Introduction

Tunnelwidening in failed anterior cruciate ligament reconstruction (ACLR) can result in the staged revision procedures with a need for bone transplantation prior to revision reconstruction. Limited knowledge exist regarding to quality of different transplantation methods. The present study used CT-scanning to evaluate tunnel bone density after allogenic bone chips and bone cylinder transplantation.

We hypothesized that bone chips transplantation resulted in higher bone density than bone cylinder transplantation due to possible voids between individual cylinders in the tunnels.

Background

Pseudotumours have been associated with metal-on-metal (MoM) hip replacements. We define it as a solid mass which may have cystic components that is neither neoplastic nor infectious in aetiology. The cause of a pseudotumour is not fully understood but could be due to excessive wear, metal hypersensitivity or due to an as-yet unknown cause.

Background

Controversy persists regarding preference between Herbert and Acutrak screw for internal fixation of scaphoid non-union. Acutrak screw has been shown to have better biomechanical compression properties than Herbert screw in the laboratory setting. The aim of this study was to assess the clinical, radiological and functional outcome of patients treated with the two different screw systems.

OBJECTIVES

In elderly patients the temporary loss of function of the upper extremity due to immobilization for treatment of unstable proximal humeral fractures is a very disabling condition. Stable fixation of such fractures allowing immediate functional aftercare may contribute to early social reintegration in this group of patients. Aim of this study is to present the surgical technique of humeral blade plate fixation and the clinical and radiographic results after fixation of unstable surgical neck fractures with this implant followed by immediate functional treatment in patients older than 60 years.

Purpose

Our understanding of the spectrum of pathological lesions of the shoulder anterior capsular-labral complex in anterior instability continues to evolve. In a previous study using magnetic resonance arthrography we have showed three variants of the essential lesion of the anterior capsular-labral complex. This is the first large arthroscopic study to finely evaluate the nature and relative proportions of these three lesions in anterior instability.

Background

Osteoarthritis of basal joint of the thumb represents one of the commonest degenerative diseases of the hand and wrist region. Depending on the severity of clinical symptoms surgical treatment is often recommended. Resection arthroplasty of the CMC joint with tendon interposition can be regarded as the gold standard. The aim of our study is to compare the Burton Pellegrini technique with a new modified technique of resection arthroplasty with interposition of local capsule tissue.

Background

Femoroacetabular impingement (FAI) may be a predisposing factor in progression of osteoarthritis. The use of hip arthroscopy is in its infancy with very few studies currently reported. Early reports show favourable results for treatment of young patients with FAI. This prospective study over a larger age spectrum represents a significant addition to this expanding field of minimally invasive surgery.

Introduction

The legion knee revision system was designed as a follow and improvement to the Genesis II knee system- allowing for a surgeon directed femoral rotation as opposed to the in-built femoral rotation in the previous system.

This is a prospective review of consecutive patients who underwent knee revision surgery using the legion knee system.

Chondral injuries of the knee are extremely common and present a unique therapeutic challenge due to the poor intrinsic healing of articular cartilage. These injuries can lead to significant functional impairment. There are several treatment modalities for articular osteochondral defects, one of which is autologous chondrocyte implantation. Our study evaluates the mid to long term functional outcomes in a cohort of 828 patients who have undergone an autologous chondrocyte implantation procedure (either ACI or MACI), identifying retrospectively factors that may influence their outcome.

The influence of factors including age, sex, presence of osteoarthritis and size and site of lesion have been assessed individually and with multivariate analysis. All patients were assessed using the Bentley Functional Score, Visual Analogue Score and the Cincinnati Functional Score. Assessment were performed pre-operatively and of their status in 2010. The majority of patients had several interim scores performed at varying intervals.

The longest follow-up was 12 years (range 24 to 153 months) with a mean age of 34 years at time of procedure. The mean defect size was 486 mm2 (range 64 to 2075 mm2). The distribution of lesions was 51% Medial Femoral Condyle, 12.5% Lateral Femoral Condyle, 18% Patella (single facet), 5% Patella (Multifacet) and 6% Trochlea. 4% had cartilage transplant to multiple sites. 30% failed following this procedure at a mean time of 72 months. 52% patients stated a marked improvement in their functional outcomes within the first two years. 49% stated an excellent result following their procedure.

High failure rate was noted in those with previous cartilage regenerative procedures, transplants occurring on the patella, particularly if involving multifacets. Multiple site cartilage transplantation was also associated with a high failure rate.

Autologous chondrocyte implantation is an effective method of decreasing pain and increasing function, however patient selection plays clear role in the success of such procedure.

Introduction

Anterior Cruciate ligament reconstruction is a common operation in orthopaedics surgery. A common complication of whilst havesting the hamstring tendon is injury to the infra-patellar branch of the saphenous nerve (IPBSN), resulting in altered sensation to the anterior and lateral aspects of the knee and leg.

Introduction

Venous thromboembolism (VTE) is an uncommon complication of foot and ankle surgery but has the potential for significant morbidity and mortality. The incidence, risk factors and prevention of VTE in foot and ankle surgery is not clear.

Introduction

The advantages of metal on metal (MOM) hip replacement are decreased wear rate, preservation of bone stock, anatomical restoration and enhanced stability. Large amounts of metal wear particles and metal ions are released which may induce adverse reactions including local soft tissue toxicity, hypersensitivity reactions, bone loss and risk of carcinogenesis. Aseptic loosening can be the result of a peri prosthetic osteolysis generated as a result of a biological response to particulate wear debris.

Our aim in this study was to determine whether a steeply inclined acetabular component would give rise to a higher concentration of metal ions.

Introduction

There has been little research into the effect of suffering a simultaneous hip and upper limb fragility fracture. The aim of this study is to describe the characteristics of this important group of patients and to define the effect on outcomes such as mortality and length of stay.

Background

Thromboembolic disease is a common complication of total hip replacement (THR). The administration of postoperative anticoagulants is therefore highly recommended. The purpose of this study was to compare rivaroxaban with fondaparinux with regards to their safety and effectiveness for the prevention of venous thromboembolic events (VTE) after THR.

It appears that double bundle anterior cruciate ligament reconstruction can reproduce the original anatomy of the ligament, restoring normal kinematics and rotational control of the tibia. But an anatomical single bundle reconstruction may present very similar results, with minor technical difficulties and lower costs.

We compared two groups of 25 patients each, that underwent ACL reconstruction by the same surgeon, with a follow-up of 12–36 months. One group had double bundle reconstruction with hamstring and the other had single bundle anatomical reconstruction with patellar tendon.

Patients underwent a subjective evaluation and clinical testing with instrumented laxity with Rolimeter, and the data entered in the IKDC 2000 scale Double tunnel hamstring Vs bone-tendon-bone: Functional outcome of 85.6% Global Class A and B vs. 82.1% Class A and B. The subjective outcome (IKDC 2000) was 90.93 vs. 91.47. Pivot-shift test with 87% patients in class A and class B at 9.7% Vs 75% patients in class A, 21.4% for class B. The Rolimeter gave an average Lachman value of 2,56 and anterior drawer test of 2,88 Vs average Lachman value of 3.59 and anterior drawer test of 2.92. One leg hop test showed 85.7% knees class A, 9.5% knees class B vs. 90.4% knees class A and, 2.8% knees class B.

The subjective score was slightly higher in the single bundle anatomical reconstruction with patellar tendon, despite the overall functional outcome being higher in the double tunnel technique with hamstrings. The average Lachmann in the patellar tendon group was 1 mm higher. The rotational stability in the double tunnel was higher.

The same surgeon had better results in the double tunnel hamstrings technique, despite less experienced with this technique, which is more demanding, probably reflecting objective advantages over the single bundle reconstruction with patellar tendon

Aim

The purpose of this study was to analyze the patellofemoral kinematics in neglected adult developmental dysplasia of the hip patients with patellofemoral symptoms and tried to clarify the affect of the severity of dislocation, the amount of limb length discrepancy, the deviation of mechanical axis and the changes in femoral anteversion on patellofemoral alignment.

Introduction

Hip and knee arthroplasty present surgeons with difficult bone loss. In these cases the use of morselized allograft is a well established way of optimizing early implant fixation. In revisions, the surgical field is potentially infected. The use of allograft bone creates a “dead space” in which the immune system has impaired access, and even a small amount of bacteria may therefore theoretically increase the risk of infection.

In vivo studies have shown that allograft bone is suitable as a vehicle of local antibiotic delivery.

We hypothesized that the allograft bone could be used as a local antibiotic delivery vehicle without impairing the implant fixation, tested by mechanical push-out.

Introduction

Superior Labral Anterior Posterior Tears are being treated surgically in increasing numbers. Stiffness is the most common complication. We reviewed 115 cases of SLAP repairs to try and identify preoperative risk factors if any for stiffness.

Background

Symptomatic flexion deformity of proximal interpahalangeal joint (PIPJ) is one of the most common foot deformities and usually treated with arthrodesis. In general, percutaneous K-wires are used to stabilize the joint after excision of cartilage. K-wires projecting out of the toe need special care and can occasionally be dislodged accidentally. Furthermore issues such as cellulitis, pin tract infections, rarely osteomyelitis and need for removal make alternative fixation methods desirable. Smart toe is an intra-osseous titanium memory implant, which is stored frozen. It expands on insertion and does not require removal.

The concept of stainless steel dual mobility cups in total hip arthroplasty has demonstrated very low long-term instability rates and a 98% survival rate after 12 years. We systematically implanted titanium alloy acetabular cups during a one year period. The purpose of our retrospective study was to report the 18-year clinical outcome data in a homogeneous and continuous series of 103 primary total hip replacements after implantation of a cementless titanium cup.

All patients were implanted with NOVAE Ti (SERF) cups made of titanium alloy combined with a retentive polyethylene liner and a 22.2 mm cobalt chrome prosthetic head. Mean patient age at the time of surgery was 53 years. All patients were clinically and radiographically evaluated.

The overall 18-year actuarial cup survival rate with a 95% confidence interval was 87.4%. At last follow-up, there was no evidence of implant instability whereas acetabular aseptic loosening was reported in one case and high wear of the retentive liner in 9.

The results of this investigation confirmed the long-term stability of dual-mobility implants. The main limitation of this system was early wear of the polyethylene liner in contact with the titanium metal back and reaction with third body along with loss of liner retentivity. In our study, titanium demonstrated favourable osteointegration properties but poor tribologic characteristics, therefore suggesting its interest at the bone-cup interface only.

Introduction

This study investigates the epidemiology of proximal radial fractures and potential links to social deprivation.

Background

Modular endoprostheses today represent a standard treatment option in the management of musculoskeletal tumors of the lower extremities. Long-term results of these reconstructions, however, are often limited by the course of the underlying disease. We therefore report our experiences in cancer patients with megaprostheses of the lower limb after a minimum of 15 years.

Introduction

Unicompartmental knee arthroplasty (UKA) in patients with isolated medial osteoarthritis of the knee is nowadays a standard procedure with good results, especially with the minimally-invasive approach. However, the survival rate of the unicompartmental knee prostheses is inferior to that of total knee prostheses. Therefore, further studying of UKA is still necessary. In most mobile bearing designs the femoral component has a spherical surface and therefore its positioning is not crucial. The role of the tibial slope in UKA has not been investigated so far. The manufacturers recommend tibial slopes with values between 10° positive slope and 5° negative slope. Most surgeons try to reconstruct the anatomical slope with a high failure by measuring the slope on x-rays. The aim of this study was to investigate the influence of the tibial slope on the wear rate of a medial UKA.

Introduction

Iliac crest bone marrow aspirate (ICBMA) is frequently cited as the ‘gold-standard’ source of MSCs. Mesenchymal stem cells have been shown to reside within the intramedullary (IM) cavities of long-bones and a comparative assessment with ICBMA has not yet been performed.

Objective

In many institutions, serial casting and splinting requires many weeks of treatment and frequently results in surgery. This study evaluated the results of neonatal clubfoot correction with the Furlong method. This method was created by Furlong M.B. and Lawn G.W. in New York and was published in Archives of Pediatrics in 1960.

Introduction

Locking plates have been especially useful in the treatment of osteoporotic fractures. This study aimed to investigate the role of locking plate in femoral fractures in patients with osteogenesis imperfecta.

Introduction

Increasing numbers of elderly patients are being prescribed Clopidogrel, an anti-platelet agent for medical reasons. There are no international guidelines as to the management of patients with hip fractures on Clopidogrel in peri-operative period especially in relation to timing of the surgery. In Waterford Regional Hospital in Ireland, hip fracture surgery is deferred for 4 days and platelets are reserved for the operative/post-operative period, in case they have significant bleeding or an associated complication. We conducted a retrospective study on patients admitted over a period of 1 year.

Background

There are several case reports of chondrolysis following joint arthroscopy. Continuous post-operative infusion of local anaesthetic solutions, especially 0.5% Bupivacaine, has been implicated as the causative factor in many of these cases. Recent in vitro studies have shown that even a single exposure of articular cartilage to different local anaesthetic solutions can cause apoptosis and mitochondrial dysfunction in chondrocytes leading to cell death. There is currently no study looking at methods to prevent this toxicity of local anaesthetic solutions to articular cartilage. Glucosamine has a protective and reparative effect on articular cartilage and a Cochrane review in 2007 found that it provides mild benefit in pain and function in patients with arthritis.

Recent findings about UHMWPE oxidation from in vivo stresses lead to the need of a better understanding of which anti-oxidant additivation method is the best option for the use in orthopaedic field. A GUR 1050 crosslinked Vitamin E - blended UHMWPE has been investigated, to provide an accurate outline of its properties.

DSC and FTIR measurements, together with ageing and tensile tests were performed on compression moulded blocks, as well as biocompatibility tests, including implantation on rabbits. Moreover, wear simulations on finished components (Delta acetabular liners) have been completed.

All the test procedures have been repeated for a reference material, a GUR 1050 crosslinked and remelted standard UHMWPE (commercial name UHMWPE X-Lima), and the outcomes have been compared to the crosslinked Vitamin E - blended UHMWPE ones.

On the additivated UHMWPE, we found a ultimate tensile strength of 43 MPa, a yield strength value of 25 MPa, and an elongation to breakage equal to 320%. The degree of cristallinity was 45 ± 2%, and no signal of creation of oxidation products was detected up to 2000 h of permanence in oxidant ambient after the ageing test. The reference material showed comparable mechanical resistance values (∗ = 40 MPa, y = 20 MPa, 350% elongation), a cristallinity of 46 ± 2%, and the creation of oxidation products starting from 700 h in oxidant ambient. The biocompatibility tests indicate that the additivated material is biocompatible, as the reference X-Lima UHMWPE.

Wear tests gave a wear rate of 5,09 mg/million cycles against 6,13 mg/million cycles of the reference material, and no sign of run in wear rate.

Our results indicate that there is no change in mechanical properties in respect to the reference material. This is confirmed by DSC measurements, that show no change in cristallinity. The blend between polymer and additive assures an uniform concentration of Vitamin E across the whole thickness of the moulded block, and ageing test results on additivated UHMWPE have shown that the material possess a superior resistance to degradation phenomena.

Biocompatibility assess that the presence of Vitamin E is not detrimental for the in vivo use of the material, and wear results indicate a better wear resistance of the material, especially in the first stages of the wear process.

From these considerations, it can be concluded that the material, in respect to the standard UHMWPE, is highly resistant to oxidation phenomena, therefore it is expected to have superior in vivo endurance performance.

INTRODUCTION

Studies have suggested that there is a reduction in head-neck-ratio (HNR) associated with MoMHRA. A reduction in HNR at operation would decrease range of movement and increase impingement risk. Impingement could lead to 20 edge loading, increasing wear. Serum ion levels of Chromium (Cr) and Cobalt (Co) are surrogate markers of wear. Although acetabular component orientation has been shown to contribute to wear and PT development, the role of a decrease in HNR has only been highlighted in PT development. This study aimed to measure changes in HNR that occur at resurfacing and determine any gender- and component size-specific differences. In addition it aimed to determine whether changes in HNR could be associated with increased wear.

Introduction

Rapid identification of bacteria from extemporaneous samples would greatly help management of prosthesis joint infection. The aim of the present retrospective study was to evaluate a new molecular assay (GeneXpert MRSA-SA SSTI (Cepheid)) for detecting Staphylococcus aureus (SA) and methicillin resistance directly from bone and joint samples in less an hour (58 minutes).

Introduction

Infection of endoprostheses is a serious complication in orthopedic surgery. As silver is known for its antibactierial effects, silver-coated endoprostheses have gained increased attention to decrease infection rates. However, cytotoxic effects of silver on bone cells have not been investigated in detail. We aimed to investigate whether silver nano-/microparticles and ionic silver exert cytotoxic effects on osteoblasts and osteoclasts in vitro and to correlate potential effects with the antibacterial effect on Staph. epidermidis.

Aims

Will Hydroxyapatite hip (HA) arthroplasty associated with ceramic bearings produce uncomplicated function in younger, active patients’ The incidence of aseptic loosening, dislocation and broken implants has been particularly investigated.

Debris disease from plastic debris contributes to aseptic loosening. Hard-Hard bearings should obviate this problem. Metal-metal will release ions which might be deleterious. Experience with metal-metal resurfacing has high lighted problems including pseudo-tumours. Ceramic bearings may fracture but otherwise appear free of complications.

Introduction

Large wear rate reductions have been shown for crosslinked PE in simulators and short- to mid-term clinical wear studies. However, concerns persist about long-term in-vivo oxidation (especially with annealed PE), late accelerating wear and the possibly higher osteolytic potential of crosslinked PE particle debris. This is the first long-term study comparing conventional to crosslinked PE investigating whether the wear reduction is maintained in the long-term and if reduced osteolysis becomes evident.

Introduction

There is a need for a standardised guideline to assist in optimal decision-making in diabetics who have acquired an ankle fracture. Through a critical analysis of the literature, a diagnostic and management algorithm that incorporates a quantitative scoring system is proposed and presented for consideration.

Aim

We studied the characteristics of patient attendances at the Camp Bastion Field Hospital in the peak period of clinical activity. It has been expected that the summer of 2009 in Afghanistan would cause increased battle intensity due to the Afghan presidential referendum. Furthermore it was expected that civilian casualties would make up an increasing share of the total number of patients.

Electromagnetic navigation versus conventional Total Knee Arthroplasty: Clinical improvements Optical and electromagnetic (EM) tracking systems are widely used commercially. However in orthopaedic applications optical systems dominate the market. Optical systems suffer from deficiencies due to line of sight. EM trackers are smaller but are affected by metal. The accuracy of the two tracker systems has been seen to be comparable1. Recent advancements in optical navigated TKA have shown improved overall limb alignment, implant placement and reduce outliers when compared to conventional TKA2-4.

This study is the first RCT to compare EM and conventional TKA. Two groups of 100 patients underwent TKA using either the EM navigation system or the conventional method. Frontal, sagittal and rotational alignment was analysed from a CT scan. Clinical scores including Oxford Knee Score (OKS) and Knee/Function American Knee Society Score (AKSS) were recorded pre-op, and at 3 and 12 months post-op. 3 month data presented includes 180 patients (n = 90). The 12 months data presented includes 140 (n = 70).

The two groups had similar mean mechanical axis alignments (EM 0.31o valgus, conventional 0.15o valgus). The mechanical axis alignment was improved in the EM group with 92% within +/-3o of neutral compared to 84% of the conventional group (p = 0.90). The alignment of the EM group was improved in terms of frontal femoral, frontal tibial, sagittal femoral, sagittal tibial and tibial rotation alignment. However, only the sagittal femoral alignment was significantly improved in the EM group (p = 0.04). Clinically, both TKA groups showed significant improvements in OKS and AKSS scores between both pre-op to 3 month post-op and 3 months to 12 months post-op (p<0.001). The OKS and the AKSS knee score for the EM group was significantly better at 3 months post-op (OXS p = 0.02, AKSS knee p = 0.04). However there was no difference between the groups at 12 months. The mean pre-op range of motion (ROM) for both groups was 105o. This decreased to 102o in the EM group and 99o in the conventional group at 3 months. There was a significant improvement at 12 months post-op, EM = 113o (p = 0.012) and conventional = 112o (p = 0.026). There was no significant difference in ROM between the two groups at 3 or 12 months post-op.

Therefore the alignment outcome of the EM TKA group was improved compared to the conventional group. The EM group also showed clinical improvements at 3 months post-op however these were not seen again at 12 months post-op. ROM was seen to decrease at 3 months post-op but then significantly improve by 12 month post-op.

INTRODUCTION

Short femoral nail is the most popular instrumentation for femoral trochanteric fractures. PFNA is in widely use and good results are reported. In these papers, fracture classification and evaluation of surgical results were based on plain X-ray. However, some cases of delayed union, non-union, and blade cut out showed no critical problems in immediate postoperative X-ray. Cause of these complications was not able to solve in X-ray analysis. CT scan provides more information about fracture pattern and position of nail and blade. CT analysis is likely to solve the cause of these complications.

The equinovarus hind foot deformity is one of the most common deformities in children with spastic paralysis and is usually secondary to cerebral palsy. Split posterior tibialis tendon transfer is performed to balance the flexible spastic varus foot and is preferable to posterior tibialis lengthening, as the muscle does not loose its power and therefore the possibility of a valgus or calcaneovalgus deformity is diminished. The cohort of the study consisted of 50 children with cerebral palsy who underwent split posterior tibial lengthening to manage spastic equinovarus hind foot deformity. Our inclusion criteria were: ambulatory patients with cerebral palsy, age less than 6 years at the time of the operation, varus deformity of the hind foot during gait, flexible varus hind foot deformity, and the follow-up at least 4 years. We retrospectively evaluated 33 ambulant patients with flexible spastic varus hind foot deformity. Twenty-eight patients presented unilateral and 5 bilateral involvement. The mean age at the time of the operation was 10,8 years (6–17) and the mean follow-up was 10 years (4–14). Eighteen feet presented also equinus hind foot deformity, requiring concomitant Achilles cord lengthening. Clinical evaluation was based on the inspection of the patients while standing and walking, the range of motion of the foot and ankle, callus formation and the foot appearance using the clinical criteria of Kling et al. Anteroposterior and lateral weight-bearing radiographs of the talo-first metatarsal angle were measured. The position of the hind foot was evaluated according to the criteria of Chang et al for the surgical outcome. 20 feet were graded excellent, 14 were graded good and 4 were graded poor. Feet with recurrent equinovarus deformity or overcorrection into valgus or calcaneovalgus deformity were considered as poor results. There were 23 feet presenting concomitant cavus foot component that underwent supplementary operations performed at the same time with the index operation. None of the feet presented mild or severe valgus postoperatively, while 4 feet presented severe varus deformity and underwent calcaneocuboid fusion sixteen and eighteen months after the index operation. On the anteroposterior and lateral weight-bearing radiographs the feet with severe varus had a negative talo-first metatarsal angle (mean −26,8 ± 18,4), those with mild varus had a mean of −14,5 ± 12,2. In feet with the hind foot in neutral position the mean value was 5.0 ± 7.4. The results of the feet in patients with hemiplegic pattern were better and significantly different than the diplegic and quadriplegic ones (p = 0.005). The results in our cases were in general satisfactory as 34 out of 38 feet were graded excellent and good. The feet with poor results presented a residual varus deformity due to intraoperative technical errors.

Introduction

Femorotibial malalignment exceeding ±3° is a recognised contributor of early mechanical failure after total knee replacement (TKR). The angle between the mechanical and anatomical axes of the femur remains the best guide to restore alignment. We investigated where the femoral head lies relative to the pelvis and how its position varies with respect to recognised demographic and anatomic parameters. We have tested the hypothesis of the senior author that the position of the centre of the femoral head varies very little, and if its location can be identified, it could serve to outline the mechanical axis of the femur without the need for sophisticated imaging.

Between July 2000 and December 2002, 263 consecutive patients across 5 surgical centers underwent to a revision surgery of a failed acetabular component in which TM acetabular components were used.

There were 150 women and 113 men with a mean age of 69.5 years.

The indication for acetabular revision was aseptic loosening in 186 cases (70.7%)

Clinical evaluations were performed using the Harris hip score, the WOMAC and UCLA activity scale.

Implant and screw position, polyethylene wear, radiolucent lines, gaps, and osteolysis were assessed. Preoperatively, acetabular bone deficiency was categorized using the classification of Paprosky et al.

Statistical analysis was performed using nonparametric correlations. Standard life table was constructed, and the survival rate was calculated by means of Kaplan-Meier method.

The overall mean follow-up was 73.6 months (range, 60–84 months), and no patient was lost to follow-up.

The preoperative HHS rating improved from a mean of 43.6 ± 11.4 before revision, to a mean of 82.1 ± 10.7.

None of the patients was re-revised for loosening. The cumulative prosthesis survival was 99.2% at 5 years.

There was no correlation found between the various degrees of acetabular bony defect and the magnitude of clinical results (independent of pre-revision Paprosky grade). The use of component augments allowed us to minimize the volume of morsellized allograft used for defect repair.

TM acetabular component demonstrates promising midterm results similar to those reported by other authors.

Objective

Overviewing the literature, pain and redislocation after surgical treatment of patellofemoral instability (PFI) is described with up to 30 %, especially with techniques involving the extensor mechanism, the lateral retinaculum or the medial vastus. However, outcome data about revision surgery is missing. Therefore, it was the purpose of this prospective study to evaluate the clinical outcome after revision surgery with an isolated or a combined reco. of the medial patellofemoral ligament (MPFL) with a follow up of 12 months. The indication for additional procedures such as distal femoral osteotomies (DFO), trochleoplasty, reclosing of the lateral retinaculum (RLR) or lateralisation of the tuberosity (LT) were performed depending on the clinical and radiological pathomorphologies.

Introduction

Debate remains which surgical technique should be used for ankle arthrodesis. Several open approaches have been described, as well as the arthroscopic method, using a variety of fixation devices.

Both arthroscopic and open procedures have good results with union rates of 93–95%, 3% malunion rate and patient satisfaction of 70–90%, although some report complication rates as high as 40%.

Introduction

Radiolucencies beneath the tibial component are well recognized in knee arthroplasty; the aetiology and significance are poorly understood. Non-progressive narrow radiolucencies with a sclerotic margin are thought not to be indicative of loosening. Factors which decrease the incidence of radiolucencies include cementless fixation and the use of pulse lavage. Leg/component alignment or BMI do not influence radiolucency. We are not aware of any studies that have looked at the effect of load type on radiolucency.

The Oxford domed lateral tibial component was introduced to decrease the bearing dislocation rate that was unacceptably high with the flat tibial tray. However, the introduction of the domed tibial component alters the forces transmitted through the implant-cement-bone interface. As the Oxford UKR uses a fully congruent mobile bearing, the forces transmitted through the interface with a flat tray are compressive, except for the effect of friction. However, with the domed tibial component shear forces are introduced. The aim of this study was to assess the prevalence of radiolucency beneath the previous flat design and the new domed tibial tray.

Introduction

Oxidized zirconium (OxZr) is used as a ceramic surface for femoral components in total knee arthroplasty (TKA). The aim of this study was to investigate its performance by examining retrieved femoral components and their corresponding PE inserts in matched comparison with conventional chrome/cobalt/molybdenum alloy (CrCoMo).

Background

Medical complications and death are rare events following elective orthopaedic surgery. Diagnostic and operative codes are routinely collected on every patient admitted to hospital in the English NHS (hospital episode statistics, HES). This is the first study investigating rates of these events following total joint replacement (TJR) on a national scale in the NHS.

Background

Exeter Trauma Stem (ETS) is a polished tapered collarless monopolar prosthesis used for cemented hemiarthroplasty for fracture neck of femur. Two modular rasps are available on the instrumentation set. The larger rasp, in practice, rarely fits into the femur making trial reduction impossible. Our hypothesis was that the absence of a trial reduction could affect leg length and stability of the prosthesis.

Shoulder pain or loss of normal range of motion is a frequent complaint in the outpatient clinic. Of these presentations, rotator cuff injury is a common cause. This can range from mild, transient inflammation of the tendons, to partial tears of tendons, or even full thickness tears. Disruption of the tendons can occur from forceful forward throwing actions undertaken in some sports, for example baseball pitching, more commonly in the UK however, chronic impingement can lead eventually to a tendon tear-usually seen in an older population. Current methods of investigation of such injuries after clinical history and examination, includes plain film radiography, ultrasonography, magnetic resonance imaging and arthrography. We decided to look at how ultrasound can be used in the district general hospital for investigation of such injuries.

Introduction

The length of hospital stay following a hip fracture has decreased significantly during the past decades. Knowing that a hip fracture patient is often one with several comorbidities and high mortality, is it possible to further decrease the length of stay without compromising the quality of care?

Introduction

This study reports the results of percutaneous autologous bone marrow grafting in 62 patients with corticosteroids treatment who had one hip osteonecrosis treated with bone marrow (BM) injection and the other contralateral hip osteonecrosis with core decompression (CD) alone. Only patients with bilateral symptomatic osteonecrosis and with those hips at stage I or II (as defined by Steinberg) were included in this study.

A simple classification system, NOF complexity classification, was developed at the Great Western Hospital Trauma and Orthopaedic department, allowing stratification of resources. This is a four-group classification system, each group with two elements, firstly the patients medical fitness and secondly the complexity of the fracture. (C0=medically fit + simple fracture, C1=medically fit + complex fracture, C2=medically unfit + simple fracture, C3=medically unfit + complex fracture)

Between June 2008 and June 2009, data was collected retrospectively for 290 patients during a weekly MDT meeting to enter data that has been gathered into a departmental database to monitor our performance. The outcomes that we looked for to test the validity of this classification are the thirty-day mortality, annual mortality and length of hospital stay all stratified by complexity.

Results showed that there has been a strong correlation between the complexity classification and the 30-day and annual mortality with P values of 0.015 and 0.008 respectively. This resulted in a 30-day mortality of 4.4%, which is half the national average. Our average length of stay was equal to the national average of 23 days.

This classification system has allowed an improvement in service by adapting a classification system, which is understood by both the Orthogeriatric and Orthopaedic teams.

The management of pelvic fractures remains a challenging problem for orthopaedic surgeons. The prompt recognition of unstable fracture patterns is important in reducing mortality and morbidity. It is perceived wisdom that a fracture of the transverse process of L5 is a predictor of pelvic fracture instability. There is a paucity of evidence in the literature to support this belief. The aim of our study was to determine if a fracture of the transverse process of L5 was a predictor of pelvic fracture instability.

The Hospital Trauma database was reviewed. Between 2006 and 2009, 65 pelvic fractures were identified. They were classified according to the Burgess and Young classification. There were 37 stable and 28 unstable fractures. 14 patients had an associated fracture of the transverse process of L5; 9 were associated with an unstable fracture pattern. The odds ratio was 3; the relative risk 1.7.

A fracture of the transverse process of L5 is associated with an increased risk of pelvic fracture instability. Its presence should alert the attending physicians to the possibility of an unstable injury.

Background

An increased incidence of periprosthetic osteolysis, resulting in loss of biologic fixation, has been recently reported in contemporary THAs with low-carbide metal-on-metal compared to metal-on-polyethylene couple bearings. A hypersensitivity reaction due to Co and Cr debris is reported as a potential cause for failure of THAs with high-carbide bearings, but there are no evidence-based data for this reaction in low-carbide metal-on-metal bearings.

Introduction

There has been renewed interest in the unicompartmental knee arthroplasty with reports of good long term outcomes. Advantages over a more extensive knee replacement include: preservation of bone stock, retention of both cruciate ligaments, preservation of other compartments and better knee kinematics. However, a number of authors have commented on the problem of osseous defects requiring technically difficult revision surgery. Furthermore, a number of recent national register studies have shown inferior survivorship when compared to total knee arthroplasty.

The purpose of this study was to review the cases of our patients who had a revision total knee arthroplasty for failed unicompartmental knee arthroplasty. To determine the reason for failure, describe the technical difficulties during revision surgery and record the clinical outcomes of the revision arthroplasties.

Unicompartmental knee replacements (UKRs) have inconsistent and variable survivorships reported in the literature. It has been suggested that many are revised for ongoing pain with no other mode of failure identified. Using a medial UKR with an all-polyethylene non-congruent tibial component from 2004–7, we noted a revision rate of 9/98 cases (9.2%) at a mean of 39 months. Subchondral sclerosis was noted under the tibial component in 3/9 revisions with well fixed implants, and the aim of this study was to investigate this as a mode of failure. 89 UKRs in 77 patients were investigated radiographically (at mean 50 months) and with SF-12 and Oxford Knee scores at mean follow up 55 months. Subjectively 23/89 cases (25%) had sclerosis under the tibial component. We describe a method of quantifying this sclerosis as a greyscale ratio (GSR), which was significantly correlated with presence/absence of sclerosis (p<0.001). Significant predictors of elevated GSR (increasing sclerosis) were female sex (p<0.001) and elevated BMI (P=0.010) on both univariate and multivariate analysis. In turn, elevated GSR was significantly associated with poorer improvement in OKS (p<0.05) at the time of final follow up. We hypothesise that this sclerosis results from repetitive microfracture and adaptive remodelling in the proximal tibia due to increased strain. Finite element analysis is required to investigate this further, but we suggest caution should be employed when considering all polyethylene UKR implants in older women and in those with BMI >35.

INTRODUCTION

Hallux Valgus is a common foot condition, which may affect mobility and lifestyle. Corrective surgery is performed as a day case procedure, however, post-operatively; patients remain limited in their ability to drive for a variable period. In the laboratory settings, emergency brake response time after first metatarsal osteotomy has been studied but there is no published study of patients’ experience of driving after this surgery. This study was aimed at assessing patients’ driving ability and comfort after Hallux Valgus corrective surgery.

INTRODUCTION

Computer-aided systems have been developed recently in order to improve the precision of implantation of unicompartmental knee replacement (UKR).

Minimal invasive techniques may decrease the surgical trauma related to the prosthesis implantation, but there might be a concern about the potential for a loss of accuracy. Mobile bearing prostheses have been developed to decrease the risk of polyethylene wear, but are technically more demanding. Navigation might help to compensate for these difficulties.

We wanted to combine the theoretical advantages of the three different techniques by developing a navigated, minimal invasive, mobile bearing unicompartmental knee prosthesis.

Both posterior and anterior surgery have potential for complete scoliosis correction. Significant difference in judging the procedures still persists.

Femoroacetabular impingement (FAI) is a pathologic condition of the hip that leads to osteoarthrosis. The goal of the surgical hip dislocation is to correct the bony malformations to prevent the progression of osteoarthrosis. We investigated the topographical cartilage thickness variation in patients with FAI and early stage osteoarthrosis using an ultrasonic probe during surgical hip dislocation.

We performed a prospective case-series of 38 patients (41 hips) that underwent surgical hip dislocation. The mean age at operation was 30.6 (range, 18–48) years. Indication for surgery was symptomatic FAI with 4 hips (10%) with pincer-type, 7 hips (17%) with cam-type, and 20 hips (73%) with mixed-type of FAI. Cartilage thickness was measured intraoperatively using an A-mode 22 MHz ultrasonic probe at 8 locations on the acetabular cartilage.

The thickest acetabular cartilage was found in the weight bearing zone (range 2.8–3.5mm), whereas the thinnest cartilage was in the posterior acetabular horn (1.0–2.2 mm). In all hips, cartilage was thicker in the periphery area compared to the central area. In the anterior and posterior acetabular horn, the anterior area, and the superior area (central parts) a significantly decreased cartilage thickness in pincer-type compared to cam-type of FAI was found (p<0.05).

Cartilage thickness shows topographical differences in all types of FAI with pincer-type of FAI having generally thinner cartilage than cam-type FAI. This is the first study measuring in vivo cartilage thickness in the human hip.

Purpose

Exeter stem was introduced to Japanese market at 1996. Since then, owing to its excellent clinical results, the number of the stem used has been increased year by year and more than 2000 stems have been implanted during the year 2009. The present study aims to prove its efficacy for Japanese patients by evaluating short term results of four major dedicated hip centers.

Background

There are few studies of total knee replacements with cemented tibia and uncemented femur (hybrid). Previous studies have not shown any difference in revision rate between different fixation methods, but these studies had few hybrid prostheses. This study evaluates the results of hybrid knee replacements based on data from the Norwegian Arthroplasty Register (NAR).

Study Design

Retrospective review.

Rivaroxaban, an oral direct factor Xa inhibitor was introduced for thromboprophylaxis at the Royal Cornwall Hospital for hip and knee arthroplasty surgery in October 2009.

Our aim was to investigate how safely Rivaroxaban could be implemented and how quickly its regular use was established.

We identified 140 patients from theatre logbooks who underwent elective total hip and knee joint replacements between October 2009 and March 2010. Patient notes, computer and DVT clinic records data were collected to determine the uptake of the new drug and the incidence of post-operative complications. We compared our chemical thromboprophylactic rates to those recorded at discharge in a 4-month period prior to our study in 2009. In addition we quantified the time needed before a newly introduced drug becomes established in clinical practice.

Patients were divided into two groups. Those who received Rivaroxaban were in group A (n=78, 55.7%) and those who received alternative or no chemical thromboprophylaxis constituted group B (n=62, 44.3%). All patients were prescribed TEDs stockings.

10.3% [8/78] of patients in group A suffered wound complications compared with 6.6% [4/62] of group B patients. Within group A we found that 41.1% (n=7) of the documented wound complications were wound ooze. DVTs occurred in both groups, 1 in group A and 2 in group B. 4 patients had postoperative haematemesis, 2 in each group.

Group A had 17 (22%) documented complications. A similar number (n=15, 24%) of patients in group B had recorded complications.

Our complication rates compared favourably to the RECORD 1–3 pooled study.

From January to April 2009, prior to introduction of Rivaroxaban, 51% of all elective hip and knee replacement surgery patients were receiving any chemical thromboprophylaxis on discharge. This increased to 83% following introduction of Rivaroxaban. During the first month of introduction of Rivaroxaban at our hospital, following NICE guideline, 28% of patients who qualified to receive the drug did. This improved to 95% by the time it had been in use by 3 months.

The data shows that there is no statistical significance in complications in thromboprophylaxis in elective total hip and knee replacement surgery between Group A and Group B (P-value 0.8941). This shows similar complication rates to the RECORD clinical study and concludes a safe introduction of the drug to our District General Hospital.

Patients in Group A had a reduced occurrence of thrombotic events, but an increase in cases of wound ooze when compared to group B.

Following the introduction of Rivaroxaban, it took 3 months for 95% of eligible patients for the drug to be NICE compliant. This demonstrated a 3 month run in time for the implementation of this new treatment regime in our hospital.

Introduction

Hip fracture is a worldwide problem, not only as far as epidemiology is concerned but also regarding economical issues. Surgery is the current standard treatment. However owing to age, and patients co-morbidities complications are common. Surgical site infection is directly related to operative procedure, and surgeons' experience may be very important when making plans for outcome improvement. In this paper we study the role of hip surgeons versus general orthopaedic surgeons in relation to postoperative site infection. Operative hypothesis determines that hip surgeons have less infection rates than general orthopaedic surgeons. Null hypothesis that infection rates are rather the same.

Introduction

Distal radius fractures (DRF) are a common injury in the A&E departments, being a major cause of disability of the upper extremity. The aim of this prospective study is to assess the possible association between objective physical variables such as wrist range of movement (ROM), radiological parameters, and upper extremity disability (measured by the DASH questionnaire), after conservative treatment of DRF.

Introduction

Due to the commercial launch of newly developed ceramic-on-metal (COM) bearings, we compared the deformation and stresses in the liner with ceramic-on-ceramic (COC), metal-on-metal (MOM) as well as ceramic-on-polyethylene (COP) bearings using a finite-element (FE)-model, analyzing a variety of head size and implant position. Liner deformation in terms of change in inner diameter as well as peak stresses were evaluated.

Introduction

We evaluated the osteogenic potential of a novel biomimetic bone paste (DBSint®), made of a combination of a human demineralized bone matrix (hDBM) and a nano-structured magnesium-enriched hydroxyapatite (Mg-HA), in a standardized clinical model of high tibial osteotomy for genu varus.

Introduction

The concept of the golden patient (GP) was introduced to our busy teaching district general hospital, in April 2009, to improve trauma theatre start times following disappointing results from a previous in-hospital study. The GP is a pre-selected first patient on the following day trauma list who is medically fit with a clear surgical plan. The GP should have already been seen by an anaesthetist and be ready to be sent for by theatres early. It has been shown by others to improve operation start times and could be used to improve trauma services and meet clinical targets more readily.

Total hip replacements have been shown to give superior outcomes in patients with intracapsular fractures of the neck of femur compared with hemiarthroplasty. Collarless uncemented femoral stems give excellent long term results in elective hip replacements but there are few studies looking at their outcomes in fractured neck of femur patients. There is some concern that in trauma patients bone quality maybe inferior as most neck of femur fractures are secondary to osteoporosis. The presence of osteoporosis and subsequent widened femoral canal may compromise the mechanical stability of uncemented femoral stems and result in early subsidence, which can lead to altered leg length and decreased hip stability. The aim of this study was to assess whether early subsidence occurred when collarless uncemented stems were used to treat patients with fractures of the neck of femur.

Post-operative radiographs of 33 patients, mean age 71, who underwent an uncemented collarless total hip replacement for a fracture, were reviewed. The distance from the calcar to the tip of the prosthesis was measured for each patient on the initial post operative radiograph and again on the follow-up radiograph at 6 months post operation. Any subsidence was recorded and magnification for each radiograph was calculated by measuring the diameter of the femoral head, which was known to be 36mm. Distances were then adjusted for magnification. The same procedure was performed on 36 age-matched patients, mean age 71, who underwent elective uncemented total hip replacements for osteoarthritis. Hospital notes for each patient were reviewed to assess for complications and DEXA scan results for trauma patients were also evaluated where available.

The mean femoral stem subsidence was significantly greater in the fracture cohort than in elective patients (p = 0.001) with mean subsidence of 4.07mm (range 0.02–18.5mm) and 1.57mm (range 0–5.5mm) respectively. In the fracture cohort there were 3 revisions within 6 months of surgery, 1 for infection and 2 for femoral stem subsidence leading to dislocation. There were no revisions in the elective cohort. DEXA scan results were available for 21 of the 33 fracture cohort patients. All these patients had abnormal bone density with 52% being osteoporotic and 48% osteopenic.

This study showed that collarless uncemented stems subsided significantly when performed for fractures and had a high early revision rate. We therefore recommend that cemented or collared femoral stems be used in patients with femoral neck fractures requiring total hip replacement to reduce the risk of femoral stem subsidence.

Introduction

In knee arthroplasty a ceramic component has several advantages: first, there is no ion release implying a risk for potential allergies. Second, the hardness of the material leads to a scratch resistance which ultimately reduces PE wear over time. In the past, ceramic components in knee applications were limited in the variety of design possibilities due to necessary thickness of the component resulting from the associated fracture risk of ceramics.

By the development of an alumina matrix composite material with increased mechanical properties it is possible to develop ceramic knee components which have nearly the same design as a metal component and use the same implantation technique as well as the same instruments. This offers the surgeon the opportunity to choose intraoperatively between metal or ceramic knee components. Extensive in-vitro testing shows that ceramic knee components achieve superior mechanical test results. The reliability of the components is proven by two different burst tests and a fatigue test for both a femoral and a tibial ceramic knee component.

Introduction

It has been postulated that a mild clubfoot does better than a severe clubfoot no matter what treatment course is taken. There have been previous efforts to classify clubfoot. For units worldwide that use the Ponseti Method of clubfoot management, the Pirani scoring system is widely used. This scoring system has previously been shown to predict the number of plasters required to gain correction. Our study aimed to investigate whether the Pirani score gave an indication of longer-term outcome using tibialis anterior tendon transfer as an endpoint.

Introduction

Primary malign tumors and solitary metastatic lesions of the thoracic and thoracolumbar spine are indications for radical en bloc resections. Extracompartimental tumor infiltration makes the achievement of adequate oncological resection more difficult and requires an extension of the resection margins. We present a retrospective clinical study of patients that underwent chest wall resection in combination with vertebrectomy due to sarcomas and solitary metastases for assessing the clinical outcome especially focusing on onco-surgical results.

Background

Boxer's fractures are the most common type of metacarpal fracture. It commonly occurs during fistfights or from punching a wall. Greer et al demonstrated that it is usually an intentional injury and these patients were at increased risk for recurrent injury (2). Further work suggested that patients with such injuries had higher features of antisocial, self- harm and impulsive behavior, compared with control groups (3).

There is little that has been reported on children and adolescents who present with such fractures.

This study aims to assess aggression scores in young patients with metacarpal fractures due to punching using a validated questionnaire.

Introduction

Total Hip Arthroplasty (THA) in patients after proximal femoral osteotomy remains a major challenge. Inferior survival for both cementless and cemented THA has been reported in this subgroup of patients.

Background

Acute anterior dislocation of the glenohumeral joint may be complicated by injury to neighboring structures. These injuries are best considered a spectrum of injury ranging from an isolated dislocation (unifocal injury), through injuries associated with either nerve or osteoligamentous injury (bifocal injury), to injuries where there is evidence of both nerve and osteoligamentous injury. The latter combination has previously been described as the “terrible triad,” although we prefer the term “trifocal,” recognizing that this is the more severe end of an injury spectrum and avoiding confusion with the terrible triad of the elbow. We evaluated the prevalence and risk factors for nerve and osteoligamentous injuries associated with an acute anterior glenohumeral dislocation in a large consecutive series of patients treated in our Unit.

Background

In Sweden approximately 6000 patients yearly sustain displaced femoral neck fractures. During the last decade there has been a shift towards more arthroplasties at the expense of internal fixation. In 2008 approximately 75% of the dislocated femoral neck fractures in Sweden were treated with arthroplasties. Those patients are typically elderly and frail and the vast majority of them receive hemiarthroplasties. In 2005 a national hemiarthroplasty registration was established as part of the Swedish Hip Arthroplasty Register (SHAR).

Introduction

The pathophysiology of high failure rates following rotator cuff tendon repairs, particularly massive tears, is not fully understood. Collagen structural changes have been shown to alter tendon thermal and mechanical properties. Thermal changes in small biopsies, detected by differential scanning calorimetry (DSC) can help to quantify collagen structural differences in torn rotator cuff tendons. This study aimed to form a quantitative rather than qualitative assessment, of whether differences in collagen structure and integrity existed between small biopsies of normal, small and massive rotator cuff tears using DSC.

Background

Jumper's knee is the result of violent and repeated contractions of quadriceps muscle caused by rapid acceleration and deceleration, jumping and kicking that load on patellar tendon stressing its mechanical resistance. The porpose of this retrospective study is to analyze the results, after the debridment of the patellar tendon and the patellar apex abrasion performed by arthroscopy, at a mean follow-up of seven years.

Background

Radiofrequency Kyphoplasty (RFK) provides a new minimally invasive procedure to treat vertebral compression fractures (VCF).

Objectives

The risk of infection after type III° open fractures is high (10–50%). Preemptive antibiotic therapy may prevent posttraumatic infection and improve the outcome. Recommendations about the type and duration of antibiotic vary among the institutions and it remains unclear whether gram-negative bacilli or anaerobs need to be covered.

In Europe, the most commonly recommended antibiotic is amoxicillin/clavulanic acid.

We retrospectively analyzed microbiology, characteristics and outcome of patients with open type III° fractures treated at our institution.

PURPOSE

To evaluate the late radiographic and functional complications occurring after treatment of reverse oblique trochanteric fractures with the proximal femoral nail.

Purpouse

We hypothesized that patients receiving a medial collagen meniscus implant (MCMI) would show better clinical, radiograpich and Magnetic Resonanace Imaging (MRI) outcomes than patients treated with partial medial meniscectomy (PMM) at minimum 10 year FU.

Introduction

Acetabular cup positioning has been linked to dislocation and increased bearing surface wear. A previous study found correlations between patient and surgical factors and acetabular component position. The purpose of this study was to determine if acetabular cup positioning improves when surgeons receive feedback on their performance.

INTRODUCTION

Analysis of retrieved ceramic components have shown areas of localized ‘stripe wear’, which have been attributed to joint laxity and/or impingement resulting in subluxation of the head, causing wear on the edge of the cup. Studies have been conducted into the effects of mild subluxation, however few in vitro tests have looked at severe subluxation. The aim of this study was to develop a more clinically relevant subluxation protocol.

INTRODUCTION

Although simulation studies have shown superior wear properties of metal-on-metal articulations, increased concern exists regarding the excess in-vivo wear of a small number of Metal-on-Metal-Hip-Resurfacing (MoMHRA) implants. Serum ion levels of Chromium (Cr) and Cobalt (Co) are surrogate markers of wear. Risk factors associated with increased wear include female gender, small components, dysplasia, cup orientation outside safe zone and femoral head downsize during surgery with an associated decrease in Head-Neck-Ratio (HNR). However, these factors are interlinked. This study aims to identify the factors that are most important for subsequent wear of MoMHRA, by performing a multivariate analysis.

We evaluated the results of Cementless Surface Replacement Arthroplasty (CSRA) of the shoulder in 67 patients with advanced glenohumeral destruction who have an intact rotator cuff.

Between november 2002 and december 2008, 70 CSRA (32 Copeland/ Biomet and 38 SMRR/ Lima) were implanted in 67 patients. A deltopectoral approach was used in 34 cases and an anterosuperior approach in 36 cases. Patients were assessed using Constant score, a patient satisfaction score and a detailed radiographic analysis. The mean follow up was 3.4 years (range 1 to 7.5 years).

The mean Constant score improved preoperatively from 17.6 points (range 2–55) to an average postoperative score of 66.1 (range 13–91). The pain score improved from 1.13 points (range 0–6) to 12.3 points (range 3–15). The forward flexion and external rotation improved from 71° (range 20 to 140) and 0° (range −40 to +45) to 143° (range 60 to180) and 34.4° (range −20 to +60) respectively.

Complications included: 1 subscapularis detachment, 5 secondary rotator cuff tear, 1sepsis, 3 patients with shoulder stiffness.

No shift in implant position was observed. 11 humeral components developed radiolucencies at the prosthesis-bone interface. The radiographic analysis involved a system of dividing the prosthesis/bone interface into 5 zones.

The best clinical results were significantly achieved in patients with necrosis compared with osteoarthritis (Constant Score, ant. elevation, ext. Rotation).

Using regression analysis we found that changes in the head-shaft angle position of the implant (valgus/varus placement of the CSRA) significantly predicted the age and sex adjusted Constant score. When the inclination angle of the humeral head decreases, the adjusted Constant score increases. In the same model, we also found that the lateral offset of the humerus significantly predicted the adjusted Constant score. When the lateral offset of the humerus decreases, the adjusted Constant score increases.

The medialization of the glenoid significantly and negatively predicted the Constant score.

Purpose

Evaluation of our experience on the treatment of comminuted, radial head fractures, and of the outcomes of pyrocarbon prosthetic replacement in such cases.

BACKGROUND

From 1995 the cost of litigation to the National Health Service (NHS) from surgical procedures has been over 1.3 billion GBP. Spinal patients can present diagnostic challenges and the consequences of delayed diagnosis and surgical complications can be devastating. As a consequence these patients represent a high risk when surgeons seek to indemnify themselves.

We therefore, aim to highlight the litigation patterns for these injuries within the United Kingdom.

Background

Sterile Surgical Helmet System (SSHS) are used routinely in hip and knee arthroplasty in order to decrease the risk of infection. It protects surgeon from splash and also prevents contamination of surgical field from reverse splash by virtue of its perceived sterility. A prospective study was conducted to confirm if SSHS remain sterile throughout the procedure in Hip (THA) and Knee (TKA) Arthroplasty. We also evaluated if type of theatre had any effect on degree of contamination.

Introduction

Traumatized musculoskeletal tissue often exhibits prolonged time to healing, mostly due to low blood flow and innervation. Intermittent Pneumatic Compression (IPC) increases blood flow and decreases thromboembolic event after orthopedic surgery,[1] however little is known about healing effects.[2] We hypothesized that IPC could stimulate tissue repair: 1.) blood flow 2.) nerve ingrowth 3.) tissue proliferation and during immobilisation enhance 4.) biomechanical tissue properties.

Aims and objectives

The aim of this study was to statistically analyse the calcaneal fractures occurring in the community and distribution within the various age groups divided into decades.

Background

A number of studies have reported on the early failure of the Oxford unicompartmental knee arthroplasty. However, less evidence is available regarding the outcome following revision of failed unicompartmental knee prostheses to total knee arthroplasty. The aims of this study were to determine the time to failure for the Oxford unicompartmental knee arthroplasty and to assess the short-term outcome following revision surgery.

Introduction

There is a challenge to detect partial tear of the ACL, the number of bundle injured and the proportion of fibers torn. The MRI was shown efficient to individualize the two anteromedial (AM) and posterolateral (PL) bundles of the ACL. The purpose of this study was to assess the ability of the MRI to detect partial tears of the ACL on axial views to display the AM and PL bundles.

Introduction

Surgical treatment is justified in patients with fifth metacarpal shaft fractures with angulation exceeding 30 degrees, as these patients are prone to have shortening, restriction of movements, decreased efficiency of the flexor tendons and poor cosmetic results1,2. The authors describe a new technique where these patients can be treated in the clinic non-surgically.

INTRODUCTION

The introduction of hard-on-hard bearings and the consequences of increased wear due to edge-loading have renewed interest in the importance of acetabular component orientation for implant survival and functional outcome following hip arthroplasty. Some studies have shown increased dislocation risk when the cup is mal-oriented which has led to the identification of a safe-zone1. The aims of this prospective, multi-centered study of primary total hip arthroplasty (THA) were to: 1. Identify factors that influence cup orientation and 2. Describe the effect of cup orientation on clinical outcome.

Introduction

Conservative treatment of Achilles tendon ruptures may lead to re-rupture. Open surgical repair entails a risk of skin necrosis or infection. Several percutaneous techniques have been used, like Tenolig® or Achillon®, but these techniques are costly and may be marred by wound healing problems. Ma and Griffith described a technique for percutaneous repair witch left the suture and the knot under the skin, thus reducing the risk for infection.

Background

There is doubt regarding resection compared to curettage for pelvic metastases. Previous studies have reported that curettage is associated with decreased survival compared with wide resection, and have justified a radical surgical approach to achieve pain palliation and tumor control.

Purpose

To investigate the prognostic effect of surgical margins in soft tissue sarcoma on Local Recurrence (LRFS), Metastasis (MFS) and Disease Free Survival (DFS).

Introduction

The policy of treating open fractures within 6 hrs can result in complex operations being performed under sub optimal conditions. The purpose of this study was to determine the association between time to initial debridement and rate of infection in high energy (Grade III) open fractures of Tibia.

INTRODUCTION

Fresh bipolar shell osteochondral allograft (FBOA) is a controversial treatment option for post-traumatic ankle arthritis. Immunological response to transplanted cartilage may play a role in failure. Aim of the study is to compare two groups of patients who received FBOA in association or not to immunosuppressive therapy.