Material and Methods: The study is made on 10 cadaver first metatarsals. The metatarsals are fixed to a device. The metatarsal inclination and pronation of the metatarsal can be changed by this device. 15-30-45 degrees inclination and 0-10-20 degrees pronation are applied to the metatarsals. After applying radio opaque putty to the medial and lateral articular edges; metatarsal dorsal diaphysial ridge, the x-ray and digital images are taken at different degrees of inclination and pronation. The measurement of PASA is done by graphic software on computer. The statistical analysis is performed by paired sample T-test. Results: We found that changing the inclination has no effect on PASA (p>
0.1). The pronation of first metatarsal has found to have a positive effect on PASA (p<
0.005). As the degree of pronation increases, the degree of PASA is found to be increased also. No difference was found between the measurements of x-ray and digital photography images. Discussion: Inclination of the first metatarsal can change depending on the height of the medial longitudinal arch. By this experimental study we tried to simulate the pes cavus and pes planus deformity on the radiologic measurement of the hallux by modifying the inclination and pronation of the first metatarsal. According to the current study, inclination has no effect on measurement of PASA. Pronation of the first metatarsal accompanies some hallux deformities. As pronation influences the measurement of PASA, the current data suggests that the measurement of PASA is not suitable for making clinical and surgical decisions.
Hip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes. A systematic review identified a list of measurements previously used in studies reporting radiological hip outcomes in children with CP. These measurements informed a two-round Delphi study, conducted among orthopaedic surgeons and specialist physiotherapists. Participants rated each measurement on a nine-point Likert scale (‘not important’ to ‘critically important’). A consensus meeting was held to finalize the CMS.Aims
Methods
To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so. Six surgeons and eight radiographers were invited to participate in four online surveys. The generic survey comprised erect and left and right bending radiographs of eight individuals with scoliosis, with an average age of 14.6 years. Respondents were asked to indicate whether each bending film was optimal (adequate) or suboptimal. In the first survey, they were also asked if they currently assessed the adequacy of bending films. A similar second survey was sent out two weeks later, using the same eight cases but in a different order. In the third survey, a guide for assessing bending film adequacy was attached along with the radiographs to introduce the novel T1-45B method, in which the upper endplate of T1 must tilt ≥ 45° from baseline for the study to be considered optimal. A fourth and final survey was subsequently conducted for confirmation.Aims
Methods
This study examined windswept deformity (WSD) of the knee, comparing prevalence and contributing factors in healthy and osteoarthritic (OA) cohorts. A case-control radiological study was undertaken comparing 500 healthy knees (250 adults) with a consecutive sample of 710 OA knees (355 adults) undergoing bilateral total knee arthroplasty. The mechanical hip-knee-ankle angle (mHKA), medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were determined for each knee, and the arithmetic hip-knee-ankle angle (aHKA), joint line obliquity, and Coronal Plane Alignment of the Knee (CPAK) types were calculated. WSD was defined as a varus mHKA of < -2° in one limb and a valgus mHKA of > 2° in the contralateral limb. The primary outcome was the proportional difference in WSD prevalence between healthy and OA groups. Secondary outcomes were the proportional difference in WSD prevalence between constitutional varus and valgus CPAK types, and to explore associations between predefined variables and WSD within the OA group.Aims
Methods
This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018.Aims
Methods
The purpose of our study was to compare the alignment achieved by navigated mobile bearing unicompartmental arthroplasty with that of standard instrumentation. We looked at postoperative X-Rays of 18 unicompartmental mobile bearing arthroplasties performed by two surgeons. 12 of these performed by one surgeon, consisting of 6 navigated E-Motion™ mobile bearing knees and 6, Phase 3 Oxford™ unicompartmental mobile bearing knees. The remaining 6 were Phase 3 Oxford™ unicompartmental mobile bearing knees, performed by a different surgeon.
Post-traumatic periprosthetic acetabular fractures are rare but serious. Few studies carried out on small cohorts have reported them in the literature. The aim of this work is to describe the specific characteristics of post-traumatic periprosthetic acetabular fractures, and the outcome of their surgical treatment in terms of function and complications. Patients with this type of fracture were identified retrospectively over a period of six years (January 2016 to December 2021). The following data were collected: demographic characteristics, date of insertion of the prosthesis, details of the intervention, date of the trauma, characteristics of the fracture, and type of treatment. Functional results were assessed with the Harris Hip Score (HHS). Data concerning complications of treatment were collected.Aims
Methods
A variety of surgical methods and strategies have been demonstrated for Andersson lesion (AL) therapy. In 2011, we proposed and identified the feasibility of stabilizing the spine without curettaging the vertebral or discovertebral lesion to cure non-kyphotic AL. Additionally, due to the excellent reunion ability of ankylosing spondylitis, we further came up with minimally invasive spinal surgery (MIS) to avoid the need for both bone graft and lesion curettage in AL surgery. However, there is a paucity of research into the comparison between open spinal fusion (OSF) and early MIS in the treatment of AL. The purpose of this study was to investigate and compare the clinical outcomes and radiological evaluation of our early MIS approach and OSF for AL. A total of 39 patients diagnosed with AL who underwent surgery from January 2004 to December 2022 were retrospectively screened for eligibility. Patients with AL were divided into an MIS group and an OSF group. The primary outcomes were union of the lesion on radiograph and CT, as well as the visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores immediately after surgery, and at the follow-up (mean 29 months (standard error (SE) 9)). The secondary outcomes were total blood loss during surgery, operating time, and improvement in the radiological parameters: global and local kyphosis, sagittal vertical axis, sagittal alignment, and chin-brow vertical angle immediately after surgery and at the follow-up.Aims
Methods
INTRODUCTION. One of the main goals of total knee arthroplasty (TKA) is to restore an adequate range of motion. The posterior femoral offset (PFO) may have a significant influence on the final flexion angle after TKA. The purpose of the present study was to compare the conventional, radiologic measurement of the PFO before and after TKA to the intra-operative, navigated measurement of the antero-posterior femoral dimension before and after TKA implantation. MATERIAL. 100 consecutive cases referred for end-stage knee osteo-arthritis have been included. Inclusion criteria were the availability of pre-TKA and post-TKA lateral X-rays and a navigated TKA implantation. There was no exclusion criterion. METHODS. Pre-TKA and post-TKA digital lateral X-rays were performed with fluoroscopic control of the superposition of both femoral. The PFO was defined as the distance between the anterior femoral cortex and the most posterior point of the femoral condyles (figure 1). The TKA was implanted with help of a navigation system. The standard navigated procedure involves a navigated palpation of the anterior femoral cortex just proximal to the trochlea (figure 2) and a navigated palpation of the most posterior point of both femoral condyles (figure 3), allowing computation of the pre-TKA navigated PFO. The post-TKA PFO was calculated according to the the antero-posterior position of the prosthetic trochlea in comparison to the anterior femoral cortex and the size of the femoral implant. Pre-TKA and post-TKA radiologic and navigated measurements of the PFO were compared with a paired Student t-test and calculation of the coefficient of linear correlation. The coherence between the data was analyzed according to Bland-Altman. The radiologic and navigated PFO changes were compared with a paired Student t-test and calculation of the coefficient of linear correlation. The sample size was calculated to allow detecting a 3 mm difference at a 0.05 level of significance and a power of 0.90. All statistical tests were performed at a 0.05 level of significance. RESULTS. The mean paired difference between pre-TKA radiologic and navigated measurement was 3.8 mm ± 4.1 mm (range, −5.2 to 17.9 mm) (p<0.001). There was a significant moderate positive correlation between both measurements (R² = 0.41, p<0.001). There was a good coherence between both measurements (R² = 0.04). The mean paired difference between post-TKA radiologic and navigated measurement was 5.9 mm ± 4.8 mm (range, −24.0 to 16.9 mm) (p<0.001). There was a significant moderate positive correlation between both measurements (R² = 0.51, p<0.001). There was a poor coherence between both measurements (R² = 0.11). The mean paired radiologic PFO change was 1.5 mm ± 5.2 mm. The mean paired navigated PFO change was −0.9 mm ± 4.0 mm (range, −14.0 to 12.2 mm) (p<0.001). There was a significant weak positive correlation between both measurements (R² = 0.21, p<0.001). There was a good coherence between both measurements (R² = 0.002). DISCUSSION. We observed a significant difference between radiologic and navigated results. This difference is likely to be clinically significant. CONCLUSION.
Ankle fracture fixation is commonly performed by junior trainees. Simulation training using cadavers may shorten the learning curve and result in a technically superior surgical performance. We undertook a preliminary, pragmatic, single-blinded, multicentre, randomized controlled trial of cadaveric simulation versus standard training. Primary outcome was fracture reduction on postoperative radiographs.Aims
Methods
To investigate the risk factors for unsuccessful radial head reduction (RHR) in children with chronic Monteggia fractures (CMFs) treated surgically. 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 Aims
Methods
The impact of a diaphyseal femoral deformity on knee alignment varies according to its severity and localization. The aims of this study were to determine a method of assessing the impact of diaphyseal femoral deformities on knee alignment for the varus knee, and to evaluate the reliability and the reproducibility of this method in a large cohort of osteoarthritic patients. All patients who underwent a knee arthroplasty from 2019 to 2021 were included. Exclusion criteria were genu valgus, flexion contracture (> 5°), previous femoral osteotomy or fracture, total hip arthroplasty, and femoral rotational disorder. A total of 205 patients met the inclusion criteria. The mean age was 62.2 years (SD 8.4). The mean BMI was 33.1 kg/m2 (SD 5.5). The radiological measurements were performed twice by two independent reviewers, and included hip knee ankle (HKA) angle, mechanical medial distal femoral angle (mMDFA), anatomical medial distal femoral angle (aMDFA), femoral neck shaft angle (NSA), femoral bowing angle (FBow), the distance between the knee centre and the top of the FBow (DK), and the angle representing the FBow impact on the knee (C’KS angle).Aims
Methods
Aims. To study the outcomes of DVR plating for distal radius fractures. Methods. We prospectively studied all patients managed with a DVR plate, over a twelve-month period in 2006/07. All patients were seen in our dedicated research clinic at 2, 6, 12 and 26 weeks post-operatively. Physiotherapy started at 2 weeks post-operatively. Active range of motion (ROM) of the injured wrist was recorded at 6, 12 and 26 weeks and compared with the normal side. Standardised radiographs were taken at 2 and 6 weeks and compared with pre- and post-operative films for radial and volar angulations, relative radial length, ulnar variance and implant position. Patient satisfaction was measured with the Patient Rated Wrist Evaluation score (PRWE) at 6, 12 and 26 weeks. Results. 129 patients (male:female 1:3) with a median age of 59 years (92-17 years) were seen. Mean measurements of pre-operative films were of 16 degrees dorsal angulation, 15 degrees radial inclination, 7 mm relative radial length and +2mm ulnar variance. In comparison post-operative results were -6 degrees, +22 degrees, 11mm and 0mm respectively, which remained unchanged at 2 and 6 weeks. The mean comparative active ROM was 70%, 88% and 98% at 6, 12 and 26 weeks respectively. The PRWE Score showed a mild degree of disability at 6 weeks and only minimal disability at 12 and 26 weeks. There were two cases of lost fracture position and no case of deep infection. Conclusion. Our study suggests that the DVR locking plate provides excellent fracture stability, allowing for early rehabilitation, with minimal complications.
Background. Patellar instability is a complex, multi-factorial disorder. Radiological assessment is regarded as an important part of the management of this population. The purpose of this study was to determine the intra- and inter-rater reliability of common radiological measurements used to evaluate patellar instability. Methods. One hundred and fifty x-rays from 51 individuals were reviewed by five reviewers: two orthopaedic trainees, a radiological trainee, a consultant radiologist and an orthopaedic physiotherapist.
Introduction/Background: Uncemented total hip arthrolpasty [THA] was developed to achieve biological fixation of the prosthesis through integration of components into the prepared bone, especially in young patients with higher functional demands and longer life expectancy. The aim of this study was to update the results of a prospectiv series of primary cementless total hip arthroplasties after a minimum of 10 years follow-up. Materials and Methods: We reviewed 201 consecutive uncemented Bi-contact [Aesculap, Tuttlingen, Germany] THA in 177 patients. Harris hip score was recorded pre-operatively and at most recent follow up.
Summary. The dGEMRIC index correlates more strongly with the pattern of radiographic joint space narrowing in hip osteoarthritis at five year follow-up than morphological measurements of the proximal femur. It therefore offers potential to refine predictive models of hip osteoarthritis progression. Introduction. Longitudinal general population studies have shown that femoroacetabular impingement increases the risk of developing hip osteoarthritis, however, morphological parameters have a low positive predictive value. Arthroscopic debridement of impingement lesions has been proposed as a potential strategy for the prevention of osteoarthritis, however, the development of such strategies requires the identification of individuals at high risk of disease progression. We investigated whether delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) predicts disease progression. This imaging modality is an indirect measure of cartilage glycosaminoglycan content. Patients and Methods. 34 asymptomatic individuals from a longitudinal cohort study (sibkids) were assessed at baseline with the collection of Patient Reported Outcome Measures (PROMs), anteroposterior and cross-table lateral radiographs, 3D morphological MRI, and dGEMRIC at 3T of their index hip. A dGEMRIC index was calculated as a ratio of the anterosuperior acetabular cartilage T1 relaxation time and the total femoral and acetabular cartilage T1 relaxation time. 29 individuals were followed up at 5 years for repeat assessment (average age 51 years and range 36 to 67).
Introduction and Aims: Although the association between femoroacetabular impingement and osteoarthritis is established, it is not yet clear which hips have the greatest likelihood to rapidly progress to end-stage disease. We investigated the possible relation of specific radiological parameters, each indicative of a structural aspect of the hip joint, to progression of osteoarthritis. Materials and Methods: Pairs of plain anteroposterior pelvic radiographs, spaced at least 10 years apart, of 43 patients (47 hips) with pistol-grip deformity of the femur and mild (Tönnis grade 1) or moderate (Tönnis grade 2) arthritis were reviewed.
Introduction: The technology available for replacing/ resurfacing the hip joint is constantly evolving. The practicing surgeon can now choose from a wide array of components to perform a cemented, hybrid, uncemented total hip arthroplasty (THA), or a hip resurfacing. The potential advantages and disadvantages of all have been widely reported in the literature. The choice of implant depends on a number of factors, such as, patient age and level of activity, hip anatomy, and the surgeons’ preference and expertise. The aim of our study was to evaluate and compare the restoration of hip biomechanics following the insertion of three different, commonly used constructs. Methods: We compared the postoperative anteroposterior radiographs from 40 patients who underwent cemented THA, 45 patients who underwent uncemented THA and 40 who underwent Articular Surface Replacement (ASR). All procedures were carried out by a single consultant orthopaedic surgeon who was experienced in the insertion of all three different implant designs. The acetabular offset and height, and the femoral offset and limb length were measured, with reference to the normal contralateral hip, using accepted methods. Results – Hip resurfacing resulted in a significant reduction in femoral offset (p <
0.001), with accurate restoration of limb length. Both cemented and uncemented THA resulted in a significant increase in femoral offset, both also resulted in significant leg – lengthening (p<
0.001), this was more marked with uncemented THA’s.
Background: The determinants of range of movement following knee replacement may be surgically modifiable (tibial slope, posterior condylar offset or the level of the joint line) or non modifiable (pre-operative range of movement, sex or BMI). We aimed to quantify the influence of these factors upon restoration of flexion in the arthritic knee following knee replacement. Methods: Patients were included from two prospective trials for three different designs of knee replacement. Range of movement was recorded using a standard measuring technique preoperatively and 12 months after surgery.
Background: First MTP joint arthrodesis is a well established and very common procedure for painful arthrosis. Plate fixation method has been used with successful outcome (97–100%) by few authors but it is yet to be accepted universally for fear of complications. Aim: To evaluate clinical and radiological outcome of first MTP fusion using low profile Acumed plate. Methods: We retrospectively reviewed 125 patients who had 1st MTP arthrodesis (over 6 year period) for painful Hallux Rigidus not relieved by conservative means and for rheumatoid forefoot reconstruction. The preoperative evaluation included a subjective questionnaire, physical exam, AOFAS hallux score and radiographic measurements. Post-operatively, all patients were mobilised with heel weight bearing shoes for six weeks. All patients had follow up of minimum 6 months(range 6 months to 6 years). At the final follow-up all patients had answered a questionnaire which evaluated any limitations of daily activity and restrictions in footwear.
