Introduction. Low dose technology of an EOS scanner allows mechanical axis radiographs to be produced using a continuously moving x-ray emitting a thin beam to form a single image which includes all three joints, without the need for stitching. The aim of this study was to identify necessary improvements to enable effective interpretation of the radiographs, and to assess whether the quality of the radiographs varied by production method compared to a previous audit of CR and DR radiographs. Materials and Methods. 8 domains were identified based on a previous audit using the acronym MECHANIC each defining the qualities required for a radiograph to meet the criteria. 100 mechanical axis radiographs produced using conventional and digital methods were analysed in the original study to assess how many radiographs met the described criteria. The same criteria were amended and used to assess 123 different mechanical axis radiographs in the follow up study following the introduction of the EOS scanner, in which 77 were produced using EOS and 46 were produced using conventional and digital methods. Results. The second study showed improvement in 2 of the 6 domains being assessed and the result remained the same in 1 domain, with a mean change of +2%. There was a large increase in the number of radiographs with impeccable stitching in the second study due to the use of the EOS scanner. When comparing the methods of production, there were a greater percentage of EOS radiographs meeting the criteria for each domain compared to conventional and digital radiographs. Those produced using the EOS scanner had a mean 0.83% more radiographs meeting the criteria per domain. Conclusions. The overall quality of mechanical axis radiographs being produced has increased, but varies largely between the 6 domains. The EOS produced radiographs overall were of a greater quality than those produced using conventional and digital methods, but still had areas which required significant improvement

Aims. Mechanical stimulation is a key factor in the development and healing of tendon-bone insertion. Treadmill training is an important rehabilitation treatment. This study aims to investigate the benefits of treadmill training initiated on postoperative day 7 for tendon-bone insertion healing. Methods. A tendon-bone insertion injury healing model was established in 92 C57BL/6 male mice. All mice were divided into control and training groups by random digital table method. The control group mice had full free activity in the cage, and the training group mice started the treadmill training on postoperative day 7. The quality of tendon-bone insertion healing was evaluated by histology, immunohistochemistry, reverse transcription quantitative polymerase chain reaction, Western blotting, micro-CT, micro-MRI, open field tests, and CatWalk gait and biomechanical assessments. Results. Our results showed a significantly higher tendon-bone insertion histomorphological score in the training group, and the messenger RNA and protein expression levels of type II collagen (COL2A1), SOX9, and type X collagen (COL10A1) were significantly elevated. Additionally, tendon-bone insertion resulted in less scar hyperplasia after treadmill training, the bone mineral density (BMD) and bone volume/tissue volume (BV/TV) were significantly improved, and the force required to induce failure became stronger in the training group. Functionally, the motor ability, limb stride length, and stride frequency of mice with tendon-bone insertion injuries were significantly improved in the training group compared with the control group. Conclusion. Treadmill training initiated on postoperative day 7 is beneficial to tendon-bone insertion healing, promoting biomechanical strength and motor function. Our findings are expected to guide clinical rehabilitation training programmes. Cite this article: Bone Joint Res 2023;12(5):339–351

Aims

The aim of this study was to determine satisfaction rates after hip and knee arthroplasty in patients who did not respond to postoperative patient-reported outcome measures (PROMs), characteristics of non-responders, and contact preferences to maximize response rates.

Objectives. The Attune total knee arthroplasty (TKA) has been used in over 600 000 patients worldwide. Registry data show good clinical outcome; however, concerns over the cement-tibial interface have been reported. We used retrieval analysis to give further insight into this controversial topic. Methods. We examined 12 titanium (Ti) PFC Sigma implants, eight cobalt-chromium (CoCr) PFC Sigma implants, eight cobalt-chromium PFC Sigma rotating platform (RP) implants, and 11 Attune implants. We used a peer-reviewed digital imaging method to quantify the amount of cement attached to the backside of each tibial tray. We then measured: 1) the size of tibial tray thickness, tray projections, peripheral lips, and undercuts; and 2) surface roughness (Ra) on the backside and keel of the trays. Statistical analyses were performed to investigate differences between the two designs. Results. There was no evidence of cement attachment on any of the 11 Attune trays examined. There were significant differences between Ti and CoCr PFC Sigma implants and Attune designs (p < 0.05); however, there was no significant difference between CoCr PFC Sigma RP and Attune designs (p > 0.05). There were significant differences in the design features between the investigated designs (p < 0.05). Conclusion. The majority of the earliest PFC Sigma designs showed evidence of cement, while all of the retrieved Attune trays and the majority of the RP PFC trays in this study had no cement attached. This may be attributable to the design differences of these implants, in particular in relation to the cement pockets. Our results may help explain a controversial aspect related to cement attachment in a recently introduced TKA design. Cite this article: A. Cerquiglini, J. Henckel, H. Hothi, P. Allen, J. Lewis, A. Eskelinen, J. Skinner, M. T. Hirschmann, A. J. Hart. Analysis of the Attune tibial tray backside: A comparative retrieval study. Bone Joint Res 2019;8:136–145. DOI: 10.1302/2046-3758.83.BJJ-2018-0102.R2

Introduction: Templating of radiographs is part of pre-operative planning in Total Hip Replacement (THR). Digital radiograph technology allows the manipulation of images, altering magnification and therefore affecting accuracy and reproducibility in templating. We have performed a study to investigate templating for hybrid total hip arthroplasty comparing digital hard copies with three computer methods to scale for magnification, in order to assess whether on-screen images can be templated directly with existing acetate templates. Methods: 20 patients undergoing hybrid THR had pre-operative radiographs taken with a 10 pence coin attached to the skin overlying their greater trochanter. On-screen computer images were manipulated using either the 10p coin as a marker to scale for magnification, or two digital line methods using computer software against external ruler scales. Templating were performed for acetabular size, femoral offset, stem offset and stem size by three grades of observer, and the on-screen images were compared with hard copy digital prints. Intraclass Correlation (ICC) analyses were performed to assess intra-observer and inter-observer variability for the four methods. Comparisons were also made between templated results and the sizes of the inserted prostheses. Results: All methods showed good reproducibility with all ICC values for intra-observer variability greater than 0.7. Inter-observer variability was less consistent, and the two digital line methods were the least reliable, with accuracy of sizing compared with the inserted prostheses varying between −1.6% to +10.2%. The hard copy radiographs showed better reproducibility than the 10p method, but less accuracy with 3.7% under-sizing. The 10p method was most accurate, with no significant differences for offset or acetabulum compared with the inserted prostheses, and templated under-sizing of only 0.9%. Discussion: On-screen templating of digital radiographs with standard acetate templates is accurate and reproducible if a radio-opaque marker such as a 10p coin is included when taking the original radiograph

Introduction and Objectives: This is a prospective analysis of clinical and radiographic outcomes of total hip prosthesis with alumina-on-alumina friction coupling implants performed at two hospitals. Materials and Methods: This study analyzes 60 prostheses with alumina-on-alumina friction coupling (Ceraver-Osteal) (May 1999-May 2002). The Cerafit cup was used in association with 32 Multicone-HAC stems and 28 Anatomic-HAC. Of these cases, 36 were male, and 24 were female, with average age being 47.05+/−12.60 years. Mean follow-up time was 2.3 years. There were no lost or revised cases. Radiographic analysis was done according to Johnston et al., and wear was assessed using the Sychterz method in a special computer program (Auto-CAD R14). Results: All cases had good clinical and radiographic outcomes. There were no revisions or loosening of the implants. There was one dislocation and one intraoperative fracture, which were both treated by conservative means. There were no infections. The distance between the centres of the femoral head and the cup on the initial radiograph (position zero) was 2.49+/−0.70mm. This measurement stayed constant with time, and no changes were observed associated with so-called early wear or initial seating. Mean wear with respect to a reference of position zero was 0.0184+/−0.0187. This figure is below the error level of the measuring system and thus is not measurable. Discussion and Conclusions: The alumina-on-alumina prosthesis (Ceraver) yields positive clinical and radiographic results at 4 years. Even though the alumina partially distorts the radiographic image, no evidence of early wear due to seating of the components was observed at four years of follow up using the Sychterz digitalized method

Objectives. There remains a lack of data on the reliability of methods to estimate tibial coverage achieved during total knee replacement. In order to address this gap, the intra- and interobserver reliability of a three-dimensional (3D) digital templating method was assessed with one symmetric and one asymmetric prosthesis design. Methods. A total of 120 template procedures were performed according to specific rotational and over-hang criteria by three observers at time zero and again two weeks later. Total and sub-region coverage were calculated and the reliability of the templating and measurement method was evaluated. Results. Excellent intra- and interobserver reliability was observed for total coverage, when minimal component overhang (intraclass correlation coefficient (ICC) = 0.87) or no component overhang (ICC = 0.92) was permitted, regardless of rotational restrictions. Conclusions. Measurement of tibial coverage can be reliable using the templating method described even if the rotational axis selected still has a minor influence

Introduction: The biological activity of PE-particles released due to wear is an established risk-factor for osteolysis and loosening after Total Hip Arthroplasty (THA). Cup position and orientation might have an effect on the risk of impingement and wear, thus contribute to the risk of aseptic loosening in the long-term what should be studied. Methods: Between 1984 and 1987 a total of 149 cemented total hips (Müller all-poly cup, Müller straight stem, 32 mm head) have been implanted. All implants had a standardised clinical and radiological follow-up. The pre- and postoperative centre of rotation of the hip and the orientation of the cup were determined. Migration, linear wear and direction of wear were measured twice with standard Methods: and the digital EBRA method. Wear-volume was calculated, taking direction of wear and cup orientation into account. Radiographs were analysed for progressive osteolysis and loosening. Results: 1 patient was lost to follow-up, 47 had died, 7 had been revised before 10 years follow-up. 18 patients had a missing or poor final radiograph, leaving 75 hips for long-term analysis. 41 were in male patients, mean age was 66.2 (+/− 11.0) years, mean follow-up 15.4 (+/−4.1) years. Mean inclination was 40.7° (+/− 7.1), mean anteversion was 14.8° (+/−8.4) And the mean cup positioning was 3.8 mm (+/− 4.3) medial and 5.3 mm (+/− 3.5) cranial. Osteolysis was found in 36 cups, 18 of them have been revised. The average linear wear was 1.1 (+/− 0.9) mm, the average wear volume 798.7 (+/−622.3) mm3, the linear wear rate 0.07 (+/−0.06) mm/year and the volumetric wear rate 54.5 (+/− 43.2) mm3/year. Younger patients had increased linear wear rates (p=0.035). Osteolysis of the cup, cup migration and cup revision were correlated with linear and volumetric wear (all p=< 0.001). There was no correlation of the cup position, inclination and anteversion with osteolysis, loosening and any of the wear parameters. Volume calculation did not provide further information. Conclusion: We found a strong correlation between wear and loosening of PE cups, but cup position and orientation did not affect osteolysis and loosening. Thus in contrast to hard-hard bearings polyethylene is a forgiving bearing surface and improvement of the cup orientation (e.g. due to navigation) will not result in increased cup survival, as long as extreme positioning errors are avoided

Introduction: Simulator wear studies of crosslinked polyethylene (PE) show promising results but long-term clinical investigations addressing concerns about in-vivo aging, PE deterioration, late wear and osteolysis are scarce. This study reports the longest published follow-up comparing conventional to crosslinked PE. Methods: Crosslinked PE (Stryker Duration: 3MRad gamma irradiation in N2, post-irradiation annealed) was compared to conventional PE (3MRad gamma irradiation in air) in a MTS hip simulator and a prospective randomized clinical study involving 48 THA patients (Stryker ABG-II stem and cup, 28mm ball diameter) with a mean follow-up of 8 (7–9) years. Patients were followed-up annually using the HHS, radiographs and wear measurements applying a digital Livermore method. Results: Forty patients (23 conventional, 17 Duration) were left for analysis (five premature deaths, 3 loss to follow-up). Both groups were statistically non-different (p> 0.1) regarding age (63.9 years), gender, BMI, stem size, cup size, cup inclination and liner thickness leaving the insert material as the only variable. Pre-op HHS (39.7) and post-op HHS (93.7) were also not different. At 8-years the wear rate was significantly (p< 0.01) lower for Duration [0.088 ± 0.03 mm/yr (0.02–0.14)] than conventional PE [0.142 ± 0.07 mm/yr (0.05–0.31)]. This reduction (−38%) compared well to the simulator (−45%) and did not change over time (−33% at 5-years). Radiolucencies and signs of osteolysis were also less in the Duration group (n.s.). Discussion: In-vivo wear reduction by crosslinked PE is similar as predicted by the simulator and does not seem to deteriorate over time. Concerns over higher levels of residual free radicals after annealing instead of remelting do not seem justified. The lower wear correlated with reduced radiographic signs of osteolysis which may result in superior survival at longer follow-up

The June 2012 Trauma Roundup³⁶⁰ looks at: nerve injuries of warfare; the medical complications of earthquakes; the measuring of tissue pressures in compartment syndrome; the risk of plunging through the bone when drilling; bony nonunion and negative pressure therapy; surgery for the posteriorly dislocated hip; whether to use the sliding screw or intramedullary nail for the trochanteric fracture; antegrade interlocking nailing for the distal femoral fracture; and gunshot wounds to the pancreas.

Objectives

The accuracy and precision of two new methods of model-based radiostereometric analysis (RSA) were hypothesised to be superior to a plain radiograph method in the assessment of polyethylene (PE) wear.