Purpose

The study aim was to assess how the periprosthetic bone density of the MiniHip™ changed in the course of the first year. Is there a correlation between the decrease in bone density with CCD angle or stem size? Are there other variables influencing the changes in bone density?

Aim

The purpose of the study was to analyse short- and medium-term results of a modern cementless short stem design hip joint endoprosthesis together with different parameters (offset, CCD, leg length), radiological findings and scores.

Introduction: Posterior calcaneal exostosis treatment modalities showed many controversially opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimal surgical invasive technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems.

Material and Methods: We operate on 121 patients with an age range between 17–58 years, 60 males and 61 females. The radiologic examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. 108 patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 45.2 months (12–96).

Results: According to the Ogilvie-Harris-Score 53 patients presented good and 55 patients excellent results, while 5 patients showed fair results, and 8 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. Only minor postoperative complications were observed.

Conclusion: ECP is an effective and of minimal-invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique has less morbidity, less operating time, and nearly no complications, moreover the pathology can better be differentiated.

Material and Methods: This prospective study included 15 patients, 9 males and 6 females, who have been scoped for peroneal tendon disorder between 1999 and 2004. All patients were diagnosed clinically to have chronic peroneal tendon dysfunction and all had conventional x-ray films, ultrasonographic assessment and magnetic resonance imaging. The mean age was 44 (range 23 to 65). The mean duration of symptoms were 16 (range from 2 to 65). All patient had a trial of conservative treatment before being referred to us.

Results: 7 patients was found to have tenosynovitis, which could be resected endoscopically in all cases. In 2 patients a low lying muscle belly (LLMB) of peroneus brevis was present; this could be resected with a shaver very easily. 1 patient had a peroneal tendon instability. This was surgical treated in an open technique with reconstruction of the retinaculum. In 5 patients we could document partial lesions of the peroneal tendons (fig.6,7). This were posttraumtic after a supination trauma in 2 patients and degenerative in the remaining 3 patients. In 4 patients this could be treated minimal invasive with debridement. In one patient a traumatic longitudinal splitting tear was reconstructed with open surgery.

At time of follow up (average 2.8 years; range: 78– 18 months) all patients where without symptom on average 3 months (range: 4 – 17 weeks) after surgery. They where able to perform all activities of daily living as well as moderate athletic activities such as jogging and biking. These clinical results where stable until the time of follow-up.

Clincal relevance: Tendoscopy of the peroneal tendons is an effective and minimal invasive management tool, that can be indicated in many of peroneal disorders. Further studied are needed at that respect to improve results and promote minimal invasive surgical techniques.

Introduction: Viscosupplementation is an effective treatment for patients suffering from knee osteoarthritis (OA). Most available products use 3 or 5 injection regimens. The objective of this study was to compare the safety and efficacy of a single 6 mL intra-articular administration of hylan G-F 20 with placebo.

Methods: In this prospective, multicenter, randomized, double-blind study, patients diagnosed with knee OA were randomized to one 6-mL injection of hylan G-F 20 or saline. The primary efficacy analysis (WOMAC A) was performed on the intent-to-treat population and was based on a repeated-measures model over the 26 weeks of the study. The incidence of adverse events (AEs) was collected over the study duration

Results: 253 patients were randomized to hylan G-F 20 (n=124) or placebo (n=129). Mean age was 63 years (42–84), BMI 29.4 (19.5–52.4 kg/m2), 71% were female, and all had primary knee OA of Kellgren Lawrence grade 2 (45%) or 3 (55%). Patients in the hylan G-F 20 group experienced a mean change from baseline in their WOMAC A Likert pain score (0–4 scale) over 26 weeks (primary efficacy criteria) of −0.84, which was statistically significantly different from the change reported in the placebo group (−0.69, p=0.047). Statistically significant differences favoring hylan G-F 20 were also reported for most of the secondary efficacy criteria: WOMAC A1 (estimate Odds Ratio over 26 weeks placebo/hylan G-F 20, 0.64, p=0.013), patient global assessment (0.69, p=0.029), and clinical observer global assessment (0.71, p=0.041); WOMAC B and C changes were not statistically significant between groups. There was no statistically significant difference in the use of rescue medication between the 2 groups. There were no serious AEs related to treatment. In the target knee, injection-related AEs occurred in 4.9% and 3.1% of patients for hylan G-F 20 and placebo, respectively, and treatment-related AEs occurred in 3.3% and 0.8% of patients, respectively. All target knee AEs were local pain, with or without joint swelling or effusion, and were of mild or moderate intensity.

Conclusion: This double-blind placebo-controlled study showed one injection of hylan G-F 20, possibly repeated 6 months later, was safe and provided symptomatic relief lasting up to 6 months in patients with knee OA.

Introduction: Shoulder surface replacement arthroplasty has been established for several decades as a mean to restore comfort and function of the shoulder for many afflictions that derange the normal anatomy. The surface replacement may offer some advantages over the stemmed prostheses.

Purpose: The purpose of the study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with bony defects of the humeral head.

Patients and Methods: The study was conducted on 18 patients (2 patients with chronic posterior dislocation, 8 patients with AVN, 8 patients with posttraumatic head necrosis) with bony head defects that were operated on between 1999 and 2006. The patients were followed up clinically and radiologically for a mean of 24.8 months (range, 10–78 months). There were 8 female and 10 male shoulders. The mean age was 55.3 years (range, 27–71). The clinical assessment was performed with the Constant score.

Results: The constant score significantly improved from a mean of 14.83 points preoperatively to 64.34 points postoperatively. The average pain score increased from 0.3 points to 9.8 points. The average ROM score increased from 8.21 points to 23.21 points. The humeral offset increased from 22.3 mm to 28.8 mm.

Conclusion: The shoulder surface replacement arthroplasty shows good mid-term results in patients with bony defects.

Introduction: Shoulder surface replacement arthroplasty has been established for several decades as a mean to restore comfort and function of the shoulder for many afflictions that derange the normal anatomy. The surface replacement may offer some advantages over the stemmed prostheses.

Purpose: The purpose of the study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with a degenerative arthritis.

Patients and Methods: The study was conducted on 76 patients with degenerative joint disease of the shoulder that were operated on between 1999 and 2006. The patients were prospectively followed up clinically and radiologically for a mean of 26.2 months (range, 9–80 months). There were 41 female and 35 male shoulders. The mean age was 64.4 years (range, 54–86). The mean operative time was 42 minutes (range, 27–62 minutes). The clinical assessment was performed with the Constant score Results: The constant score significantly improved from a mean of 16.32 points preoperatively to 68.72 points postoperatively. The average pain score increased from 0.2 points to 10.2 points. The average ROM score increased from 9.22 points to 24.73 points. The humeral offset increased from 24.2mm to 29.2mm.

Conclusion: The shoulder surface replacement arthroplasty shows good mid-term results in patients with degenerative shoulder disease.

Introduction: Glenohumeral arthritis with a massive rotator cuff tear is a devastating condition that seriously compromises the comfort and function of the shoulder. Cuff tear arthropathy presents a unique surgical challenge and many arthroplasty options were used for its treatment. The purpose of this study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with cuff tear arthropathy and intact subscapularis function.

Patients and Methods: The study was conducted on twenty five shoulders in twenty five patients with cuff tear arthropathy with the subscapularis tendon still intact. The patients were prospectively followed up clinically and radiologically for a mean of 26 months (range, 15–38 months). There were 16 female and 9 male shoulders. The mean age was 69.04 years (range,53–83years). The mean operative time was 38 minutes (range, 28–56minutes). The clinical assessment was performed with the Constant score.

Results: The constant score significantly improved from a mean of 14.04 points preoperatively to 53.17 points postoperatively. Of the patients, 88% considered the shoulder to be much better or better as a result of the operation.

Radiologically, the humeral offset, the lateral gleno-humeral offset (coracoid base to the greater tuberosity), height of center of instant rotation and the acromio-humeral distance were significantly increased. No intra-or postoperative complications encountered.

Conclusion: Our early results with the use of Copeland surface replacement in selected cases with cuff tear arthropathy were encouraging. The patients showed significant clinical (pain and range of motion) and radiological improvements. Moreover, if the surface replacement were to fail for any reason, it can be revised to a reverse prosthesis type as there is no lack of bone stock.

Purpose: The objective of this study was to compare the safety and efficacy of 1 × 6 mL intra-articular administration of hylan G-F 20 with placebo.

Methods: In this prospective, multicenter, randomized, double-blind study, patients diagnosed with knee OA were randomized to one 6-mL injection of hylan G-F 20 or saline. The primary efficacy analysis (WOMAC A) was performed on the intent-to-treat population and was based on a repeated-measures model over the 26 weeks of the study.

Results: 253 patients were randomized to hylan G-F 20 (n=124) or placebo (n=129). Mean age was 63 years (42–84), BMI 29.4 (19.5–52.4 kg/m2), 71% were female, and all had primary knee OA of Kellgren Lawrence grade 2 (45%) or 3 (55%). Patients in the hylan G-F 20 group experienced a mean change from baseline in their WOMAC A Likert pain score (0–4 scale) over 26 weeks (primary efficacy criteria) of −0.84, which was statistically significantly different from the change reported in the placebo group (−0.69, p=0.047). Statistically significant differences favoring hylan G-F 20 were also reported for most of the secondary efficacy criteria: WOMAC A1 (estimate Odds Ratio over 26 weeks placebo/hylan G-F 20, 0.64, p=0.013), patient global assessment (0.69, p=0.029), and clinical observer global assessment (0.71, p=0.041); WOMAC B and C changes were not statistically significant between groups. The OMERACT-OARSI responder analysis indicated that 59% of the patients were responders in the hylan G-F 20 group versus 51% in placebo group (0.66, p=0.059). There was no statistically significant difference in the use of rescue medication (acetaminophen) between the 2 groups.

Discussion and Conclusion: This double-blind placebo-controlled study showed one injection of hylan G-F 20 provided symptomatic relief lasting up to 6 months in patients with knee OA; it avoids the need for multiple injections.

Purpose: To evaluate the safety and efficacy of hylan G-F 20 viscosupplementation in patients with symptomatic osteoarthritis (OA) of the ankle.

Methods: Prospective, multi-center, open study in patients with primary or secondary grade II talocrural OA confirmed by X-ray. At baseline, patients had to score between 50–90 mm on the Patient-completed Ankle OA Pain VAS (0–100 mm). Patients received one intra-articular injection of 2 ml of hylan G-F 20 and were given an option of a second and final 2 ml injection if their pain remained between 50-90 mm on the VAS after 1, 2 or 3 months. Intraarticular injections were placed in the anteromedial portal of the ankle joint as described for ankle arthroscopy. Patients were followed for 6 months after the final injection. As rescue medication, patients could only take paracetamol up to 4 g per day, except on the day of or the day before a study visit.

All treatment emergent adverse events (AEs) were recorded. The primary efficacy endpoint was change from baseline (at final injection) in the Ankle OA Pain VAS at 3 months after the final injection. Secondary endpoints were Ankle OA Pain VAS scores at all other time-points, total Ankle OA Scale, Patient and Physician Global OA Assessment (VAS), and health-related quality of life (SF-36).

Results: Fifty-five patients (33 M; 22 F) were enrolled and received a first injection of hylan G-F 20. Twenty-four patients (44%) received a second injection. The mean age was 41 years (range 19–70). Overall, treatment with hylan G-F 20 was well tolerated. Seventeen patients (31%) had a treatment related AE of the target ankle. All were of mild or moderate intensity, the majority consisting of arthralgia and injection site pain. There was a statistically significant decrease in Ankle OA Pain VAS score from 68.0 mm at Baseline to 33.8 mm at Month 3 (p< 0.001, paired t-test), which was maintained at 6 months follow-up. The decrease was statistically significant at all time points. Patients who received only 1 injection demonstrated a greater decrease at 3 months (−42.5 mm) than patients with 2 injections (−23.5 mm). The secondary efficacy endpoints showed similar results. Of the total study population, 29 patients (53%) were responders (i.e. at least a 50% decrease in ankle OA pain) after 3 months. 64% of patients receiving 1 injection were responders after 3 months. The SF-36 questionnaire showed statistically significant improvements for both the physical and mental component scores at 3 and 6 months follow-up.

Conclusions: Treatment of OA of the ankle with intraarticular hylan G-F 20 injections is well tolerated. Treatment with hylan G-F 20 significantly decreases pain which is maintained for up to 6 months.

Purpose: The purpose of the study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with two main indications.

Patients and Methods: The study was conducted on fifty shoulders in fifty patients between 2003 and 2005; 17 patients suffered from rotator cuff pathology. The patients were prospectively followed up clinically and radiologically for a mean of 12.7 months (range, 6–30 months). There were 30 female and 20 male shoulders. The mean age was 66.63 years (range, 21–85). The mean operative time was 44.6 minutes (range, 29–62 minutes). The clinical assessment was performed with the Constant score

Results: The constant score significantly improved from a mean of 15.52 points preoperatively to 57.02 points postoperatively. Of the patients, 96% considered the shoulder to be much better or better as a result of the operation. The Constant-Score improved in the group with degenerative arthritis from 16.32 point pre- to 62.25 postoperatively. In rotator cuff arthropathy the score improved from 14.19 to 53.06.

Radiologically, the humeral offset, the lateral gleno-humeral offset (coracoid base to the greater tuberosity) as well as the acromiohumeral distance were significantly increased. No intra-or postoperative complications encountered.

Conclusion: We conclude that the shoulder surface replacement arthroplasty allows good conservation of the bone stock and avoiding the complications encountered with the stemmed prostheses. In patients with rotator cuff arthropathy there are two main indications:

- patients below the age of 70, in order to avoid complications of the reverse prosthesis