Lag screw cut-out is a serious complication of dynamic hip screw fixation in trochanteric hip fractures. Lag screw position is recognised as a crucial factor influencing the occurrence of lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesize that it could enhance the reliability of predicting lag screw cut-out in these injuries.

A retrospective study of hip fracture cases was conducted from January 2018 to July 2022. A total of 109 patients were eligible for the final analysis. The modified TAD was measured in millimetres, based on the sum of the traditional TAD in the lateral view and the net value of two distances in the anteroposterior (AP) view. The first distance is from the lag screw tip to the opposite point on the femoral head along the lag screw axis, while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if it is inferior. Receiver operating characteristic (ROC) curve analysis was used to assess the reliability of various parameters for evaluating the lag screw position within the femoral head.

Factors such as reduction quality, fracture pattern according to the AO/OTA classification, TAD, Calcar-Referenced TAD, Axis Blade Angle, Parker’s ratio in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the novel parameter exhibited 90.1% sensitivity and 90.9% specificity for predicting lag screw cut-out at a cut-off value of 25 mm, with a p-value < 0.001.

The modified TAD demonstrated the highest reliability in predicting lag screw cut-out. A value of 25 mm may potentially reduce the risk of lag screw cut-out in trochanteric hip fractures.

A number of studies suggest revision of unicompartmental knee replacement (UKR) to total knee replacement (TKR) is straightforward. We hypothesise that this is not always the case in terms of complexity, cost and clinical outcome.

We identified 23 consecutive patients revised from UKR to TKR by 2 consultant surgeons (2005–2008). These were matched by age, sex and comorbidity to a cohort of primary TKRs (42 patients) performed during the same period. Data were collected regarding demographics, cost (surgical time & implants) and 1 & 5-year follow-up of clinical outcome (OKS) and outpatients attended.

There was no statistically significant difference in cost of implants for revision UKR to TKR vs. primary TKR (p=0.08), however operative time was significantly higher in the revision group. One year mean OKS was significantly higher in the primary TKR group (mean 30 vs. 23 p=0.03), but 5-year follow up showed no significant difference (mean OKS 27 vs. 32 p=0.20). The revision group had statistically significantly greater number of follow-up appointments (mean 6 Vs. 2 p<0.0001).

Revision of UKR to TKR is not a universally straightforward procedure, carrying significant overall cost implications. Clinical outcomes, although significantly different at 1 year are almost the same at 5 years.

Cementless surface replacement arthroplasty (CSRA) is an established treatment for glenohumeral osteoarthritis. Few studies however, evaluate its role in cuff tear arthopathy. The purpose of this study is to compare the outcomes of CSRA for both glenohumeral osteoarthritis and cuff tear arthopathy.

42 CSRA with the Mark IV Copeland prosthesis were performed for glenohumeral osteoarthritis (n=21) or cuff tear arthopathy (n=21). Patients were assessed with Oxford and Constant scores, patient satisfaction, range of motion and radiologically with plain radiographs.

Mean follow-up and age was 5.2 years and 74 years in both groups. Functional outcomes were significantly higher in OA compared with CTA with OSS improving from 18 to 37.5 and 15 to 26 in both groups respectively. Forward flexion improved from 60° to 126° and 42° to 74° in both groups. Three patients in the CTA group had a deficient subscapularis tendon, two of whom dislocated anteriorly.

Humeral head resurfacing arthroplasty is a viable treatment option for glenohumeral osteoarthritis. In patients with CTA, functional gains are limited. We suggest CSRA should be considered in low demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis due to the high risk of dislocation.

The Femoro Patella Vialli (FPV) is indicated for isolated patello-femoral joint replacement (PFJR). It is now the second most commonly used PFJR in the UK, however there are limited studies evaluating its outcome. Key differences include a larger component sulcus angle of 140 degrees which more closely mimics the normal knee.

Between 2006 and 2012, we performed 53 consecutive FPV patellofemoral arthroplasties in 41 patients with isolated patellofemoral joint osteoarthritis. Mean age was 62.2years (39–86) and mean follow-up was 3.5 years. Mean Oxford Knee scores improved from 19.7 to 37.7 at latest follow-up. Ninety four percent of patients were happy or very happy with their knees. Progression of tibiofemoral osteoarthritis was seen 12% of knees. 2 knees required revision to TKR at 7 months post-operatively, which we attribute to poor patient selection. There were no cases of maltracking patella or patella dislocations at final follow-up, which we attribute to the larger sulcus angle. There were no cases of radiological loosening.

Our findings suggest the FPV patellofemoral prosthesis has good mid-term functional outcomes.

Introduction

Isolated trochlea fractures are very rare and have only been described previously as case reports.

Introduction

In January 2000, the Bone and Joint Decade was formally launched at the headquarters of the World Health Organization in Geneva, Switzerland. The goal was “to improve the health-related quality of life for people with musculoskeletal disorders throughout the world”. They aimed to do this, in part, by “raising awareness of the growing burden of musculoskeletal disorders on society”. The Bone and Joint Decade has 63 supporting governments, over 700 supporting government and non-government organisations and a budget in the millions. It was the largest musculoskeletal health promotion campaign in history.

Aim

To determine if the location and pattern of knee pain as described by the patients using the knee pain map was comparable with the intra articular pathology found on arthroscopy as well as to facilitate diagnosis based on pain.

The surgical treatment of bone tumours can result in large perioperative blood loss due to their large sizes and hypervascularity. Preoperative embolisation has been successfully used to downgrade vascularity, thus reducing perioperative blood loss and its associated complications. Prior to embolization era, blood loss as high as 18,500mL have been reported peri-opratively.

Twenty-six patients with a variety of bone tumours (average size 10.5×7.5×5.5cm), who underwent pre-operative embolisation between 2005 and 2009, were retrospectively studied. The group comprised of 17 females and 9 males. Their mean age was 38 years old. All patients underwent surgical resection within 48 hours of embolization. Mean blood loss was 796mL and required on average 1.1units of blood. We experienced no complications.

Pre-operative arterial embolisation of large, richly vascular bone tumours in anatomically difficult positions, is a safe and effective method of downstaging vascularity and reducing blood loss.

Aim: To identify the incidence of post-operative morbidity in elective total hip replacement patients as a cause for prolonged admission using the POMS. To assess the utility of POMS as a measure of short term orthopaedic outcome and a tool to influence decision making for appropriate discharge time.

Background: The currently available methods for assessing overall surgical outcome (as opposed to quality of life or joint specific outcome) are generally unreliable, unvalidated, unresponsive and almost always inconsistent. Mortality is usually infrequent and length of hospital of stay is likely to be affected by non-medical factors and monitoring of complications is subject to variations in both definition and intensity of surveillance.

The POMS is the only published method for prospectively describing complications associated with major surgery. It comprises a 9-point survey and provides a generic measure of short term post-operative outcome. Data is simple and quick to collect and easily learnt. No additional tests are required for data collection.

Method: Patients undergoing elective primary and revision hip arthroplasty were recruited. Research assistants collected POMS data prospectively on postoperative days 1, 3, 5, 8 and 15 (if the patients were still in hospital).

Results: 182 patients were recruited and followed-up. Median length of stay was 11 days (range 2–58). Of the patients remaining in hospital on post-operative days 1, 3, 5, 8 and 15, 0% (n=182), 34% (n=61), 30% (n=51), 29% (n=39) and 63% (n=22), respectively, had no evidence of medical morbidity as defined by the POMS.

Conclusions: The POMS is a generic post-operative screening survey, designed to monitor morbidity in all main organ systems. This study suggests that a significant proportion of orthopaedic patients remain in hospital despite having no evidence of medical morbidity as defined by the POMS. Length of hospital stay is influenced by a number of other factors, further investigation is warranted to identify the factors responsible for their post-operative length of stay. We also hypothesize that POMS may be very useful in areas were managed care / insurance companies dictate the length of hospital stays.