The Medial Patellofemoral Ligament (MPFL) is the main restraining force against lateral patellar displacement. It is often disrupted following patellar subluxation or dislocation. MPFL reconstruction is frequently performed when conservative management fails and the patient experiences recurrent patellar dislocation. Various MPFL reconstruction procedures have been described in the literature and reported outcomes are encouraging. This study analyses the radiographic outcomes following MPFL reconstruction.

From January 2006 to January 2011, 76 consecutive patients (80 knees) with patellar recurrent dislocation underwent medial patellofemoral ligament reconstruction in three large teaching hospitals. Mean follow-up was 31.8 months (range, 13–72). Semitendinosus and gracilis autografts were used for the reconstruction and all procedures were carried out by the senior authors (WL, BR, CW, MB).

Plain radiographs (Anteroposterior (AP), Lateral and Skyline) performed preoperatively and postoperatively were used to compare the sulcus angle, congruence angle, lateral patellofemoral angle, trochlear dysplasia (Dejour classification), trochlear boss height and patellar height (Caton-Deschamps ratio). Plain radiographs (Lateral) performed postoperatively were used to evaluate the femoral tunnel placement used for MPFL reconstruction.

The sulcus angle improved from 143.2° (122.9–157.7) to 139.3° (115.7–154.6) and the congruence angle improved from 26.7° (−17.5–82.6) to 0.26° (−35.3–7.8). The lateral patellofemoral angle was 7.99° (3.2–19.2) preoperatively and 9.02° (3.2–18.2) postoperatively. The Caton-Deschamps ratio was 1.2 (1.0–1.5) preoperatively and 1.0 (0.8–1.1) postoperatively. Using the Dejour classification of trochlear dysplasia, all preoperative radiographs were considered to be grade C or D and all postoperative radiographs were considered to be grade A or B. Trochlear boss height was 5.9mm (1.8–11.6) preoperatively and 4.7mm (1.6–6.9) postoperatively. 59% of the femoral tunnels were considered to be in a good position on postoperative radiographs.

This study displayed a significant improvement in postoperative radiographic parameters, demonstrating the importance of anatomic restoration when performing MPFL reconstruction.

The purpose of this prospective study was to assess the functional outcome in thoracolumbar vertebra fractures that were treated nonsurgically.

From 1999 to 2005, seventy-four patients with single-level nonpathologic fractures, with angle of kyphosis less than 20° and with no or minor neurological impairment and without neurological deterioration were managed non-operatively. A custom-made thoracolumbosacral orthosis was worn by all patients for six months and early ambulation was recommended. The average follow-up period was 34 months (range, 14 to 59 months). Functional, pain, and employment status were assessed using the Denis system. Radiographic evaluation of vertebral kyphosis, local kyphosis angle, anterior body compression, and sagittal index were performed at time of injury, and final follow-up. Paired t test and Wilcoxon signed rank test were used for statistical analyses.

At final follow-up, 63 patients (86.3%) were rated P1 (no pain), 8 patients (11%) were rated P2 (occasional pain), 2 patients (2.7%) were rated P3 (moderate pain), and 0 patients (0%) were rated P5 (constant severe pain). Sixty-five patients (90%) were able to work at the same level (W1) and the rest was W2 and no W3,4,5. According to radiographic evaluation although all the results showed statistically significant differences, these were too small to be important clinically. The initial local kyphosis angle averaged 14.73° (sd 5.08), and at follow-up it averaged 15.99° (sd 4.98). The initial sagital index averaged 16.1° (sd 5.69), and at follow-up it averaged 16.79° (sd 5.63).

As conclusion nonoperative treatment of selected patients with thoracolumbar vertebral fracture predictably leads to acceptable functional and radiographic results. Conservative management resulted in minimal loss of work potential in these patients and no correlation was found between fracture type and clinical outcome.

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.

A prospective study was conducted to determine the functional and radiographic outcome of sacroiliac arthrodesis. Twenty patients were enrolled and the mean follow-up period was 4.6 years. SI joint instability was the most common etiology. Seventeen of twenty patients (85%) went on to a solid fusion. Statistically significant improvement was noted postoperatively in five of eight SF-36 categories (PF, RP, BP, SF, and RE), with a positive trend in the others. We conclude that sacroiliac arthrodesis is successful in the treatment of sacroiliac disorders, however its success is dependent on careful patient selection.

The purpose of this study was to determine the functional and radiographic outcome of sacroiliac joint arthrodesis.

Twenty consecutive patients were enrolled with an average age of 45.1 years. Plain radiographs and SF-36 Health Surveys were obtained prior to surgery and during the follow-up period.

Mean duration of symptoms was 2.6 years and mean follow-up was 4.6 years. SI joint instability was the most common etiology and was present in twelve patients. Seventeen of Twenty (85%) patients went on to a solid fusion. Of the three patients who did not fuse, two remained symptomatic and required revision surgery. Fifteen of twenty patients (75%) completed pre- and post-operative SF-36 forms. Improvement was noted in all SF-36 categories. PF improved from 31.8±31.0 to 50.7±34.5 (p< 0.030). RP improved from a 0.0±0.0 to 31.3±41.5 (p< 0.012). BP improved from 15.6±11.1 to 35.7±24.7 (p< 0.009). SF improved from 37.5±21.0 to 61.5±24.1 (p< 0.028). Finally, RE improved from 46.2±48.2 to 66.7±44.9 (p< 0.012). Improvement was also noted in GH, VT, and MH from 52.2±23.5, 30.8±21.7, and 56.0±28.3, respectively to 56.1±20.5, 44.6±25.8, and 61.3±26.3, respectively, however these were not significant (p values 0.345, 0.064, and 0.220, respectively).

In this prospective study, a fusion rate of 85% was achieved, and statistically significant improvement in functional outcome was observed in five of eight SF-36 categories with a positive trend in the others.

Sacroiliac arthrodesis is successful in the treatment of SI joint instability, arthritis, spondyloarthropathy, and dysfunction, however, its success is dependent on careful patient selection.

Introduction

Post-traumatic arthritis is the commonest cause of arthritis of the ankle. Development of arthritis is dependent on the restoration of pre-injury anatomy. To assess the effect of grade of lead surgeon on the accuracy of surgical reduction, we performed a retrospective radiographic analysis of all ankle fractures undergoing open reduction and internal fixation, in a single institution.

Objective: To evaluate the subjective clinical outcomes, radiographic results and complications associated with single solid rod anterior instrumentation in neuromuscular scoliosis.

Design: Retrospective clinical case series with a mean follow up of 30 months (range 24 – 42 months).

Subjects: 9 consecutive cases (6F, 3M) with a mean age 15 years (range 11 – 24 years), underwent single solid rod anterior instrumentation of their neuromuscular thoracolumbar scoliosis between 1994 and 2000. The heterogeneous patient group consisted of 5 spinal dysraphism, and 1 each of prune belly syndrome, arthrogryposis, myotonic dystrophy and congenital myopathic dystrophy (muscle eye brain syndrome). All patients were ambulatory and had minimal pelvic obliquity (< 15 degrees).

Outcome measures: Pre-operative, post-operative and final follow up measurements were collected for 1) Cobb angles, 2) apical vertebral translation (AVT), 3) thoracic kyphosis (T5-12) and 4) lumbar lordosis (L1-5). Operative complications, pseudarthrosis, metalwork failure and loss of correction were also recorded.

Results: There was 1 each of rod breakage and upper thoracic curve progression requiring supplementary posterior surgery. For the remaining 7 patients, the average follow-up corrections for Cobb angle was 56% (49 to 22 degrees), AVT was 49% (5.1 to 2.6 cms), and both the thoracic kyphosis and lumbar lordosis remained unchanged. No significant loss in correction occurred during the post-operative period to final follow-up in all the above parameters. No pseudarthrosis, vascular or neurological complications were encountered. Subjectively, there were 6 excellent and 1 good results.

Conclusions: In this limited case review, selective anterior instrumentation for neuromuscular scoliosis using a single solid rod system resulted in acceptable clinical and radiographic outcomes. Our results appear to compare favourably with those published for the recommended method of posterior instrumentation. Advantages include preservation of distal lumbar motion segments whilst maintaining segmental saggital and coronal alignment. We believe that this method of scoliosis correction has a definite yet select role in patients who are ambulatory, have minimal pelvic obliquity (< 15 degrees), non-progressive pathology and near normal mental function.

Aim

To establish the incidence of clinically significant avascular necrosis (AVN) and the resultant influence on radiological outcome following medial open reduction for DDH.

There has been considerable debate regarding the factors that predict clinical and radiographic outcomes in patients with acetabular fractures and associated posterior hip dislocations. We used a prospective database of acetabular fractures to identify variables associated with clinical and radiographic outcomes. Quality of fracture reduction was identified as the only significant predictor of radiographic grade, clinical function, and development of post-traumatic arthritis. Our findings support Letournel’s report that quality of the fracture reduction remains the most important factor associated with outcome in patients with acetabular fractures and concomitant posterior hip dislocations.

There has been considerable debate regarding the factors that predict clinical and radiographic outcomes in patients with acetabular fractures and associated posterior hip dislocations.

To identify variables associated with clinical and radiographic outcomes.

Utilizing a prospective database of acetabular fractures, we identified patients with posterior hip dislocations operatively managed within three weeks of injury and having a minimum of two years of follow up. Demographic information, operative findings, and outcomes were recorded. We conducted a series of uni-variable analyses to determine whether any independent variables were significantly associated with the dependent variable.

Among one hundred and nine eligible patients with posterior hip dislocations, the most common fracture types included the posterior wall and transverse with associated posterior wall fractures. An anatomic reduction of the fracture was achieved in ninety-six patients. At their most recent follow up, the majority of patient maintained a good to excellent radiographic grade. Of those who underwent clinical outcome grading (ninety-four patients), 83% achieved good or excellent outcomes. Overall radiographic grade correlated with each domain of the clinical grade including ambulation, range of motion, and pain. Quality of fracture reduction was identified as the only significant predictor of radiographic grade, clinical function, and development of post-traumatic arthritis. All patients with poor reductions and imperfect reductions, respectively, had developed arthritis compared to 24% of patients with anatomic reductions.

Our findings support Letournel’s report that quality of the fracture reduction remains the most important factor associated with outcome in patients with acetabular fractures and concomitant posterior hip dislocations.

Funding: This study was funded by a research grant from Stryker Orthopaedics, Los Angeles, California. Dr. Bhandari was funded, in part, by a fellowship from AO International, Davos, Switzerland and AO North America, Paoli, Pennsylvania.

We compared self-reported pain and function, complications and revision rates, and radiographic outcomes of hydroxylapatite(HA) or cemented tibial fixation in the first five years following primary total knee arthroplasty. This was a randomised clinical trial of eighty-one patients

Prospective, randomised clinical trial. Patients less than seventy years of age with non-inflammatory knee arthritis. Eighty-one patients were randomised at the time of surgery to receive HA or cemented tibial fixation. Subjects were evaluated preoperatively, six months, one and five years postoperatively by a physical therapist who was blinded to group allocation. X-rays were evaluated by an experienced arthroplasty surgeon who did not perform any of the surgeries. Self-reported pain and function, the primary outcomes, were measured by the Western Ontario McMaster (WOMAC) Osteoarthritis Index and the RAND 36-item Health Services Inventory (RAND-36). Complications and revision rates were determined through hospital record review and at each patient evaluation. The Knee Society Radiological Score was used to evaluate plain radiographs at each assessment.

There was slightly more pain in HA group at six months as measured by both the WOMAC and RAND-36, a difference that disappeared by the one-year assessment. There were no differences in function, radiographic findings or complications at any time. Finally, no subjects required revision of the tibial prosthesis during the study.

Overall, no significant differences were seen between groups. The initial difference in self-reported pain disappeared by twelve-months postoperatively. At five-years postoperatively, there is no advantage to HA tibial fixation over cemented tibial fixation.

Purpose of the study: We report the clinical and radiographic results of a series of revision total hip arthroplasties performed for aseptic loosening using a non-demented modular femoral implant (PP).

Material and methods: From 1991 to 2003, 146 revisions of total hip arthroplasty were performed using the same non-cemented modular femoral implant (PP). At mean nine years follow-up (3.5–17 years), 24 patients had died, 26 had insufficient data for review and 39 were lost to follow-up. The analysis thus included 54 cases. All revisions were performed for aseptic loosening. Mean age at surgery was 60 years. Preoperative bone damage, according to the Sofcot classification, was grade I and II (69%), grade III (26%), grade IV (5.5%). Clinical outcome was assessed with the Harris and Postel-Merle-d’Aubigné scores. The radiological review analysed stem anchoring, lucency and periprosthetic reconstruction.

Results: At mean nine years follow-up, the mean Harris score was 71 points, the mean PMA score 12.8 points. Patient satisfaction was 70%. There were five cases with deep infection (9%), five with dislocation and six intra-operative periprosthetic fractures. Trochanterotomy non-union was noted in 26% of patients. Mean impaction of the femoral stem was 5 mm (range 0–16 mm). There was a statistically significant association between the degree of bone damage and the quality of the bone reconstruction (p=0.012). Mean increase in cortical thickness in zones 1 and 2 (Gruen) was 1.1 mm and 1.6 mm respectively. In Gruen zones 2 and 6, the gain was 6 and 10 mm respectively. There were nine surgical revisions (17%) for deep infection (n=4), recurrent aseptic loosening and fracture of the femoral implant (n=1). The ten-year survival taking aseptic loosening as the endpoint was 90%.0

Discussion and Conclusion: Our work showed the good long-term results obtained with this implant for revision total hip arthroplasty. It allows clinical improvement, periprosthetic bone reconstruction and a low rate of surgical revision.

Treatment Centres (TCs) specialise in common elective operations with long waiting lists. One of the concerns that has arisen with this enforced new healthcare model is the potential for suboptimal outcomes after joint arthroplasty. In order to decrease this risk we set in place a number of measures and have evaluated the outcome of the fist 100 total hip and total knee replacements undertaken at our TC and compared these to 100 consecutive controls undertaken concurrently by out hip and knee service. •Cases were only to be performed by consultant orthopaedic surgeons appointed to our trust – to the exclusion of visiting / sessional arrangements. •Same implants and care pathways as used within the rest of our department. •Weekly team arthroplasty rounds and planning sessions.

There was no significant difference in baseline demographics with both groups showing a slight female preponderance, and similar age ranges (35–88 av. 62; 42–86 av. 64). The treatment centres patients were heavier (78Kg range 48–111Kg; 72Kg range 43–101Kg). The TC group averaged 2.9 comorbidities per patient compared to 2.2. The average time to discharge was similar at 7.6 days . There was no significant difference in the improvement in Harris Hip or Knee Society Scores at a minimum 6 months follow-up. There were 2 infections in the TC group and one in the control group. There were 3 thromboembolic complications in each group and there was one unrelated death in each group. There was one dislocation and one fracture in the TC group and two fractures in the control group. Radiographic criteria including implant size, position, slope, offset, cementing and alignment were comparable in the two groups.

TC patients are not “fitter more predictable” patients and may have greater comorbidity. Our insistence on a local consultant led service and on identical standards to those of our non TC department have generated similar short term outcomes to those of non TC patients.

Purpose: Since the pathomechanism of patellofemoral malalignment is complex, multifactorial and varies individually, the ideal treatment has been a matter of controversy. The purpose of this study was to demonstrate the clinical outcome and radiographic changes of knees with patellofemoral malalignment treated with Fulkerson osteotomy after a minimum follow-up of 24 months.

Materials and Methods: Sixty knees in 40 patients (32 female and 8 male) were examined with a mean of 55 20 (25 97) months after having undergone medialization of the tibial tubercle using Fulkerson osteotomy for patel-lofemoral malalignment. Mean age at surgery was 20 7 (12 42) years. Prior surgery of medial retinacular plication in 4 knees and lateral retinacular release in 1 knee had been performed. During surgery, amount of tibial tubercle transfer was determined by examining the patellar tracking over full range of knee motion. After Fulkerson osteotomy, proximal realignment procedures were added depending on arthroscopic appearance of the patellofemoral adaptation. The clinical outcome was evaluated using Fulkersons knee instability scale. The radiographic parameters including congruence angle, lateral patellofemoral angle, tilting angle and lateral shift ratio were measured in Merchant view.

Results: Mean distance of medial transfer of tibial tubercle was 12.8 3.1 (8 22) mm. Lateral retinacular release in 54 knees and adductor magnus tenodesis (Avikainen procedure) in 2 knees were simultaneously performed combined with Fulkerson osteotomy. All radiographic parameters at the final follow-up were significantly improved compared to the preoperative values (p < 0.05 in a paired t-test), that is, from 23.0 14.6 to 0.4 13.7 degrees in congruence angle, from −6.3 9.0 to 0.4 6.9 degrees in lateral patellofemoral angle, from 25.1 11.5 to 16.3 5.6 degrees in tilting angle and from 35 24 to 17 9% in lateral shift ratio. Mean score in Fulkersons knee instability scale was 96 5 points at the final follow-up. All knees except 3 were ranked as excellent, very good or good. Two knees with moderate osteoarthritis of the patellofemoral joint were ranked as fair. One knee that had postoperative recurrence of patellar subluxation underwent a revision surgery with Avikainen procedure.

Discussion: In the clinical study with a minimum 2-year follow-up, Fulkerson tibial tubercle osteotomy provided excellent or good overall outcome in 93% of patients in combination with proximal realignment surgeries. Although all radiographic parameters were significantly improved, it was found that the lateral shift of the patella was more effectively corrected compared to the lateral tilt. It was suggested that reconstruction of the medial patellofemoral structures might be more suitable than Fulkerson osteotomy for some knees characterized by significant lateral tilt.

Introduction: A prospective randomized study of artifical disc replacement vs. lumbar fusion for one-level disc pathology with 2 year minimum follow-up was completed in compliance with a U.S. FDA protocol.

Methods: A total of 15 investigational sites enrolled 375 subjects with a randomization in a 2:1 ratio. Of the 375, 205 were randomized to receive the Charité artificial disc, and 99 were randomized to receive anterior lumbar interbody fusion with BAK cages. An additional group of 71 patients received the Charité disc as “training cases” prior to beginning randomization. Clinical outcome measures included VAS, Oswestry Disability Index, and SF-36 Healthy Surveys. A total of 6,900 radiographs were digitized throughout the 24 month treatment interval. The 276 disc replacement patients were allocated into one of three groups based on radiographic technical paramenters-- Group I – Ideal, defined as Charité disc placement within 3 mm of ideal in both planes. Coronal plane = AP radiograph = midline or within 3 mm of midline. Mid-Sagittal plane = Lateral radiograph = 2mm posterior to middle of vertebral body or within 3mm of this axis. Group II —Suboptimal (not ideal) and Group III – Poor.

Results: The Charité prosthesis was significantly more effective than BAK in restoring the height of the collapsed disk space (p < 0.001). In Charité cases, the mean initial disc space height at the L5-S1 operative level was 5.2 mm +/− 1.44 (Std Dev) and increased to a mean of 13.5 mm +/− 1.18 (Std Dev). For BAK, the initial disc space height was 5.9.mm +/− 1.74 and increased to an immediate post-operative disk space height of 11.9 mm +/− 2.07. There was less subsidence with the Charite disk replacement than the BAK control at 2 years (p < 0.001). Of the 276 subject radiographs analysed with Charité disc replacement, 83% were classified as Group I, 11% as Group II, and 6% as Group III.

The mean Oswestry Disability Index scores at 2 years correlated with technical accuracy in placement of the prosthesis: Group I – 24.1; Group II – 30.3; and Group III – 36.3 (p < .05). The Mean VAS scores at 2 years correlated with technical accuracy in placement of the prosthesis: Group I – 28.3; Group II – 35.4; and Group III – 48.4 (p = 0.016). The mean flexion/extension range of motion and prosthesis function also correlated with device placement: Group I – 7.12 +/− 4.06 degrees; Group II – 7.47 +/− 4.41 degrees; and Group III – 3.15 +/− 3.51 degrees (p = 0.003).

Discussion: The surgical technical accuracy of Charité artificial disc placement correlated with clinical outcome, range of motion, and device functionality at 2 years. The Charité Lumbar Disk replacement proved to be a successful alternative to traditional lumbar fusion in every parameter. The results from this U.S. Investigational study confirm that proper placement of the Charité artificial disc improves clinical and radiological outcomes.

Historically avoidance of avascular necrosis (AVN) has been the primary objective in the management of an acute unstable slipped upper femoral epiphysis (SUFE). When achieved through pinning in situ it was invariably associated with significant malunion. With increasing appreciation of the consequences of femoroacetabular impingement, modern techniques aim to correct deformity and avoid AVN. Exactly what constitutes an acute unstable SUFE is a source of debate but should represent 5–10% of all cases. This audit reviewed cases over the past 25 years treated in one region. Of 89 patients with 113 slips, 21 hips were recorded as unstable. During this period the management has evolved from closed reduction and stabilization through pinning in situ, to open reduction. Radiographic outcomes following these three treatment methods were compared with record of any subsequent surgery in the form of osteotomy or total hip arthroplasty. Currently the lowest reported incidence of AVN in patients with an acute unstable slip is associated with the Parsch technique which combines open arthrotomy, digital reduction and screw fixation. Early outcomes with this technique are in accordance with those reported in the literature and represents a significant improvement in outcome when compared to earlier techniques used in the management of the severe unstable SUFE

Introduction. A modern total knee replacement system was introduced in 2012 in order to improve the mechanics of total knee replacement (TKR). The purpose of this study was to assess the early clinical and radiographic outcomes of patients who have been treated with this modern TKR system at two years postoperatively. Methods. Patients who received this TKR system between June of 2012 and September of 2014 were included in this prospective registry-based follow-up study. Demographics, component, and surgical data were collected. Radiographic outcomes were also assessed. Patient reported outcome measures (PROMs) of all patients with 2-year follow-up data were collected. Reasons for revision and overall survival at 2-years were evaluated. Results. The study population consisted of 290 patients (307 knees). The mean age was 66 years and 61% were women. 250 patients received cruciate retaining and 57 patients posterior stabilized implants. The median tibiofemoral axis was in 4° valgus and the femoral component was in 5° valgus and 2° flexion. The median coronal and sagittal alignment of the tibial component was −1° varus and −5° slope, respectively. Most patients had tibial components that fit the tibial resection. At one year, 7 of 80 knees had a radiolucency in the tibia or femur. At two years, two of 30 knees had a radiolucency in the tibia or femur. Mean PROMs for thirty-six patients at two years were: EQ-5D WHI 0.76 (range 0.31–1.00), EQ-5D VAS 82 (range 48–98), UCLA activity score 5.3 (range 2–10), KOOS pain 70.9 (22–100), symptoms 69 (14–96), ADL 74.2 (18–100), sports 51.4 (0–100), and QoL 59.8 (0–90). Cumulative 2-year implant survival was 97.1%. There were 7 revisions for infection and 2 revisions due to an unsatisfactory clinical outcome. Conclusion. Clinical and radiographic outcomes at two years were good, and overall implant survival was excellent

Introduction. This study compares outcomes of vertebroplasty(VP) and kyphoplasty(KP) in 125 consecutive female Asian patients above 65 years with L1 osteoporotic vertebral compression fractures. Methods. 57 and 68 patients underwent VP and KP respectively from 2004 to 2008. Outcomes were measured prospectively at pre-operation, 1 month, 6 months and 2 years post-operation by blinded assessors. Radiographic outcome: Anterior, middle and posterior vertebral heights of the L1 vertebral body Functional outcome: Short-Form 36(SF-36) score, Visual Analogue Scale(VAS) score for back pain. Results. There was greater improvement of anterior and middle vertebral heights immediately post-surgery for the KP group as compared to the VP group(P<0.001). At 2 years post-surgery, the KP group had better maintenance of L1 vertebral body height with percentage loss of 16.4%, 17.3% and 8.84% of anterior, middle and posterior vertebral height respectively as compared to the VP group who had a greater loss of 29.2%, 42.3% and 17% respectively(p<0.001). Back pain improved post-operatively in both groups with no significant difference in VAS back pain score between the two groups at each follow-up time point(P>0.05). SF-36 score improved post-operatively in both groups (P=0.001). At 2 years post-surgery, the physical functioning domain of SF-36 was better in the KP group (P=0.01). Conclusion. KP provides better restoration and maintenance of anterior and middle vertebral heights with better physical function outcome”

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 peri-operative morbidity. The purpose of this paper is to report the radiographic and clinical outcomes of posterior-based circumferential arthrodesis using a novel expandable interbody cage. Methods:. A prospective pilot clinical trial with one year follow-up of the only expandable cage approved by the FDA for interbody application. Clinical outcomes measured include ODI and VAS for back and leg. Radiographic outcomes include arthrodesis rates based upon CT scan. Statistical significance for change in health status was calculated using Student's t-test. Results:. 10 consecutive patients (11 levels) with lumbar degenerative pathology underwent circumferential arthrodesis with a transforaminal interbody approach. 10 of 11 levels were fused based upon CT scan. ODI scores improved a median of 37 to 20 at 6 months and 17 at one year (p = 0.0003). The VAS for back and leg pain likewise from 6 to 2 at 12 months (p = −.003). No patient reported an increase in leg pain from pre-op to post-op. One patient with a 2-level fusion had a non-union at 1 level requiring revision surgery. Conclusion:. Circumferential arthrodesis with a TLIF approach is an important technique for the management of lumbar degenerative pathology. The experience with a novel expandable TLIF cage demonstrates excellent results based upon clinical outcome and fusion rates. The expandable interbody cage allows in-situ height increase which is useful for optimizing clinical and radiographic outcomes in TLIF surgery

Introduction:. Significant proximal femoral remodeling occurs after total hip arthroplasty (THA), with regions of bone loss, and regions of hypertrophy. This study compared three implants for changes in femoral bone mineral density over 2 years following primary uncemented hip arthroplasty with a conventional stem (THA), a novel femoral neck-sparing short hip stem (NS-THA), and resurfacing hip arthroplasty (RHA). Methods:. Seventy-one patients participated in this non-randomized, prospective study. All patients had a diagnosis of osteoarthritis and underwent primary uncemented hip arthroplasty. Dual Energy XRay Absorptomitry (DXA) scans were performed at preoperative, 3–7 days post-op, 6 weeks, 6 months, one, and two years post-op. Using custom 2 cm zones, 19 zones were observed for percent changes in bone mineral density (BMD). Radiographs and Harris Hip scores were obtained at each visit. Results:. Age, gender, and BMI were found to be statistically different with fewer females and lower age in the RHA group, and a lower age in the NS-THA group. In all three groups, regions that were located proximally were shown to be the most susceptible to bone loss. Combined 2 cm zones 1C/7C, 2A/6A, and 2B/6B showed statistical significance (p < 0.05). Bone loss in the proximal regions was 8–10% lower with the femoral neck-sparing short stem, and least in the RHA group, causing little to no BMD loss in proximal regions. Radiographic outcomes and clinical results including Harris Hip scores were equal between the groups. Conclusion:. Consistent with our hypothesis, it was found that hip arthroplasty with a conventional stem resulted in the highest proximal femoral bone loss, and resurfacing arthroplasty was associated with the least bone loss. The femoral neck-sparing short stem ameliorated the bone loss seen with traditional hip arthroplasty, and approximated the bone preservation seen with hip resurfacing. The short stem neck-sparing device may provide some of the benefits of hip resurfacing, but could potentially have wider indications for use

Purpose: To describe the pattern of injury, surgical technique and outcomes of Monteggia type IID fracture dislocations. Method: Design: Retrospective review of prospectively collected clinical and radiographic patient data in orthopaedic trauma database with prospectively collected outcome scores. Setting: Level 1 university based trauma center. Patients / Participants: All patients with Monteggia type IID fracture dislocations admitted from January 2000 to July 2005. Intervention: Review of patient demographics, fracture pattern, method of fixation, complications, additional surgical procedures, and clinical and radiographic outcome measures. Main Outcome Measurements: Clinical outcomes: elbow range of motion, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), PREE (Patient Rated Elbow Evaluation), complications. Radiographic outcomes: quality of fracture reduction, healing time, degenerative change and heterotopic ossification. Results: Sixteen patients were included in the study. All fractures united. There were seven complications in 6 patients including 3 contractures with associated heterotopic ossification, 1 pronator syndrome and late radial nerve palsy, 1 radial head collapse and a DVT in the same patient and 1 with prominent hardware. Outcome scores were obtained on 11 patients at an average of 49 months (range 25 – 82 months) post-operatively. The average Quickdash score was 11 (range 0–43) and the average PREE score was 13 (range 0–34). Conclusion: Monteggia IID fracture dislocations are complex injuries with a recurring pattern. Rigid anatomic fixation, early range of motion and avoidance of complications leads to a good outcome

Background. Proximal phalangeal fractures are caused by an injury to the dorsum of the hand. This usually causes volar angulation which is unstable when reduced. K-wiring or external fixation can damage the soft tissue envelope, can introduce infection and can loosen or displace. Traction splinting is not well described for these fractures. Objectives. Functional and radiographic assessment of all patients with proximal phalangeal fractures treated with traction splinting. Methods. Theatre records were examined for relevant injuries over a 2 year period. These patients were then assessed using a QuickDASH score, a questionnaire specific to traction splinting and with pre-op, intra-op, post-op and follow-up radiographs. Results. A total of 7 patients were treated with traction splinting, all by the senior author (FJS). Clinical follow was 16 months (range12-20). QuickDASH scores were 0, 0, 0, 0, 0, 2.5, 25/100. With regard to work (n=6), all patients but one scored 0/100 for disability with one patient describing mild work related difficulties. Those participating in sports/performing arts (n=6) scored 0/100. There were no finger-tip pain or numbness issues. Finger length perception was satisfactory in all patients. The splint slipped in 3 patients, secondary to horse riding, showering and through scratching. Two patients reported having a measurable loss of motion in the affected digit (follow-up 18 and 20 months), both with mild functional deficit. Radiographic outcomes showed that traction achieved acceptable length restoration, with no angular deformities. Finger length was maintained in all but one patient who had a shortening of 3.2mm. Conclusions. Traction splinting is a non-invasive, safe and inexpensive method of treating proximal phalangeal fractures. Results of our follow-up study show excellent functional and radiographic outcomes with minimal long term morbidity for this treatment option