Introduction. With the widespread legalization of cannabis across the United States, well-powered studies evaluating the impact of cannabis use disorder on outcomes following primary total hip arthroplasty are warranted. Therefore, the aim of this study was to determine whether cannabis use disorder has an effect on patients who undergo primary hip arthroplasty in terms of: 1) hospital lengths of stay (LOS); 2) medical
Screw fixation is an established method for anterior cruciate ligament (ACL) reconstruction, although with a high rate of
Abstract. Objectives. The principle of osteoporotic vertebral compression fracture (OVCF) is fixing instability, providing anterior support, and decompression. Contraindication for vertebroplasty is anterior or posterior wall fracture. The study objectives was to evaluate the efficacy and safety of vertebroplasty with short segmented PMMA cement augmented pedicle screws for OVCF with posterior/anterior wall fracture patients. Methods. A retrospective study of 24 patients of DGOU type-4 (vertebra plana) OVCF with posterior/anterior wall fracture, were treated by vertebroplasty and short segment PMMA cement augmented pedicle screws fixation. Radiological parameters (kyphosis angle and compression ratio) and clinical parameters Visual analogue scale (VAS) and Oswestry disability index (ODI) were analysed. Results. A significant improvement was noted in VAS (preoperative, 7.90 ±0.60; final follow-up 2.90 ± 0.54) and ODI (77.10 ± 6.96 to 21.30 ± 6.70), (P < 0.05). Neurological improvement was noted in all patients. Kyphosis corrected significantly from preoperative 23.20±5.90 to 5.30±1.40 postoperative with 5% (3.30± 2.95) loss of correction at final follow-up. Anterior vertebral height restored significantly from 55.80±11.9% t0 87.6±13.1% postoperative with 4.5±4.0% loss at final follow-up. One case had cement leakage was found, but the patient is asymptomatic. No
Abstract. Objectives. To evaluate the safety and efficacy of vertebroplasty with short segmented cement augmented pedicle screws fixation for severe osteoporotic vertebral compression fractures (OVCF) with posterior/anterior wall fractured patients. Methods. A retrospective study of 24 patients of DGOU type-4 (vertebra plana) OVCF with posterior/anterior wall fracture, were treated by vertebroplasty and short segment PMMA cement augmented pedicle screws fixation. Radiological parameters (kyphosis angle and compression ratio) and clinical parameters Visual analogue scale (VAS) and Oswestry disability index (ODI) were analysed. Results. A significant improvement was noted in VAS (preoperative, 7.90 ± 0.60; final follow-up 2.90 ± 0.54) and ODI (77.10 ± 6.96 to 21.30 ± 6.70), (P < 0.05). Neurological improvement was noted in all patients. Kyphosis corrected significantly from preoperative 23.20 ± 5.90 to 5.30 ± 1.40 postoperative with 5% (3.30 ± 2.95) loss of correction at final follow-up. Anterior vertebral height restored significantly from 55.80 ± 11.9% to 87.6 ± 13.1% postoperative with 4.5 ± 4.0% loss at final follow-up. One case had cement leakage was found, but the patient is asymptomatic. No
Fractures of the lateral clavicle with complete displacement have a high non-union rate and are associated with poor functional outcomes following non-operative treatment. Various operative techniques are available but preliminary studies of open reduction and tunnelled suspensory device (ORTSD) fixation report good early functional outcomes with a low rate of complications. This study assesses the functional outcomes in a large series of patients treated using ORTSD. After surgical reconstruction in 67 patients, outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Oxford score at six weeks, and three, six and twelve months post-operatively. 55 of 64 surviving patients were contacted at a mean of 69 (27–120) months to complete DASH and Oxford scores, evaluate overall satisfaction, and document any complications. At one year post-operatively, the mean Oxford score was 46.4 and mean DASH score was 2.4 points (59/67 patients assessed). At a mean of 69 months after surgery, the mean Oxford score was 46.5 and mean DASH score was 2.2 (55 surviving and contactable patients). There were no significant differences between the one-year functional scores and those at the latest follow-up. Two patients developed symptomatic non-union requiring re-operation, and two developed an asymptomatic fibrous union not requiring surgery. The five-year survival when considering only obligate revision for
This multi-centre single-blind randomised control trial compared outcomes in patients with acute displaced mid-shaft clavicle fractures treated either by primary open reduction and plate fixation (ORPF), or non-operative treatment (NT). Two-hundred patients were randomised to receive either ORPF or NT. Functional assessment was conducted up to one-year using DASH, SF-12 and Constant scores (CS). Union was evaluated using radiographs and CT. Rate of non-union was significantly reduced after ORPF (1 following ORPF, 16 following NT, odds ratio=0.07, 95% CI=0.01–0.50, p=0.0006). 7 patients had delayed-union after NT. Group allocation to ORPF was independently predictive of development of non-union. DASH and CS were significantly better in the ORPF group 3-months post-surgery, but not at one-year (mean DASH = 6.2 after NT versus 3.7 after ORPF, p=0.09; mean CS = 86.1 after NT versus 90.7 after ORPF, p=0.05). Group allocation was not predictive of one-year outcome. Non-union was the only factor independently predictive of one-year functional outcome. There were no significant differences in time off work or subjective scores. Five patients underwent revision for complications after ORPF. 10 patients underwent metalwork removal. Treatment cost was significantly greater after ORPF (p=0.001). ORPF reduces rate of non-union compared with NT and is associated with better early functional outcomes. Improved outcomes are not sustained at one-year. Differences in functional outcome appear to be mediated by prevention of non-union from ORPF. ORPF is more expensive and associated with
The management of mid-shaft clavicle fractures (MSCFs) has evolved over the last three decades. Controversy exists over which specific fracture patterns to treat and when. This review aims to synthesize the literature in order to formulate an appropriate management algorithm for these injuries in both adolescents and adults. This is a systematic review of clinical studies comparing the outcomes of operative and nonoperative treatments for MSCFs in the past 15 years. The literature was searched using, PubMed, Google scholar, OVID Medline, and Embase. All databases were searched with identical search terms: mid-shaft clavicle fractures (± fixation) (± nonoperative).Aims
Methods
INTRODUCTION. Young patients (< 50 years old) have been reported to have a higher risk of revision following total hip arthroplasty (THA) than older patient cohorts, possibly to due higher activity, a higher incidence of deformity and greater probability of prior surgery. Ceramic-on-ceramic bearing surfaces have been proposed for use in young and active individuals due to their low wear, low risk of adverse biologic reaction, and long-term survivorship. We assessed the clinical results and long-term survivorship of uncemented ceramic-on-ceramic THA in a young patient population. METHODS. Between August 1999 and December 2007, 220 total hip arthroplasties in 191 patients under 50 years of age at the time of surgery were performed using alumina ceramic-ceramic bearings as part of a prospective, non-randomized study. All patients received uncemented acetabular components with flush-mounted acetabular liners using an 18 degree taper, and uncemented femoral components. The average patient age at the time of surgery was 42.1 ±7.2 years (range: 17.4 years to 49.9 years), and the average time to follow-up was 10.1 ±2.4 years (range: 4.2 years to 15.2 years). We evaluated
The aim of this prospective study was to assess safety and effectiveness of Spacer-K, a pre-formed articulating spacer made of gentamicin-impregnated acrylic bone cement. used in two-stage exchange technique for the infected total knee arthroplasty. 32 consecutive patients infected total knee arthroplasty were operated on in two centres. Infection was caused by Coagulase neg. Staphylococcus (21), Staphylococcus aureus (4), and others (4). In 3 case microorganisms were not identified. The mean implantation time of the spacer was 11 weeks (range, 7 to 28 weeks). The rehabilitation program between stages consisted in early range of motion exercises and partial weight-bearing. In one patient removal of the spacer and insertion of a molded cement block with vancomycin was necessary because of insurgence of methicillin-resistant Staphylococcus aureus. The mean follow-up of 32 knees after removal of the spacer and insertion of the new prosthesis was 40 months (range, 24 to 75 months. The mean Knee Society functional score during spacer management was rated 75 points (range, 41 to 91 points) and was rated 87 points (range, 77 to 97 points) at latest follow-up. Preoperative range of motion improved markedly after removal of the infected prosthesis and insertion of the spacer. Neither breakage nor clinically relevant surface wear were detected. No
To evaluate mid-to long-term patient-reported outcome measures (PROMs) of endoprosthetic reconstruction after resection of malignant tumours arising around the knee, and to investigate the risk factors for unfavourable PROMs. The medical records of 75 patients who underwent surgery between 2000 and 2020 were retrospectively reviewed, and 44 patients who were alive and available for follow-up (at a mean of 9.7 years postoperatively) were included in the study. Leg length discrepancy was measured on whole-leg radiographs, and functional assessment was performed with PROMs (Toronto Extremity Salvage Score (TESS) and Comprehensive Outcome Measure for Musculoskeletal Oncology Lower Extremity (COMMON-LE)) with two different aspects. The thresholds for unfavourable PROMs were determined using anchor questions regarding satisfaction, and the risk factors for unfavourable PROMs were investigated.Aims
Methods
The risk of mechanical failure of modular revision hip stems is frequently mentioned in the literature, but little is currently known about the actual clinical failure rates of this type of prosthesis. The current retrospective long-term analysis examines the distal and modular failure patterns of the Prevision hip stem from 18 years of clinical use. A design improvement of the modular taper was introduced in 2008, and the data could also be used to compare the original and the current design of the modular connection. We performed an analysis of the Prevision modular hip stem using the manufacturer’s vigilance database and investigated different mechanical failure patterns of the hip stem from January 2004 to December 2022.Aims
Methods
Introduction:. Young patients have been reported to have a higher risk of revision following total hip arthroplasty (THA) than older cohorts, possibly to due higher activity and a higher incidence of deformity and prior surgery. Ceramic-on-ceramic bearing surfaces have been proposed for use in young and active individuals due to their low wear, low risk of adverse biologic reaction, and long-term survivorship. We assessed the clinical results and long-term survivorship of uncemented ceramic-on-ceramic THA in a young patient population. Methods:. 341 total hip arthroplasties in 218 patients under 50 years of age at the time of surgery were performed were performed using alumina ceramic-on-ceramic bearings from August 1999 to April 2009 as part of a prospective nonrandomized study. All patients received uncemented acetabular components with flush-mounted acetabular liners using an 18 degree taper and uncemented femoral components. The average patient age at the time of surgery was 41.7 years (range 17.8–49.9 years). The minimum follow-up time was 2 years, (mean 9.1, range 2–13.9). We evaluated
To determine the major risk factors for unplanned reoperations (UROs) following corrective surgery for adult spinal deformity (ASD) and their interactions, using machine learning-based prediction algorithms and game theory. Patients who underwent surgery for ASD, with a minimum of two-year follow-up, were retrospectively reviewed. In total, 210 patients were included and randomly allocated into training (70% of the sample size) and test (the remaining 30%) sets to develop the machine learning algorithm. Risk factors were included in the analysis, along with clinical characteristics and parameters acquired through diagnostic radiology.Aims
Methods
The aim of this study was to perform a systematic review and bias evaluation of the current literature to create an overview of risk factors for re-revision following revision total knee arthroplasty (rTKA). A systematic search of MEDLINE and Embase was completed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The studies were required to include a population of index rTKAs. Primary or secondary outcomes had to be re-revision. The association between preoperative factors and the effect on the risk for re-revision was also required to be reported by the studies.Aims
Methods
The aim of this study was to report long-term clinical outcomes of a modern convertible metal-backed glenoid (MBG) in total shoulder arthroplasty (TSA). After a minimum of 15 years, a previously studied cohort of 35 patients who received a modern convertible MBG during the period 1996 to 2005 was contacted for clinical and radiological follow-up. At last follow-up, patients were evaluated radiologically and clinically according to the Constant Score, Simple Shoulder Test, and visual analogue scale for pain. Complications and revisions were recorded, and survival analysis was performed.Aims
Methods
Chronic osteomyelitis (COM) of the lower limb in adults can be surgically managed by either limb reconstruction or amputation. This scoping review aims to map the outcomes used in studies surgically managing COM in order to aid future development of a core outcome set. A total of 11 databases were searched. A subset of studies published between 1 October 2020 and 1 January 2011 from a larger review mapping research on limb reconstruction and limb amputation for the management of lower limb COM were eligible. All outcomes were extracted and recorded verbatim. Outcomes were grouped and categorized as per the revised Williamson and Clarke taxonomy.Aims
Methods
Patients with proximal femoral fractures (PFFs) are often multimorbid, thus unplanned readmissions following surgery are common. We therefore aimed to analyze 30-day and one-year readmission rates, reasons for, and factors associated with, readmission risk in a cohort of patients with surgically treated PFFs across Austria. Data from 11,270 patients with PFFs, treated surgically (osteosyntheses, n = 6,435; endoprostheses, n = 4,835) at Austrian hospitals within a one-year period (January to December 2021) was retrieved from the Leistungsorientierte Krankenanstaltenfinanzierung (Achievement-Oriented Hospital Financing). The 30-day and one-year readmission rates were reported. Readmission risk for any complication, as well as general medicine-, internal medicine-, and surgery/injury-associated complications, and factors associated with readmissions, were investigated.Aims
Methods
Introduction. Historically, amputation or rotationplasty were the treatment of choice in skeletally immature patients. The introduction of expandable endoprostheses in the late 1980s offered the advantages of limb-salvage and limb length equality at skeletal maturity and a promising alternative with improved cosmetic results and immediate weight bearing. Objective. to describe the Rizzoli experience in reconstruction with three different types of expandable prostheses in growing children with malignant bone tumors of the femur, assess the outcome of limb salvage in these patients, analyze survival and complications related to these prostheses used over time. Materials and Methods. Between 1996 and 2010, 39 expandable implants were used in 32 children (16 boys and 16 girls; mean age, 9 years at initial surgery) with bone sarcomas of the femur treated with limb salvage using expandable prostheses. The most common diagnosis was osteoblastic osteosarcoma; all children were classified as having a stage IIB lesion and had preoperative and postoperative chemotherapy. The minimally invasive Kotz Growing prosthesis was used in 17 cases (10 primary implant and 7 revision after failure of non-invasive Repiphysis®), the non-invasive Repiphysis® in 15 cases and Stanmore® expandable prostheses in 7 cases. The mean follow-up was 48 months. Functional evaluation and survival analysis of the children and implants were performed. Results. The rate of
Introduction. Our short segment anterior technique produces similar correction and better functional outcomes for patients with adolescent idiopathic scoliosis by instrumentation of fewer levels than does posterior segmental instrumentation. We present the results of the first consecutive 45 patients operated by the short segment bone-on-bone anterior scoliosis technique, with a mean follow-up of 6 years. Every patient was followed up over 2 years and none was lost to follow-up. Methods. The patients (28 with thoracic scoliosis; 17 with thoracolumbar scoliosis) were operated between 1996 and 2004 for single curve idiopathic scoliosis. The mean age was 19 years (range 9–51); 87% of the cohort was female and the mean follow-up was 72 months (range 28–121). We operated on curves less than 75° by the short segment anterior approach with total discectomy, bone-on-bone apposition, and dual-rod instrumentation. We assessed the sagittal and coronal corrections on erect anteroposterior and lateral radiographs done preoperatively, postoperatively, and at final follow-up. Results. A mean of five vertebrae (four discs) were instrumented. The mean operative time was 360 min, blood loss was 877mL, and hospital stay was 9·1 days. The preoperative thoracolumbar major curve was 50·5°, and 18·3° at final follow-up (image A, B). The preoperative lower tilt angle was 27·7°, and 8·3° at final follow-up. The main preoperative thoracic curve was 52·5°, and the final postoperative curve measured 27·9° (image C, D). The lower preoperative tilt angle was 20·9°, and 11° at final follow-up. Spontaneous improvement of 37·4% was noted in thoracic compensatory curves and 47·5% in thoracolumbar compensatory curves. The sagittal and coronal balance was restored in all patients. There was no loss of correction in the operated segment. There were no infections, non-unions, or neurological, vascular, pulmonary, or
Purpose: Congenital proximal radioulnar synostosis is a rare anomaly of failure of segmentation of the radius and ulna resulting in a fixed rotational position of the forearm from neutral to maximum pronation. Several surgical options have been proposed for the treatment of this condition. We have treated six forearms in five children with pronation deformity using derotational osteotomies of the radius and ulna with postoperative wire stabilisation of the ulna. The surgical technique and results of treatment with this method are presented. Methods: With this technique, osteotomies were performed at the midshaft of the ulna and the distal diaph-yseal-metaphyseal junction of the radius. The insertion of intramedullary Ilizarov wires facilitated manual derotation of the radius and ulna to a functional position of 100 supination of the forearm. Postoperatively, the forearm was immobilised in a cast for an average of 6.3 weeks and the wire was removed when there was evidence of union. 3 boys and 2 girls with a mean age of 4.9 years underwent surgery with this method and were followed-up for an average of 29 months (range 12 to 43 months). Results: Forearm position improved from an average pronation deformity of 68.3 degrees to the pre-planned position of 100 degrees supination in all cases. Bone union was achieved in all six forearms by 6.3 weeks. At their most recent follow-up, there was no loss of correction evident in any of the patients. There was one complication, namely haematoma formation at the radial osteotomy site mimicking compartment syndrome and requiring exploration, although no soft tissue compromise was evident. Conclusion: The principal advantages of this technique include the ease of the surgical approach for the distal radial osteotomy, the longterm maintenance of rotational correction and the need for single wire stabilisation of the ulna only, which in theory reduces the potential risk of
