Aims

Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give rise to complications, such as nonunion, limited forearm pronation and supination, restricted elbow range of motion, radioulnar synostosis, and prolonged pain. Treatment options for this injury remain a topic of debate, with limited research available and no consensus on the optimal approach. Therefore, this trial aims to compare clinical, radiological, and functional outcomes of two treatment methods: open reduction and internal fixation (ORIF) versus nonoperative treatment in patients with isolated ulnar diaphyseal fractures.

Purpose: The optimal treatment for displaced femoral neck fractures in patients aged 60–80 years is controversial. Orthopaedists that advocate for arthroplasty cite strong evidence that there is an increased revision rate with internal fixation. We aimed to explore patient preferences for the treatment of a displaced femoral neck fracture using a novel decision board approach.

Method: We developed a decision board presenting descriptions, expected outcomes, and potential complications of hemiarthroplasty and internal fixation for the treatment of displaced femoral neck fractures. 108 healthy volunteers were confronted with the scenario of sustaining a displaced femoral neck fracture and presented the decision board, then asked to state their preference for operative procedure, and describe the reasons for their choice.

Results: After application of the decision board with all outcomes presented for each alternative (internal fixation versus arthroplasty), 61/108 (56%) participants chose internal fixation over arthroplasty as their operative procedure of choice. Factors that contributed to this choice included: less blood loss (61%), shorter operation time (31%), less mortality (20%), and less invasive (18%). Participants who preferred arthroplasty (44%) did so primarily due to the lower re-operation rate (94%), better mobility (9%) and shorter hospital stay (4%).

Conclusion: Despite common surgeon preferences for arthroplasty, over half of participants preferred internal fixation due to less blood loss, shorter operative times, lower mortality, and less invasiveness. Surgeons should not assume that patients would prefer arthroplasty over internal fixation; the decision board can be an effective aid to incorporate patients’ preferences into the decision-making process.

To evaluate the effect of implant articular geometry on postoperative range of motion (ROM) after primary total knee arthroplasty for osteoarthritis, we conducted a retrospective case-control study of one hundred and twenty patients (sixty in each group) comparing Scorpio® Posterior Cruciate Substituting implant using Superflex® versus traditional tibial insert. Cases and controls were matched 1:1 for surgeon and gender. Both groups had similar baseline characteristics. Except for KSS Clinical Score at six months (mean: 92.8 for Superflex® versus 87.6 for traditional insert; p=0.029), there was no statistically significant difference between the two groups in knee scores or ROM up to one-year postoperatively.

To evaluate the effect of implant articular geometry on postoperative range of motion (ROM) after primary TKA.

Despite the advent of high flexion knee designs, surgical technique and patient driven factors remain the overriding determining factors for ultimate flexion range achieved following TKA.

One hundred and twenty patients (sixty in each group) were included. Both groups had similar baseline characteristics. Except for KSS Clinical Score at 6 month (mean ± SD: 92.8 ± 5.8 for Superflex® versus 87.6 ± 14.6 for traditional insert; p=0.029), there was no statistically significant difference between the two groups in knee scores or ROM. Flexion at one year for Superflex® was 113.5° ± 10.5 compared with 113.2° ± 11.9 for traditional tibial insert (p=0.869).

Retrospective cohort study of a prospectively gathered database of TKA’s performed at a high-volume arthroplasty center from 1998 to 2003. Inclusion Criteria: primary TKA for osteoarthritis using Scorpio® Posterior Cruciate Substituting implant with Superflex® tibial insert versus traditional insert. Exclusion Criteria: WSIB, prior history of septic arthritis, and previous knee surgery. Cases and controls were matched 1:1 for surgeon and gender. Postoperative care was standardized. Data points included demographics, operative details, pre- and post-operative Knee Society Score (KSS), Oxford Knee Score and range of motion at six weeks, six months and one year postoperatively. P< 0.05 was considered statistically significant.

Despite improvements in knee prostheses design, patient factors and surgical technique remain the most important determinants of outcome in primary TKA, particularly ROM.

Introduction and Aims: Periprosthetic bone loss is responsible for the majority of cases of implant failure after total joint arthroplasty. Bisphosphonates are effective in reducing bone loss in many conditions associated with accelerated bone turnover. Our aim was to determine the effect of bisphosphonates on periprosthetic bone mineral density (BMD, g/cm2) after total joint arthroplasty.

Method: We conducted computerised searches for randomised controlled trials, evaluating the effects of bisphosphonates on periprosthetic bone mineral density in patients undergoing primary total joint arthroplasty. We searched MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews and the United Kingdom National Research Register Web-site to November 2003. Computerised searches of the archives of AAOS Annual Meetings 1989–2003 were also conducted. Additional strategies to identify articles included a hand search of the bibliographies of relevant articles and direct contact with the authors.

Results: Of 386 citations initially identified, nine citations met our eligibility criteria. The total number of randomised controlled trials was six (five published and one abstract). Four trials evaluated total hip arthroplasty and two examined total knee arthroplasty. Five trials used alendronate and one used pamidronate. Quality scores ranged from 65 to 75. The pooled sample size was 290 patients. Less periprosthetic bone loss occurred in the intervention group compared to the control group at the following follow-up intervals: three months (n=128, Weighted Mean Difference (WMD): 3.3%, 95% Confidence Interval (CI): 1.9–4.7, p< 0.01); six months (n=224, WMD: 4.5%, CI: 1.6–7.4, p< 0.001); and 12 months (n=173, WMD: 4.2%, CI: 1.5–6.9, p=0.03). Tests of heterogeneity revealed greater maintenance of BMD in cemented arthroplasty than in uncemented arthroplasty (WMD: 7.5%, CI: 4.3–10.7 versus WMD: 2.1%, CI: 0.61–3.6, respectively, p< 0.001) at 12 months follow-up.

Conclusion: Bisphosphonates have a beneficial effect on maintaining periprosthetic bone stock compared to control after total joint arthroplasty. The effect seems greater in cemented arthroplasty and total knee arthroplasty. Whether this increase in BMD results in improved fixation and longevity of prosthetic components remains unanswered. Larger trials evaluating the effect of bisphosphonates on rates of implant loosening and functional outcomes are needed.