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Osteoarthritis (OA) is the most common degenerative joint disease, affecting primarily the hip, knee, and hand (Ip 2005). OA of the knee and hip is the 11th highest contributor to global disability (Cross et al. 2014). Hip OA is diagnosed using radiographs, computed tomography (CT), and/or magnetic resonance imaging (MRI). Hip OA affects the whole hip joint, causing pain and reduced range of motion (Altman et al. 1991). The cause of pain in OA is not well understood, but it may be attributed to abnormal growth of blood vessels and nerves in the subchondral bone of the femoral head (Kumar et al. 2013). Quantifying blood vessels and nerves and correlating their presence with diagnostic techniques such as MRI will establish a relationship between femoral head degeneration and pain levels and current diagnostic signs. The aims of this study were: (1) to develop a reproducible histological technique to identify blood vessels and nerves in bone sections; and (2) to apply this protocol to identify blood vessel and nerve characteristics within osteoarthritic femoral heads. Femoral heads were retrieved from 8 OA patients (age range: 40-76; 5 female and 3 male) undergoing total hip replacement surgery. Each sample was evaluated for the presence of subchondral bone cysts using micro-computed tomography (µCT), then regions containing cysts were isolated and dissected for histological processing. Different fixation times in paraformaldehyde (PFA) were tested in three samples to assess the effect of fixation time on binding of the primary antibody to the target. Samples were stained with hematoxylin and eosin to evaluate overall tissue morphology, safarin-O and fast green to visualize the integrity of articular cartilage, anti-CD31 to identify vascular endothelium, and anti-PGP 9.5 to identify peripheral nerve fibers. A protocol was successfully developed to identify CD31-positive blood vessels and PGP 9.5-positive nerves in osteoarthritic femoral heads. The immunohistochemistry protocols for staining with anti-CD31 and anti-PGP 9.5 were optimized for maximum intensity of target staining, minimal background staining, and minimal artefactual tissue folding. Fixation time in PFA was not found to have an effect on quality of staining with anti-CD31. Blood vessels were found in all eight of the samples collected, and peripheral nerves were found in five of the samples. Special attention was paid to regions with fibrous subchondral bone cysts, because these are the most likely type to undergo neurovascular invasion. Out of the five samples with fibrous subchondral bone cysts, blood vessels were identified in all five cyst regions, and peripheral nerves were identified in three cyst regions. Using the protocols developed in this study, blood vessels and nerves were found in osteoarthritic femoral heads. In future, a larger sample set will be used to correlate the nature of blood vessel density and nerves that are found in bone marrow lesions identified on MRI scans obtained before surgery and are associated with bone cysts. This is an important step towards identifying more effective treatments for OA that address the specific underlying causes and the development of non-treatable pain.

Metal-on-metal (MM) bearings have been considered as an alternative to conventional metal-on-polyethylene (MPE) bearings because of their lower volumetric wear, but concern exists due to potential metal hypersensitivity. Metal hypersensitivity reactions have been thought to be T cell-mediated delayed type hypersensitivity (DTH) reaction. However some of the MM periprosthetic tissues show the presence of B- and plasma cells, as well as massive fibrin exudation, which are not characteristic of a DTH reaction. Therefore, the exact nature of the hypersensitivity reaction(s) MM implants remains unclear. The present study aimed to compare the phenotypes of lymphocytes from the peripheral blood and synovial fluid of patients with failed MM and MPE implants, and from volunteers with no implant (peripheral blood only). Results in peripheral blood showed differences in the T-cell populations depending on the implant type. This included differences in the proportions of T-helper and T-cytotoxic cells, and T-cells expressing IFN-g. Results in synovial fluid showed a significant difference between MM and MPE groups for the B-cells. Both groups depicted a predominance of T-cell lymphocytes in synovial fluid and overall larger proportions of memory cells than in peripheral blood, but group sizes were rather small. Overall, T-cell cytokine expression (analyzed in peripheral blood only because of the limited number of synovial fluid samples) did not exhibit characteristics of a DTH reaction and the proportions of memory lymphocytes did not indicate activation of a specific subset in the MM group. Nevertheless, group sizes still remain to be increased.

Background: To determine the pass rate of the final exit examination of the College of Orthopaedic Surgeons of South Africa [FC Orth(SA)] and to assess the correlation between the written component with the clinical and oral component. Methods: Results of candidates who participated in the FC Orth(SA) final examination during a 12-year period from March 2005 through to November 2016 were assessed retrospectively. Pass rates and component averages were analysed using descriptive and inferential statistics. Spearman's rho test was used to determine the correlation between the components. Results: A total of 399 candidates made 541 attempts at the written component of the examination; 71.5% of attempts were successful and 387 candidates were invited to the clinical and oral component, of which 341 (88%) candidates were certified. The second-attempt pass rate for those candidates who wrote the written component again was 42%. The average annual increase in the number of certified candidates was 8.5%. The overall certifying rate increased by 1.5% for this period. Invited candidates who scored less than 54% for the written component were at significant risk of failing the clinical and oral component. The written component showed weak correlation with the clinical and oral component (r=O.48). Conclusion: While the written component was found to be an effective gatekeeper, as evidenced by a high eventual certifying rate, the results of this component of the FCOrth(SA) final examination did not correlate strongly with the performance in the clinical and oral component. This finding confirms the value of the written component as part of a comprehensive assessment for the quality of orthopaedic surgeons.

No description available.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Pain management is a vital component of post-operative nursing care. Orthopaedic patients in particular experience severe pain following surgical intervention. Since effective pain management is crucial in the post-operative recovery of orthopaedic patients, it was essential to explore the knowledge and clinical practice of nurses in orthopaedic wards. The aim of the study was to establish nurses’ knowledge and clinical practice for adult postoperative pain management of orthopaedic patients. A non-experimental, descriptive self-administered survey using a quantitative approach was applied. The total population of N=97 registered professional and enrolled nurses working in dedicated orthopaedic wards in two central hospitals in the Cape Town Metropole district, South Africa were invited to participate in the study. A structured questionnaire was used to collect the data. Reliability and validity was assured by means of a pilot study and consultation with nursing experts and a statistician. Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch. Permission for access to the hospitals was obtained from the hospital and nursing managers. Informed written consent was obtained from the participants. The data was analysed by the statistician and presented in frequencies, tables and histograms. The variables were compared using either the Pearson chi-square test for differences in nursing category or the Mann-Whitney U-test for differences in years of experience. The analysis of the results illustrated knowledge deficits, inconsistent clinical practices and limited training in post-operative pain management. The recommendations include training courses, revision of the patient’s observation chart and formulation of policies and guidelines for pain management. Appropriate knowledge and clinical skills of nurses are critical to ensure optimal pain management for post-operative orthopaedic patients. / AFRIKAANSE OPSOMMING: Die bestuur van pyn is ’n essensiële component van post-operatiewe verpleegsorg. Ortopediese pasiënte ervaar spesifiek fel pyn na afloop van ’n chirugiese intervensie. Aangesien effektiewe pynbestuur belangrik in die post-operatiewe herstel van ortopediese pasiënte speel, was dit nodig om die kennis en kliniese praktyke van verpleegpersoneel in ortopediese sale te verken. Die doel van die studie was om verpleegpersoneel se kennis en kliniese ervaring van volwasse post-operatiewe pynbestuur van ortopediese pasiënte vas te stel. ’n Nie-eksperimentele, deskriptiewe, self-toegediende opname is toegepas wat gebruik maak van ’n kwantitatiewe benadering. Die totale populasie van 97 geregistreerde professionele en ingeskrewe verpleegkundiges wat in toegewyde ortopediese sale van twee sentrale hospitale in die Kaapstad Metropol distrik, Suid Afrika werk, is genooi om aan die studie deel te neem. ’n Gestruktureerde vraelys is gebruik om data in te samel. Betroubaarheid en geldigheid is verseker deur middel van ’n voortoets en konsultasie met verpleegkundige kenners en ’n statistikus. Etiese goedkeuring is verkry van die Gesondheidsnavorsing Etiese Komitee van die Universiteit Stellenbosch. Toestemming om toegang tot die hospitale te kry is verkry van die hospitaal en verpleegbestuurders. Ingeligte, geskrewe toestemming is van die deelnemers verkry. Die data is geanaliseer deur die statistikus en is aangebied in frekwensietabelle en histogramme. Die veranderlikes is vergelyk deur of die Pearson chi-vierkant toets te doen vir verskille in verpleegkategorieë, of die Mann-Whitney U-toets vir verskille in jare ervaring. Die analise van die resultate het kennistekorte, teenstrydige kliniese praktyke en beperkte opleiding in post-operatiewe pynbestuur uitgewys. Die aanbevelings sluit opleidingskursusse, hersiening van pasiënte se waarnemingsgrafiek en die formulering van beleid en riglyne vir pynbestuur in. Toepaslike kennis en kliniese vaardighede van verpleegpersoneel is krities om optimale pynbestuur vir post-operatiewe ortopediese pasiënte te verseker.

Thesis (MMed (Surgical Sciences. Orthopaedic Surgery))--University of Stellenbosch, 2010. / Objective: This research paper reports on the radiographic outcome of unstable thoracolumbar injuries with short segment posterior instrumentation as standalone treatment; in order to review rate of instrumentation failure and identify possible contributing factors. Background: Short segment posterior instrumentation is the treatment method of choice for unstable thoracolumbar injuries in the Acute Spinal Cord Injury Unit (Groote Schuur Hospital). It is considered adequate treatment in fracture cases with an intact posterior longitudinal ligament, and Gaines score below 7 (Parker JW 2000); as well as fracture dislocations, and seatbelt-type injuries (without loss of bone column - bearing integrity). The available body of literature often states instrumentation failure rates of up to 50% (Alanay A 2001, Tezeren G 2005). The same high level of catastrophic hardware failure is not evident in the unit researched. Methods: Sixty-five consecutive patients undergoing the aforementioned surgery were studied. Patients were divided into two main cohorts, namely the “Fracture group” (n=40) consisting of unstable burst fractures and unstable compression fractures; and the “Dislocation group” (n=25) consisting of fracture dislocations and seatbelt-type injuries. The groups reflect similar goals in surgical treatment for the grouped injuries, with reduction in loss of sagittal profile and maintenance thereof being the main aim in the fracture group, appropriately treated with Schantz pin constructs; and maintenance in position only, the goal in the dislocation group, managed with pedicle screw constructs. Data was reviewed in terms of complications, correction of deformity, and subsequent loss of correction with associated instrumentation failure. Secondly, factors influencing the aforementioned were sought, and stratified in terms of relevance. Results: Average follow up was 278 days for the fracture group and 177 days for the dislocation group (all patients included were deemed to have achieved radiological fusion – if fusion technique was employed). There was an average correction in kyphotic deformity of 10.25 degrees. Subsequent loss in sagittal profile averaged 2 degrees (injured level) and 5 degrees (thoracolumbar region) in the combined fracture and dislocation group. The only factor showing a superior trend in loss of reduction achieved was the absence of bone graft (when non-fusion technique was employed). Instrumentation complications occurred in two cases (bent connection rods in a Schantz pin construct with exaggerated loss in regional sagittal profile, and bent Schantz pins). These complications represent a 3.07% hardware failure in total. None of the failures were considered catastrophic. Conclusion: Short segment posterior instrumentation is a safe and effective option in the treatment of unstable thoracolumbar fractures as a standalone measure.

Thesis (MMed (Surgical Sciences. Orthopaedic Surgery))--University of Stellenbosch, 2010. / No abstract available

The discipline of orthopaedic surgery is a fast growing surgical specialty directed at the diagnosis and management of disorders of the musculoskeletal system e.g. acute trauma, fractured or dislocated joints, elective reconstructive surgery as well as related research. The standard of care in orthopaedic surgery treatment reflects the status of its evolution and what is currently available in terms of the knowledge, surgical expertise, orthopaedic implant materials, and equipment. It is the duty of the orthopaedic surgeon to live up to the promise as best he or she can to heal when it is possible to heal and to provide the level of care expected that transcends simple surgical expertise and bio-technological intervention. The informed consent process is an often neglected but vital component of the standard of care which has to satisfy prescribed ethical and legal requirements. This research is focused on how to heighten the awareness of, and to encourage engagement within the orthopaedic surgery fraternity with the informed consent process. If the informed consent is given more recognition within this group, it will benefit the potentially vulnerable orthopaedic patient, protect the orthopaedic surgeon against litigation, and importantly, contribute to the ethical imperatives bound in a doctor-patient relationship. For this research, a vast search of the available local and international literature has been perused and my finding is that the application of Ethics and recognition of the informed consent concept within the medical community in general is gathering momentum and it must be both supported and internalized by those in orthopaedic surgical practice.