The Royal Infirmary of Edinburgh, or RIE, often (but incorrectly) known as the Edinburgh Royal Infirmary, or ERI, was established in 1729 and is the oldest voluntary hospital in Scotland. The new buildings of 1879 were claimed to be the largest voluntary hospital in the United Kingdom, and later on, the Empire. The hospital moved to a new 900 bed site in 2003 in Little France. It is the site of clinical medicine teaching as well as a teaching hospital for the University of Edinburgh Medical School. In 1960, the first successful kidney transplant performed in the UK was at this hospital. In 1964, the world's first coronary care unit was established at the hospital. It is the only site for liver, pancreas and pancreatic islet cell transplantation and one of two sites for kidney transplantation in Scotland. In 2012, the Emergency Department had 113,000 patient attendances, the highest number in Scotland. It is managed by NHS Lothian.
To define the ‘patient acceptable symptom state’ (PASS) and ‘minimum important change’ (MIC) for the Oxford Hip Score (OHS) following aseptic revision total hip arthroplasty (rTHA), and identify factors associated with their achievement. A prospective cohort of 135 patients (138 hips) undergoing aseptic rTHA at a single centre were followed up at one and two years postoperatively. Demographics, health-related quality of life (HRQoL; EQ-5D) and OHS were recorded at each timepoint. Anchor techniques were used to define the MIC and PASS. Regression models identified factors associated with PASS and MIC achievement. The OHS PASS was 31.5 and 33.5 at one and two years postoperatively, respectively. The MIC was 8.5 at both timepoints. A greater preoperative EQ-5D was independently associated with PASS achievement at both timepoints. One-year MIC achievement was independently associated with lower BMI (p = 0.042) and lower preoperative OHS (p = 0.007), whilst lower preoperative OHS (p = 0.016) alone was independently associated with two year MIC achievement (p = 0.016). Lower preoperative EQ-5D and ASA grade 3 were associated with failure to achieve either PASS or MIC at one year (p = 0.030) and two years (p = 0.013) postoperatively, respectively. The PASS and MIC thresholds for the OHS following aseptic rTHA contextualise the score and can inform study design. Greater preoperative HRQoL was independently associated with PASS achievement, whilst worse preoperative function was independently associated with MIC achievement. These thresholds should be considered in conjunction when assessing outcomes following aseptic rTHA.
Background Trigeminal neuralgia associated with multiple sclerosis (MS-TN) is frequently refractory to medical and procedural therapy, particularly in the absence of neurovascular compression. Surgical options are limited when microvascular decompression is not appropriate. We report a salvage surgical approach combining internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory MS-related trigeminal neuralgia. Case presentation A 50-year-old woman with relapsing-remitting multiple sclerosis presented with medically refractory right-sided trigeminal neuralgia predominantly involving the V2/V3 distributions. She had previously failed optimisation of pharmacotherapy, two percutaneous retrogasserian glycerol rhizotomies, and Gamma Knife radiosurgery performed within the preceding year. Posterior fossa exploration via a retrosigmoid approach demonstrated no neurovascular conflict. Internal neurolysis (nerve combing) was therefore performed and supplemented with targeted glycerol delivery to the proximal cisternal segment of the trigeminal root adjacent to the radiologically relevant demyelinating lesion. Postoperatively, the patient experienced immediate improvement in facial pain with preservation of trigeminal sensation and no new neurological deficits. Her early postoperative course was complicated by a wound infection requiring surgical washout and antibiotic therapy. At 43-month follow-up, she remained free of ipsilateral trigeminal neuralgia with substantially reduced medication requirements. She later developed contralateral facial pain controlled with low-dose carbamazepine without recurrence on the operated side. Conclusion This report describes, to our knowledge, the first published case of combined internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory multiple sclerosis-related trigeminal neuralgia. In this highly selected case, durable ipsilateral pain control was observed. However, causal interpretation is limited by the single-case design, the combined nature of the intervention, and the potential delayed effects of prior radiosurgery. This approach should therefore be regarded as hypothesis-generating rather than practice-defining, but may merit further study as a salvage strategy in selected patients without neurovascular compression after failure of medical, percutaneous, and radiosurgical treatments.
PURPOSE OF REVIEW:Survival rates following liver transplantation now exceed 90% at one year. However, the patient group undergoing liver transplantation is increasingly complex, requiring continued focus on improving perioperative care to sustain these survival outcomes. This review highlights recent advances in the postoperative care of the liver transplantation patient. RECENT FINDINGS:Modern care integrates Enhanced Recovery After Surgery (ERAS) principles, which emphasise early mobilisation and device minimisation. Risk stratification has become increasingly sophisticated, with frailty and cardiopulmonary exercise testing providing powerful prognostic information; emerging machine learning approaches may further refine personalised risk prediction.Goal-directed haemodynamic management is advocated, with restrictive fluid strategies and viscoelastic haemostatic assays to minimise transfusion. Advances in graft optimisation have expanded the donor pool: normothermic regional perfusion reduces ischaemic cholangiopathy in donation after cardiac death grafts, while machine perfusion systems show promise in improving early graft function.Advanced organ support (extracorporeal membrane oxygenation) requires careful graft-conscious management. Infection prevention strategies include tailored prophylaxis approaches. Nutrition and structured prehabilitation/rehabilitation programmes support recovery, reduce complications and address persistent functional deficits. SUMMARY:Collectively, these developments reflect a shift toward personalised, multidisciplinary postoperative care, aimed at improving both survival and quality of life for liver transplantation recipients.
This finite element study evaluated the biomechanical performance of asymmetric metaphyseal cones in large Type 2a/b medial tibial defects simulating medial tibial plateau fractures during acute total knee arthroplasty, to determine thresholds for safe clinical application. A finite element model of a tibia with tibial baseplate, asymmetric metaphyseal cone, and short cemented stem was utilised. Sixteen medial fracture patterns (AORI Type 2a/b defects) were simulated with unsupported surface area ratios from 0% to 60%. Two physiological loading scenarios (walking and stair descending) were applied. Implant stability was evaluated through tangential and normal micromotions at the bone-cone coating interface, with thresholds of 150 μm for osseointegration and 50 μm for long-term stability. Bone mechanical response was quantified through principal strain distributions. Tangential and normal micromotions increased with defect size but remained below critical thresholds, with maximum tangential micromotion of 36 μm during stair descending at a 60% ratio. Micromotions and bone strain demonstrated a threshold effect at approximately 52% ratio, beyond which both parameters increased substantially. At a 60% ratio during stair descending, 0.11% and 0.12% of bone volume exceeded tension and compression thresholds, respectively. Asymmetric metaphyseal cones maintain sufficient stability for managing medial tibial plateau fractures during acute total knee arthroplasty, with interface micromotion below critical thresholds even in severe defects. The recommended maximum unsupported area ratio is 52%, providing a clear quantitative threshold for clinical decision-making.
Recurrent lumbar disc herniation (RLDH) is a common complication after discectomy, occurring in 2%–25% of patients and contributing to higher reoperation rates, reduced satisfaction, and substantial direct and indirect costs. This review evaluates the economic consequences of RLDH and the relative cost-effectiveness of available management strategies. A systematic search of OVID, MEDLINE, and the Cochrane Library was performed through August 2025. Peer-reviewed, English-language studies were included if they examined adults (≥18 years) with RLDH and reported economic data. Exclusion criteria were studies limited to primary, cervical, or thoracic herniations; animal or cadaveric models; and abstracts. Extracted variables included study design, sample size, follow-up duration, and cost components. Of 283 records identified, 220 were screened and 35 underwent full-text review. Six studies met inclusion criteria, with 2 added through citation searching. Reported costs varied considerably: repeat discectomy added $6,907 in one analysis, while fusion increased expenses by more than 350%. Across studies, repeat discectomy remained the most cost-efficient option, providing comparable outcomes with reduced perioperative expenditures. Conservative management had the lowest immediate direct costs (≈$2,300) but likely underestimates the overall burden due to unmeasured productivity losses. Annular closure devices demonstrated potential cost savings of $2,000–5,000 over 2–5 years. RLDH imposes a substantial economic burden. Heterogeneity in costing methods remains a major limitation which hinders evidence-based determinations. Greater transparency, methodological standardization, and incorporation of societal perspectives are essential to accurately assess the socioeconomic impact of RLDH.
