Young, high-demand patients with large post-traumatic tibial osteochondral defects are difficult to treat. Fresh osteochondral allografting is a joint-preserving treatment option that is well-established for such defects. Our objectives were to investigate the long-term graft survivorships, functional outcomes and associated complications for this technique. We prospectively recruited patients who had received fresh osteochondral allografts for post-traumatic tibial plateau defects over 3cm in diameter and 1cm in depth with a minimum of 5 years follow-up. The grafts were retrieved within 24 hours, stored in cefalozolin/bacitracin solution at 4°C, non-irradiated and used within 72 hours. Tissue matching was not performed but joints were matched for size and morphology. Realignment osteotomies were performed for malaligned limbs. The Modified Hospital for Knee Surgery Scoring System (MHKSS) was used for functional outcome measure. Kaplan-Meier survivorship analysis was performed with conversion to TKR as end point for graft failure.Introduction
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The purpose of this study was to evaluate the independent contributions of surgeon procedure volume, hospital procedure volume, and standardisation of care on short-term post-operative outcomes and resource utilisation in lower-extremity total joint arthroplasty. An analysis of 182,146 consecutive patients who underwent primary total joint arthroplasty was performed with use of data entered into the Perspective database by 3421 physicians from 312 hospitals over a two-year period. Adherence to evidence-based processes of care was defined by administration of appropriate perioperative antibiotic prophylaxis, beta blockade, and venous thromboembolism prophylaxis. Patient outcomes included mortality, length of hospital stay, discharge disposition, surgical complications, readmissions, and reoperations within the first 30 days after discharge. Hierarchical models were used to estimate effects of hospital and surgeon procedure volume and standardisation on individual and combined surgical outcomes and length of stay.Background
Methods
An osteochondral defect in the knees of young active patients represents a treatment challenge to the orthopaedic surgeon. Early studies with allogenic cartilage transplantation showed this tissue to be immunologically privileged, showed fresh grafts to maintain hyaline cartilage, and surviving chondrocytes several years after implantation. Between January 1978 and October 1995 we enrolled 63 patients in a prospective non-randomised study of fresh osteochondral allografts for post-traumatic distal femur defects in our institute. Five international patients who were lost to follow-up were excluded from this study. The indications for the procedure were: patients younger than 50 years of age having unipolar post-traumatic defects, or osteochondritis dissecans larger than three cm in diameter and one cm in depth.Background
Methods
Salvage procedures on the 1st MTPJ following failed arthroplasty, arthrodesis or hallux valgus surgery are difficult and complicated by bone loss. This results in shortened first ray and transfer metatarsalgia. We present our experience of using tri-cortical interposition grafts to manage this challenging problem. Between 2002 and 2009 our department performed 21 1st MTPJ arthrodeses using a tri-cortical iliac crest interposition graft. Surgical fixation was achieved with a compact foot plate. We performed a retrospective review from the medical notes and radiographs along with American Foot and Ankle scores which were collected prospectively. We analysed the following parameters: time to radiological union, requirement for further surgery, lengthening of 1st ray and any post operative complications.Background
Methods
To study the efficacy of Hydroxyapatite (HAC) Ceramic Coated hip arthroplasty. Is it suitable for the younger patient? This series of 2390 primary HAC hip arthroplasties has been studied for up to 21 years. (569 hips over 10 years including 98 hips over 15 years) Patients are assessed by Harris Hip Score and plain X-ray. The prosthesis consists of a fully coated stem and a fully coated acetabulum. A ceramic head articulates with an acetabular liner which is either plastic (UHMW polythene) or ceramic. No cement is used. HA coated implants are physiologically fixed to cancellous bone by a process of osseointegration. Other uncemented implants are pathologically fixed by fibrous scar tissue. These two methods of fixation should be considered separately and not combined as ‘uncemented’.Aim
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