Debate surrounds the optimum operative treatment of periprosthetic distal femoral fractures (PDFFs) at the level of well fixed femoral components; lateral locking plate fixation (LLP-ORIF) or distal femoral replacement (DFR). To determine which attributed the least
Our objective was to conduct a systematic review and meta-analysis, comparing differences in clinical outcomes between either autologous or synthetic bone grafts in the operative management of tibial plateau fractures: a traumatic pattern of injury, associated with poor long-term functional prognosis. A structured search of MEDLINE, EMBASE, The Bone & Joint and CENTRAL databases from inception until 07/28/2021 was performed. Randomised, controlled, clinical trials that compared autologous and synthetic bone grafts in tibial plateau fractures were included. Preclinical studies, clinical studies in paediatric patients, pathological fractures, fracture non-union or chondral defects were excluded. Outcome data was assessed using the Risk of Bias 2 (ROB2) framework and synthesised in random-effect meta-analysis. Preferred Reported Items for Systematic Review and Meta-Analysis guidance was followed throughout. Six comparable studies involving 352 patients were identified from 3,078 records. Following ROB2 assessment, five studies (337 patients) were eligible for meta-analysis. Within these studies, more complex tibia plateau fracture patterns (Schatzker IV-VI) were predominant. Primary outcomes showed non-significant reductions in articular depression at immediate postoperative (mean difference −0.45mm, p=0.25, 95% confidence interval (95%CI): −1.21-0.31mm, I. 2. =0%) and long-term (>6 months, standard mean difference −0.56, p=0.09, 95%CI: −1.20-0.08, I. 2. =73%) follow-up in synthetic bone grafts. Secondary outcomes included mechanical alignment, limb functionality, defect site pain, occurrence of surgical site infections, secondary surgery, perioperative blood loss, and duration of surgery. Blood loss was lower (90.08ml, p<0.001, 95%CI: 41.49-138.67ml, I. 2. =0%) and surgery was shorter (16.17minutes, p=0.04, 95%CI: 0.39-31.94minutes, I. 2. =63%) in synthetic treatment groups. All other secondary measures were statistically comparable. Our findings supersede previous literature, demonstrating that synthetic bone grafts are non-inferior to autologous bone grafts, despite their perceived disadvantages (e.g. being biologically inert). In conclusion, surgeons should consider synthetic bone grafts when optimising
Bilateral one stage total knee replacement (TKR) has a number of advantages. There is one operative procedure and anesthetic and overall recovery time is significantly reduced. It is a more cost-effective procedure in that acute hospital stay is less and although rehabilitation time is greater in the short term, overall it is less. Additionally, if there is a bilateral flexion contracture present there is an inevitable loss of extension if a single knee is operated upon as this knee will assume the position of the unoperated knee. Patients greatly prefer having both knees corrected at one operative setting rather than having to have the inconvenience and pain associated with a second operative procedure at three to six months after the first one. There are potential disadvantages to a one stage procedure. One concern has been that there is more
Obesity is clearly a worldwide epidemic with significant social, health care and economic implications. A clear association between obesity and the need for both hip and knee replacement surgery has been demonstrated. Specifically the presence of class 3 obesity (BMI > 40) increases the incidence of THA by 8.5 times and the incidence of TKA by 32.7 times, compared with patients of normal weight. Issues related to TJA in the morbidly obese include:. Outcomes - There is a growing body of evidence to support the premise that patients undergoing either THA or TKA who are morbidly obese derive significant benefit from the surgical intervention. Specifically patient and disease specific outcome measures (WOMAC, SF-12, KSCRS, HSS) demonstrate equal change between pre-operative and post-operative scores in those patients of normal weight compared to the morbidly obese cohort. Complications - It would appear that the rate of deep infection is increased in the morbidly obese, and that the greater the BMI, the greater the risk of infection. This is important to understand and appreciate pre-operatively as the surgeon discusses the risk/benefit ratio of the operative intervention. There is little debate that performing total joint arthroplasty in the morbidly obese is technically challenging and that the potential for increased
Bilateral one stage total knee replacement has a number of advantages. There is one operative procedure and anesthetic and overall recovery time is significantly reduced. It is a more cost effective procedure in that acute hospital stay is less and although rehabilitation time is greater in the short term overall it is less. Additionally if there is a bilateral flexion contracture present there is an inevitable loss of extension if a single knee is operated upon as this knee will assume the position of the unoperated knee. Patients greatly prefer having both knees corrected at one operative setting rather than having to have the inconvenience and pain associated with a second operative procedure at three to six months after the first one. There are potential disadvantages to a one stage procedure. One concern has been that there is more
In the early days of total hip arthroplasty, the discussion of surgical approaches centered on issues related to obtaining optimum exposure for accurate insertion and fixation of implants and appropriate restoration of hip kinematics. More recently, attention has been directed to those aspects of exposure that appear to be associated with rapid recovery, shorter lengths of stay, less pain and minimal gait disturbance. The role of less invasive (“MIS”) exposures in achieving these outcomes has been sharply and extensively debated. Currently, the Direct Anterior Approach is being used by an increasing number of surgeons to address these outcomes. The purpose of this presentation is to discuss the relationship of total hip surgical approaches to
Purpose. The purpose of this study is to know the
Introduction:. Circumferential arthrodesis of the spine may be achieved by posterior-only or anterior and posterior surgery. Posterior-based interbody fusions have significant limitations including unreliable improvement of segmental lordosis and variable rates of post-operative radiculopathy. Combined anterior and posterior surgery introduces significant cost and
Bilateral one-stage total knee replacement has a number of advantages. There is one operative procedure and anesthetic and overall recovery time is significantly reduced. It is a more cost effective procedure in that acute hospital stay is less and although rehabilitation time is greater in the short term overall it is less. Additionally if there is a bilateral flexion contracture present there is an inevitable loss of extension if a single knee is operated upon as this knee will assume the position of the unoperated knee. Patients greatly prefer having both knees corrected at one operative setting rather than having to have the inconvenience and pain associated with a second operative procedure at three to six months after the first one. There are potential disadvantages to a one-stage procedure. One concern has been that there is more
Total knee replacement (TKR) is considered the “gold standard” treatment for advanced osteoarthritis (OA) of the knee with good survivorship and functional outcomes. However up to 20% of patients undergoing TKR may have unicompartmental disease only. Treatment options for medial compartment arthritis can include both unicompartmental knee replacements (UKR) and TKR. While some surgeons favor TKR with a proven track record, others prefer UKR due to more normal joint kinematics, better proprioception and better motion. There is also a higher rate of return to sports amongst patients with UKR compared to TKR. When considering all knee procedures, partial knee replacements account for 7–9%, primary TKRs for 83–88%, and revision knee replacements for 5–8%. Unicompartmental Knee Replacements comprise more than 90% of all partial knee replacement procedures. Proponents of UKR cite as advantages the preservation of normal knee kinematics, lower
Femoral shaft fractures are usually the result of high energy trauma and are often associated with poly-trauma. Inappropriate treatment results in prolonged morbidity and disability. The treatment of choice for fixation is an interlocking intramedullary nail inserted by closed technique. This study reviewed the perioperative difficulties associated with late nailing of femoral fractures at a busy trauma unit. Thirty four consecutive femoral nails were reviewed retrospectively. Delay to surgery, operative time and
Summary. Metastatic spinal disease is a common entity of much debate in terms of ideal surgical treatment. The introduction of MIS can be a game-changer in the treatment of MSD due to less
Malpositioning of the component of a total knee implant and malalignment of the leg is one of the significant factors for the outcome after Total Knee Arthroplasty. Previous studies have shown that the use of a navigation system can improve these. This article presents the initial results of a prospective and non-randomised study describing navigated implantation in TKA with special reference to soft tissue balancing in knees with posttraumatic deformity. The secondary objective is to found out reproducibility of the software. Methods: Since January 2004, 15 patients with post-traumatic arthrosis of the knee and axial malalignment of more than 15 degrees, pre operative arc of motion 75 degrees admitted to our senior author for TKA have been followed up prospectively. The data were collected over a period of 25 months. Apart from the usual clinical evaluations, no patients had CT of the leg prior to the operation &
postoperatively. Intra-operative and
For decades the treatment of chronic post-traumatic osteomyelitis associated with bone exposure has been one of the most serious problems in the field of orthopaedic surgery. “Sterilisation” of the osteomyelitic site, that is radical débridement of all infected tissue, is the basic requirement of the treatment; in the past, the remaining defect of the débrided area was closed with skin grafts, which were removed in a further stage when the infection had cleared; then the defect was filled with muscle flap and bone graft of various types. Both soft tissue and osseous reconstruction took a relatively long period of time, requiring several-stage treatment. Over the years, introduction of microsurgery led to free muscle flaps and skin graft in one reconstruction setting in the 1970s and thin fascio-cutaneous flap reconstruction in the 1980s, allowing a shorter period of hospitalisation and an improvement in patients’ lifestyle. We performed a retrospective study of 22 patients treated for chronic osteomyelitis (middle or distal 1/3 of the leg, n=10; tarsus, n=6; forearm, n=6) by means of free vascularised bone graft or composite grafts between 1992 and 2003. In most of them a two-stage treatment was performed (resection and sterilisation in the first stage and bone transfer in the second one); in others a one-stage treatment was performed. In 78.5% of cases the infection was cured without requiring secondary procedures; revision of the flap was carried out in 12.3% of cases. In only one case leg amputation under the knee was necessary. In spite of advanced treatment protocols, persisting infection and residual functional deficit is not rare. Over the years the approach has changed. The application of microsurgical tissue transfers for reconstruction of the extremities allows repair of significant bone and soft-tissue defects. A wide variety of free flaps offers the potential to reconstruct nearly any defect of the limbs. The total array of flaps and their indications is beyond the scope of a single discussion, but this paper focuses on a few flaps that have found application for coverage and functional restoration of the limbs. Microsurgical transfers allow more radical débridement of the area affected by osteomyelitis with low
The incidence of hip fractures is rising, and at the same time the patients are getting increasingly frail and elderly. Patients in Europe have a median hospitalization time of as much as 28 days, and the
Introduction The management of severe pain associated with progressive adult scoliosis remains a challenging problem. Radicular symptoms are often caused by bony foraminal stenosis and significant global and segmental imbalance may exist in both the sagittal and coronal planes. The patients are often elderly and have intercurrent medical conditions. The use of disc space distraction, pedicle screw instrumentation and posterior lumbar interbody fusion (PLIF) with Insert and Rotate prostheses has been shown to be effective in the correction of sagittal plane deformity (. 1. ). The current study examines the safety, clinical and radiological efficacy of this technique in the management of adult multilevel scoliosis. Methods A prospective single cohort observational study of 15 consecutive patients with a degenerative scoliosis of 20 degrees or greater managed using an Insert and Rotate PLIF technique between October 2000 and July 2003. The minimum follow-up was 2 years. Clinical outcome measures included VAS pain score, SF-12, LBOS and Patient Satisfaction survey. Pre- and post-operative measures of radiological sagittal and coronal deformity were manually obtained. Wilcoxon signed-ranks test and Spearman’s non parametric test for correlation were used with significance set at 0.05. Results The median age was 72 years (range: 56–80). Male: female ratio was 6:9. PLIF was carried out at 2 levels in 7 patients, 3–5 levels in 8 patients. Median blood loss was 1100mls for 2 level patients and 2550mls for 3–5 level patients. Operating time was 345mins and 545mins in the 2 and 3–5 level cases respectively. Median pre-operative scoliosis was 31degrees (range: 20–65) and post-operatively measured 14degrees (range: 0–30, p=0.001). Median pre-op VAS of 53 reduced to 20 (p=0.003). LBOS improved from 24 to 37 (p=0.004). A correlation was found between the amount of pre-operative coronal plane deformity and the post-operative VAS (r=0.6, p=0.003). 13 of the 15 patients considered the procedure was worthwhile and that they would have it again under similar circumstances. Early post-operative complications included electrolyte/fluid disturbance in 2 patients, 2 cardiac arrhythmias, one DVT/PE and 2 returns to the O.R. for pain caused by a misplaced pedicle screw or bone graft. One patient developed a progressive scoliosis above the fusion and one a pathological wedge compression fracture. 4 patients required late surgery including 2 who had been fused down to L5 and required extension of their fusion to the sacrum for pain associated with an L5/S1 foraminal stenosis and one who developed a painful non-union. Discussion PLIF with an Insert and Rotate technique following disc space distraction for severe and progressive adult scoliotic deformity is technically difficult and can be associated with significant
Background: The long term survival of patients with type II and III spinal muscular atrophy differs considerably from patients with Duchenne muscular dystrophy. Despite this, treatment of scoliosis in both groups is often reported together. 1. There are only sporadic reports, all with small numbers, of combined anterior and posterior (two stage) scoliosis surgery in patients with spinal muscular atrophy (SMA). 1. The aim of the current study was to document the
The August 2014 Knee Roundup360 looks at: re-admission following total knee replacement; out with the old and in with the new? computer navigation revisited; approach less important in knee replacement; is obesity driving a rise in knee replacements?; knee replacement isn’t cheap in the obese; cruciate substitution doesn’t increase knee flexion; and sonication useful diagnostic aid in two-stage revision.