Aims. The aims of this study were to: 1) report on a cohort of skeletally mature patients with native hip and knee septic arthritis over a 14-year period; 2) to determine the rate of
The inflammatory cascade associated with prosthetic implant wear debris, in addition to diseases such as rheumatoid arthritis and periodontitis, it is shown to drastically influence bone turnover in the local environment. Ultimately, this leads to enhanced osteoclastic resorption and the suppression of bone formation by osteoblasts causing implant failure,
The present study aimed to investigate whether patients with inflammatory bowel disease (IBD) undergoing joint arthroplasty have a higher incidence of adverse outcomes than those without IBD. A comprehensive literature search was conducted to identify eligible studies reporting postoperative outcomes in IBD patients undergoing joint arthroplasty. The primary outcomes included postoperative complications, while the secondary outcomes included unplanned readmission, length of stay (LOS), joint reoperation/implant revision, and cost of care. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model when heterogeneity was substantial.Aims
Methods
Aim of the study. Aim of this study was to find out which factors influence the outcome after both column fractures of the acetabulum. Methods. We performed a retrospective analyse of 115 patients with both column acetabular fractures. The period between the injury and follow-up ranges between 2 and 19 years, 5,7 years on average. The initial displacement, the presence of a dislocation of the hip and fractures of the femoral head were analyzed on the initial radiographs. Postoperative displacement was classified according the classification of Matta. The common classifications of Helfet (posttraumatic arthrosis), Ficat/Arlet (femur head necrosis) and Brooker (periarticular calcification) were used to radiologically classify the long term results. Statistics were performed by the Chi-square-test. Results. We could find a clear tendency between the result of replacement and the radiological long-term result. 10 % of the patients with a postoperative displacement 1 mm had a
The primary aim of this study was to determine the ten-year outcome following surgical treatment for femoroacetabular impingement (FAI). We assessed whether the evolution of practice from open to arthroscopic techniques influenced outcomes and tested whether any patient, radiological, or surgical factors were associated with outcome. Prospectively collected data of a consecutive single-surgeon cohort, operated for FAI between January 2005 and January 2015, were retrospectively studied. The cohort comprised 393 hips (365 patients; 71% male (n = 278)), with a mean age of 34.5 years (SD 10.0). Over the study period, techniques evolved from open surgical dislocation (n = 94) to a combined arthroscopy-Hueter technique (HA + Hueter; n = 61) to a pure arthroscopic technique (HA; n = 238). Outcome measures of interest included modes of failures, complications, reoperation, and patient-reported outcome measures (PROMs). Demographic, radiological, and surgical factors were tested for possible association with outcome.Aims
Methods
Leukocyte esterase (LE) has shown to be an accurate marker of prosthetic joint infections and has been proposed as an alternative to frozen section (FS) for intra-operative diagnosis. In this study, intra-operative determination of LE was compared with FS for the diagnosis of periprosthetic hip infections. One hundred and nineteen patients undergoing hip revision surgery due to prosthetic
Aim. Pre-operative distinction between prosthetic joint infections (PJI) and non-infectious causes of
The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA. A retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis.Aims
Methods
Aim. Clear differentiation between aseptic failure and prosthetic joint infection remains one of the goals of modern orthopaedic surgery. New diagnostic methods can provide more precise evaluation of the etiology of prosthetic
The lack of disease-modifying treatments for osteoarthritis (OA) is linked to a shortage of suitable biomarkers. This study combines multi-molecule synovial fluid analysis with machine learning to produce an accurate diagnostic biomarker model for end-stage knee OA (esOA). Synovial fluid (SF) from patients with esOA, non-OA knee injury, and inflammatory knee arthritis were analyzed for 35 potential markers using immunoassays. Partial least square discriminant analysis (PLS-DA) was used to derive a biomarker model for cohort classification. The ability of the biomarker model to diagnose esOA was validated by identical wide-spectrum SF analysis of a test cohort of ten patients with esOA.Aims
Methods
Background. Constitutional knee varus increases the risk of medial OA disease due to increase in the knee adduction moment and shifting of the mechanical axis medially. Hueter-Volkmann's law states that the amount of load experienced by the growth plate during development influences the bone morphology. For this reason, heightened sports activity during growth is associated with constitutional varus due to added knee adduction moment. In early OA, X-rays often show a flattened medial femoral condyle extension facet (EF). However, it is unknown whether this is a result of osteoarthritic wear, creep deformation over decades of use, or an outcome of Hueter-Volkmann's law during development. A larger and flattened medial EF can bear more weight, due to increased load distribution. However, a flattened EF may also extrude the meniscus, leading meniscus degeneration and
Constitutional knee varus increases the risk of medial OA disease due to increase in the knee adduction moment and shifting of the mechanical axis medially. Hueter-Volkmann’s law states that the amount of load experienced by the growth plate during development influences the bone morphology. For this reason, heightened sports activity during growth is associated with constitutional varus due to added knee adduction moment. In early OA, X-rays often show a flattened medial femoral condyle extension facet (EF). However, it is unknown whether this is a result of osteoarthritic wear, creep deformation over decades of use, or an outcome of Hueter-Volkmann’s law during development. A larger and flattened medial EF can bear more weight, due to increased load distribution. However, a flattened EF may also extrude the meniscus, leading meniscus degeneration and
Synovial fluid white blood cell (WBC) count and percentage of polymorphonuclear cells (%PMN) are elevated at periprosthetic joint infection (PJI). Leucocytes produce different interleukins (IL), including IL-6, so we hypothesized that synovial fluid IL-6 could be a more accurate predictor of PJI than synovial fluid WBC count and %PMN. The main aim of our study was to compare the predictive performance of all three diagnostic tests in the detection of PJI. Patients undergoing total hip or knee revision surgery were included. In the perioperative assessment phase, synovial fluid WBC count, %PMN, and IL-6 concentration were measured. Patients were labeled as positive or negative according to the predefined cut-off values for IL-6 and WBC count with %PMN. Intraoperative samples for microbiological and histopathological analysis were obtained. PJI was defined as the presence of sinus tract, inflammation in histopathological samples, and growth of the same microorganism in a minimum of two or more samples out of at least four taken.Aims
Methods
Clear differentiation between aseptic failure and prosthetic joint infection remains one of the goals of modern orthopaedic surgery. The development of new diagnostic methods enabled more precise evaluation of the etiology of prosthetic
Effectiveness and long term stability of hip resurfacing and total hip arthroplasty for osteoarthritis patients are still debated nowadays. Several clinical and biomechanical issues have to be considered, including pain relief, return to function, femoral neck fractures, impingement and prosthesis loosening. Normally, patients with hip arthroplasties are facing gait adaptation and at risk of fall. Sudden impact loading and twisting during sideway falls may lead to femoral fractures and
Ultra-high molecular weight polyethylene (UHMWPE) has been the gold standard material of choice for the load-bearing articulating surface in knee joint prostheses. However, the application of joint replacements to younger (aged < 64 years) and more active people plus the general increase in life expectancy results in an urgent need for a longer lasting material with better in-use performance. There are three major material related causes that can lead to
Background: Femoral heads donated at primary arthroplasty are screened microbiologically. Contaminated femoral heads are either discarded or irradiated in an effort to protect recipients from the risk of transmitted infection. Aims:. Determine the contamination rate of donated femoral heads at primary arthroplasty within the Trent Region between July 1992 and July 2001. Does femoral head contamination result in an increased rate of early infection in the allograft donor?. Method: We reviewed the culture results of all femoral heads donated to the Leicester Bone Bank. All patients with a contaminated femoral head that were operated upon in the Leicestershire region were then compared to a control group of patients with no contamination of their femoral heads. The two groups of patients were then cross-referenced against the data in the Trent Arthroplasty Audit Group database. Hospital records of all patients who had a complication or re-operation were also reviewed to determine their outcome. Results: A contamination rate of 9% was present with 365 of 4043 femoral heads culturing positive at the time of retrieval. Coagulase negative Staphylococcus was isolated in 75% of the cases. At a minimum of one year follow up, there was no statistically significant difference in the complication or revision rate of age matched patients whose femoral heads cultured positive compared to those whose heads were sterile. Conclusion: The allograft contamination rate is similar to other published series with coagulase negative staphylococcus being the most prevalent contaminant. The available evidence confirms what has been anecdotal in the past. Femoral head culture results play no role in determining future
Background. Ankle arthroplasty is increasingly used to reduce pain and improve or maintain joint mobility in end-stage ankle arthritis. Both treatments show similar results with regard to functional outcome scores and sport related activities. However, the rates of complications and reoperations were higher after ankle replacement. Particularly for the first implant designs, with more promising results for newer designs. One of these newer designs is the Mobility Total Ankle System. Short term results in recent literature describe an improvement of functional outcomes; however complication rates vary widely, ranging from 9 to 37% and the 4-year survival rates ranging between 84 and 98 percent. Therefore, the aim of this study was to assess the clinical and radiographic short term results of the Mobility prosthesis. Methods. Between March 2008 and September 2013, 67 primary total ankle arthroplasties with the Mobility prosthesis were performed, in 64 patients, by one experienced foot and ankle surgeon. Complications, reoperations, failures and the survival rate were retrospectively examined. Patient reported outcomes were assessed with the use of the FFI score and visual analogue scale (VAS) for pain. Prosthesis alignment was measured on the first weightbearing radiographs of the ankle according to the procedure described by Rippstein et al.1 (Fig. 1). Results. The mean follow-up period was 40 months (range 12–78 months). There were two intraoperative and 13 postoperative complications, requiring seven reoperations. The reason for reoperation was painful impingement of the medial and/or lateral gutter (n=4), a deep infection (n=1), subsidence of the talus component (n=1) and a cyst located in the tibiofibular
Although it is generally accepted that revision total elbow replacement may be necessary for loosening, instability, peri-prosthetic fracture and infection there is less agreement as to whether surgery should be performed as a one or two stage procedure. This can be of vital importance since the soft tissues around the elbow are often relatively poor making a single operation desirable. However, a one stage procedure in the presence of undetected low grade infection will result in
Although it is generally accepted that revision total elbow replacement may be necessary for loosening, instability, peri-prosthetic fracture and infection there is less agreement as to whether surgery should be performed as a one or two stage procedure. This can be of vital importance since the soft tissues around the elbow are often relatively poor making a single operation desirable. However, a one stage procedure in the presence of undetected low grade infection will result in