunate ligament tears it only had 91% sensitivity and 88% specificity.Wrist arthrogram and arthroscopy are both invasive techniques.


J Yates, M Choudhry, G Keys; Case report, Journal of Clinical Pharmacy and Therapeutics; 20 Nov 2012

To read the full article you will need your Athens account details

A case report describing a suspected rivaroxaban hypersensitivity reaction in a surgical patient

Author information:   Department of Orthopaedics, Macclesfield District General Hospital, East Cheshire NHS Trust, Macclesfield


What is known and Objective: Rivaroxaban is an oral anticoagulant, currently licensed for use as a venous thromboembolism (VTE) prophylaxis, and recommended by the National Institute for Clinical Excellence (NICE) for all patients undergoing elective hip and knee replacement surgery in the UK. We present the first case of a suspected hypersensitivity to rivaroxaban.

Case summary: A 57-year-old man with no previous allergies underwent an uncomplicated, elective partial knee replacement, after which he was prescribed a routine 2-week course of rivaroxaban 10 mg. He developed an allergic response requiring readmission for assessment and treatment 7 days post-operatively.

What is new and Conclusion:  We believe this to be the first published case of hypersensitivity associated with rivaroxaban. More research is needed to determine this association. At the same time, given the growing range and increasing use of anticoagulants, particular vigilance is required regarding potential side effects so that these may be managed quickly and effectively in the early stages.

News from AQuA: August 2012

Seminar Invitation: Clinical leadership for integration
You are invited to an AQuA evening seminar and we are delighted to welcome John Howarth and Hugh Reeve to discuss Clinical leadership for integration – A view from the Provider and Commissioning perspective in Cumbria.
For more information please contact Liz Ashall-Payne at Elizabeth.Ashall-Payne@srft.nhs.uk.

To book on this session please follow this link: www.nhsevents.org

Registration is now open for the final Advancing Quality stroke collaborative of 2012. 

18th September 2012, 10:00am – 01:00pm
Following on from our last event in May, this collaborative will focus on what steps have been taken to improve and sustain the care and management of stroke patients across the North West through the AQ measures.
Full details are available via the registration site: www.nhsevents.org

AQuA Report – Managing Elective Demand – Opportunity to comment on draft AQuA report

As part of the work to finalise the forthcoming AQuA report “Managing Elective Demand”, AQuA is inviting representatives from PCTs/CCGs to a small informal event in July to help shape the final content of the report. Attendees at this session will have access to the draft AQuA report and can discuss the content with members of the AQuA team that were involved in its production. The aim of the session is to gain feedback from commissioner colleagues to help shape the final version of a report (planned for launch in September) which will help to meet commissioners needs around developing responses to managing demand for elective care and provide the basis for further opportunities for AQuA to support local improvement activities.

The meeting will be held in Meeting Room 3 at the Mayo Building, Salford Royal Trust on 19th July at 2 pm till 5 pm. Please contact Chris Linward, AQuA Associate to book a place on this session. Chris.linward@srft.nhs.uk.

Shared Decision Making in Cancer Care WebEx

8th August 2012, 14.00-15.00pm. Presented by Dr Pauline Leonard.
Register for the WebEx here.

Patient Value Maximisation & Shared Decision Making WebEx

11th September 2012, 13.30-14.30pm. Presented by Daghni Rajasingam.

Register for the WebEx here.

Shared Decision Making -The GP Perspective
Shared Decision Making -The GP Perspective! – 11th October 2012, 10.30-11.30am

Integration Discovery Community Focussed Seminar Session
13th September 2012, 01:30pm – 04:30pm.

Seminar: Clinical Leadership for Integration
13th September 2012, 04:30pm – 06:30pm
Full details are available via the registration site: www.nhsevents.org 

Lead Innovation and Create Value – September 25th 2012 at Fab Lab Manchester

Please find attached details of an Innovation event being run by our colleagues at The Manufacturing Institute on September, 25, 2012.
Link to full details…

Advancing Quality orthopaedics collaborative
26th September 2012, 01:00pm – 04:00pm
Registration is now open for the next Advancing Quality collaborative focusing on orthopaedics.

Advancing Quality teams from across the region are invited to attend this collaborative on 26th September 2012, 1pm-4pm, to learn the latest developments in hip and knee replacement surgery.
Full details are available via the registration site: www.nhsevents.org

Patient Safety Ambassadors
We are pleased to announce the launch of our second AQuA Patient Safety Ambassador Programme, designed to support Trust Chairs to identify cultural changes needed and assist in the development and understanding of the skills, systems and processes required to assure comprehensive safety and quality governance. This will be undertaken during three workshop based modules delivered during September – December 2012 and supported with an individual learning and reflective log.  For more information, please contact Alison.cole@srft.nhs.uk     Book your place online.

Recruiting for the next free “Nurse First” cohort in Manchester in September 2012
Nurse First is the most intensive innovation and leadership programme in the UK for clinical staff. It is a free 21 – day residential programme that runs over a year and includes masterclasses, learning sets and coaching support, developed in partnership with the Queens Nursing Institute, Bucks New University, the Shaftesbury Partnership and Johnson & Johnson. It will support you to: create innovative ideas to clinical challenges, raise the funding needed to make these ideas happen and help you implement them in your organisation.
For more information visit: www.nursefirst.org.uk

Get to grips with PDSA testing
Are you ready to start PDSA testing around the ‘Safe & Timely Discharge’ interventions? As we start work on PDSA testing of our 4 ‘safe & timely discharge interventions’ I invite you to join me for a practical ‘PDSA – Hands on, Getting to grips with PDSA’ afternoon on 23rd May at the Frank Rifkin Lecture Theatre, at the Mayo Centre, Salford Royal Hospital Trust, 2-4pm.

Avoiding unnecessary Hospital Admissions and inappropriate A&E attendances of Children & Young People with Long Term Conditions

AQuA Improvement Methodologies (AIM)  in End of Life Care
Cohort 10 (Sept – Oct 2012)
The AQuA Improvement Methodology programme in End of Life Care is geared at front line staff/operational leaders in End of Life Care wanting to gain an introduction to the fundamentals and concepts of quality improvement. Delegates will work on their own End of Life Care improvement project and develop a project plan, aim and measures throughout the programme. Suitable for staff with a basic knowledge of quality improvement tools or for experienced staff wanting to refresh their knowledge and skills.
Book online at: www.nhsevents.org Booking closes 10th August 2012 (each individual in the team is required to book a place)

The Institute for Healthcare Improvement (IHI) Open School
The Institute for Healthcare Improvement (IHI) Open School is a professional educational community that provides online education and training to enable individuals to become change agents in healthcare improvement. AQuA has purchased a number of licenses which will enable current AQuA members to benefit free of charge. This is a real opportunity to develop skills and capacity in individuals whilst supporting the quality and safety agenda in organisations.

In February 2012 we offered each AQuA member the opportunity to assign 5 licenses to named individuals within their organisation. However a number of organisations have yet to take up their full quota of licences. If your organisation has not taken up its licences and you wish to benefit from this excellent opportunity, please contact Lucy Davies on lucy.davies@srft.nhs.uk.
To listen to a WebEx entitled An Introduction to the IHI Open School, please click here.

Dementia Improvement Weekly Planner

R Singhal, SK Dheerendra, CP Charalambous, M Waseem; Teaching basic shoulder ultrasonography…; Medical Ultrasonography, 2012

Teaching basic shoulder ultrasonography to orthopaedic postgraduate trainees–effectiveness of a training workshop

R Singhal, SK Dheerendra, CP Charalambous Medical ultrasonography, 2012
 trainees – effectiveness of a training workshop Rohit Singhal1, Sujay Kumar Dheerendra2, Charalambos Panayiotou Charalambous1, Mohammad Waseem2 1 Blackpool Victoria Hospital, United Kingdom, 2 Macclesfield District General Hospital, United Kingdom 

Introduction: Ultrasound examination of the shoulder conducted by  orthopaedic surgeons in the diagnosis and treatment of shoulder conditions is increasingly reported.  Shoulder ultrasound is not a mandatory component of postgraduate orthopaedic training in the United Kingdom. The aim of this study was to assess the effectiveness of the shoulder ultrasound teaching workshop administered to postgraduate orthopaedic surgical trainees.

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Medicines and Healthcare products Regulatory Agency: Orthopaedics

The following section/document has been added/updated

Title: Orthpaedics

Summary: The MHRA is issuing updated information and advice about the management and monitoring of patients implanted with metal-on-metal (MoM) hip replacements.

You can find the section/document here: http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&ssDocName=CON096875

Keys, GW et al: Bone Joint Surgery Br, Dec 2011

 Bone Joint Surg Br.2011 Dec;93(12):1610-6.

Examination of ten fractured Oxford unicompartmental knee bearings.


Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK.


Since the Oxford knee was first used unicompartmentally in 1982, a small number of bearings have fractured. Of 14 retrieved bearings, we examined ten samples with known durations in situ (four Phase 1, four Phase 2 and two Phase 3). Evidence of impingement and associated abnormally high wear (> 0.05 mm per year) as well as oxidation was observed in all bearings. In four samples the fracture was associated with the posterior radio-opaque wire. Fracture surfaces indicated fatigue failure, and scanning electron microscopy suggested that the crack initiated in the thinnest region. The estimated incidence of fracture was 3.20% for Phase 1, 0.74% for Phase 2, 0.35% for Phase 3, and 0% for Phase 3 without the posterior marker wire. The important aetiological factors for bearing fracture are impingement leading to high wear, oxidation, and the posterior marker wire. With improved surgical technique, impingement and high wear should be prevented and modern polyethylene may reduce the oxidation risk. A posterior marker wire is no longer used in the polyethylene meniscus. Therefore, the rate of fracture, which is now very low, should be reduced to a negligible level.