Patients with Paget's Disease of Bone (PDB) more frequently require total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, controversy remains regarding their outcome. This project aims to evaluate the current literature regarding outcomes following THA and TKA in PDB patients.

MEDLINE, EMBASE and Cochrane databases were searched on February 15th, 2022. Inclusion criteria comprised studies evaluating outcomes following THA/TKA in PDB patients. Quality of included studies was assessed using the Newcastle-Ottawa Scale.

19 articles (published between 1976–2022) were included, comprising 58,695 patients (48,766 controls and 10,018 PDB patients), from 209 potentially relevant titles. No study was of high quality. PDB patient pooled mortality was 32.5% at mean 7.8(0.1-20) years following THA and 31.0% at mean 8.5(2-20) years following TKA. PDB patient revision rate was 4.4% at mean 7.2(0-20) years following THA and 2.2% at mean 7.4(2-20) years following TKA. Renal complications, respiratory complications, heterotopic ossification, and surgical site infection were the most common medical and surgical complications.

The largest systematic review, to date, evaluating outcomes following THA and TKA in PDB patients. All functional outcome scores improved. PDB patient revision rate was comparable to UK National Joint Registry. However, there is a significant need for prospective matched case-control studies to robustly compare outcomes in PDB patients with unaffected counterparts.

The aim of this study was to perform a systematic review of the literature on Gustilo-Anderson (GA) type IIIB open tibial shaft (AO-42) injuries to determine the consistency of reporting in the literature.

A search of PubMed, EMBASE and Cochrane Central Register of Controlled Trials was performed to identify relevant studies published from January 2000 to January 2021 using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The study was registered using the PROSPERO International prospective register of systematic reviews. Patient/injury demographics, management and outcome reporting were recorded.

There were 32 studies that met the inclusion criteria with a total of 1,947 patients (70.3% male, 29.7% female). There were 6 studies (18.8%) studies that reported on comorbidities and smoking, with mechanism of injury reported in 22 (68.8%). No studies reported on all operative criteria included, with only three studies (9.4%) reporting for time to antibiotics, 14 studies (43.8%) for time from injury to debridement and nine studies (28.1%) for time to definitive fixation. All studies reported on the rate of deep infection, with a high proportion documenting union rate (26/32, 81.3%). However, only two studies reported on mortality or on other post-operative complications (2/32, 6.3%). Only 12 studies (37.5%) provided any patient reported outcomes.

This study has demonstrated a deficiency and a lack of standardized variable and outcome reporting in the orthopaedic literature for Gustilo-Anderson type IIIB open tibial shaft fractures. We propose a future international collaborative Delphi process is needed to standardize.

Abstract

Total Hip Arthroplasty (THA) is one of the most successful and cost-effective treatments available for painful hip arthritis. Unfortunately, dislocation following primary THA is one of the most common complications, occurring in approximately 0.50–10percnt; cases. However, there is little literature that investigates the effects that dislocation has on the patient's overall function and satisfaction.

We reviewed 229 THA patients that had sustained dislocation from a prospective database, consisting 156 single dislocations and 73 with two or more. Patient outcomes were compared with a matched control group of 196 patients without dislocation in the same follow-up period. Harris Hip Score (HHS) and patient satisfaction were recorded pre-operatively and at one, five and ten years post-operatively. Mann-Whitney test compared HHS between control and dislocation groups, Chi-Square test compared patient satisfaction and implant survival.

Total HHS and functional component were significantly lower in the dislocation group at one, five and ten years (p<0.05). HHS Pain component revealed a significant difference but only at one and three years (p<0.05). Patient satisfaction only showed a significant difference at one-year review. Dislocation rates were significantly higher in females. Implant survivorship was significantly lower in the dislocation group at 15-years.

Hip-function and implant survival is significantly reduced following prosthesis dislocation, however patient satisfaction and pain levels appear unaffected at long-term follow-up.

The Low Contact Stress (LCS) mobile-bearing total knee replacement (TKR) was designed to minimize polyethylene wear, aseptic loosening and osteolysis. However, registry data suggests there is a significantly greater revision rate associated with the LCS TKR.

The primary aim of this study was to assess long-term survivorship of the LCS implant. Secondary aims were to assess survival according to mechanism of failure and identify predictors of revision.

We retrospectively identified 1091 LCS TKRs that were performed between 1993 and 2006. There was incomplete data available 33 who were excluded. The mean age of the cohort was 69 (SD 9.2) years and there were 577 TKRs performed in females and 481 in males. Mean follow up was 14 years (SD 4.3).

There were 59 revisions during the study period: 14 for infection, 18 for instability, and 27 for polyethylene wear. 392 patients died during follow up. All cause survival at 10-year was 95% (95%CI 91.7–98.3) and at 15-year was 93% (95%CI 88.6–97.8). Survival at 10-years according to mechanism of failure was: infection 99% (95%CI 94–100%), instability 98% (95%CI 94–100%), and polyethylene wear 98% (95%CI92–100). Of the 27 with polyethylene wear only 19 had associated osteolysis requiring component revision, the other 8 had simple polyethylene exchanges. Cox regression analysis, adjusting for confounding variables, identified younger age was the only predictor of revision (hazard ratio 0.96, 95%CI 0.94–0.99, p=0.003).

The LCS TKR demonstrates excellent long-term survivorship with a low rate of revision for osteolysis, however the risk is increased in younger patients.

Despite the high success rates of Reverse Shoulder replacements, complications of instability & scapular notching are a concern. Factors reducing relative motion of implant to underlying bone which include lateral offset to centre of rotation, screw & central peg insertion angle and early osteo-integration are maximized in the Trabecular Metal Reverse total shoulder system. We present clinico-radiological outcomes over 72 months.

Analysis of a single surgeon series of 140 Reverse total shoulder replacements in 135 patients was done. Mean age was 72(range 58– 87 yrs); 81 females: 54 males. Indications were Rotator cuff arthropathy {n= 88} (63%); Osteo-arthritis with dysfunctional cuff {n= 22}(15%); post-trauma{n=23} (15%); revision from hemiarthroplasty {n=3} (2.4%) and from surface replacement {n=4} (2.8%)

All patients were assessed using pre-operative Constants and Oxford scores and clinical & radiographic reviews with standard X-Rays at 6 weeks, 3, 6,12 months and yearly thereafter. X rays included an AP view in 45 degrees of external rotation and modified axillary view. Inferior Scapular notching using the Nerot-Sirveaux grades and Peg Glenoid Rim Distance were looked into by a consultant musculoskeletal radiologist/ Orthopaedic surgeon/ Senior Fellow (post CCT) or a specialist Trainee (ST4 and above). Pain on the visual analogue scale decreased by 98% (9.1 to 0.8) (p<0.01). Constant score improved by 81.8% (12.4 to 68.1) (p<0.05), Oxford shoulder score by 76.7% (56 to 13) (p<0.05). 95.6% of Humeral stems had no radiolucent lines and 4.4% had < 2mm of lucency. Scapular notching was calculated using Sirveaux grades with Peg scapular base angle distance (PSBA) measurements on PACS with Siemens calibration (grade 1= 4 (2.8%); grade 2 =1; grade 3 =0; grade 4=0). 3.57% showed radiographic signs of scapular notching at 72 months. Range of Peg Glenoid Rim Distance was 1.66 to 2.31 cm. Power analysis showed 65 patients were needed to have an 80% power to detect relation of Peg Glenoid Rim Distance to Scapular notching. A likelihood ratio test from Logistic regression model to check correlation of Peg Glenoid Rim Distance to Scapular notching gave a p value of 0.0005. A likelihood ratio from Logistic regression gave a p value of 0.0004 for Infraglenoid Scapular spurs. Highest incidence of spurring was seen in Reverse Total Shoulder Replacements done for Trauma and lowest in patients who got the procedure for Osteoarthritis. Complications included two glenosphere revisions; two stitch abscesses and two Acromial fractures in patients who had a fall two years after the procedure. Improved surgical outcomes can be attributed to surgical technique and implant characteristics. Trabacular metal promotes early osteointegration which resists shearing action of Deltoid on Glenoid component. This allows early mobilisation. Deltoid split approach preserves integrity of Subscapularis and Acromial osteotomy and lateral clavicle excision improve exposure and prevent Acromion fracture. Positioning the Glenoid component inferiorly on the Glenoid decreases incidence of Scapular notching.

Our mid-term validated outcomes are promising with only 3.57% Grade I/II radiographic signs of scapular notching. Long term studies (10 year follow ups) are necessary to confirm its efficacy.

Introduction

There is limited evidence assessing the effect of the Ankle Foot Orthosis (AFO) on gait improvements in diplegic cerebral palsy. In particular, the effect of the AFO on vertical forces during gait has not been reported. Appropriate vertical ground reaction forces are crucial in enabling children with CP to walk efficiently. This study investigated the effect of AFO application on the vertical forces in gait, particularly the second vertical peak in force (FZ2) in late stance. The force data was compared with the barefoot walk.