This study used a national registry to assess the outcomes of hip arthroscopy (HA) for the treatment femoroacetabular impingement (FAI).

All HAs for FAI recorded in the UK Non-Arthroplasty Hip Registry (NAHR) between January 2012 and September 2023 were identified. Cases were grouped according to the index procedure performed for FAI (cam, pincer, or mixed). Patient outcomes captured included the International Hip Outcome Tool (iHOT)-12.

7,511 HAs were identified; 4,583 cam (61%), 675 pincer (9%), 2,253 mixed (30%). Mean age (34.8) was similar between groups. There was a greater proportion of females in the pincer group (75%) compared to cam (52%) and mixed (50%). A higher proportion of patients had a recorded cartilage injury in association with a cam lesion compared to pincer. The pincer group had poorer mean pre-op iHOT-12 scores (31.6 \[95%CI 29.9 to 33.3\]; n=364) compared to cam (33.7 \[95%CI 32.1 to 34.4\]; n=3,941) and achieved significantly lower scores at 12 months (pincer = 52.6 (50.2 to 55); n=249, cam = 58.3 (57.1 to 59.5); n=1,679).

Overall, significant (p < 0.0001) iHOT-12 and EQ-5D improvement vs baseline pre-operative scores were achieved for all FAI subtypes at 6 months (overall mean iHOT-12 improvement +26.0 \[95%CI 25.0 to 26.9\]; n=2,983) and maintained out to 12 months (+26.2 \[25.1 to 27.2\]; n=2,760) at which point 67% and 48% of patients continued to demonstrate a score improvement greater than or equal to the minimum clinically important difference (>/=13 points) and substantial clinical benefit (>/=28 points) for iHOT-12 respectively.

This study demonstrates excellent early functional outcomes following HA undertaken for FAI in a large national registry.

Aims

Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures.

Abstract

Optimal acetabular component position in Total Hip Arthroplasty is vital for avoiding complications such as dislocation and impingement, Transverse acetabular ligament (TAL) have been shown to be a reliable landmark to guide optimum acetabular cup position. Reports of iliopsoas impingement caused by acetabular components exist. The Psoas fossa (PF) is not a well-regarded landmark for Component positioning. Our aim was to assess the relationship of the TAL and PF in relation to Acetabular Component positioning.

A total of 22 cadavers were implanted on 4 occasions with the an uncemented acetabular component. Measurements were taken between the inner edge of TAL and the base of the acetabular component and the distance between the lower end of the PF and the most medial end of TAL.

The distance between the edge of the acetabular component and TAL was a mean of 1.6cm (range 1.4–18cm). The distance between the medial end of TAL and the lowest part of PF was a mean of 1.cm (range 1,3–1.8cm) It was evident that the edge of PF was not aligned with TAL.

Optimal acetabular component position is vital to the longevity and outcome following THA. TAL provides a landmark to guide acetabular component position. However we feel the PF is a better landmark to allow appropriate positioning of the acetabular component inside edge of the acetabulum inside the bone without exposure of the component rim and thus preventing iliopsoas impingement at the psoas notch and resultant groin pain.

Advanced osteoarthritis of knee is associated with low-backache in a significant number of patients and adversely affects the quality of life. There is a paucity of literature describing outcomes of backache after total-knee-arthroplasty (TKA).

We evaluated backache in patients of advanced knee-osteoarthritis and their functional and radiological outcomes after TKA after approval from Institutional ethics committee.

Fifty-nine patients (40 females and 19 males) were included. Mean body-mass index was 28.7. Mean visual analogue score (VAS) for knee-pain was 7.98 preoperatively and 1.6 in follow-up. For chronic backache, the mean VAS score improved from 6.08 to 2.4, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improved from 67.5 to 37.8, Knee society score (KSS) from 49.8 to 76.6, Oswestry Disability Index (ODI) Score from 55.44 to 34.65 and SF-36 Quality-of-life score from 44.95 to 74.63. There was a significant correlation between in knee and low-back functional scores. Magnetic resonance imaging-based scoring of degenerative changes (Pfirrmann grading) showed improvement only in 13.5% patients; 56% showed no change and 30.5% showed deterioration of scores.

Chronic low backache is a significant co-morbidity in advanced knee-osteoarthritis. TKA has the potential to relieve backache along with knee-pain and improves quality of life.

Trauma & Orthopaedic Department, Bronglais Hospital & Hywel Dda University Health Board, Aberystwyth, UK

Auto-CAD study is done to observe the effects of head neck ratio (HNR) in joint replacements. Total hip replacement joints were reconstructed on CAD with increasing diameter of the head keeping neck diameter constant in 1997. Simulation was done and Range of Movement (ROM), impingement and stability of the hip joint was noted. A graph was plotted with HNR on X-axis and ROM on Y-axis. It was observed that as the HNR increases the ROM of the joint is increased, impingement is reduced and stability is also increased. It is also observed that diameter of the head and neck is more important than considering only head diameter of the hip joint. The graphical analysis confirms that different diameters of the head may have same HNR depending on the neck diameter. So even in smaller diameter head the HNR may be more due to smaller diameter neck and may be more advantages than larger diameter head with bigger neck having smaller HNR. We conclude that HNR is more important than the head diameter alone in hip replacements.

Auto-CAD study is done to observe effects of head neck ratio (HNR) in hip replacements.

Total hip replacement joints were reconstructed on CAD with increasing diameter of the head keeping neck diameter constant in 1997. Simulation was done and Range of Movement (ROM), impingement and stability of the hip joint was noted. A graph was plotted with Head Neck Ratio (HNR) on X-axis and ROM on Y-axis. It was observed that as the HNR increases the ROM of the joint is increased, impingement is reduced and stability is also increased. It is also observed that diameter of the head and neck is more important than considering only head diameter of the hip joint. The graphical analysis confirms that different diameters of the head may have same HNR depending on the neck diameter. So even in smaller diameter head the HNR may be more due to smaller diameter neck and may be more advantages than larger diameter head with bigger neck having smaller HNR.

We conclude that HNR is more important than the head diameter alone in hip replacements.

Tunning fork lines (TFL) were drawn on ankle anterior-posterior radiographs to assess the talar shift in ankle fractures.

A 3-D ankle joint reconstruction was prepared by mapping normal ankle joint using auto CAD in 1997. TFL were drawn using normal anatomical landmarks on saggital, coronal and transverse planes. The ankle joint anatomical relationship with talus was studied in various rotation simulating radiographic anterior-posterior views and talar shift was studied. Between 2006 and 2012 on antero-posterior view of ankle radiographs and PACS, TFL were drawn. The premise is that in a normal radiograph the superior-lateral dome of the talus lies medial to the handle of TFL, and in ankle with talar shift the dome of the talus would cross this line laterally. In two district hospitals 100 radiographs were observed by 4 observers in 67 males and 33 females with mean age of 49 (15–82) years. The TFL confirmed talar shift with sensitivity of 99.2 % showing talarshift and inferior tibio-fibular ankle diastasis.

We conclude that in ankle anterio-posterior view it is possible to comment on the talar shift and diastasis of the ankle joint, even if proper ankle mortise views were not available.

The PFNA is used routinely at the RUH for unstable peri-trochanteric and femoral fractures. Failure of operative treatment is associated with increased morbidity and financial burden. We analysed surgical and fracture factors, aiming to identify those associated with fixation failure.

Retrospective analysis of 76 consecutive patients treated with a PFNA between 2009–2012 was performed. Patient demographics were assessed, along with fracture classification, adequacy of reduction, tip apex distance (TAD) and grade of surgeon. Failure was defined as metal work failure, non-union or need for repeat procedure.

The mean age was 78.9 years (25.9–97.4). 21 were male and 49 female. There were 17 failures (24.3%) (7 required further surgery). 10 failures were per-trochanteric, 2 sub-trochanteric and 5 mid-shaft fractures. Complications included 4 broken and 6 backed-out distal locking screws, 2 blade cut-outs, 1 nail fracture and 4 non-unions. All per-trochanteric were adequately reduced with a TAD <25 mm. 11/17 had consultant supervision.

A high rate of backed-out distal locking screws was identified. We found no concerns with adequacy of reduction, TAD or consultant supervision.

This study assesses the incidence of noise in ceramic on ceramic (COC) bearings compared to metal on polyethylene (MOP) bearings. Noise after MOP implants has rarely been studied and they never been linked to squeaking.

We have developed a noise characterising hip questionnaire and sent it along with the Oxford Hip Score (OHS) to 1000 patients; 509 respondents, 282 COC and 227 MOP; median age 63.7 (range 45–92), median follow up 2.9 years (range 6–156 months).

47 (17%) of the COC patients reported noise compared to 19 (8%) of the MOP patients (P=0.048). 9 COC and 4 MOP patients reported their hip noise as squeaking. We found the incidence of squeaking in the COC hips to be 3.2% compared to 1.8% in the MOP hips. Overall, 27% patients with noise reported avoiding recreational activities because of it and patient's with noisy hips scored on average 4 points less in the OHS (COC: P=0.04 and MOP: P =0.007).

This is the first study to report squeaking from MOP hip replacements. We therefore believe the squeaking hip phenomenon is not exclusive to hard bearings. Surprisingly, only a small proportion of patients described nose from their as a ‘squeak’. Noisy hip implants may have social implications, and patients should be aware of this. We have shown a relationship between noise and a lower OHS. However, longer follow-up and further study is needed to link noise to a poorly functioning implant.

The anatomy of the first metatarsophalangeal (MTP) joint and, in particular, the metatarsosesamoid articulation remains poorly understood. Its effect on sesamoid function and the pathomechanics of this joint have not been described.

Fresh frozen cadaveric specimens without evidence of forefoot deformity were dissected to assess the articulating surfaces throughout a normal range of motion. The dissections were digitally reconstructed in various positions of dorsiflexion and plantarflexion using a MicroScribe, enabling quantitative analyses in a virtual 3D environment.

In 75% of specimens, there was some degree of chondral loss within the metatarsosesamoid articulation. The metatarsal surface was more commonly affected. These changes most frequently involved the tibial metatarsosesamoid joint.

The tibial sesamoid had an average excursion of 14.2 mm in the sagittal plane when the 1st MTP joint was moved from 10 degrees of plantarflexion to 60 degrees of dorsiflexion; the average excursion of the fibular sesamoid was 8.7 mm. The sesamoids also move in a medial to lateral fashion when the joint was dorsiflexed. The excursion of the tibial sesamoid was 2.8 mm when the joint was maximally dorsiflexed while that of the fibular sesamoid was 3.2 mm.

There appears to be differential tracking of the hallucal sesamoids. The tibial sesamoid has comparatively increased longitudinal excursion whilst the fibular sesamoid has comparatively greater lateral excursion.

This greater excursion of the tibial sesamoid could explain the higher incidence of sesamoiditis in this bone. The differential excursion of the 2 metatarsosesamoid articulations is also a factor that should be considered in the design and mechanics of an effective hallux MTP joint arthroplasty.

The aim of this study was to characterise noise associated with ceramic-on-ceramic total hip arthroplasty (THA).

A questionnaire was constructed to assess noise associated with THA. 116 patients responded. All had ceramic-on-ceramic hybrid THA at Glasgow Royal Infirmary between 2005 and 2007 using a Trident prosthesis and Exeter stem. Oxford Hip Questionnaires (OHS) were also completed by the patients.

16.4% of respondents reported noise associated with their ceramic hip. The vast majority reported onset at least 1 year after implantation. The most common noise types were ‘clicking’ (47%) or ‘grinding’ (42%), while ‘squeaking’ was least frequently reported (11%). Noise was most commonly brought on by bending and during sit to stand movements.

No correlation was identified between the incidence of noise and any patient specific factor or demographic variable. The mean OHS at questionnaire follow-up was 39 and there was no significant difference in OHS when comparing noisy and silent hips (p=0.65). Only 1 patient limited social or recreational activities and overall patients felt the noise had minimal effect on their quality of life.

Acetabular component inclination angles were compared on post-operative x-rays. There was no significant difference (p=0.51) in inclination angles of the noisy (47.1°±6.3°, range 30–57°) and silent hips (47.8°±6.1°, range 35–68°). The groups were further analysed for deviation out with the desirable inclination range of 40–45°. Of the noisy hips, a total of 73% were out with this range compared to 63% in the silent hip group.

The incidence of noise within this ceramic-on-ceramic THA group did not appear to be related to patient specific factors, patient reported outcome (OHS) or acetabular inclination angles. Subjective appraisal of the noise revealed that ‘squeaking’ was not common but patients tended to report ‘clicking’ and ‘grinding’ more. The precipitation of noise with bending activities reinforces a possible mechanical cause.

In fractures electrical currents generated by piezoelectric and junctional diode effects initiate and augment healing. Conductive fixators may interfere with these currents causing delayed/nonunion which can be avoided by non conductive fixators, facilitating osteosynthesis. Null hypothesis of no difference and two tailed alternate hypothesis of any could be better was used. Impugn change in Electrical properties for demarcating union rate.

Patients of Gustillo's grade I and II tibia fractures were randomised in conductive and non conductive fixator groups in a blinded manner. Electrical and clinico-radiological properties were compared every two weeks for 20 weeks, recoding magnitude and significant difference. Capacitance(p=0.03), Impedance(p=0.002), Inductance(p=0.01) and Reactance(p=0.02) are the electrical parameters which not only demarcated union rate but orchestrated diagnosis of fracture healing. In Non-conducting group, after removal of fixator at week 10, Local Tenderness was consistently absent, Rust Score was higher at week 18 and 20(p=0.01), absence of abnormal mobility was 58% higher and 100% at week 12(p < 0.05), Presence of weight bearing was higher from week 16(OR=15, p=0.03), presence of transmitted movement was 2.4 times higher at week 10(95% CI=0.17–34.93, p=0.52) and was 100% at week 14.

Fractures heal at a faster rate if fixed by insulated non-conducting external fixators. Electrical parameters can be used to demarcate and monitor fracture healing.

Introduction

Microdiscectomies and microdecompressions are traditionally defined as procedures performed with a small incision using magnification. There are no studies in the literature comparing the magnification techniques used in these operations. We compared magnifying loupes and microscopes as the senior author was trained with both instruments and was equally comfortable using both.

Introduction

The anatomy of the first metatarsophalangeal (MTP) joint and, in particular, the metatarsosesamoid articulation remains poorly understood. The movements of the sesamoids in relation to the metatarsal plays a key role in the function of the first MTP joint. Although the disorders affecting the sesamoids are described well, the movements of the metatarsosesamoid joints and the pathomechanics of these joints have not been described. We have performed a cadaver study detailing and quantifying the three dimensional movements occurring at these joints.

Introduction

A prospective study was done using Kirschner (K) wires to internally fix capitellum fractures and its results were analysed.

INTRODUCTION

There is historical evidence of increased incidence of transitional cell tumours of the renal tract in workers exposed to high levels of metal ions. This study was designed to establish any correlation between Metal on metal bearing hip arthroplasty and TCC.

Purpose

Handgrip dynamometry has previously been used to detect pre - operative malnutrition and predict the likelihood of post - operative complications. This study explored whether a relationship exists between pre-operative pinch and power grip strength and length of hospital stay in patients undergoing hip and knee arthroplasty. We investigated whether handgrip dynamometry could be used pre - operatively to identify patients at greater risk of longer inpatient stays.

Tunning fork lines (TFL) were drawn on ankle anterior-posterior radiograph to assess the talar shift.

A 3-D ankle joint reconstruction was prepared by mapping normal ankle joint using auto CAD in 1997. Tunning fork lines were drawn using normal anatomical landmarks on saggital, coronal and transverse planes. The ankle joint anatomical relationship with talus was studied in various rotation simulating radiographic anterior-posterior views and talar shift was studied.

Between 2006 and 2012 on antero-posterior view of ankle radiographs and PACS, ‘Tunning Fork Lines’ (TFL) were drawn. The superior two vertical lines of the TFL were drawn above the ankle joint perpendicular to the distal tibial articular surface. First line tangent to anterior lip of the inferior tibio-fibular joint and second line tangent to the posterior lip of the inferior tibio-fibular joint parallel to each other. The horizontal third line was drawn parallel to distal tibial articular surface perpendicular to first two lines connecting them. The fourth line (handle of the tunning fork) was drawn vertically below the ankle joint midway between the first two lines perpendicular to the third line. In a normal radiograph the superior-lateral dome of the talus lies medial to the handle of TFL, and in ankle with talar shift the dome of the talus crosses this line laterally. In two district hospitals 100 radiographs were observed by 4 observers in 67 males and 33 females with mean age of 49 (15–82) years. The TFL confirmed talar shift with sensitivity of 99.2 % showing talarshift and inferior tibio-fibular ankle diastasis.

We conclude that in ankle anterio-posterior view it is possible to comment on the talar shift and diastasis of the ankle joint if proper ankle mortise view is not available.

Introduction

The anatomy of the first metatarsophalangeal (MTP) joint and, in particular, the metatarsosesamoid articulation remains poorly understood. The movements of the sesamoids in relation to the metatarsal plays a key role in the function of the first MTP joint. Although the disorders affecting the sesamoids are described well, the movements of the metatarsosesamoid joints and the pathomechanics of these joints have not been described. We have performed a cadaver study detailing and quantifying the three dimensional movements occurring at these joints.

The early surgical management of the anterior cruciate ligament (ACL) tears in children remains controversial. The argument for nonoperative treatment is driven by concerns about the risk of growth arrest caused by a transphyseal procedure. On the other hand, early surgical reconstruction is favoured because of poor compliance with conservative treatment and increased risk of secondary damage due to instability. This paper reports a series of 39 very young children who had an ACL reconstruction using a transphyseal procedure with a hamstring graft. Patients were followed to skeletal maturity or for a minimum of three years. Only those patients with either a chronological age less than 14 years or with a Tanner stage of 1 and 2 of puberty were included in the study. Thirty children were Tanner 1 or 2 and nine were Tanner 3-4 but were younger than 14. The mean age at operation was 12.2 years (Range 9.5-14.2, Median 12.4). The mean follow up was 60.7 months (range 36-129, median: 51) months. Thirty four patients had attained skeletal maturity at the last follow up. The mean Lysholm score improved from 72.4 pre-operatively to 95.86 postoperatively (p<0.0001). The mean Tegner activity scale was 4.23 after injury and it improved to 7.52 after operation (p<0.0001)) which was a reasonable comparison to the pre- injury score of 8.0. One patient had a mild valgus deformity with no functional disturbance. No other growth related abnormalities including limb length discrepancy were noted. There has been one re-rupture but all others had good or excellent outcome. This is one of the largest series reporting the long term results of ACL reconstruction in very young children. Most other studies include children up to the age of 16. Based on our results we can conclude that transphyseal ACL reconstruction modified for very young patients is a safe procedure.