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Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_5 | Pages 3 - 3
1 Jul 2020
Chan G Aladwan R Hook S Rogers B Ricketts D Stott P
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Introduction

Dislocated hip hemiarthroplasties (HA) are associated with a 45% revision rate and 40% mortality rate.

Implant selection for HA operations vary with no universally accepted implant choice. The WHiTE3 trial suggested older designs such as the Thompson has equitable outcomes to more modern and expensive implants such as the Exeter V40+Unitrax.

Our multi-centre consecutive series of NOFs patients treated with HA assesses the impact of surgical and patient factors on dislocation risk.

Methods

Medical and radiographic records for patients treated between 1stJanuary 2009 and 30thSeptember 2017 with a HA at three acute hospitals were reviewed.

Implant and dislocation data were recorded. Patient demographics, comorbidities and operation details were extracted from the medical records and NHFD. Patients were excluded if there were no postoperative radiographs or when HA had been performed as a revision procedure.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_19 | Pages 36 - 36
22 Nov 2024
Goumenos S Hipfl C Michalski B Pidgaiska O Mewes M Stöckle U Perka C Meller S
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Background

Postoperative dislocation is one of the main surgical complications and the primary cause for revision surgery after 2-stage implant exchange due to periprosthetic infection of a total hip arthroplasty.

Objective

The aims of our study were (1) to determine the incidence of dislocation after two-stage THA reimplantation without spacer placement, (2) to evaluate relevant risk factors for dislocation and (3) to assess the final functional outcome of those patients.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 15 - 15
1 Dec 2021
Müller SLC Morgenstern M Kühl R Muri T Kalbermatten D Clauss M Schaefer D Sendi P Osinga R
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Aim

Fracture-related infection (FRI) is a severe post-traumatic complication which can be accompanied with a soft-tissue defect or an avital soft-tissue envelope. In these cases, a thoroughly planned orthoplastic approach is imperative since a vital soft-tissue envelope is mandatory to achieve fracture union and infection eradication. The aim of our study was to analyse plastic surgical aspects in the management of FRIs, including the type and outcome of soft-tissue reconstruction (STR), and to investigate the long-term outcome of FRI after STR.

Method

Patients with a lower leg FRI requiring STR that were treated from 2010 to 2018 at our center were included in this retrospective analysis. STR involved the use of local, pedicled and free flaps. The primary outcome was the success rate of STR, and the secondary outcome was long-term fracture consolidation and cure of infection.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_21 | Pages 65 - 65
1 Dec 2016
Kerslake S Lafave M Hiemstra L
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Clinical management of patellofemoral (PF) instability is a challenge, particularly considering the wide range of contributing variables that must be taken into consideration when determining optimal treatment. An important outcome measure to consider in this patient population is disease-specific quality of life (QOL). The purpose of this study was to factor analyse and reduce the total number of items in the Banff Patellar Instability Instrument (BPII). Subsequent to the factor analysis, the new, item-reduced BPII 2.0 was tested for validity, reliability and responsiveness. Disease-specific QOL was measured in patients with a confirmed diagnosis of PF instability (n = 223) at the initial consultation with the original BPII. Data from these BPII scores was used to employ a principal component analysis (PCA) to factor analyse and reduce the total number of items in the original BPII, to create the new BPII 2.0. The BPII 2.0 underwent content validation (Cronbach's Alpha, patient interviews and reading-level); construct validation (ANOVA comparing the initial consultation, 6, 12 and 24 month post-operative, Eta squared); convergent validation (Pearson r correlation to the original BPII); responsiveness testing (Eta squared, anchor-based distribution testing); and reliability testing (intra-class correlation coefficient (ICC) 2,k). The original BPII was successfully reduced from 32 to 23 items. The new BPII 2.0 demonstrated excellent Cronbach's Alpha values: initial consult = 0.91; 6-months = 0.96; 12-months = 0.97; and 24-months post-operative = 0.76. Grade-level reading assessment for all items in the BPII 2.0 was below grade twelve. The ANOVA determined the BPII 2.0 was able to discriminate between the initial consultation, 6, 12 and 24 months post-operative assessments, with significant differences between each time-point (p < 0.05). Eta squared was 0.40, demonstrating a medium to large effect size. Convergent validity was established with the BPII 2.0 significantly correlated to the original BPII (initial consult = 0.82, 6-month = 0.90, 12-month = 0.90, and 24-month = 0.94). Anchor-based responsiveness was established with a significant correlation between the 7-point scale of patient-perceived improvement and 24-month post-operative BPII 2.0 scores. Strong reliability was established with an ICC (2,k) = .97. The BPII has undergone a critical step in its psychometric and clinimetric evolution: structural validation. With the work completed in this study, the BPII and BPII 2.0 have completed assessment of seven of the nine Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) properties including: 1) Internal consistency; 2) Reliability; 3) Standard error of measurement; 4) Content validation; 5) Structural validity; 6) Criterion validity; and, 7) Responsiveness testing. Completion of these assessments and the introduction of a structurally valid and shorter questionnaire, the BPII 2.0, provides a definitive level of credibility to this disease-specific outcome measure


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_17 | Pages 2 - 2
1 Apr 2013
Campbell P Bishop A Dunn K Main C Thomas E Foster N
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Background. A wide array of measures has been developed to assess the role of psychological factors in the development and persistence of pain. Yet there is likely to be considerable conceptual overlap between such measures, and consequently a lack of clarity about the importance of psychological factors. Purpose. To investigate whether conceptual overlap exists within psychological measures used in back pain research. Methods. An observational cohort study of 1591 back pain primary care consulters provided data on anxiety, depression, self-efficacy, coping, illness perceptions, fear avoidance and catastrophising. Exploratory and confirmatory factor analysis (EFA and CFA) was carried out at the sub-scale level (n=20) to investigate factor structure. Derived factors were then tested using hierarchical linear regression in relation to clinical outcomes (pain intensity and disability). Results. EFA derived 4 factors from the sub-scale measures. Factors were termed ‘distress’ (comprising depression, anxiety, pain self-efficacy, fear avoidance, catastrophising), ‘cognitive’ (cognitive coping strategies), ‘causes’ (psychological, immunity, risk factors) and ‘future’ (expectancies of potential treatment and recovery), and accounted for 65.5% of the data. CFA confirmed the validity of these factors. The distress factor was found to have the strongest association with patients' outcomes, accounting for 28.7% of the variance in pain intensity, and 53.6% in disability. Conclusion. Considerable overlap exists in psychological measures used in back pain research. Most measures tap in to patients' emotional distress; this factor was shown to have the greatest association with clinical outcomes. These findings have implications for the way psychological measures are used in back pain research. No conflicts of interest. Source of funding: Programme Grant awarded by the Arthritis Research UK [13413] and Dr KM Dunn's Wellcome Trust Grant [083572]. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_1 | Pages 39 - 39
1 Feb 2020
Okamoto Y Otsuki S Wakama H Okayoshi T Neo M
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Introduction

The global rapid growth of the aging population has some likelihood to create a serious crisis on health-care and economy at an unprecedented pace. To extend Healthy Life Expectancy (HALE) in a number of countries, it is desired more than ever to investigate characteristic and prognosis of numerous diseases. This enlightenment and recent studies on patient-reported outcome measures (PROMs) will drive the increasing interest in the quality of life among the world.

The demand for primary THAs by 2030 would rise up to 174% in USA. It is expected that the number of the elderly will surge significantly in the future, thus more septuagenarian and octogenarian are undergoing THA. Moreover, HALE of Japanese female near the age of 75 years, followed to Singapore, is still increasing. Therefore, concerns exist about the PROMs of performing THA in this age-group worldwide. Nevertheless almost the well-established procedure, little agreement has been reached to the elderly. We aimed to clarify the mid-term PROMs after THA over 75-year old.

Methods

Between 2005 and 2013, we performed 720 consecutive primary cemented THAs through a direct lateral approach. Of these, 503 female patients (655 hips) underwent THA for treatment of osteoarthritis, with a minimum follow-up of 5 years, were retrospectively enrolled into the study. We excluded 191 patients (252 hips) aged less than 65-year at the time of surgery and 58 patients (60) because of post-traumatic arthritis or previous surgery (37), or lack of data (23). Thus, 343 hips remained eligible for our study, contributed by 254 patients. We investigated Quality-adjusted life year (QALY), EuroQol 5-Dimension 5-Level scale (EQ-5D) and the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ, which was a disease-specific and self-administered questionnaire, reflecting the specificity of the Japanese cultural lifestyle) in patients aged 75 years or older (154 hips, Group-E) compared with those aged 65 to 74 years (189 hips, Group-C) retrospectively. We evaluated the association between patients aged 75 years or older and the following potential risk factors, using logistic regression analysis: age, number of vertebral fractures (VFs), American Society of Anesthesiologists physical status (ASA-PS) and Charlson Comorbidity Index (CCI). A p value of < 0.05 was considered significant for the Mann-Whitney U test.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 134 - 134
1 May 2012
G. W A. R
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Introduction

Excessive soft tissue swelling will delay surgery for a proportion of patients admitted with ankle fractures. Surgical and anesthetic teams may waste time assessing patients destined to be cancelled due to swelling. The aim of this investigation was to determine factors associated with cancellation.

Methods

Case notes of 87 patients (46 male, 41 female), mean age 43 years (range, 13 to 80) who underwent ankle fracture fixation were retrospectively analysed. 31 of 87 ankles (36%) were unsuitable for day after admission surgery due to swelling. Factors investigated included age, gender, mechanism of injury, fracture configuration and necessity for reduction on arrival in the emergency department due to dislocation; each factor was independently analysed for significance using Fisher's exact test.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 62 - 62
7 Aug 2023
Khatri C Harrison C Scott C Clement N MacDonald D Metcalfe A Rodrigues J
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Abstract. Background. The Forgotten Joint Score (FJS) is a 12-item patient reported outcome measurement instrument. It was developed with classical test theory, without testing assumptions such as unidimensionality (all items reflect one underlying factor), appropriate weighting of each item, no differential item function (DIF, different groups answer the same way), and monotonicity (people with higher function have higher score). We applied item response theory (IRT) to improve the validity of FJS to contemporary standards to optimise it for ongoing use. Research Questions. Does the FJS reflect one latent trait? Can an IRT model be fitted to the FJS to provide interval-scaled measurement?. Methodology. Participants undergoing primary total knee replacement provided pre-operative and post-operative (6-months) responses for FJS. An exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and Mokken analysis were conducted. The data were fitted to a graded response model (GRM). Results. 1288 response patterns were analysed. EFA showed a one factor model (all 12 items load to one underlying trait). CFA demonstrated excellent model fit (X2 <0.001, Tucker Lewis Index=0.96, Comparative Fit Index=0.96). Items did not have equal weighting. The FJS demonstrated good monotonicity with no differential item functioning by sex, age, or body mass index. Conclusions. The FJS meets key validity assumptions supporting its use in clinical practice and research. The IRT-adapted FJS provides continuous measurements with greater granularity including individual measurement error. This adapted score has advantages over traditional FJS scoring, being interval scaled (using GRM) and can be retrospectively applied to existing response sets


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_12 | Pages 15 - 15
10 Jun 2024
Goodall R Borsky K Harrison C Welck M Malhotra K Rodrigues J
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Background. The Manchester-Oxford Foot Questionnaire (MOxFQ) is a condition specific patient reported outcome measure (PROM) for foot and ankle surgery. It consists of 16 items across three subscales measuring distinct, but related traits: walking/standing ability, pain, and social interaction. Although it is the most used foot and ankle PROM in the UK, initial MOxFQ validation involved analysis of only 100 individuals undergoing hallux valgus surgery. This project aimed to establish whether an individual's response to the MOxFQ varies with anatomical region of disease (measurement invariance), and to explore structural validity of the factor structure (subscale items) of the MOxFQ. Methods. This was a single-centre, prospective cohort study involving 6640 patients (mean age 52, range 10–90 years) presenting with a wide range of foot and ankle pathologies between 2013 and 2021. Firstly, to assess whether the MOxFQ responses vary by anatomical region of foot and ankle disease, we performed multi-group confirmatory factor analysis. Secondly, to assess the structural validity of the subscale items, exploratory and confirmatory factor analyses were performed. Results. Measurement invariance by pathology was confirmed suggesting the same model can be used across all foot and ankle anatomical regions. Exploratory factor analysis demonstrated a 2–3 factor model, and suggested that item 13 (inability to carry out my work/everyday activities) and item 14 (inability to undertake social/recreational activities) loaded more positively onto the walking/standing subscale than their original social interaction subscale. Conclusions. This large-cohort study supports the current widespread use of the MOxFQ across a broad range of foot and ankle pathologies. Items 13 and 14 might be better moved from the “social interaction” to the “walking/standing” subscale and this may have future implications for deriving/analysing subscale scores


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_15 | Pages 9 - 9
7 Aug 2024
Evans DW
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Background. Disability is an important multifaceted construct. The aim of this study was to develop and evaluate a brief, generic self-reported disability questionnaire: the Universal Disability Index (UDI). Methods. Convenience sampling was used to collect general population data via an online survey. Data were randomly divided into training and validation subsets. The dimensionality and structure of eight UDI questionnaire items were evaluated using exploratory factor analysis (EFA, training subset) followed by confirmatory factor analysis (CFA, validation subset). To assess concurrent validity, the UDI summed score from the full dataset was compared to the Groningen Activity Restriction Scale (GARS) and the Graded Chronic Pain Scale (GCPS) disability scores. Internal consistency was also assessed. Results. 403 participants enrolled; 364 completed at least one UDI item. Three single-factor versions of the UDI were assessed (8-item, 7-item, and 6-item). All versions performed well during EFA and CFA (182 cases assigned to each), but none met the RMSEA (Root Mean Square Error of Approximation) criterion (≤ 0.08). All versions of the UDI had high internal consistency (Cronbach's α > 0.90) and were strongly correlated (Pearson's r > 0.7) with both GARS and GCPS disability scores, indicating concurrent validity. Conclusions. A brief, generic self-reported disability questionnaire was found to be valid and to possess good psychometric properties. The UDI has a single factor structure and either a 6-item, 7-item or 8-item version can be used to measure disability. For brevity and parsimony, the 6-item UDI is recommended, but further testing of all versions is warranted. Conflicts of interest. No conflicts of interest. Sources of funding. No funding obtained


Bone & Joint Open
Vol. 5, Issue 8 | Pages 688 - 696
22 Aug 2024
Hanusrichter Y Gebert C Steinbeck M Dudda M Hardes J Frieler S Jeys LM Wessling M

Aims. Custom-made partial pelvis replacements (PPRs) are increasingly used in the reconstruction of large acetabular defects and have mainly been designed using a triflange approach, requiring extensive soft-tissue dissection. The monoflange design, where primary intramedullary fixation within the ilium combined with a monoflange for rotational stability, was anticipated to overcome this obstacle. The aim of this study was to evaluate the design with regard to functional outcome, complications, and acetabular reconstruction. Methods. Between 2014 and 2023, 79 patients with a mean follow-up of 33 months (SD 22; 9 to 103) were included. Functional outcome was measured using the Harris Hip Score and EuroQol five-dimension questionnaire (EQ-5D). PPR revisions were defined as an endpoint, and subgroups were analyzed to determine risk factors. Results. Implantation was possible in all cases with a 2D centre of rotation deviation of 10 mm (SD 5.8; 1 to 29). PPR revision was necessary in eight (10%) patients. HHS increased significantly from 33 to 72 postoperatively, with a mean increase of 39 points (p < 0.001). Postoperative EQ-5D score was 0.7 (SD 0.3; -0.3 to 1). Risk factor analysis showed significant revision rates for septic indications (p ≤ 0.001) as well as femoral defect size (p = 0.001). Conclusion. Since large acetabular defects are being treated surgically more often, custom-made PPR should be integrated as an option in treatment algorithms. Monoflange PPR, with primary iliac fixation, offers a viable treatment option for Paprosky III defects with promising functional results, while requiring less soft-tissue exposure and allowing immediate full weightbearing. Cite this article: Bone Jt Open 2024;5(8):688–696


Bone & Joint Research
Vol. 13, Issue 8 | Pages 392 - 400
5 Aug 2024
Barakat A Evans J Gibbons C Singh HP

Aims. The Oxford Shoulder Score (OSS) is a 12-item measure commonly used for the assessment of shoulder surgeries. This study explores whether computerized adaptive testing (CAT) provides a shortened, individually tailored questionnaire while maintaining test accuracy. Methods. A total of 16,238 preoperative OSS were available in the National Joint Registry (NJR) for England, Wales, Northern Ireland, the Isle of Man, and the States of Guernsey dataset (April 2012 to April 2022). Prior to CAT, the foundational item response theory (IRT) assumptions of unidimensionality, monotonicity, and local independence were established. CAT compared sequential item selection with stopping criteria set at standard error (SE) < 0.32 and SE < 0.45 (equivalent to reliability coefficients of 0.90 and 0.80) to full-length patient-reported outcome measure (PROM) precision. Results. Confirmatory factor analysis (CFA) for unidimensionality exhibited satisfactory fit with root mean square standardized residual (RSMSR) of 0.06 (cut-off ≤ 0.08) but not with comparative fit index (CFI) of 0.85 or Tucker-Lewis index (TLI) of 0.82 (cut-off > 0.90). Monotonicity, measured by H value, yielded 0.482, signifying good monotonic trends. Local independence was generally met, with Yen’s Q3 statistic > 0.2 for most items. The median item count for completing the CAT simulation with a SE of 0.32 was 3 (IQR 3 to 12), while for a SE of 0.45 it was 2 (IQR 2 to 6). This constituted only 25% and 16%, respectively, when compared to the 12-item full-length questionnaire. Conclusion. Calibrating IRT for the OSS has resulted in the development of an efficient and shortened CAT while maintaining accuracy and reliability. Through the reduction of redundant items and implementation of a standardized measurement scale, our study highlights a promising approach to alleviate time burden and potentially enhance compliance with these widely used outcome measures. Cite this article: Bone Joint Res 2024;13(8):392–400


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_2 | Pages 37 - 37
10 Feb 2023
McPhee I
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There are numerous patient satisfaction questionnaires by none specific for an Independent Medical Examination (IME). The aim of this study was to develop and evaluate a questionnaire suitable for an IME. The questionnaire (IMESQ) consisted of five process domains (“Interpersonal manner”, “Communication”, “Technical ability”, “Information exchange”, “Time allocation”) and an outcome domain (“Satisfaction”), each with a five-scale Likert response. An 11-point numerical satisfaction scale (NSS) and a 3-point scale question on the “willing to undergo another examination with the doctor if required” were alternative measures of validation. The questionnaire was tested against numerous independent variables. Statistical analysis included Spearman correlation ((r. S. ) between the items in the questionnaire and the total score with the NSS, and “willing to undergo another examination with the doctor if required” with point-biserial correlation (r. pb. ). Internal consistent reliability was tested using split-half correlation coefficient (r. SB. ) and Cronbach's alpha coefficient (α). The construct was subjected to Factor Analysis. The results from 53 respondents were analysed. There was moderate to strong inter-item correlation (r. s. range 0.57 to 0.83, median 0.67, p < 0.01) and good correlation with the NSS (r. s. = 0.79, p < 0.01) and dichotomous question (r. pb. = 0.45, p < 0.01). Five respondents were “neither satisfied or dissatisfied” (Item 6) and 12 recorded “maybe” to further examination. The split-half correlation was strong (r. SB. = 0.76, p < 0.01). There was good internal consistency reliability (α = 0.92). “Interpersonal manner” (ψ = 4.3) was the only item to have an eigenvalue greater than one, accounting to 72% of the variance across the scale. Eigenvector analysis confirmed the questionnaire was unidimentional. The IMESQ is a brief questionnaire to assess satisfaction with an IME. It is validated and has good internal consistency reliability. The five process domains can identify areas of suboptimal performance: useful for a 360° audit


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_7 | Pages 116 - 116
4 Apr 2023
Zhang J Zhu J Zhou A Thahir A Krkovic M
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Treatment of tibial osteomyelitis can be challenging and lengthy, with numerous complications possible during rehabilitation. We report on the usage of the Taylor Spatial Frame (TSF) for a large cohort of patients, and analyse factors that affect outcomes. Between 2015-2020, 51 patients were treated with TSF for osteomyelitis at a major trauma centre. Demographic, infection and treatment factors of: age, smoking status, diabetes, and BMI, acute (<6 weeks post injury) or chronic (>6 weeks) osteomyelitis, bacteria isolated, time to debridement, therapy/surgery number of TSF, time TSF was in, antibiotic treatment period, time to partial weight bear (PWB) and full weight bear (FWB) prescriptions, were collected. Outcomes of complications and time to union were obtained. Radiological union was achieved at mean 11.0 months. Mean follow up was 24.1 months. Six and three patients were further treated with fusion and amputation respectively. Mean treatment time with TSF was 12.1 months. 78% had some complications, with pin site infection, malunion, and non-union being most prevalent. Univariate factor analysis, multicollinearity diagnostics, then multivariate model construction were performed. Staphylococcus Epidermidis in bone debridement microbiology was significantly negatively associated with pin site infection (OR 0.093, 95% CI 0.011-0.828) and malunion (OR 0.698, 95% CI 0.573-0.849), and enterococcus with non-union (OR 0.775, 95% CI 0.656-0.916), during the treatment period. Time to union was significantly positively associated with time from admission to debridement (p=0.035), time TSF was in (p=0.021), presence of complications (p=0.045), bone loss complication(p=0.037), time to FWB prescription(p=0.001). We have analysed the effectiveness of TSF in the treatment of tibial osteomyelitis, and elucidated important injury, treatment and rehabilitation factors that affect outcome. The negative bacterial-complication cross associations could be due to successful eradication as culture specific antibiotics were used postoperatively. Earlier patient full weight bearing could enhance callous formation leading to faster union


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_1 | Pages 34 - 34
1 Feb 2021
Boekesteijn R Smolders J Busch V Smulders K Geurts A
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Introduction. Wearable sensors are promising tools for fast clinical gait evaluations in individuals with osteoarthritis (OA) of the knee and hip. However, gait assessments with wearable sensor are often limited to relatively simple straight-ahead walking paradigms. Parameters reflecting more complex and relevant aspects of gait, including dual-tasking, turning, and compensatory upper body motion are often overlooked in literature. The aim of this study was to investigate turning, dual-task performance, and upper body motion in individuals with knee or hip OA in addition to spatiotemporal gait parameters, taking shared covariance between gait parameters into account. Methods. Gait was compared between individuals with unilateral knee (n=25) or hip (n=26) OA scheduled for joint replacement, and healthy controls (n=27). For 2 minutes, subjects walked back-and-forth a 6 meter trajectory making 180 degree turns, with and without a secondary cognitive task. Gait parameters were collected using four inertial measurement units on feet, waist, and trunk. To test if turning, dual-tasking, and upper body motion had added value above common spatiotemporal parameters, a factor analysis was conducted. Standardized mean differences were computed for the comparison between knee or hip OA and healthy controls. One gait parameter was selected per gait domain based on factor loading and effect size for the comparison between OA groups and healthy controls. Results. Four independent domains of gait were obtained: speed-spatial, speed-temporal, dual task cost, and upper body motion. Turning parameters were part of the speed-temporal domain. From the gait domains that were obtained, stride length (speed-spatial) and cadence (speed-temporal) had the strongest factor loadings and effect sizes for both knee and hip OA, and lumbar sagittal range of motion (upper body motion) for hip OA only. Although dual-task cost was an independent domain, it was not sensitive to knee or hip OA. Conclusions. Stride length, cadence, and lumbar sagittal range of motion were non-redundant and sensitive gait parameters, representing (compensatory) gait adaptations in individuals with knee or hip OA. Turning or dual-task parameters had limited additional value for evaluating gait in knee and hip OA, although dual-task cost constituted a separate gait domain. These findings hold promise for objective gait assessments in the clinic using wearable sensors. Future steps should include testing responsiveness of these gait domains to interventions aiming to improve mobility, including knee and hip arthroplasty


Bone & Joint Open
Vol. 5, Issue 7 | Pages 581 - 591
12 Jul 2024
Wang W Xiong Z Huang D Li Y Huang Y Guo Y Andreacchio A Canavese F Chen S

Aims

To investigate the risk factors for unsuccessful radial head reduction (RHR) in children with chronic Monteggia fractures (CMFs) treated surgically.

Methods

A total of 209 children (mean age 6.84 years (SD 2.87)), who underwent surgical treatment for CMFs between March 2015 and March 2023 at six institutions, were retrospectively reviewed. Assessed risk factors included age, sex, laterality, dislocation direction and distance, preoperative proximal radial metaphysis width, time from injury to surgery, reduction method, annular ligament reconstruction, radiocapitellar joint fixation, ulnar osteotomy, site of ulnar osteotomy, preoperative and postoperative ulnar angulation, ulnar fixation method, progressive ulnar distraction, and postoperative cast immobilization. Independent-samples t-test, chi-squared test, and logistic regression analysis were used to identify the risk factors associated with unsuccessful RHR.


Bone & Joint Open
Vol. 5, Issue 3 | Pages 210 - 217
13 Mar 2024
Mthethwa PG Marais LC Aldous CM

Aims

The aim of this study is to determine the predictors of overall survival (OS) and predictive factors of poor prognosis of conventional high-grade osteosarcoma of the limbs in a single-centre in South Africa.

Methods

We performed a retrospective cross-sectional analysis to identify the prognostic factors that predict the OS of patients with histologically confirmed high-grade conventional osteosarcoma of the limbs over ten years. We employed the Cox proportional regression model and the Kaplan-Meier method for statistical analysis.


Bone & Joint Research
Vol. 12, Issue 8 | Pages 467 - 475
2 Aug 2023
Wu H Sun D Wang S Jia C Shen J Wang X Hou C Xie Z Luo F

Aims

This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis.

Methods

We included adult patients with limb osteomyelitis who received debridement and ALCS insertion into the bone defect as definitive management between 2013 and 2020 in our clinical centre. The follow-up time was at least two years. Data on patients’ demographics, clinical characteristics, and infection recurrence were retrospectively collected and analyzed.


Bone & Joint Research
Vol. 12, Issue 4 | Pages 259 - 273
6 Apr 2023
Lu R Wang Y Qu Y Wang S Peng C You H Zhu W Chen A

Aims

Osteoarthritis (OA) is a prevalent joint disorder with inflammatory response and cartilage deterioration as its main features. Dihydrocaffeic acid (DHCA), a bioactive component extracted from natural plant (gynura bicolor), has demonstrated anti-inflammatory properties in various diseases. We aimed to explore the chondroprotective effect of DHCA on OA and its potential mechanism.

Methods

In vitro, interleukin-1 beta (IL-1β) was used to establish the mice OA chondrocytes. Cell counting kit-8 evaluated chondrocyte viability. Western blotting analyzed the expression levels of collagen II, aggrecan, SOX9, inducible nitric oxide synthase (iNOS), IL-6, matrix metalloproteinases (MMPs: MMP1, MMP3, and MMP13), and signalling molecules associated with nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) pathways. Immunofluorescence analysis assessed the expression of aggrecan, collagen II, MMP13, and p-P65. In vivo, a destabilized medial meniscus (DMM) surgery was used to induce mice OA knee joints. After injection of DHCA or a vehicle into the injured joints, histological staining gauged the severity of cartilage damage.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_10 | Pages 21 - 21
1 Oct 2020
Amstutz HC Le Duff MJ
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Background. Hip resurfacing arthoplasty (HRA) showed promising early and mid-terms results at the beginning of the new millennium. Adverse local tissue reactions associated with metal debris considerably slowed down the implantation of HRA which use is now limited to a few specialized centers. The long term success of this procedure, however, is still largely unknown. This study aimed to provide the clinical results of a series of 400 consecutive HRA with a minimum follow-up of 20 years. Methods. All patients treated with Conserve. ®. Plus HRA between November 1996 and November 2000 were retrospectively selected and 355 patients (400 hips) were included. The clinical results of this series was previously reported in 2004 at a follow up of 2 to 6 years[1]. There were 96 women (27%) and 259 men (73%). Mean age at surgery was 48.2 ± 10.9 years. Long-term survivorship was assessed with Kaplan-Meier survival estimates. UCLA hip scores and SF-12 quality of life scores were collected at follow-up visits. Radiographic positioning of the acetabular component was assessed with the computation of the contact patch to rim (CPR) distance. Radiolucencies about the metaphyseal stem and around the acetabular component were recorded to assess the quality of the component fixation. Results. The mean time of follow up was 16.3 ± 5.5 years including 183 hips beyond 20 yrs. Nine hips were lost to follow up (2.2%) Thirty-three patients (35 hips,8.8%) died of causes unrelated to the surgery at a mean 11.9 ± 5.3 years after surgery The mean UCLA hip scores at last follow-up were 9.3 ± 1.0, 9.1 ± 1.4, 9.0 ± 1.8, and 6.9 ± 1.7 for pain, walking, function, and activity, respectively. Post-operative SF-12 scores were 48.4 ± 10.3 for the physical component and 48.5 ± 15.5 for the mental component and did not differ from those of the general US population. Fifty-five patients (60 hips) underwent revision surgery at a mean time of 9.3 ± 5.8 years. Indications for revision surgery included acetabular component loosening (12 hips), femoral component loosening (31 hips), femoral neck fracture (6 hips), wear (6 hips), sepsis (2 hips), recurrent dislocations (1 hip), acetabular component protrusion after over-reaming (1 hip) and unknown (1 hip which was revised in another center). Using any revision as an endpoint, the Kaplan-Meier survivorship was 95.2% at 5 years, 91.2% at 10 years, 87.3% at 15 years, and 83.2% at 20 years. A multivariate model for risk factor analysis showed a diagnosis of developmental dysplasia (p=0.020) and a low body mass index (typically associated with higher levels of activity) (p=0.032), to be significantly related to revision for any reason. Female sex was not a risk factor after adjustment for hip dysplasia and component size was made (Table 1). There was only 1 femoral failure (a late neck fracture 19 years after surgery) among the hips reconstructed with a cemented metaphyseal stem (n=59). Five of the 6 hips (1.5%) with wear-related failures all had mal-positioned sockets (CPR distance <10mm) and were therefore preventable. There were no cases with a high score of aseptic lymphocytic vasculitis-associated lesions (ALVAL)[2], suggesting metal sensitivity. X-ray analysis showed excellent persisting fixation in all but one hip. Conclusions. In this group of patients operated over 20 years ago, HRA keeps providing excellent pain relief and quality of life to the patients. Subsequent progress in the preparation of the femoral head has considerably reduced the failure rate on the femoral side which was the main mode of failure in this initial series[3, 4]. The 83.1% 20 year survivorship of this initial series surpasses that of total hip arthroplasties in use 20 years ago in this young patient population[5]. Life-long durability of the device is anticipated for most of the remaining patients. The established benefits of this procedure, such as a low dislocation rate, an anatomic reconstruction with physiologic loading of the proximal femur, the absence of taper corrosion, and an easy conversion if ever necessary, make HRA a preferable alternative to THA in young and active patients. For any figures, tables, or references, please contact the authors directly