01 Jun 2017

Volume 5 Issue 2


From the Editor

This issue really should have something of interest for every orthopaedic surgeon. The breadth of our specialty is truly remarkable and the reports from our specialist society meetings demonstrate the energy of the organisers and participants, their international reach and the inclusion of the whole team. The steadily rising number of attendees at their conferences is a tangible measure of their success.

We have articles on education, professional development and medico-legal issues, but the core theme is basic science. We provide you with up-dates on the fundamental process of fracture healing and the evidence to support our approach to articular cartilage regeneration. Professor Tim Board is the guest editor and has written on the continuing conundrum of avascular necrosis of the femoral head where we still struggle to understand the causes or provide optimal treatment.

The “Getting it right first time” programme now encompasses many specialties though orthopaedics led the way. Rachel Yates explains the rationale of the process that supports clinicians taking the lead to improve outcomes and reduce variation based on sound evidence. It is vital that we take responsibility for stewardship of our resources, but we need to understand how to assess the cost effectiveness of our surgery. Belen Corbacho explains the importance of the QALY and what data you should consider when assessing health technology interventions.

Few things depress a surgeon more than a patient presenting with early infection after knee replacement. The impact on the patient can be catastrophic and it is vital that the right decisions are made as quickly as possible. Rhidian Morgan-Jones provides a clear and logical approach.

There is no doubt that you will want easy access to your copy of “JTO” and refer back to previous editions. We are excited to announce that you can now download the journal via the JTO App – just search for JTO @ BOA on the App Store or Google Play.


Phil Turner - BOA Vice President Elect



Reference Lists


The Use of QALYs in the Economic Evaluation of Orthopaedics Treatments

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Bisphosphonate - associated Femoral Fractures: Lessons Learnt

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FRCS (T&O): a Trainee's and Educationalist's Perspective on Exam Preparation

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How I ... Manage the Acutely Infected TKR?

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Legg-Calve-Perthes Disease: 100 Years of Controversy: But Could the Answers be Forthcoming?

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5. Tripathy S, Sen R, Dhatt S, Goyal T. 2010. Legg-Calvé-Perthes Disease Current Concepts. Orthop, 11(1)

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11. Kim HK, Aruwajoye O, Stetler J, Stall A. 2012. Effects of non-weight-bearing on the immature femoral head following ischemic osteonecrosis: an experimental investigation in immature pigs. J Bone Joint Surg, 94(24), 2228-2237.

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16. Joseph B, Varghese G, Mulpuri K, Narasimha Rao K, Nair NS. 2003. Natural evolution of Perthes disease: a study of 610 children under 12 years of age at disease onset. J Pediatr Orthop, 23(5), 590-600.  

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18. Siddesh ND, Shah H, Tercier S, Pai H, Nair S, Joseph B. 2014. The sphericity deviation score: a quantitative radiologic outcome measure of Legg-Calve-Perthes disease applicable at the stage of healing and at skeletal maturity. J Pediatr Orthop, 34(5), 522-528.

19. Nelson D, Zenios M, Ward K, Ramachandran M, Little DG. 2007. The deformity index as a predictor of final radiological outcome in Perthes' disease. J Bone Joint Surg Br, 89(10), 1369-74.

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23. Brech GC, Guarnieiro R. 2006. Evaluation of physiotherapy in the treatment of Legg-Calve-Perthes disease. Clinics, 61(6), 521-528.

24. Saran N, Varghese R, Mulpuri K. 2012. Do femoral or Salter innominate osteotomies improve femoral head sphericity in Legg-Calve-Perthes disease? A meta analysis. Clin Ortho Relat Res, 470(9), 2383-2393.

25. Wiig O, Terjesen T, Svenningson S. 2008. Prognostic factors and outcome of treatment in Perthes’ disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br, 90(10), 1364-1371.  

26. Terjesen T, Wiig O, Svenningsen S. 2012. Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calve-Perthes disease. Clin Orthop Relat Res, 470(9):2394-2401.

27. Joseph B, Rao N, Mulpuri K, Varghese G, Nair S. 2005. How does a femoral osteotomy alter the natural evolution of Perthes disease? J Pediatr Orthop B, 14(1), 10-15.

28. Wichlacz W, Sotirow B, Sionek A, Czop A. 2004. Surgical outcome for children in the early phase of Perthes’ disease. Ortop Traumatol Rehabil, 6(6), 712-717.

29. Young ML, Little DG, Kim HK. 2012. Evidence for using bisphosphonate to treat Legg-Calvé-Perthes disease. Clin Orthop Relat Res, 470(9), 2462-75.

30. Herrera-Soto JA, Price CT. 2011. Core decompression and labral support for the treatment of juvenile osteonecrosis. J Pediatr Orthop, 31(2), S212-216.

31. Hosny GA, El-Deeb K, Fadel M, Laklouk M. 2011. Arthrodiastasis of the hip. J Pediatr Orthop, 31(2), S229-234.  

32. Kurup HV, Clarke NM. 2011. Sugioka transtrochanteric valgus osteotomy for hinge abduction in children. J Pediatr Orthop, 31(7), 727-731

Scrubbing Under the Influence

1. Kirschner MH, Lang RA, Breuer B, Breuer M, Gronver CS, Zwingers T, Bottrich JG, Arndt A, Brauer Ute, Hintzpeter M, Burmeister MA, Fauteck JD. Transdermal Resorption of an Ethanol and 2-propanolol Containing Skin Disinfectant. Langenbecks Arch Surg 2009; 394: 151-157

2. Parienti JJ, Thibon P, Heller R, Le Roux Y, von Theobald P, Bensadoun H, Bouvet A, Lemarchand F, Le Coutour X. Hand-Rubbing with an aqueous Alcoholic Solution vs Tranditional Hand Scrubbing and 30 Day Surgical Site Infection Rates – A Randomised Equivalence Study. J Am Med Assoc 2002; 288: 722-727

3. Barbut F, Djamjian L, Passot C, Petit JC. Efficacy of 2 Alcohol Based gels and 1 Alcohol Based Rinse for Surgical Hand Disinfection. Infect Control Hosp Epidemiol 2007; 28: 1013-1015

4. Widmer AF, Rotter M, Voss A, Nthumba P, Allegranzi B, Boyce J, Pittet D. Surgical Hand Preparation: State-OfThe-Art. J Hosp Infect 2010; 74: 112-122

5. Marchetti MG, Kampf G, Finzi G, Salvatorelli G. Evaluation of the Bactericidal Effect of Five Products for Surgical Hand Disinfection According to prEN 12054 and prEN 12791. J Hosp Infect 2003; 54: 63-67

6. World Health Organisation: WHO Guidelines on Hand Hygiene in Healthcare, Executive Summary. http://www.who.int/patientsafety/challenge/en/  

7. Kampf G, Ostermeyer C, Heeg P. Surgical Hand Disinfection with a Propanol-Based Hand Rub: Equivalence of Shorter Application Times. J Hosp Infect 2005; 59: 304-310

8. Bessonneau V, Thomas O. Assessment of Exposure to Alcohol Vapour from Alcohol-Based Hand Rubs. Int J Environ Res Public Health 2012; 9(3): 868-879

9. Bessonneau V, Clement M, Thomas O. Can intensive Use of Alcohol Based Hand Rubs Lead to Passive Alcoholization? Int J Environ Res Public Health 2010; 7: 3038-3390

10. Below H, Partecke I, Huebner NO, Bieber N, Nicolai T, Usche A, Assadian O, Below E, Kampf G, Parzefall W, Heidecke CD, Zuba D, Bessonneau V, Kohlmann T, Kramer A. Dermal and Pulmonary Absorption from Propan-1ol and Propan-2-ol from Hand Rubs. Am J Infect Control 2012; 40: 250-257

11. Driving Vehicle Licencing Agency: Drink Drive Limit. https://www.gov.uk/drink-drive-limit

12. Turner P, Saeed B, Kelsey MC. Dermal Absorption of Isopropyl Alcohol from a Commercial Hand Rub: Implications for its use in Hand Decontamination. J Hosp Infect 2004; 56: 287-290

Propose Changes to Soft Tissue Injury - Whiplash - Claims Process 2017

1. Dalton J (2017) http://www.insurancebusinessmag.com/uk/news/breaking-news/industry-bodies-react-togovernment-whiplash-reforms-60929.aspx

2. Evans D (2017) “Chief Executive: How APIL has been fighting on a number of fronts.” PI Focus March  p7

3. Fletcher B (2017) https://www.insurancefraudbureau.org/media-centre/news/2017/ifb-responds-togovernment-whiplash-reforms/

4. Miller I (2017) http://www.piblawg.co.uk/post/2017/02/25/whiplash-injuries-a-tale-of-two-systems1

5. Ministry of Justice(2016) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/581387/reforming-soft-tissueinjury-claims-process.pdf

6. Ministry of Justice (2017) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/581387/reforming-soft-tissueinjury-claims-process.pdf

7. Twambley A (2017) http://accesstojusticeactiongroup.co.uk/access-justice-responds-publication-prisons-courtsbill/

8. Williams D (2017) http://www.axa.co.uk/newsroom/media-releases/2017/response-to-the-reforms-to-thewhiplash-consultation-as-part-of-the-prisons-and-courts-bill/