To review prospectively collected data on patients undergoing primary total hip arthroplasty utilizing two different cementless acetabular components. All patients undergoing primary total hip replacement surgery at our institution are entered prospectively into a database which includes history and physical examination, radiology, WOMAC and SF-36 scores. The patients are re-examined, re-x-rayed and re-scored at 3 months, 6 months and 1 year after surgery and yearly thereafter. Using this database we are able to identify patients who have undergone total hip replacement using one of two geometric variants of the acetabular component. The first design is hemispherical and the second design has a peripheral rim expansion designed to increase initial press-fit stability.Purpose
Method
The purpose of the study was to determine the rate of conversion from RSA to THR in a number of Canadian centers performing resurfacings Retrospective review was undertaken in 12 Canadian Centers to determine the rate of revision and reason for conversion from RSA to THR. Averages and cross-tabulation with Chi-Squared analysis was performed. kaplan Meier survivorship was calculated.Purpose
Method
There is increasing evidence that primary fixation of displaced mid-shaft fractures of the clavicle results in superior short-term outcomes when compared to traditional non-operative methods. However, the results from published studies are limited to relatively short-term (one year or less) follow-up. Accurate data of longer follow-up is important for a number of reasons, including patient prognostication, counseling and care, the design of future trials, and the economic analysis of treatment. The purpose of this paper was to examine the results of the two year follow up of patients enrolled in a previously published randomized clinical trial of operative versus non-operative treatment of displaced fractures of the clavicle. Using a comprehensive and standard assessment that included DASH (Disabilities of the Arm, Shoulder and Hand) and CSS (Constant Shoulder Scores) scores, we evaluated ninety-five patients of the original cohort of one hundred and thirty-two patients at two years following their injury.Purpose
Method
Femoroacetabular impingement (FAI) may contribute to the development of early onset hip osteoarthritis (OA). A cam lesion (or pistol grip deformity) of the proximal femur reduces head-neck offset resulting in cam type FAI. The alpha angle is a radiographic measurement recommended for diagnosis of cam type FAI. The purpose of this study was to determine if patients that develop end stage hip OA prior to 55 years of age have radiographic evidence of cam type FAI. The anteroposterior (AP) pelvis and lateral hip radiographs of 244 patients (261 hips) who presented to our institution for hip arthroplasty or hip fracture fixation between 2006 and 2008 were retrospectively reviewed. Three cohorts were compared: 1) patients with end stage hip OA < 55 years old (N=76); 2) patients with end stage hip OA > 55 years old (N=84); 3) hip fracture patients > 65 years old without radiographic evidence of hip arthritis were used as controls (N=101). Patients with inflammatory arthritis, avascular necrosis and post-traumatic hip OA were excluded. Alpha angles were measured on the AP pelvis and lateral radiographs by three coauthors using ImageJ 1.43 software (National Institutes of Health, USA). For patients with end stage hip OA, AP alpha angles were measured on both the hip with OA and the contralateral hip. Lateral alpha angles were measured only on the hip with OA. For patients with hip fracture, AP alpha angles were measured on the non-fractured hip and lateral alpha angles were measured on the fractured hip. A one-way ANOVA with post hoc Tukeys HSD test was used to compare the AP and lateral alpha angles for the three cohorts.Purpose
Method
Angiogenesis and osteogenesis are essential for bone growth, fracture repair, and bone remodeling. VEGF has an important role in bone repair by promoting angiogenesis and osteogenesis. In our previous study, endothelial progenitor cells (EPCs) promoted bone healing in a rat segmental bone defect as confirmed by radiological, histological and microCT evaluations (Atesok, Li, Schemitsch 2010); EPC treatment of fractures resulted in a significantly higher strength by biomechanical examination (Li, Schemitsch 2010). In addition, cell-based VEGF gene transfer has been effective in the treatment of segmental bone defects in a rabbit model (Li, Schemitsch et al 2009); Purpose of this study: Evaluation of VEGF gene expression after EPC local therapy for a rat segmental bone defect. Rat bone marrow-derived EPCs were isolated from the rat bone marrow by the Ficoll-paque gradient centrifuge technique. The EPCs were cultured for 7 to 10 days in endothelial cell growth medium with supplements (EGM-2-MV-SingleQuots, Clonetics). and collected for treatment of the rat segmental bone defect. EPCs were identified by immunocytochemistry staining with primary antibodies for CD34, CD133, FLK-1, and vWF. A total of fifty six rats were studied. A five millimeter segmental bone defect was created in the middle 1/3 of each femur followed by mini plate fixation. The treatment group received 1×106 EPCs locally at the bone defect and control animals received saline only. Seven control and seven EPC treated rats were included in each group at 1, 2, 3 and 10 weeks. Animals were sacrificed at the end of the treatment period, and specimens from the fracture gap area were collected and immediately frozen. Rat VEGF mRNA was measured by reverse transcriptase-polymerase chain reaction (RT-PCR) and quantified by VisionWorksLS. All measurements were performed in triplicate.Purpose
Method
Displaced midshaft clavicular fractures are a common injury with a high occurrence rate in young, active individuals. Non-operative care has traditionally been the standard of care for such fractures, but more recent studies have suggested benefits following primary operative fixation. The purpose of this study was to review the literature on displaced midshaft clavicle fractures, identify randomized controlled trials of operative versus non-operative treatment, and pool the functional outcome and complication rates (including nonunion and symptomatic malunion), to arrive at summary estimates of these outcomes. A systematic review of the literature was performed to identify studies of randomized controlled trials comparing operative versus non-operative care for displaced midshaft clavicle fractures. Meeting abstracts were also searched and included in this study.Purpose
Method
Femoral shaft fractures are routinely treated using antegrade intramedullary nailing under fluoroscopic guidance. Malreduction is common and can be due to multiple factors. Correct entry point identification can help minimize malreduction and the risk of iatrogenic fracture. This study aims to compare landmark identification used to guide nail entry, the piriformis fossa (PF) and the trochanteric tip (T), via computer navigation and conventional fluoroscopy. The location of the PF and T were digitized under direct visualization with a three-dimensional scribe on ten, fresh-frozen cadaveric right femora (two male, eight female) by three fellowship trained orthopaedic surgeons. To estimate inter- and intraobserver reliability of the direct measurements, an intraclass correlation coefficient was calculated with a minimum of two weeks between measurements. Under navigation, each specimen was draped and antero-posterior (AP) and lateral radiographs of the proximal femur were taken with a c-arm and image intensifier. The c-arm was positioned in a neutral position (0 for AP, 90 for lateral) and rotated in 5 increments, yielding a range of acceptable images. Images, in increments of 5, within the AP range (with a neutral lateral) were loaded into a navigation system (Stryker, MI). A single surgeon digitized the T and PF directly based on conventional fluoroscopy, and again directed by navigation, yielding two measurements per entry point per specimen. This was repeated for the lateral range. Hierarchical linear modelling and a Wilcox rank test were used to determine differences in accuracy and precision, respectively, in the identification of PF and T using computer navigation vs. conventional fluoroscopy.Purpose
Method
The SPRINT trial randomized 1226 patients with tibial shaft fractures treated by intramedullary (IM) nailing to reamed versus unreamed groups. Using data from this trial, we completed a subgroup analysis of those patients who required two or more reoperations following the initial IM fracture stabilization. We identified 44 patients with tibial shaft fractures who required two or more reoperations following IM nailing. We considered those that were reamed vs unreamed, open vs closed, those that were planned for reoperation after the 12 month follow up, and the indications for reoperation.Purpose
Method
This prospective randomised controlled trial aims to compare the clinical and radiological outcomes of ceramic on ceramic, cobalt chrome on ultra-high molecular weight polyethylene, and cobalt chrome on highly cross-linked polyethylene bearing surfaces at a minimum of five years. One hundred and two primary total hip replacements were performed in ninety one patients between February 2003 and March 2005. All patients were younger than 65 (mean 52.7, 19–64). They were randomised to receive one of the three bearing surfaces. All patients had 28mm articulations with a Reflection uncemented acetabular component and a Synergy stem (Smith & Nephew, Memphis, Tennessee). Patients were followed up periodically up to at least sixty months following surgery. Outcome measures included WOMAC and SF12 scores. Radiological assessment included implant position, evidence of osteolysis and measurement of linear wear.Purpose
Method
The Birmingham Mid-Head Resection (BMHR) is a bone-conserving, short-stem alternative to hip resurfacing for patients with compromised femoral head anatomy. It is unclear, however, if an uncemented, metaphyseal fixed stem confers a mechanical advantage to that of a traditional hip resurfacing in which the femoral prosthesis is cemented to the prepared femoral head. Thus, we aimed to determine if a metaphyseal fixed, bone preserving femoral component provided superior mechanical strength in resisting neck fracture compared to a conventional hip resurfacing arthroplasty. Sixteen matched pairs of human cadaveric femurs were divided evenly between specimens receiving a traditional epiphyseal fixed hip resurfacing arthroplasty (BHR) and those receiving a metaphyseal fixed BMHR. Pre-preparation scaled digital radiographs were taken of all specimens to determine anatomical parameters as well as planned stem-shaft angles and implant sizes. A minimum of 10 degrees of relative valgus alignment was planned for all implants and the planned stem-shaft angles and implant sizes were equal between femur pairs. Prior to preparation, bone mineral density scans of the femurs were obtained. Prepared specimens were potted, positioned in single-leg stance and tested to failure using a mechanical testing machine. Load-displacement curves were used to calculate construct stiffness, failure energy and ultimate failure load.Purpose
Method
the general attitude of the orthopaedic surgeon toward intimate partner violence, the attitude of the orthopaedic surgeon toward victims and batterers, and the clinical relevance of intimate partner violence in orthopaedic surgery.
victims must be getting something out of the abusive relationships (16%); some women have personalities that cause the abuse (20%); and the battering would stop if the batterer quite abusing alcohol (40%). In the past year, approximately half of the surgeons (50.8%) acknowledged identification of a victim of IPV; however, only 4.0% of respondents currently screened for IPV among female patients with injuries. Surgeons expressed concerns about lack of knowledge in the management of abused women (30%) Guidelines for the detection and management of IPV were uncommon in most surgeons’ practices (7.8%).