Hallux valgus (HV) presents as a common forefoot deformity that causes problems with pain, mobility, footwear, and quality of life. The most common open correction used in the UK is the Scarf and Akin osteotomy, which has good clinical and radiological outcomes and high levels of patient satisfaction when used to treat a varying degrees of deformity. However, there are concerns regarding recurrence rates and long-term outcomes. Minimally invasive or percutaneous surgery (MIS) has gained popularity, offering the potential for similar clinical and radiological outcomes with reduced postoperative pain and smaller scars. Despite this, MIS techniques vary widely, hindering comparison and standardization. This review evaluates the evidence for both open Scarf and Akin osteotomy and newer-generation MIS techniques. Fourth-generation MIS emphasizes multiplanar rotational deformity correction through stable fixation. While MIS techniques show promise, their evidence mainly comprises single-surgeon case series. Comparative studies between open and MIS techniques suggest similar clinical and radiological outcomes, although MIS may offer advantages in scar length and less early postoperative pain. MIS may afford superior correction in severe deformity and lower recurrence rates due to correcting the bony deformity rather than soft-tissue correction. Recurrence remains a challenge in HV surgery, necessitating long-term follow-up and standardized outcome measures for assessment. Any comparison between the techniques requires comparative studies. Surgeons must weigh the advantages and risks of both open and MIS approaches in collaboration with patients to determine the most suitable treatment. Cite this article:
Electromagnetic induction heating has demonstrated in vitro antibacterial efficacy over biofilms on metallic biomaterials, although no in vivo studies have been published. Assessment of side effects, including thermal necrosis of adjacent tissue, would determine transferability into clinical practice. Our goal was to assess bone necrosis and antibacterial efficacy of induction heating on biofilm-infected implants in an in vivo setting. Titanium-aluminium-vanadium (Ti6Al4V) screws were implanted in medial condyle of New Zealand giant rabbit knee. Study intervention consisted of induction heating of the screw head up to 70°C for 3.5 minutes after implantation using a portable device. Both knees were implanted, and induction heating was applied unilaterally keeping contralateral knee as paired control. Sterile screws were implanted in six rabbits, while the other six received screws coated with Aims
Methods
According to the latest report from the German Arthroplasty Registry, aseptic loosening is the primary cause of implant failure following primary hip arthroplasty. Osteolysis of the proximal femur due to the stress-shielding of the bone by the implant causes loss of fixation of the proximal femoral stem, while the distal stem remains fixed. Removing a fixed stem is a challenging process. Current removal methods rely on manual tools such as chisels, burrs, osteotomes, drills and mills, which pose the risk of bone fracture and cortical perforation. Others such as ultrasound and laser, generate temperatures that could cause
The risk of postoperative complications after resection of soft-tissue sarcoma in the medial thigh is higher than in other locations. This study investigated whether a vessel sealing system (VSS) could help reduce the risk of postoperative complications after wide resection of soft-tissue sarcoma in the medial thigh. Of 285 patients who underwent wide resection for soft-tissue sarcoma between 2014 and 2021 at our institution, 78 patients with tumours in the medial thigh were extracted from our database. Information on clinicopathological characteristics, preoperative treatment, surgical treatment (use of VSS, blood loss volume, operating time), and postoperative course (complications, postoperative haemoglobin changes, total drainage volume, and drainage and hospitalization durations) were obtained from medical records. We statistically compared clinical outcomes between patients whose surgery did or did not use VSS (VSS and non-VSS groups, respectively).Aims
Methods
This exploratory randomized controlled trial (RCT) aimed to determine the splint-related outcomes when using the novel biodegradable wood-composite splint (Woodcast) compared to standard synthetic fibreglass (Dynacast) for the immobilization of undisplaced upper limb fractures in children. An exploratory RCT was performed at a tertiary paediatric referral hospital between 1 June 2018 and 30 September 2019. The intention-to-treat population consisted of 170 patients (mean age 8.42 years (SD 3.42); Woodcast (WCG), n = 84, 57 male (67.9%); Dynacast (DNG), n = 86, 58 male (67.4%)). Patients with undisplaced upper limb fractures were randomly assigned to WCG or DNG treatment groups. Primary outcome was the stress stability of the splint material, defined as absence of any deformations or fractures within the splint during study period. Secondary outcomes included patient satisfaction and medical staff opinion. Additionally, biomechanical and chemical analysis of the splint samples was carried out.Aims
Methods
The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome. We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome.Aims
Methods
The Fassier Duval (FD) rod is a third-generation telescopic implant for children with osteogenesis imperfecta (OI). Threaded fixation enables proximal insertion without opening the knee or ankle joint. We have reviewed our combined two-centre experience with this implant. In total, 34 children with a mean age of five years (1 to 14) with severe OI have undergone rodding of 72 lower limb long bones (27 tibial, 45 femoral) for recurrent fractures with progressive deformity despite optimized bone health and bisphosphonate therapy. Data were collected prospectively, with 1.5 to 11 years follow-up.Aims
Methods
Objectives. Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty. Non-contact induction heating of metal implants is a new and emerging treatment for PJI. However, there may be concerns for potential tissue necrosis. It is thought that segmental induction heating can be used to control the thermal dose and to limit collateral
The well-fixed cemented femoral stem and surrounding cement can be challenging to remove. Success requires evaluation of the quality of the cement mantle (interface lucency), position of the stem, extent of cement below the tip of the stem and skill with the specialised instruments and techniques needed to remove the stem and cement without perforating the femur. Smooth surfaced stems can usually be easily removed from the surrounding cement mantle with a variety of stem extractors that attach to the trunnion or an extraction hole on the implant. Roughened stems can be freed from the surrounding cement mantle with osteotomes or a narrow high speed burr and then extracted with the above instruments. Following this, the well-fixed cement mantle needs to be removed. Adequate exposure and visualization of the cement column is essential to remove the well-fixed cement without damage to the bone in the femur. This is important since fixation of a revision femoral component typically requires at least 4 cm of contact with supportive cortical bone, which can be difficult to obtain if the femur is perforated or if the isthmus damaged. Proximally, cement in the metaphyseal region can be thinned with a high speed burr, then split radially and removed piecemeal. It is essential to remember that both osteotomes and high speed burrs will cut thru bone easier than cement and use of these instruments poses a substantial risk of unintended bone removal and perforation of the femur if done improperly. These instruments should, as a result, be used under direct vision. Removal of more distal cement in the femur typically requires use of an extended femoral osteotomy (ETO) to allow for adequate access to the well-fixed cement in the bowed femoral canal. An ETO also facilitates more efficient removal of cement in the proximal femur. The ETO should be carefully planned so that it is distal enough to allow for access to the end of the cement column and still allow for stable fixation of a new implant. Too short of an ETO increases the risk of femoral perforation since the straight cement removal instruments cannot negotiate the bowed femoral canal to access the end of the cement column without risk of perforation. An ETO that is too distal makes cement removal easier, but may not allow for sufficient fixation of a new revision femoral stem. Cement below the level of the ETO cannot be directly visualised and specialised instruments are necessary to safely remove this distal cement. Radiofrequency cement removal devices use high frequency (ultrasonic) radio waves to melt the cement within the canal. Although cement removal with these devices is time consuming and tedious, they do substantially reduce the chances of femoral perforation. These devices can, however, generate considerable heat locally and can result in
We aimed to evaluate the temperature around the nerve root during drilling of the lamina and to
determine whether irrigation during drilling can reduce the chance of nerve root injury. Lumbar nerve roots were exposed to frictional heat by high-speed drilling of the lamina in a live
rabbit model, with saline (room temperature (RT) or chilled saline) or without saline (control)
irrigation. We measured temperatures surrounding the nerve root and made histological
evaluations.Aims
Materials and Methods
The aim of this study was to determine whether chilled irrigation
saline decreases the incidence of clinical upper limb palsy (ULP;
a reduction of one grade or more on manual muscle testing; MMT),
based on the idea that ULP results from thermal damage to the nerve
roots by heat generated by friction during bone drilling. Irrigation saline for drilling was used at room temperature (RT,
25.6°C) in open-door laminoplasty in 400 patients (RT group) and
chilled to a mean temperature of 12.1°C during operations for 400
patients (low-temperature (LT) group). We assessed deltoid, biceps,
and triceps brachii muscle strength by MMT. ULP occurring within
two days post-operatively was categorised as early-onset palsy.Aims
Methods
This animal study compares different methods
of performing an osteotomy, including using an Erbium-doped Yttrium
Aluminum Garnet laser, histologically, radiologically and biomechanically.
A total of 24 New Zealand rabbits were divided into four groups
(Group I: multihole-drilling; Group II: Gigli saw; Group III: electrical
saw blade and Group IV: laser). A proximal transverse diaphyseal
osteotomy was performed on the right tibias of the rabbits after the
application of a circular external fixator. The rabbits were killed
six weeks after the procedure, the operated tibias were resected
and radiographs taken. The specimens were tested biomechanically using three-point bending
forces, and four tibias from each group were examined histologically.
Outcome parameters were the biomechanical stability of the tibias
as assessed by the failure to load and radiographic and histological
examination of the osteotomy site. The osteotomies healed in all specimens both radiographically
and histologically. The differences in the mean radiographic (p
= 0.568) and histological (p = 0.71) scores, and in the mean failure
loads (p = 0.180) were not statistically significant between the
groups. Different methods of performing an osteotomy give similar quality
of union. The laser osteotomy, which is not widely used in orthopaedics
is an alternative to the current methods. Cite this article:
The well-fixed cemented femoral stem and surrounding cement can be challenging to remove. Success requires evaluation of the quality of the cement mantle (interface lucency), position of the stem, extent of cement below the tip of the stem and skill with the specialised instruments and techniques needed to remove the stem and cement without perforating the femur. Smooth surfaced stems can usually be easily removed from the surrounding cement mantle with a variety of stem extractors that attach to the trunnion or an extraction hole on the implant. Roughened stems can be freed from the surrounding cement mantle with osteotomes or a narrow high speed burr and then extracted with the above instruments. Following this, the well fixed cement mantle needs to be removed. Adequate exposure and visualization of the cement column is essential to remove the well-fixed cement without damage to the bone in the femur. This is important since fixation of a revision femoral component typically requires at least 4cm of contact with supportive cortical bone, which can be difficult to obtain if the femur is perforated or if the isthmus damaged. Proximally, cement in the metaphyseal region can be thinned with a high speed burr, then split radially and removed piecemeal. It is essential to remember that both osteotomes and high speed burrs will cut thru bone easier than cement and use of these instruments poses a substantial risk of unintended bone removal and perforation of the femur if done improperly. These instruments should, as a result, be used under direct vision. Removal of more distal cement in the femur typically requires use of an extended femoral osteotomy (ETO) to allow for adequate access to the well-fixed cement in the bowed femoral canal. An ETO also facilitates more efficient removal of cement in the proximal femur. The ETO should be carefully planned so that it is distal enough to allow for access to the end of the cement column and still allow for stable fixation of a new implant. Too short of an ETO increases the risk of femoral perforation since the straight cement removal instruments cannot negotiate the bowed femoral canal to access the end of the cement column without risk of perforation. An ETO that is too distal makes cement removal easier, but may not allow for sufficient fixation of a new revision femoral stem. Cement below the level of the ETO cannot be directly visualised and specialised instruments are necessary to safely remove this distal cement. Radiofrequency cement removal devices (OSCAR) use high frequency (ultrasonic) radio waves to melt the cement within the canal. Although cement removal with these devices is time consuming and tedious, they do substantially reduce the chances of femoral perforation. These devices can, however, generate considerable heat locally and can result in
