The aim is to evaluate the effectiveness of pericardium patch as a tendon augmentation graft in the repair of massive rotator cuff tear. This is prospective study analysis of a consecutive series of 60 patients who underwent open repair of a massive rotator cuff tear with patch between 1999 and 2007. The inclusion criteria were: symptomatic with pain, deficit of elevation, not responsive to the physiotherapy, tear size (massive: 2 or more tendons), minimum follow-up of 2 years since surgery, active and motivated patients. All were assessed preoperatively with plain radiographs (anteroposterior and axillary views), ultrasound and NMR of the shoulder. The study group consistent of 60 patients (39 men and 21 women) with the mean age of was 66 years (range, 46–81). The mean duration of symptoms before repair was 18 months (range 3–48). Patients were assessed with UCLA score, visual analog scale (Vas scale) and ultrasound preoperatively, at 1 year, and at 3 years. The change in UCLA scores, Vas scale were analyzed with the paired Student's test, assuming a normal distribution of the total score. Satisfactory results were achieved in 49 patients: mean preoperative UCLA score improved from 9.3 to 16.9 at final follow-up.

For pain, the mean preoperative value of Vas scale was 9,1, postoperative mean value was 4.9. Range of motion and abduction power improved not significantly after surgery, although patients satisfaction levels were high. Imaging studies identified intact patch in 15 patients and patch detachment in 45. No adverse side effects (infection, rejection, allergy) were reported during the study period.

The results of our study suggest that patients (appropriately selected) with a massive full-thickness rotator cuff tear can be expected to have a pain relief after repair, but not a significantly improved of functional outcome.

Introduction

A recent review of the literature on metal-on-metal total hip arthroplasties (THA) revealed the lack of comparative clinical studies with a sufficient sample size and the inclusion of patient-reported outcomes as well as patient activity levels.

The reported results of compression fractures are poor. These results are not influenced by the severity of compression, the fracture site or the residual deformity. Otherwise, the factors that determine a patient's recovery are unknown. This study wants to identify the factors determining a patient's recovery after surgical treatment of compression fractures of the thoracolumbar spine. Therefore, in 31 surgically treated patients the pre-injury versus the 12-month follow-up differences in back pain, in global outcome and in participation were prospectively recorded. For this, the visual analogue scale for pain (VAS scale) and the Greenough and Fraser low back outcome scale were used. Of the latter scale, the 3 questions pertaining to participation were combined to create a participation subscale. For these differences and for time lost from work multiple linear regressions with combinations of 16 possible predictors were performed.

At one year patients who smoke report a 25% less favorable global outcome and return 2.8 points (out of 10) less closely to their pre-injury pain level than patients who do not smoke. Patients with a fracture at the thoraco-lumbar junction return 3.3 points less closely to their pre-injury level on the VAS scale than those with a lumbar fracture. For each decrease in 1 of the 3 education levels, the patients stay away from work 15 weeks longer. Per degree of sagittal index at follow-up, patients stay 9 days longer at home. For each increase in level of occupation the return to the pre-injury participation level is 10% less favorable. The variability of time lost from work and of recovery of global outcome, pain and participation level explained by our models is 73%, 37%, 25% and 13% respectively.

Smoking, localization of the fracture at the thoraco-lumbar junction and a high pre-existent level of occupation are strong negative predictors for recovery. A lower education level and sagittal fracture deformity at follow-up are negative predictors for sick leave but might also reflect the concerns of the physician when deciding about return to work.

Introduction

Dislocation following total hip arthroplasty THA is a major short term complication not infrequently resulting in revision arthroplasty. Malposition of the acetabular component in THA results in a higher rate of dislocation as well as increased wear and osteolysis. The aim of this study was to assess the effect of mode of fixation on positioning of the acetabular component.

Objective

High grade hallux rigidus is a forefoot deformity characterized by a limitation of dorsiflexion of the first toe associated with pain, and severe damage of the first metatarsophalangeal joint. Most authors recommended resection arthroplasty or arthrodesis of the first metatarsophalangeal joint. The aim of this study was to present the results of our series of 42 consecutive cases of severe hallux rigidus treated by resection of the first metatarsal head and implant of a poly D-L lactic (PDLLA) bioreabsorbable spacer to promote the interposition of fibrous tissue to preserve the range of motion of the joint.

Percutaneous biopsies can lead to seeding of tumour cells along the biopsy tract.

Correct surgical management requires preoperative identification and excision of the biopsy tract at time of surgery. These tracts become increasingly difficult to identify with time, leading to risk of inadequate excision of the biopsy tract and recurrence of the tumour at the biopsy site. We conducted a prospective study involving 45 patients who had tissue biopsies for bone and soft tissue tumours between February and May 2008. All the biopsies were performed by consultant radiologist under ultrasound or CT guidance. Case note analysis, patient history and examination at the time of surgery were used to collect data. 23 of 45 patients had accurate identification of the biopsy tract by the surgeon at the time of excision. The mean time between biopsy and excision was 52 days (range 6–140). 22 of 45 patients had unidentifiable biopsy site, with the mean time between biopsy and excision being 98 days(range 13–164) p=0.0004(paired t test). All 4 patients who received post-biopsy radiotherapy had unidentifiable biopsy site tract (mean duration 104 days) and 11 of the 18 patients who underwent neoadjuvant chemotherapy had an unidentifiable biopsy tract (mean duration 108 days). We concluded that identification of biopsy site was more difficult after 50 days, especially in patients who underwent radiotherapy and chemotherapy.

Following this study, all the patients who had biopsies of tumours had the site marked with India ink tattoo. We, then prospectively reviewed 36 patients between July and September 2010 who underwent excision of bone and soft tissue tumours and had their biopsy sites marked with India ink tattoo. After needle biopsy, one drop of the dye was applied at the site of the biopsy. This was taken up by capillary action beneath the dermis and remained present until the patient returned for their definitive surgery. The biopsy site was easily identifiable by the patients and the operating surgeon in all 36 patients. The mean time between biopsy and surgery was 77 days (range 10–299 days). Tattooing of the skin enabled the surgeon to accurately excise the biopsy tract along with the tumour. We recommend this technique of tattooing of the biopsy site with India ink, as it is safe, easily recognisable and permits accurate excision of the tract (including the tattoo), therefore preventing biopsy tract recurrence.

Introduction

Unstable intertrochanteric hip fractures (AO 31A2) continue to be a challenge, as non-locking implants have shown a considerable rate of loss of reduction. Intramedullary fixation has been recommended, although screw cut-out has been identified as problematic. This study was performed to ascertain whether treatments with the established proximal femoral nail (PFN) and the newer PFNA with blade design (proximal femoral nail antirotation) have advantages over the use of the Percutaneous Compression Plate (PCCP, developed by Gotfried).

Aim

The purpose of this study was to investigate the effects of plaster/splint immobilisation of the knee/ankle on driving performance in healthy individuals.

Introduction

The combined incubation of a composite scaffold with bone marrow stromal cells in a perfusion bioreactor could make up a novel hybrid graft material with optimal properties for early fixation of implant to bone. The aim of this study was to create a bioreactor activated graft (BAG) material, which could induce early implant fixation similar to that of allograft. Two porous scaffold materials incubated with cells in a perfusion bioreactor were tested in this study.

Aim

In the last years, many short hip stem variants were developed, almost always sharing the principle of metaphyseal and proximal diaphyseal anchorage. In this study, we analyzed the midterm results after implanting short cementless hip stem of ESKA.

Introduction

Nociceptive and neuropathic components both contribute to chronic pain. Since these components require different pain management strategies, correct pain diagnosis before and during treatment is important.

Freynhagen et al. (2006) reported that they had developed and validated the pain-DETECT questionnaire (PD-Q) to detect neuropathic components in chronic low back pain patients. They also reported that 37% of unselected cohort of chronic LBP patients had predominantly neuropathic pain. However, the extent to which neuropathic components relate to the pathomechanism of pain deriving from osteoarthritis of hip joint remains unknown.

The purpose of this study was to utilize PD-Q to investigate the relationship between neuropathic components and pain deriving from osteoarthritis of the hip joint.

Background

Non-union has traditionally been considered a rare complication following the non-operative management of clavicle fractures. A growing body of evidence has demonstrated higher rates of non-union in adults with displaced fractures. However, the variables that predict non-union in these patients remain unclear. We evaluated the prevalence and risk factors for non-union following displaced midshaft clavicle fractures in a large consecutive series of patients managed non-operatively in our Unit.

Introduction

Many literatures regarding more specific tests to diagnose the supraspinatus tendon injuries and the best rehabilitation methods to strengthen the supraspinatus have been published. However, conflicting results have been reported. 2-deoxy-2-[18F] fluoro-D-glucose (FDG) positron emission tomography (PET) has been recently used to assess skeletal muscle activities in various fields.

Background

Distal tibial metaphyseal fractures pose many complexities. This study assessed the outcomes of distal tibial fractures treated with percutaneously inserted medial locking plates.

Introduction

Following tear of its tendon, the muscle undergoes retraction, atrophy and fatty infiltration. These changes are inevitable and considered irreversible and limit the potential of successful repair of musculotendinous units. It was the purpose of this study to test the hypothesis that administration of anabolic steroids can prevent these muscular changes following experimental supraspinatus tendon release in the rabbit.

Objective

To provide a best estimate of the average treatment effect when microfracture was chosen as the intervention of choice in patients with full-thickness cartilage defects of the knee.

Purpose

Clinicians need knowledge about early and valid predictors of short-term outcome of patients with hip fracture, to adjust and plan rehabilitation. The concept of multimodal rehabilitation has proven effective. Still, some patients do not regain basic mobility independency in the acute orthopaedic setting. The aim was to examine the predictive value of age, sex, prefracture functional level, mental and health status, and fracture type of in-hospital basic mobility outcome, and discharge destination after hip fracture surgery.

Purpose

to analyze the survivorship of the RSA with a minimum 10 years follow up.

INTRODUCTION

Percutaneous surgery is an increasingly accepted technic for the treatment of Hallux valgus but it has some limitations when the intermetatarsal angle ismoderate to severe, having high risk of recurrence.

The mini tight-rope used as a complement for precutaneous surgery avoids complications of open surgery osteotomies (delays consolidation, pain, screws protusion, infection) and it allows us continue with the recurrent trend towards minimal invasive surgery.

Arthordesis of small joints of the foot is a commonly performed procedure in orthopaedics. A variety of fixation devices have been used for this purpose. Nickel-Titanium Memory compression staples for arthrodesis have been used in our institute since June 2003. We report the results of the procedure over a period of 7years involving 252 feet in 232 consecutive patients who underwent arthrodesis or an osteotomy fixation using compression staples. The patients were evaluated to determine the period of immobilization in cast and the time to radiographic joint fusion.

The emphasis of this study was to validate the safety of the implant for fusion of small joints of the foot, as well as to determine whether there is a demonstrable trend in time to fusion and period of immobilization required.

The average time to fusion was 7.2 weeks, the average period of immobilisation was 6.5 weeks. Successful union was achieved in 98% cases. We report the follow up results, finer technical aspects of the procedure and pitfalls to avoid whilst performing the fusions.

Background

Unicompartmental knee arthroplasty provides a good alternative to total knee arthroplasty in patients with isolated medial compartment osteoarthritis. There has been variable reporting in the literature as to whether age and sex affect the survival of unicompartmental knee arthroplasty. The aim of this study was to determine whether age and sex were predictors of failure for the Oxford unicompartmental knee arthroplasty.

Objective

Surgical treatment of trigger finger is usually performed as an outpatient surgery under local anesthesia n this study we present our results of surgical treatment of trigger finger performed with an ophthalmic knife which is less invasive for patient and easer for surgeon.

Several studies have reported the assessment of the femoral head coverage on plane radiograph and CT data in supine position, though young patients with the dysplastic hip often have symptoms during activities such as standing, walking, and running. On the other hand, some investigators have used a method of CT which allows standardization of the femoral head coverage against an anterior pelvic plane based on the anterior superior iliac spines and the pubic tubercle. We believe both the weight-bearing position and the standardized position to be more relevant for diagnosis and preoperative surgical assessment. So, we show the femoral head coverage in standardized position using 3D-CT method and in weight-bearing position using the plane radiograph and the three-dimensional lower extremity alignment assessment system before and after Curved periacetabular osteotomy (CPO). Especially the covered volume of the femoral head, a new concept, using the three-dimensional lower extremity alignment assessment system which differs from the affected area and is measured by the ratio of the covered area in the medial part of the line connecting the anterior point of the acetabulum with the posterior to the femoral head area in each axial slice, superior slices than the slice passing through the femoral head center, obtained from the reproduced 3D model of the pelvis and the femur in standing position allows us to integrate various measurements reported by past researchers.

We studied the consecutive 16 patients treated with CPO. In standardized position the sagittal sectional angles on the slice passing through the femoral head center using 3D-CT method gave us how the anterior, lateral, and posterior coverage was lack compared with normal subjects and whether the adequate transfer of the rotated fragment was performed after operation. The covered volume of the femoral head decides generally the deficiency or the adequateness. In standing position, though the pelvic tilt changes, the femoral head coverage on plane radiograph, representation by the CE angle, the VCA angle, AHI and ARO, was significantly improved, and the covered volume of the femoral head was significantly improved from 25.7% preoperatively to 51.1% postoperatively.

Our study showed the improvement of the femoral head coverage, including the covered volume of the femoral head as a new concept, after CPO in weight-bearing and standardized position. The morphological and functional assessment of the femoral head coverage on both pre- and post-CPO should be performed because we can obtain the objective information in standardized position and the femoral head coverage in standing position is closely connected with the pain.

Introduction

Neck of femur (NOF) fractures are one of the predominant reasons for hospital admissions in patients >65 year. These fractures are associated with a poor outcome; end to independent living in 60% of patients and a 6 month mortality of 30%. Previous studies have shown show elements of under/mal-nutrition on admission. In addition, their nutritional status shows some deterioration thereafter. The aim of this present study is to examine if the nutritional status of patients with NOF fracture admitted at our institution is associated with a larger post-operative haemoglobin drop. This is compared to an independent living age matched control group from the same geographical area.

The Bernese Periacetabular Osteotomy (PAO) has become the established method for treating developmental dysplasia of the hip. In the 1990s, the surgical technique was modified to avoid postoperative cam impingement due to uncorrected head neck offset or pincer impingement due to acetabular retroversion after reorientation. The goal of the study was to compare the survivorship of two series of PAOs with and without the modifications of the surgical technique and to calculate predictive factors for a poor outcome.

A retrospective, comparative study of two consecutive series of PAOs with a minimum follow-up of 10 years was carried out. Series A included 75 PAOs performed between 1984 and 1987 and represent the first cases of PAO. Series B included 90 hips that underwent PAO between 1997 and 2000. In this series, emphasis was put on an optimal acetabular version next to the correction of the lateral coverage. Additionally, a concomitant arthrotomy was performed in every hip to check impingement-free range of motion after reorientation and in 50 hips (56%) an additional offset correction was performed. Survivorship analyses according to Kaplan and Meier were carried out and the endpoint was defined as conversion to a total hip arthroplasty, progression of osteoarthritis, or a Merle d'Aubign score 14. Predictive factors for poor outcome were calculated using the Cox-regression analysis.

The cumulative 10-year survivorship of Series A was significantly decreased (77%; 95%-confidence interval [CI] 72–82%) compared to Series B (86%; 95%-CI 82–89%, p=0.005). Hips with an aspherical head showed a significantly increased survivorship if a concomitant offset correction was performed intraoperatively (90% [95%-CI 86–94%] versus 77% [95%-CI 71–82%], p=0.003). Preoperative factors predicting poor outcome included a high age at surgery, a Merle d'Aubign score 14, a positive impingement test, a positive Trendelenburg sign, limp, an increased grade of osteoarthritis according to Tönnis, and (sub-) luxation of the femoral head (Severin > 3). In addition, predictive factors related to the three dimensional orientation of the acetabular fragment were identified. These included total, anterior, and posterior acetabular over-coverage or under-coverage, acetabular retroversion or excessive anteversion, a lateral center edge angle < 22 °, an acetabular index > 14 °, and no offset correction in aspherical femoral heads.

A good long term result after PAO mainly depends on optimal three-dimensional orientation of the acetabulum and impingement-free range of motion with correction of an aspherical head neck junction if necessary.

Introduction

Regenerative medicine is a rapidly expanding discipline. However due to a lack of validated outcome measures, clinical trials have been far few. This study aims to assess the validity, inter-observer reliability and intra-observer reproducibility of experimental fracture healing assessment on plain radiographies. This technique involves implantation of mesenchymal stem cell (MSC) seeded constructs on only one side of the fracture after randomisation.

Introduction

In orthopaedics, clinical outcome assessment (COA) is still mostly performed by questionnaires which suffer from subjectivity, a ceiling effect and pain dominance. Real life activity monitoring (AM) holds the promise to become the new standard in COA with small light weight and easy to use accelerometers. More and more activities can be identified by algorithms based on accelerometry. The identification of stair climbing for instance is important to assess the participation of patients in normal life after an orthopaedic procedure. In this study we validated a custom made algorithm to distinguish normal gait, ascending and descending stairs on a step by step basis.

We report a retrospective review of outcome after shoulder hemiarthroplasty for proximal humerus fractures. All patients managed with shoulder hemiarthroplasty for proximal humerus fractures between 1997 and 2008 were included. Clinical notes were reviewed and surviving patients completed postal Oxford Shoulder Score (OSS) questionnaires. Results were analysed to assess whether there was a difference in outcome for those above the age of 70 years. A total of 96 patients were treated during this period. Female to male ratio was 3.36:1 with mean age 72 ± 9.6 (45–93) years at time of fracture. At time of review 30.2% of patients were dead. Two patients were lost to follow-up after discharge. Complete case notes were available in 68 patients. Response rate to the OSS was 67.2%. There were 20 patients below 70 years and 48 patients above 70 years of age. The ASA grade was II in 60% of patients. Mean follow-up was 52 months. There were 2 in hospital post-operative deaths due to medical complications. Mean OSS was 27 (3–47) of a maximum of 48, with no significant difference between groups. Overall complication rate was 27.9%, with no significant difference between groups. Ten year survival was 96.9% overall with no significant difference between groups. There appears to be no significant difference in functional outcome, complication rate, or implant survival between patients below or above the age of 70 years treated with primary hemiarthroplasty for fracture of the proximal humerus. This procedure however carries a high complication rate in this group of patients.

In hallux valgus (HV), toe pronation is frequently seen, although there may be some with no pronation.

Introduction

In an ageing population the incidence of patients sustaining a neck of femur fracture is likely to rise. Whilst the neck of femur fracture is thought to be a pre-terminal event in many patients, there is little literature following this common fracture beyond 1 year. With improving healthcare and increasing survival rate, it is likely that a proportion of patients live to have subsequent fractures. However little is known about if these occur and what the epidemiology of these fractures are.

Background

Anterior Cruciate Ligament Reconstruction is a commonly performed orthopaedic operation. The use of a four-strand semitendinosus and gracilis hamstring graft (STG) is a well established method of reconstruction to restore knee stability.

INTRODUCTION

One of the recent advances in the hard-on-hard hip arthroplasty is the development of a new material of diffusion hardened oxidised zirconium (DHOxZr). The DHOxZr material consists of a ceramic layer on the top surface which is supported by a thick oxygen diffusion hardened (DH) zone underneath. With the desired properties of metal substrate, ceramic surface and a gradient structure of the oxygen diffusion zone, the DHOxZr-on-DHOxZr bearing combination is expected to produce low wear and minimal metal ions. This can possibly address the concerns associated with metal hypersensitivity associated with metal on metal bearings and fracture risk associated with ceramics. The aim of this study was to evaluate the wear of DHOxZr-on-DHOxZr as a possible hard on hard bearing combination in hips.

The purpose of this study was to validate the usefulness of SPECT/CT as an evaluation method for determining treatment and prognosis for patellofemoral cartilage lesions, based on MRI and arthroscopic findings.

From August 2009 to February 2010, SPECT/CT was performed on 80 patients (24 male and 56 female, average 53.3 years old) with chronic anterior knee pain who had no degenerative changes or patellar malalignment on plain radiographs. Radioisotope uptake findings on patellofemoral joint from SPECT/CT were classified into three grades by one nuclear medicine specialist. In the patients who demonstrated poor improvements after conservative treatments, MRI and arthroscopy were performed. Patellofemoral cartilage conditions under arthroscopic finding (ICRS grades) were compared with SPECT/CT grading.

In all cases, there were increased uptakes on patellofemoral joints. Eighteen cases showed low uptake (Group 1), 22 cases showed medium uptake (Group 2) and 40 cases high uptake (Group 3). At the follow-up examination after mean 1.7 months, 16 cases of Group 1 (89%), 14 cases of Group 2 (64%) and 28 cases of Groups3 (70%) responded positively to the conservative treatments. For those 22 cases showing poor improvement, MRI and arthroscopy were done. Damage or thinning of patellofemoral cartilage, subchondral cyst, edema and fissuring were observed in every case that underwent MRI. Every arthroscopic case was found that there was patellofemoral cartilage damage. Each of ICRS grade I and grade II was found in 2 cases from Group 1. Two cases of grade II, 4 cases of grade III, and 2 cases of grade IV were found in Group 2. Two cases of grade II, 4 cases of grade III, and 6 cases of grade IV were found in Group 3. There was significant difference in the success rate of conservative treatment between SPECT/CT grade 1 and 2 or 3. And there was significant association between SPECT/CT grade and ICRS grade (P=0.034).

SPECT/CT could be a useful modality in determining the treatment and prognosis for patellofemoral cartilage lesions compared with MRI and arthroscopic findings.

Introduction and aim

Avascular necrosis (AVN) of femoral head remains a major post-operative complication of the surgical fixation of femoral neck fractures (#NOF). In order to reduce the incidence of AVN following this type of fracture, the National Institute for Clinical Excellence (NICE) has stated that fixation must occur within 6 hours. However, there is a paucity of information concerning whether time to fixation influences the development of AVN. The aim of the present study was to assess whether time to fixation affects the development of AVN in patients aged under 60 who had sustained a fracture (#)NOF.

Introduction

The current investigation includes a retrospective review of the experience of five Institutions with distal femur megaprostheses for tumor over a twenty year period, to analyze the incidence and etiology of failure, using a new classification system based upon the failure modes.

Introduction

In this study we decided to observe the incidence of osteoarthritis following ORIF of Lisfranc joint injury. We also intended to point out the influence of different factors such as late diagnosis of the fracture, co-fractures, and open or close fractures on the incidence of osteoarthritis.

Aim

To evaluate the correlation between the clinical Kirk Watson test and arthroscopic Geissler classification in scapholunate instability.

Introduction

Total femur implantation is a rare and challenging procedure in final revision surgery of hip and knee arthroplasties. Reports of this operation technique are even rare in literature. In this study we retrospectively analyse our patients with total femur implants.

Purpose of this study is to create an experimental model of electrophysologic evaluation of the supraspinatus muscle on rats, after traumatic rupture of its tendon.

The population of this study consisted of 10 male Sprague Dawley rats weighting 300–400g. Under general anaesthesia we proceeded with traumatic rupture of the supraspinatus tendon and exposure of the muscle. The scapula was immobilized, and the supraspinatus tendon was attached to a force transducer using a 3–0 silk thread. A dissection was performed in order to identify the suprascapular nerve, which was then stimulated with a silver electrode. Stimulations were produced by a stimulator (Digitimer Stimulator DS9A) and were controlled by a programmer (Digitimer D4030). Fiber length was adjusted until a single stimulus pulse elicited maximum force during a twitch under isometric conditions. Rectangular pulses of 0.5 ms duration were applied to elicit twitch contractions. During the recordings, muscles were rinsed with Krebs solution of approximately 37 8C (pH 7.2–7.4) and aerated with a mixture of 95% O2 and 5% CO2. The output from the transducer was amplified and recorded on a digital interface (CED).

The following parameters were measured at room temperature (20–21 8C): single twitch tension; time to peak; half relaxation time; tetanic tensions at 10, 20, 40, 80 and 100 Hz; and fatigue index, which was evaluated using a protocol of low frequency (40 Hz) tetanic contraction, during 250 ms in a cycle of 1 s, for a total time of 180 s. The fatigue index value was then calculated by the formula [fatigue index=(initial tetanic tension − end tetanic tension) ∗ 100/(initial tetanic tension)]. In the end, the transducer was calibrated with standard weights and tensions were converted to grams.

The mean single twitch was 8.2, the time to peak 0.034 msec and the half relaxation time 0.028 msec. The strength of titanic muscle contractures was 5.7 msec at 10Hz and 17.7 at 100Hz. Finally, the fatigue index was calculated at 48.4.

We believe that electrophysiologic evaluation of the supraspinatus muscle in rats will help us understanding the pathology of muscle atrophy after rotator cuff tears and possibly the functional restoration after cuff repair

Introduction

Reverse shoulder replacement is a surgical option for cuff tear arthropathy. However scapular notching is a concern. Newer designs of glenospheres are available to reduce scapular notching. Eccentric glenosphere with a lowered centre of rotation have been shown to improve range of adduction in vitro. We hypothesize that the eccentric glenosphere improve clinical outcomes and reduce scapular notching.

Introduction

Osteoporosis (OP), osteoarthrosis (OA), and rheumatoid arthritis (RA) are the most common age-related degenerative bone diseases, and major public health problems in terms of enormous amount of economic cost. RA is considered as a major cause of secondary osteoporosis. At late stage, OP often leads to skeletal fractures, and OA and RA result in severe joint disability. Over the last a few decades, much significant research on the properties has been carried out on these diseases, however, a detailed comparison of the microarchitecture of cancellous bones of these diseases is not available.

In this study, we investigated three-dimensional (3-D) microarchitectural properties of OP, OA and RA cancellous bone. We hypothesized that there were significant differences in microarchitecture among OP, OA and RA bone tissues that might lead to different bone quality.

Despite proven advantages, pulsatile lavage seems to be used infrequently during preparation in cemented total knee arthroplasty. This remains irritating, as the technique has been suggested to improve radiological survival in cemented TKA, where aseptic loosening of the tibial component represents the main reason for revision. Furthermore, there may be a potential improvement of fixation strength for the tibial tray achieved by increased cement penetration. In this study, the influence of pulsed lavage on mechanical stability of the tibial component and bone cement penetration was analyzed in a cadaveric setting. Six pairs of cadaveric, proximal tibia specimen underwent computed tomography (CT) for assessment of bone mineral density (BMD) and exclusion of osseous lesions. Following surgical preparation, in one side of a pair, the tibial surface was irrigated using 1800ml normal saline and pulsatile lavage, while in the other side syringe lavage using the identical amount of fluid was applied. After careful drying, bone cement was hand-pressurized on the bone surface, tibial components were inserted and impacted in an identical way. After curing of cement, specimen underwent a postimplantation CT analysis). Cement distrubution was then assessed using a three-dimenionsional visualization software. Trabecular bone, cement and implant were segmented based on an automatic thresholding algorithm, which had been validated in a previous study. This allowed to determine median cement penetration for the entire cemented area. Furthermore, fixation strength of the tibial trays was determined by a vertical pull-out test using a servohydraulic material testing machine. Testing was performed under displacement control at a rate of 0,5mm/sec until implant failure. Data was described by median and range. Results were compared by a Wilcoxon matched pairs signed rank test with a type 1 error probability of 5 %. Median pull-out forces in the pulsed lavage group were 1275N (range 864–1391) and 568N (range 243–683) in the syringe lavage group (p=0.031). Cement penetration was likewise increased (p=0.031) in the pulsed lavage group (1.32mm; range 0.86–1.94), when compared to the syringe irrigated group (0.79mm; range 0.51–1.66). Failure occurred in the pulsatile lavage group at the implant-cement interface and in the syringe lavage group at the bone-cement interface, which indicates the weakness of the latter. Altogether, improved mechanical stability of the tibial implant and likewise increased bone cement interdigitation could be demonstrated in the current study, when pulsed lavage is implemented. Enhanced fixation strength was suggested being a key to improved survival of the implant. If this is the case, pulsatile lavage should be considered being a mandatory preparation step when cementing tibial components in TKA.

Introduction

Locking compression plate (LCP) fixation is an established method of treatment of distal third tibial fractures. No biomechanical data exists in the literature regarding their use. Additionally no data exists on the biomechanical advantage of locking screw fixation over non-locking screw fixation for these fractures. In this study the axial and torsional stiffness, axial load to failure and fatigue performance of a 3.5 mm LCP medial distal tibia Synthes plate was evaluated for the stabilisation of distal third tibial fractures. Additionally the performance of the plate in uni and bicortical locked mode as well as non-locked mode was evaluated.

Introduction

Dupuytren's disease (DD) is a fibro-proliferative disorder of the palmar fascia whereby a collagen cord contracts affected joints, resulting in flexion deformity that can impair hand function. Currently, surgery is the only effective treatment option in Europe. This 2-part study, consisting of a surgeon survey and chart audit, was designed to assess current surgical practice patterns by DD severity. We report results from the surgeon survey.

Background

Improving quality and efficiency is a priority in health policy. Several studies have shown a correlation between high hospital volume and improved results of surgery. In Norway, orthopaedic surgeons operate a relatively low number of total knee replacements compared with other countries. The number of total knee replacements has, however, increased significantly over the past 10 years.

Some studies have also shown an association between surgeon volume and outcomes after total knee arthroplasty (TKA).

Objective

To assess the beneficial use of polypropylene mesh impregnated with vancomycin in an experimental model open fractures Gustilo IIIa in rabbits.

Introduction

Proper cup positioning is a critical component in the success of total hip arthroplasty surgery. A multicenter study has been initiated to study a new type of highly cross-linked polyethylene. This study provides a unique opportunity to a review the acetabular cup placement of over 500 patients implanted in the past 2 years from 13 medical centers from the U.S., Mexico, and Europe.

Background

Impaction bone grafting with milled human allograft is the gold standard for replacing lost bone stock during revision hip surgery. Problems surrounding the use of allograft include cost, availability, disease transmission and stem subsidence (usually due to shear failure of the surrounding allograft). Aims. To investigate various polymers for use as substitute allograft. The ideal graft would be a composite with similar mechanical characteristics as allograft, and with the ability to form de novo bone.

Introduction

The same cup orientation is classically applied to all cases of hip replacement (45° abduction, 20° anteversion). We hypothesize that this orientation must be adapted to the patient's hip range of motion. We tested this hypothesis by means of an experimental study with respect to hip range of motion, comparing the classical orientation (45° and 20°), and the orientation obtained with computer-assisted navigation.

High volume infiltration with local anaesthetics (LIA) during total knee arthroplasty (TKA) for postoperative pain relief may be beneficial as compared to traditional methods. Retransfusion drains are used in TKA as alternative for allogeneic blood transfusions. When combining both modalities, recollected blood may contain large doses of local anaesthetics potentially leading to systemic toxicity during retransfusion. We investigated the safety of combining LIA and retransfusion of shed blood.

Twenty patients scheduled for primary TKA were included. During surgery two peri-articular injections with ropivacaine (total 375 mg) were given. Patients received an intraarticular retransfusion drain and a wound catheter for continuous infusion of ropivacaine (8 mg/hr) for 24 hours. Blood collected in the retransfusion device, was not retransfused but used for laboratory analyses. Patients’ blood samples were taken immediately after surgery, 3, 6 and 24 hours postoperatively. We predicted cumulative ropivacaine concentrations using patient and shed blood samples from 6 hours postoperatively. We modelled instant retransfusion by estimating the cumulative plasma concentrations. Our safety threshold was 0.15 mg/L unbound ropivacaine in a venous plasma sample, based on literature.

Total ropivacaine concentration was highest 24 hours postoperatively and unbound ropivacaine was maximal predominantly at 6 hours. Total ropivacaine concentrations ranged from 0.7 to 1.9 mg/L and unbound ropivacaine concentrations varied between 0.03 and 0.11 mg/L. At 6 hours median shed blood volume was 600 mL (range 303–869 mL). Interestingly was the difference (mean ± SD) in free fraction ropivacaine, in shed blood (68.8–4.6%) and in plasma (4.8 ± 1.1%).

Assuming retransfusion, an average 13 mg (range 6–18mg) of unbound ropivacaine would have been administered intravenously. The model used to estimate cumulative ropivacaine plasma levels showed that instant retransfusion potentially would have led to unbound venous plasma concentrations of above 0.15 mg/L.

Under the conditions in our study it is safe to use LIA in combination with continuous infusion of ropivacaine. However, in combination with the retransfusion of shed blood collected with the Bellovac ABT system this may lead to toxic levels. Before implementing the combination of both modalities formal testing is required.

Objective

The aim of this study was to determine the correlation between body weight and fracture union for displaced intracapsular fracture neck of femur treated by closed reduction and internal fixation.

Aims

We investigated the local epidemiology of Developmental Dysplasia of the Hip (DDH), in order to define incidence, identify risk factors, and refine our policy on selective ultrasound screening.

Background

An increasing number of hip prostheses are inserted without bone cement. Experimental research has shown that hydroxyapatite (HA) coated implants are strongly fixated in the bone, which is believed to reduce the likelihood of prosthetic loosening. However, in recent years, there has been much debate about the role of HA particles in third-body polyethylene (PE) wear and formerly we have shown the revision rate to be high among older-design HA coated cups.

PURPOSE OF THE STUDY

The anterior approach to the thoracic and lumbar spine is used with increasing frequency for various indications. With the advent of prosthetic intervertebral disc replacement, its use has become even more frequent and has often been associated with serious complications. The aim of this study was to evaluate vascular complications in patients who underwent anterior spinal surgery of the thoracic and lumbar spine.

Actually conservative treatment and/or minimal invasive surgical approach is considered the gold standard in the treatment of CF all around the world.

Two main italian pediatric hospitals (Bambino Gesù in Rome and Meyer in Florence) will present own series in order to realize how the two methods (Ponseti in Rome and Seringe in Florence) can be used, the right indications for each method and sharp limits as well.

The aim of this study is to compare two methods for evaluating their effectiveness and their applicability.

Introduction

The MITCH PCR is an anatomic, flexible, horse-shoe shaped acetabular component, with 2 polar fins. The rationale of the PCR cup design is to reproduce a near-physiological stress distribution in the bone adjacent to the prosthesis. The thin composite cup is designed to fuse and flex in harmony with the surrounding bony structure. Only the pathological acetabular cartilage and underlying subchondral bone of the horseshoe-shaped, load-bearing portion of the acetabular socket is replaced, thus preserving viable bone stock. The PCR is manufactured from injection moulded carbon fibre reinforced polyetheretherketone (PEEK), with a two layer outer surface comprising hydroxyapatite and plasma sprayed commercially pure titanium. It is implanted in conjunction with a large diameter low wear femoral head, producing a bearing that will generate minimal wear debris with relatively inert particles.

Pre-clinical mechanical testing, finite element analysis and biocompatibility studies have been undertaken. FEA evaluation predicts preservation of host bone density in the load bearing segments. A pilot clinical study was completed on a proto-type version of the PCR cup (the “Cambridge” cup), achieving excellent 5 and 10 year results.

Introduction

Mortality rates following hip fracture are high. There are several scoring systems which aim to predict morbidity and mortality in hospital in-patients. The Nottingham Hip Fracture Score (NHFS) was devised to predict 30 day mortality following hip fracture.

Background

The reported outcomes of unicompartmental knee replacement (UKR) for spontaneous osteonecrosis of the knee (SPONK) often derive from small series with an average followup of 5 years, enabling to generate meaningful conclusions. Therefore, we determined the long-term functional results and the 10-years survivorship of the implant in all patients with advanced SPONK of the medial tibio-femoral compartment treated with a unicompartmental knee arthroplasty at our institute.

Background

Hip resurfacing arthroplasty (HRA) has seen a recent revival with third generation Metal-on-Metal prostheses and is now widely in use. However, safety and effectiveness of hip resurfacing are still questioned. We systematically reviewed peer-reviewed literature on hip resurfacing arthroplasty to address these issues.

Introduction

Proximal tibial fractures frequently present in combination with other injuries which also have to be treated surgically. Recent publications do not consider isolated proximal tibial fracture (mono-injury) and combined injuries which include tibial fractures as two seperate medical entities. We therefore asessed the influence of additional injuries on treatment and outcome of the proximal tibial fractures.

Bone bruising of the scaphoid is a common term reported, when MRI imaging is carried out for continued pain, within the anatomical snuff box. Is this significant? Our aim was to ascertain if bone bruising lead to continued symptoms, and resulted in delayed fracture detection- an occult fracture. This was a prospective study looking at 170 patients with scaphoid injuries. Of the 170 scaphoid injuries identified there were 120 scaphoid fractures seen on scaphoid view radiographs. The remaining 50 had no fracture on radiographs, however were clinically symptomatic and had MRI scaphoid imaging which demonstrated various grades of bone bruising. All were treated in a scaphoid plaster and re-examined at 8 weeks. There 4 were patients that remained symptomatic, MRI scan were performed which revealed 3 with resolving scaphoid bone bruising and 1 with a scaphoid fracture (p-value=0.05). Two further weeks of immobilisation resolved the symptoms of those 4 patients. Therefore occult scaphoid fractures demonstrating only bone bruising may take up to 8 weeks to declare itself as a fracture. Immobilisation in a scaphoid cast should be the mainstay of treatment for a minimum period of 8 weeks.

Introduction and objectives

Intramedullary nailing is indicated to stabilization of tibia shaft fractures. Intramedullary nailing through an infra-patellar incision is commonly the technique of choice. While intramedullary nailing of simple diaphyseal fracture patterns is relatively easy, proximal tibia fractures, extremely comminuted/segmental tibia fractures, politrauma with multiple fractures in both extremities and reconstruction of bone loss segment with stiffness of the knee joint can be very challenging to treat.

A novel technique for intramedullary tibia nailing through the patella-femoral joint is described. This technique allow extension tibia during intervention time and it supplies easier reduction of the pattern of fracture above. The purpose of our investigation was to evaluate the use of this new technique in described above pattern fracture and patient situation; because we have thought that new technique can perform better outcomes in this situations.

Introduction

Cobalt chrome on polyethylene remains a widely used bearing combination in total joint replacement. However wear induced osteolysis, bulk material property degradation of highly cross-linked polyethylene (HXLPE) [1], and oxidation after implantation (thought to be as a result of lipid absorption or cyclic loading [2]) remains a concern. ECIMA is a cold-irradiated, mechanically annealed, vitamin E blended next generation HXLPE developed to maintain mechanical properties, minimise wear and to improve the oxidation resistance in the long-term. The aim of this study was to compare the in-vitro wear rate and mechanical properties of three different acetabular liners; conventional UHMWPE, HXLPE and ECIMA.

Introduction

The sliding hip screw is the implant of choice for the operative treatment of stable trochanteric femur fractures. Surgeons have been using widely the four-hole side plate DHS (Dynamic Hip screw) with four bicortical screws, which allows adequate weight bearing after operation. However, there is lacking of scientific studies that support the use of such long plate and we question ourselves if we can accomplish the same results with the use of a smaller plate. The objective of this study is to compare the results accomplished with a four-hole and a two-hole DHS side plate in the treatment of transtrochanteric fractures.

AIM

Retrospective study comparing the effectiveness of preoperative autologous blood donation versus intra-operative blood saver systems in minimizing the need for allogeneic blood transfusion in scoliosis surgery.

Introduction

The treatment of clavicle fractures remains controversial. Although most clavicle fractures can be treated successfully nonoperatively, no consensus exists for the complete range of lesions. A systematic literature review was performed to summarize and compare the results of different treatments.

Purpose

The purpose of this retrospective study was to investigate the acetabular morphology of pincer impingement hips in order to better understand damage pattern in these patients. We compared MRI measurements made at different postions from anterior to posterior on the acetbulum in patients with pure pincer type FAI to those made in patients with pure cam-type to collect parameters that may be useful in the diagnosis and classification of pincer impingement.

Background

Both from experimental studies and the large arthroplasty registries there is evidence that bacteria are more often involved in implant loosening then is currently reported. To further elucidate this potential problem, the current study investigated the hypothesis that many total hip arthroplasty revisions, classified as aseptic, are in fact low-grade infections missed with routine diagnostics.

Introduction

Many patients with displaced intracapsular femoral neck fractures (IFNF) are treated with hemiarthroplasty (HA) which has been shown superior to internal fixation(IF) the first year after injury. Long term results, however, are sparse.

Introduction

In total hip arthroplasty ceramic on ceramic bearing couples are used more and more frequently and on a wordwide basis. The main reason of this choice is reduction of wear debris and osteolysis. The tribological properties and the mechanical behaviour of the implanted ceramic must remain the same throughout the patient's life.

The aim of this study was to evaluate the resistance of Alumina Matrix Composite to environmental degradation.

INTRODUCTION

Patellar tendon (PT) autograft is an excellent choice repairing anterior cruciate ligament (ACL) ruptures. Published studies testing the biomechanical characteristics after plasty usually refer to grafts with 10mm wide. The thickness of PT and geometry of the patella have been overlooked.

The purpose of this study was to understand the geometry of PT and patella in our population, regarding their use in Bone - Patellar Tendon - Bone (BTB) technique, in order to evaluate their biomechanical efficiency and study their relationship with anthropometric parameters.

Purpose

To evaluate the long term results of the use of a postoperative autologous blood reinfusion system in total knee arthroplasty.

Introduction

Patellar tracking in total knee replacements has been extensively studied, but little is known about patellar tracking in isolated patellofemoral replacements. We compared patellar tracking and the position of the patellar groove in the natural knee, followed by implantation of the femoral component of a PFR (patella unresurfaced) and after implantation of the femoral & patellar component of the PFR.

BACKGROUND

Many patients who underwent a THA, report a feeling of more “physiological” hip and of faster recovery when bigger heads are used. The aim of this study is to evaluate the walking recovery of patients after THA with different head diameters by the means of gait analysis.

Background

Skeletal stem cells (SSCs) have been used for the treatment of osteonecrosis of the femoral head to prevent subsequent collapse. In isolation SSCs do not provide structural support but an innovative case series in Southampton, UK, has used SSCs in combination with impaction bone grafting (IBG) to improve both the biological and mechanical environment and to regenerate new bone at the necrotic site.

Introduction

One of the most common complications of ceramic on ceramic hip replacement is squeaking. The association of Accolade stem and Trident acetabular system has been reported to have squeaking incidence of up to 35,6%. There is doubt if this phenomenon occurs due to: the stem titanium alloy, the V40 femoral neck, the recessed liner of the trident cup or even the mal-seating of the trident insert on the cup.

Study design: We conducted a prospective cohort study of 448 patients with a variety of spinal metastases.

The purpose of this study is to analyze what kind of pattern of change in each posterior femoral condyle allows for a greater degree of flexion after total knee arthroplasty (TKA). The flexion angle was assessed pre-operatively, and at 12 months after the surgery in 98 patients (106 knees) who underwent consecutive TKA. We used a quantitative 3 dimensional technique using computed tomography for the assessment of changes in both the medial and lateral femoral condylar offset. There were no significant correlation between changes of each posterior condylar offset and post flexion angle (medial condyle; R=−0.038, p=0.70, lateral condyle; R=−0.090, p=0.36). There were no significant differences between changing patterns and increase rate of flexion (p=0.443). Additionally there were no significant differences between changing patterns and increase of flexion angle (p=0.593). Changes of each posterior condylar offset were no correlation to knee flexion after TKA in the current design prosthesis.

Background

Tears of the rotator cuff are a common pathology and poorly understood. Achieving a good functional outcome for patients may be difficult, and the degree of fat infiltration into the muscle is known to be a major determining factor to surgical repair and post operative function. It is the hypothesis of this study that the degree of retraction of the common central tendon as seen on MRI corresponds to the amount of fat infiltration classified according to the Goutallier grading System.

Introduction

Long-term ankle pain, stiffness or swelling are frequent following ankle fracture. We investigated whether engineered compression stocking (ECS) influenced functional outcome and quality of life (QoL).

Introduction

Metal-on-metal (MoM) articulations in total hip replacement (THR) have become an attractive option for young, active patients. Short-term reports have demonstrated elevated systemic metal ion levels in the blood and urine. Disseminated concentrations of cobalt and chromium have raised concern regarding cellular toxicity, chromosomal damage and adverse local soft tissue reactions.

Long-term studies are required to support the increased use of MoM bearings in younger patients given their potential deleterious effects. The purpose of the current study was to report the 7–13 year clinical, radiographic, and metal ion results in patients following MoM THR.

INTRODUCTION

In recent years the age of world's population has risen and with it there has been a significant increase in the frequency of hip fractures in the elderly. These fractures are known to increase morbidity and mortality. However, little is known about the frequency and characteristics of patients who sustain a second hip fracture. We examined the incidence and the underlying associated medical disorders of patients with a second fracture in the other hip.

Introduction

More than 60% of patients presenting with a hip fracture have significant medical co-morbidities and a one year mortality rate between 14% and 47%. The rating scale for the American Society of Anaesthetists (ASA) is a reliable predictor of both surgical risk and mortality with ASA 4 patients having 100% mortality at one year.1,2

INTRODUCTION

Cementless Total Hip Replacement surgery is a well established procedure for relative young patients with severe hip disease. Excellent long term clinical results have been published on the performance of the femoral component. With growing clinical experience, our concern focused on excessive wear of the Ultra High Molecular Weight Polyethylene (UHMWPE) ringloc liner of the Mallory Head cementless Total Hip Prosthesis. After its introduction in our clinic in 1997, this implant is still in use without any modification. We were concerned that due to premature liner wear, the performance of this implant would not be compliant with the international guideline on implant survival (NICE guidelines: at 10 year follow up, 90% of all implants should still be in situ). Our objective was to establish the amount of liner wear in our first 200 MH implants.

Introduction

Since the introduction of 3rd generation Metal-on-Metal-Hip-Resurfacing-Arthroplasty (MoMHRA), thousands of such prostheses have been implanted worldwide in younger patients with end-stage hip osteoarthritis. However, no independent centre has reported their medium-to-long term outcome. The aim of this study is to report the ten year survival and outcome of the Birmingham Hip Resurfacing (BHR), the most commonly used MoMHRA worldwide.

Introduction

Analysing the results of angular stable osteosynthesis in large groups of patients can give us an indication of the possibilities and limitations of both angular stable nailing and plating.

Introduction

Malrotation following total knee replacement is directly related to poor outcome. The knowledge of proximal and distal rotational axes and angles of the femur is therefore of high importance. The aim of the study was to determine whether the most used proximal and distal femoral angles; femoral anteversion angle (FAA) and posterior condylar angle (PCA) were different within individuals, between right, left and gender. As well, we studied whether the “inferior condylar angle” is correlated to the PCA and therefore useful in determining the rotation of the distal femur.

Introduction

The role of in-situ decompression in patients with severe ulnar nerve compression is still controversial. The authors present a prospective study on the results of in-situ decompression in this selected group of patients treated through a mini open incision (4cms) and complete decompression by appropriate patient positioning.

PURPOSE

Osteochondral talar defects (OCDs) are sometimes located so far posteriorly that they may not be accessible by anterior arthroscopy, even with the ankle joint in full plantar flexion, because the talar dome is covered by the tibial plafond. It was hypothesized that computed tomography (CT) of the ankle in full plantar flexion could be useful for preoperative planning. The dual purpose of this study was, firstly, to test whether CT of the ankle joint in full plantar flexion is a reliable tool for the preoperative planning of anterior ankle arthroscopy for OCDs, and, secondly, to determine the area of the talar dome that can be reached by anterior ankle arthroscopy.

Background

In poliomyelitis; hand to knee gait is the sum of quadriceps weakness and fixed knee flexion deformity. Limb shortening is another added problem. Usually, each problem is attacked separately; with variable end results and complication rates for each procedure.

Background

Adequate rotation of femoral component in total knee arthroplasty(TKR) is mandatory for preventing numerous adverse sequelae. The transepicondylar axis has been a well-accepted reference for femoral component rotation in the measured resection technique. In this technique, measured resection is performed referenced off the tibial cut - perpendicular to the tibial mechanical axis with the knee in 90 ° of flexion. However, to the best of our knowledge, it is not known whether this technique apply well to a knee with tibia vara. This study evaluates the reliability of the transepicondylar axis as a rotational landmark in knees with tibia vara.

Objectives

Osteochondral ankle defects (OCDs) mainly occur in a young, active population. In 63% of cases the defect is located on the medial talar dome. Arthroscopic debridement and microfracture is considered the primary treatment for defects up to 15 mm. To treat patients with a secondary OCD of the medial talar dome, a 15-mm diameter metal implant (HemiCAP ®) was developed. The set of 15 offset sizes was designed to correspond with the anatomy of various talar dome curvatures. Recently, two independent biomechanical cadaver studies were published, providing rationale for clinical use. The present study was undertaken to evaluate the clinical effectiveness and safety of the metal implantation technique for osteochondral lesions of the medial talar dome in a prospective study.

Background

Wear particles are considered to be the major culprit for the aseptic loosening. Their characterization is thus crucial for the understanding of their bioreactivity and contribution to the development of aseptic loosening.

Sacroiliac screw fixation is the method of choice for the definitive treatment of unstable posterior pelvic ring injuries; however this technique is demanding and associated with a high risk of iatrogenic neurovascular damage. We therefore evaluated the outcome, complications, surgical and fluoroscopy time for unstable posterior pelvic ring injuries managed with a transiliac locked compression plate.

23 patients were managed with a transiliac locked compression plate for unstable posterior pelvic injuries at a Level I Trauma Center. 21 patients were available for follow up after an average of 30 months and outcome evaluation was performed with the Pelvic Outcome Score, which is composed of a clinical, radiological, and social integration part.

The overall outcome for the pelvic outcome score was excellent in 47.6% (10 patients), good in 19% (4 patients), fair in 28.6% (6 patients) and poor in 4.8% (1 patient). 15 out of 21 patients (71.4%) returned to their normal life, 3 patients (14.3%) were limited at work, and 3 patients (14.3%) were not able to return to work due to their disabilities. The social status was unchanged to the preinjury status in 19 patients (90.5%). 13 patients (62%) stated no changes in spare time and sports activities; 4 patients (19%) had minor and another 4 patients (19%) had major restrictions. The average operation time was 101 min and intraoperative fluoroscopic time averaged 74.2 sec. No iatrogenic neurovascular injuries were observed.

Posterior percutaneous plate osteosynthesis may be a good alternative to sacral screw fixation because it is quick, safe, and associated with a good functional outcome.

Introduction

Obesity has been associated with higher complication rates and poorer outcomes following joint replacement surgery. Body mass index (BMI) is a simple index of body composition and forms part of preoperative assessment. It does not take into account the proportion of lean mass and body fat and can give a false impression of body composition in healthy manual workers. A more accurate measure of body composition is available using non-invasive bioimpedance methods. This study aims to identify whether BMI provides an accurate measure of body fat composition in patients awaiting lower limb arthroplasty surgery.

Background

The degree of postoperative pain is usually moderate to severe following Total Hip Arthroplasty (THA). Comfort and lack of pain are important for optimal mobilization and earlier home discharge.

INTRODUCTION

Hip wear simulator test results could be affected by many non-bearing related factors such as fixation surface conditions, equipment calibration and component set-up. In an effort to improve the accuracy, reliability and repeatability of hip simulator test, a quality management system has been established at the IDC hip tribology laboratory, which has been accredited by UKAS (United Kingdom Accreditation Service) in accordance with the recognised international standard ISO17025. This study demonstrates that under well-controlled laboratory and testing conditions, satisfactory repeatability can be achieved during hip simulator studies.

Aim

The present study was designed to evaluate the implantation of alginate beads containing human mature allogenic chondrocytes for the treatment of symptomatic cartilage defects in the knee.

INTRODUCTION

This study describes the prevalence of pain, functional loss and rotator cuff tears (RCTs) in a general population cohort. It is the first multidisciplinary assessment in such a cohort.

About 81,000 total knee replacements are implanted in the United Kingdom annually. Conventionally pneumatic tourniquet and surgical drains have been used in total knee arthroplasty. However, no definite evidence or guidelines exist to support their use.

The present study aims to look for any difference in perioperative recovery and complications following use of pneumatic tourniquet and surgical drains in knee replacement surgery.

We retrospectively analysed 60 total knee arthroplasties performed by 3 different surgeons at our hospital during January 2007 to June 2010. A sample size of 20 patients in each group was evaluated. Group 1: used tourniquet and drain; Group 2: used tourniquet but no drain; Group 3: didn't use tourniquet but used drain. Data was collected and analysed using statistical means, t-test & analysis of variance.

Parameters compared were surgical (anaesthetic) time, mean postoperative haemoglobin at 24 hrs, blood transfusion rate, haematoma formation, wound infection, pain, deep vein thrombosis and infection at discharge. At 6 weeks clinical follow up letters were analysed.

Our results reveal that there is no significant difference in duration of surgery in either group. Use of tourniquets didn't improve on surgical time (123–133 minutes).

Our Local Hospital Pain Score was used (1 no pain, 2 mild, 3 moderate, 4 severe and 5 worst imaginable pain). No difference at discharge was seen in either group.

Similarly no difference was seen in either group with postoperative haematoma formation with one case (5%) in Group 1 and 3 respectively.

Although the immediate postoperative haemoglobin (Hb%) was comparable in all 3 groups, Group 3 patients received more blood transfusion compared to other groups based on clinical grounds. About 50 % of Group 3 needed blood transfusion compared to 10% in Group 1 and 5% in Group 2.

There was only one proven case of superficial infection at 6 weeks (Group 2) which responded well to antibiotics. There were 4 cases of cellulitis noted at 6 weeks (3 in Group 2 and 1 in Group 3) which responded to oral antibiotics. No deep infection was noted.

The mean hospital stay in hospital was 6.5 days in Group 1, 5.5 days in Group 2 and 8 days in Group 3. There was no difference in rate of post-operative deep vein thrombosis (5% in Group 1 and 3).

The present study with the use of tourniquet and surgical drain in total knee arthroplasty showed no significant difference in surgical time and incidence of postoperative haematoma, deep vein thrombosis. Pain score at discharge was comparable and so was the infection rate. Patients in Group 2 (used tourniquet but no surgical drain) had least hospital stay (mean 5.5 days) and least blood transfusion rate (5%). Decision to use pneumatic tourniquet & drain still lies with the operating surgeon. We recommend a randomised control study for further evidence.