Cappagh National Orthopaedic Hospital

Purpose Our objective was to assess the sustainability and feasibility of implementing reusable surgical caps in an orthopaedic hospital setting by comparing them with the disposable caps currently in use. Methods A cradle-to-grave Life Cycle Assessment was conducted comparing disposable and reusable surgical caps in an orthopaedic hospital. The analysis included raw material sourcing, manufacturing, transportation, laundry, and end-of-life treatment. The functional unit was one year of surgical headwear provision, corresponding to 60 reusable caps or 18,000 disposable caps. Environmental impacts were assessed using SimaPro 9.6, Ecoinvent 3.10, and Environmental Footprint 3.1. Results Reusable caps showed lower impact in most categories over one year, including a 30% reduction in climate change impact, equivalent to around 91 kg CO2e. Laundry was the main contributor to reusable cap emissions, while polypropylene production dominated disposable cap impacts. Reusable caps had higher water use, land use, and some eutrophication impacts. Conclusion Reusable surgical caps appear to be a feasible strategy to reduce environmental burden, though pilot implementation is needed.

Fluoroscopically guided caudal epidural injections are commonly used to treat lumbar back pain with radiculopathy. Whilst hospitals internationally advise against driving for 12–24 h post injection, there are currently no standardised guidelines on when it is safe to resume driving post injection. To assess if brake response times are altered pre and post fluoroscopic-guided caudal epidural nerve root injections. Brake response times were assessed before and after fluoroscopic-guided caudal epidural nerve root injections in a cohort of patients. The average of 3 brake response times was recorded before and 30 min after injection. Statistical analysis was performed using GraphPad. A paired Student t-test was used to compare the times before and after the injections. Fifty two patients were included in this study. The mean age was 60 years. There were 25 male and 27 female patients. Mean pre-injection brake response time was 0.91 s (range 0.6–1.3), compared with 0.96 s (range 0.6–1.4) post-injection. The difference was not statistically significant (p = 0.41) in mean brake response times. Brake response time did not significantly differ pre and 30 min post fluoroscopic-guided caudal epidural nerve root injections. These findings demonstrate similar response times under simulated conditions but do not establish definitive driving safety.

Background Unicompartmental Knee Arthroplasty (UKA) provides several benefits over Total Knee Arthroplasty (TKA), including improved kinematics and quicker recovery. However, national registries often report higher revision rates for UKA. This study aims to evaluate the mid- to long-term survival rates and functional outcomes of UKA in a single-centre cohort and to identify patient-specific factors associated with revision. Methods A retrospective cohort study was conducted on 175 UKAs performed in 153 patients. Demographic data, including age at surgery, BMI, and ASA grade, were recorded. Patients were prospectively followed by the institutional arthroplasty register. The primary outcome was all-cause revision. Secondary outcomes included functional status and medical complications. Statistical analysis was performed using Fisher’s exact tests for categorical risk factors and independent t-tests for continuous variables. Results The all-cause revision rate was 20.0% (n = 35) at mean 9.5 years follow-up. All revisions were aseptic. The main indications were unexplained pain (37.1%) and progression of osteoarthritis in other compartments (28.6%). Age at index surgery was the only significant predictor. Patients under 60 had a 39.6% revision rate, while those 60 and older had a 11.5% revision rate (p < 0.0001). Functional outcomes improved significantly and were sustained. Mean WOMAC scores improved from 48.8 ± 16.9 pre-operatively to 27.5 ± 17.5 at 6 months, remaining stable at 10 years (25.5 ± 19.7). The medical complication rate was 8.6%, mainly from transient urinary retention and lower respiratory tract infections. Conclusion UKA provides excellent long-term functional outcomes and low medical morbidity. Notably, our findings show a substantially higher revision risk in patients under 60 years old, highlighting that younger patients experience a higher failure rate. These results underline the necessity for careful patient selection and thorough pre-operative counselling regarding the risk of early revision in younger individuals.

We describe the case of a 29-year-old man who presented with painful swelling in the right popliteal fossa. MRI demonstrated an extensive infiltrative soft tissue lesion encasing the right sciatic nerve and extending along the common peroneal and lateral sural cutaneous nerves. Subsequent ultrasound-guided biopsy and surgical excision confirmed desmoid-type fibromatosis. This case highlights the characteristic multimodality imaging features of desmoid-type fibromatosis involving the sciatic nerve, an uncommon site of disease, and illustrates the importance of MRI in defining the longitudinal extent of tumour and its relationship to adjacent neurovascular structures for surgical planning. Few reports describe extensive sciatic nerve encasement by desmoid-type fibromatosis with comprehensive MRI, CT, operative and pathological correlation.

Muscle herniation is an uncommon musculoskeletal condition that may present with non-specific lower limb symptoms and, in rare cases, result in peripheral nerve compression. We report the case of a 32-year-old woman who presented with a two-year history of progressive exertional bilateral lateral calf pain and dysesthesia initially suspected to represent neurogenic claudication. Lumbar spine magnetic resonance imaging (MRI) demonstrated no evidence of spinal canal stenosis, intervertebral disc herniation or nerve root compression. Subsequent MRI of both calves performed on a 1.5-T MRI system revealed bilateral focal fascial defects (measuring approximately 5-8 mm) within the lateral compartments with herniation of the peroneus longus muscles and associated compression of the superficial peroneal nerves at their fascial exit points. No vascular compression or alternative cause of nerve entrapment was identified. The patient underwent bilateral fasciotomy with superficial peroneal nerve decompression, resulting in complete resolution of symptoms. This case highlights an uncommon cause of bilateral exertional leg pain mimicking spinal claudication and emphasizes the importance of considering peripheral nerve entrapment secondary to muscle herniation when spinal investigations are inconclusive. MRI plays a key role in identifying fascial defects, muscle herniation and associated nerve compression, thereby facilitating appropriate surgical management.