Aims. The aim of this study was to assess
Aims. To assess the effect of physical exercise (PE) on the histological and transcriptional characteristics of proteoglycan-induced
Aims. The surgical management of ankle
We retrospectively reviewed the records of 1150
computer-assisted total knee replacements and analysed the clinical
and radiological outcomes of 45 knees that had
We systematically reviewed all the evidence published
in the English language on proximal interphalangeal joint (PIPJ)
replacement, to determine its effectiveness on the function of the
hand and the associated post-operative complications. Original studies were selected if they reported clinical outcome
with a minimum of one year’s follow-up. Quality was assessed using
the Cowley systematic review criteria modified for finger-joint
replacements. Of 319 articles identified, only five were adequately
reported according to our quality criteria; there were no randomised
controlled trials. PIPJ replacements had a substantial effect size
on hand pain of -23.2 (95% confidence interval (CI) -27.3 to -19.1)
and grip strength 1.2 (95% CI -10.7 to 13.1), and a small effect
on range of movement 0.2 (95% CI -0.4 to 0.8). A dorsal approach
was most successful. Post-operative loosening occurred in 10% (95%
CI 3 to 30) of ceramic and 12.5% (95% CI 7 to 21) of pyrocarbon
replacements. Post-operative complications occurred in 27.8% (95%
CI 20 to 37). We conclude that the effectiveness of PIPJ replacement has not
been established. Small observational case studies and short-term
follow-up, together with insufficient reporting of patient data,
functional outcomes and complications, limit the value of current
evidence. We recommend that a defined core set of patients, surgical and
outcome data for this intervention be routinely and systematically
collected within the framework of a joint registry.
Aims. Contemporary outcomes of primary total hip arthroplasties (THAs) with highly cross-linked polyethylene (HXLPE) liners in patients with inflammatory
Aims. Insufficient treatment response in rheumatoid arthritis (RA) patients requires novel treatment strategies to halt disease progression. The potential benefit of combination of cytokine-inhibitors in RA is still unclear and needs further investigation. To explore the impact of combined deficiency of two major cytokines, namely interleukin (IL)-1 and IL-6, in this study double deficient mice for IL-1αβ and IL-6 were investigated in different tumour necrosis factor (TNF)-driven inflammatory bone disorders, namely peripheral
Management of ankle
Knowledge of the premorbid glenoid shape and the morphological changes the bone undergoes in patients with glenohumeral
Aim. The aim of this systematic review was to assess the existing published data on tuberculous
Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) with the flexor carpi radialis (FCR) tendon is one of the most common procedures for the treatment of thumb carpometacarpal (CMC)
Introduction. Osteoarthritis in the foot and ankle affects approximately 30,000 patients annually in the UK. Evidence has shown that excess weight exacerbates foot pain, with significant increases in joint forces. However, despite the current trend for Clinical Commissioning Groups to ration surgery for obese patients, studies have not yet determined the effect of weight loss in obese patients with foot and ankle
Aims. The purpose of this study was to validate our hypothesis that centrifugation may eliminate false-positive leucocyte esterase (LE) strip test results caused by autoimmune diseases in the diagnosis of knee infection. Methods. Between January 2016 and May 2019, 83 cases, including 33 cases of septic arthritis and 50 cases of aseptic
Aim. Restarting elective services presents a challenge to restore and improve many of the planned patient care pathways which have been suspended during the response to the COVID-19 pandemic. A significant backlog of planned elective work has built up representing a considerable volume of patient need. We aimed to investigate the health status, quality of life, and the impact of delay for patients whose referrals and treatment for symptomatic joint
Aims. To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. Methods. A total of 40 patients suffering from non-rheumatoid wrist
Numerous studies have demonstrated that concomitant lower back pain (LBP) results in worse functional outcomes in patients undergoing surgical treatment for the management of end stage hip and knee arthritis. However, no equivalent studies have analysed the impact of back pain on the outcomes of patients with end stage ankle
Thumb carpometacarpal (CMC)
Aims. A pragmatic, single-centre, double-blind randomized clinical trial was conducted in a NHS teaching hospital to evaluate whether there is a difference in functional knee scores, quality-of-life outcome assessments, and complications at one-year after intervention between total knee arthroplasty (TKA) and patellofemoral arthroplasty (PFA) in patients with severe isolated patellofemoral
In patients with primary hip replacement for previous infective
End-stage ankle
Aims. The primary aim of the study was to compare the knee-specific functional outcome of robotic unicompartmental knee arthroplasty (rUKA) with manual total knee arthroplasty (mTKA) for the management of isolated medial compartment osteoarthritis. Secondary aims were to compare length of hospital stay, general health improvement, and satisfaction between rUKA and mTKA. Methods. A powered (1:3 ratio) cohort study was performed. A total of 30 patients undergoing rUKA were propensity score matched to 90 patients undergoing mTKA for isolated medial compartment
In an osteological collection of 3100 specimens, 70 were found with unilateral clavicular fractures which were matched with 70 randomly selected normal specimens. This formed the basis of a study of the incidence of
We describe the results of cemented total hip replacement in 23 patients (23 hips) with active tuberculous
Advanced osteoarthritis of the wrist or the distal articulation of the lunate with the capitate has traditionally been treated surgically by arthrodesis. In order to maintain movement, we performed proximal row carpectomy with capsular interposition arthroplasty as an alternative to arthrodesis in eight patients with advanced
Metal on metal hip resurfacing was introduced in 1992 by Derek McMinn initially using an all cementless device and then an all cemented device. A hybrid resurfacing with a cemented femoral component and a cementless acetabular component was introduced in 1994. The manufacturer of the hybrid hip resurfacing was changed in 1996. Since 1997 the Birmingham hip resurfacing has been in continuous use. The device is approved by NICE (National Institute for Clinical Excellence) for use within the NHS in patients with Osteoarthritis of the hip. The device is not yet approved for use in patients with Rheumatoid Arthritis and other types of inflammatory
It has been suggested that arthrodesis of the ankle leads to osteoarthritis of the joints of the ipsilateral hind- and midfoot. We believe these studies overlooked the presence of osteoarthritic changes in these joints before the arthrodesis. We reviewed the pre-operative radiographs of 70 patients with osteoarthritis of the ankle who underwent 71 ankle arthrodeses (one was bilateral). The talonavicular, calcaneocuboid, subtalar and naviculocuneiform joints were given an osteoarthritis score according to Kellgren and Lawrence. The mean age at operation was 54.9 years and the most common indication was for post-traumatic osteoarthritis (52 cases). A total of 68 patients showed pre-existing
Aim. A prospective cohort of patients undergoing total ankle arthroplasrty for
Aims. Total wrist arthrodesis (TWA) produces a spectrum of outcomes.
We investigated this by reviewing 77 consecutive TWA performed for
inflammatory and post-traumatic arthropathies, wrist instability
and as a salvage procedure. . Patients and Methods. All operations were performed by a single surgeon using a specifically
designed pre-contoured dorsally applied non-locking wrist arthrodesis
plate at a single centre. . Results. Median post-operative Buck-Gramcko Lohman (BGL), Disabilities
of the Arm, Shoulder and Hand and Patient Rated Wrist Evaluation
scores at six years (interquartile range (IQR) 3 to 11) were 9 (IQR
= 6 to 10), 19 (IQR = 7 to 45) and 13 (IQR = 1 to 31) respectively.
Polyarticular inflammatory
Aims. Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory
Hind and mid foot
Introduction: Progressive symptomatic tibiofemoral
Introduction: The standard implant for patients with rheumatoid arthritis is a cemented system. Early aseptic loosening is a major concern in patients with bad bone quality, usually seen in inflammatory
Introduction. Serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and synovial fluid white blood cell (WBC) count and differential are effective in diagnosing periprosthetic joint infection (PPJI); however their utility in patients with inflammatory
Intra-articular injection is a common way to deliver biologics to joints, but their effectiveness is limited by rapid clearance from the joint space. This barrier can be overcome by genetically modifying cells within the joint such that they produce anti-arthritic gene products endogenously, thereby achieving sustained, therapeutic, intra-articular concentrations of the transgene products without re-dosing. A variety of non-viral and viral vectors have been subjected to preclinical testing to evaluate their suitability for delivering genes to joints. The first transfer of a gene to a human joint used an
Introduction. In 1976 the senior author presented to the Associations the results of patellectomy with satisfactory results in less than 50% of cases. In 1989 with the increasing success of TKR we started a prospective study of the Lubinus prosthesis for patellofemoral
Introduction: Hip Resurfacing has always been an attractive concept for the treatment of hip arthritis in young patients. Excellent early and medium-term results have been reported with the Birmingham Hip Resurfacing (BHR) device in single and multi-surgeon all-diagnoses and OA series. In the present report we present the results of BHR in inflammatory
Introduction: Diabetes mellitus type 2 (DM II) affects 18.2 million Americans and can cause several chronic and morbid complications. Furthermore, 90% of Americans have radiographic evidence of osteoarthritis by age 40. Diabetes may be an important risk factor for symptomatic osteoarthritis later in life. The aim of our study is to determine if diabetic patients are predisposed to osteoarthritis. Methods: We conducted a review of the all total knee arthroplasty (TKA) cases performed at our institute during the past two years for end stage osteoarthritis. We excluded TKAs performed for post-traumatic
Introduction. Dislocation after primary total hip arthroplasty (THA) is a devastating and frequent postoperative complication. Many risk factors for dislocation have been identified, however, thus far there has been no consensus whether inflammatory
Purpose: Methods: Evaluation of the results of arthroscopic ankle arthrodesis, performed in 49 consecutive patients (52 ankles), with disabling ankle
Traditional dogma states that anterior knee pain in adolescence does not lead to patello-femoral
We report a consecutive series of 16 revision total knee arthroplasties using the Total Condylar III system in 14 patients with inflammatory
Aim: To study the carpal geometry in patients with symptomatic scaphoid non-union without
In recently, reverse shoulder arthroplasty for rotator cuff deficient
To assess the alterations in cell-specific DNA methylation associated with chondroitin sulphate response using peripheral blood collected from Kashin-Beck disease (KBD) patients before initiation of chondroitin sulphate treatment. Peripheral blood samples were collected from KBD patients at baseline of chondroitin sulphate treatment. Methylation profiles were generated using reduced representation bisulphite sequencing (RRBS) from peripheral blood. Differentially methylated regions (DMRs) were identified using MethylKit, while DMR-related genes were defined as those annotated to the gene body or 2.2-kilobase upstream regions of DMRs. Selected DMR-related genes were further validated by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) to assess expression levels. Tensor composition analysis was performed to identify cell-specific differential DNA methylation from bulk tissue.Aims
Methods
We studied retrospectively the results in 24 patients (25 feet) who had been treated by subtalar arthrodesis with internal compression for post-traumatic
We performed a systematic review to compare outcomes of cemented versus uncemented trapezio-metacarpal joint (TMCJ) replacement for treatment of base-of-thumb
Introduction and Objectives: Thumb
The accurate assessment of compartmental involvement in degenerative
The opposable thumb is one of the defining characteristics of human anatomy and is involved in most activities of daily life. Lack of optimal thumb motion results in pain, weakness, and decrease in quality of life. First carpometacarpal (CMC1) osteoarthritis (OA) is one of the most common sites of OA. Current clinical diagnosis and monitoring of CMC1 OA disease are primarily aided by X-ray radiography; however, many studies have reported discrepancies between radiographic evidence of CMC1 OA and patient-related outcomes of pain and disability. Radiographs lack soft-tissue contrast and are insufficient for the detection of early characteristics of OA such as synovitis, which play a key role in CMC OA disease progression. Magnetic resonance imaging (MRI) and two-dimensional ultrasound (2D-US) are alternative options that are excellent for imaging soft tissue pathology. However, MRI has high operating costs and long wait-times, while 2D-US is highly operator dependent and provides 2D images of 3D anatomical structures. Three-dimensional ultrasound imaging may be an option to address the clinical need for a rapid and safe point of care imaging device. The purpose of this research project is to validate the use of mechanically translated 3D-US in CMC OA patients to assess the measurement capabilities of the device in a clinically diverse population in comparison to MRI. Four CMC1-OA patients were scanned using the 3D-US device, which was attached to a Canon Aplio i700 US machine with a 14L5 linear transducer with a 10MHz operating frequency and 58mm. Complimentary MR images were acquired using a 3.0 T MRI system and LT 3D coronal photon dense cube fat suppression sequence was used. The volume of the synovium was segmented from both 3D-US and MR images by two raters and the measured volumes were compared to find volume percent differences. Paired sample t-test were used to determine any statistically significant differences between the volumetric measurements observed by the raters and in the measurements found using MRI vs. 3D-US. Interclass Correlation Coefficients were used to determine inter- and intra-rater reliability. The mean volume percent difference observed between the two raters for the 3D-US and MRI acquired synovial volumes was 1.77% and 4.76%, respectively. The smallest percent difference in volume found between raters was 0.91% and was from an MR image. A paired sample t-test demonstrated that there was no significant difference between the volumetric values observed between MRI and 3D-US. ICC values of 0.99 and 0.98 for 3D-US and MRI respectively, indicate that there was excellent inter-rater reliability between the two raters. A novel application of a 3D-US acquisition device was evaluated using a CMC OA patient population to determine its clinical feasibility and measurement capabilities in comparison to MRI. As this device is compatible with any commercially available ultrasound machine, it increases its accessibility and ease of use, while proving a method for overcoming some of the limitations associated with radiography, MRI, and 2DUS. 3DUS has the potential to provide clinicians with a tool to quantitatively measure and monitor OA progression at the patient's bedside.
Nitric oxide (NO) production by the inducible NO synthase (iNOS) and enhanced emigration of leukocytes into synovial tissue are suggested to play a crucial role in mediating chronic joint inflammation such as rheumatoid arthritis. The effects of iNOS inhibition in experimental
1. Degenerative
Aim. Young patients with ankle
Fifty-three of 55 consecutive elbow replacements for post-traumatic
Purpose and Introduction. The burden of Tuberculosis (TB) in South Africa is significant with recent reports showing an increase in the incidence of multi-drug resistant (MDR) TB. Little is known of the incidence and epidemiology, especially of MDR Tuberculous
1. A regime of treatment for acute suppurative
Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown aetiology. In RA, inflammation and pain are initial symptoms followed by bone and cartilage destruction. Proinflammatory cytokines play a significant role in the initiation and progress of inflammation and tissue destruction. Sensory neuropeptide substance P (SP) participates not only in nociception but also in pro-inflammatory processes by enhancing vasodilatation and recruitment of inflammatory cells. Ubiquitin proteasome system (UPS) activates a transcription factor, NF-κB which regulates the synthesis of proinflammatory mediators like cytokines; however its role in regulating pro inflammatory sensory neuropeptides is unknown. A number of proteasome inhibitors have been shown to down regulate the activity of NF-κB and hence reduce inflammation. In the present study, the effect of proteasome inhibitor (MG 132) on the severity of
Little is published about the use of cementless conical stems in primary hip arthroplasty for congenital hip disease. A conical stem was designed in the 80’s by Prof. Wagner. The stem is made of a rough blasted titanium alloy with a cone angle of 5° and 8 sharp longitudinal “ribs” that cut into the inner cortex, designed to achieve rotational stability: The ribs depth of penetration ranges between 0.1 and 0.5 mm and is also very important to achieve osteo-integration. The CCD angle is 135°. The stem is straight and can be implanted in any degree of version thus being very useful for dysplastic
Introduction: This study assesses the prevalence of trochlear dysplasia as a cause of patello-femoral
Forty hips, which had previously been the site of tuberculous or pyogenic
Plasmin, a proteolytic enzyme derived from the blood, may be activated in synovial fluid both by trauma to synovial tissue and cartilage, and by kinases produced by streptococci and staphylococci. Plasmin normally removes fibrin, but, when in excess, attacks the protein of cartilage matrix. Conversely, excess inhibitor favours the persistence of fibrin and subsequent fibrosis. The relationship of excess protease to the chondrolysis of suppurative
1. A twenty-five-year-old man who developed neuropathic
Symptomatic isolated scaphotrapeziotrapezoid joint
Purpose: To assess patients quality of life, pain, and functional limitations with with endstage ankle
Introduction: High tibial osteotomy is considered as alternative treatment for the unicompartmental
Background and Objective. Total hip arthroplasty (THA) has been applied to treat pain and disability in patients with post-traumatic
Introduction. Total knee replacement has been well-established form of treatment both for osteoarthritis and inflammatory
Shoulder resurfacing arthroplasty is a bone conserving option for patients with glenohumeral
Purpose: To describe the pre- and one-year post-operative preference-based, health related quality of life (health state values) among a cohort of subjects with end-stage ankle
Infection of the ankle joint is a serious problem that can have a debilitating outcome if not identified and treated appropriately. The purpose of this retrospective study is to present epidemiologic data aimed at better characterising the clinical diagnosis of septic ankle guiding empiric therapy. All admissions to Los Angeles County+USC Medical Center between 1996 and 2005 were screened to identify patients with ankle infection, shown by a synovial WBC count >
50,000, frank purulence in the joint, or positive synovial culture. Forty-two patients (33 male, 9 female) with a mean age of 44.8 (23 to 67 years) were identified. Twelve out of forty-two patients had indwelling hardware and were excluded from further analysis. Of the 30 patients with hematogenous septic ankle
Background: Femoro-patellar
Background: Osteoarthritis (OA) is a common phenomena in the population. About 80% of the patients more than 55 years of age have reontgenographic signs of OA, while 25% have clinical signs. Eventually OA leads to joint destruction, which may necessitate joint replacement. Aims: Our goal was to evaluate the synovial reaction in 10 patients who suffered from
Recently in the literature the indications of unicompartmental knee arthroplasty have been extended by the inclusion of patients with
1. Attention is drawn to the powers of resistance of the growing ends of bones in suppurative pyogenic
This study aimed to answer two questions: what are the best diagnostic methods for diagnosing bacterial arthritis of a native joint?; and what are the most commonly used definitions for bacterial arthritis of a native joint? We performed a search of PubMed, Embase, and Cochrane libraries for relevant studies published between January 1980 and April 2020. Of 3,209 identified studies, we included 27 after full screening. Sensitivity, specificity, area under the curve, and Youden index of diagnostic tests were extracted from included studies. We grouped test characteristics per diagnostic modality. We extracted the definitions used to establish a definitive diagnosis of bacterial arthritis of a native joint per study.Aims
Methods
Introduction. The treatment of glenohumeral
A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two surgical procedures was set up to obtain high-quality evidence of effectiveness. However, the trial faced recruitment challenges and struggled to maintain recruitment rates over 30%, although this is not unusual for surgical trials. We conducted a qualitative study with the aim of gathering information about recruitment practices to identify barriers to patient consent and participation to an orthopaedic trial. We collected 11 audio recordings of recruitment appointments and interviews of research team members (principal investigators and research nurses) from five hospitals involved in recruitment to an orthopaedic trial. We analyzed the qualitative data sets thematically with the aim of identifying aspects of informed consent and information provision that was either unclear, disrupted, or hindered trial recruitment.Aims
Methods
The surgical management of subtalar
Summary: The SF-36, FFI, AOS and the AOFAS AHS were recorded pre and post-operatively in patients with end-stage ankle
Purpose: Problem: Tibia plateau fractures may lead to end-stage post-traumatic
Aim of the study: The evaluation of denervation efficiency in the treatment of the
Ankle arthrodesis for isolated ankle
Introduction. The authors performed a short term prospective study of unicompartmental knee replacement (UKR) associated to patella-femoral arthroplasty (PFA) for the treatment of bicompartmental symptomatic knee arthritis. At the latest follow-up all the implants were matched to a similar computer assisted Total Knee Replacements (CAS-TKR) group implanted for the same indications. Hypothesis of the study was that this bicompartimental implants could achieve comparable outcomes to TKR with a more conservative surgery and a higher joint function. Materials and Methods. 19 cases of anteriomedial (12) or anterolateral (7)
The sternoclavicular joint (SCJ) is a pivotal
articulation in the linked system of the upper limb girdle, providing
load-bearing in compression while resisting displacement in tension
or distraction at the manubrium sterni. The SCJ and acromioclavicular
joint (ACJ) both have a small surface area of contact protected
by an intra-articular fibrocartilaginous disc and are supported
by strong extrinsic and intrinsic capsular ligaments. The function
of load-sharing in the upper limb by bulky periscapular and thoracobrachial
muscles is extremely important to the longevity of both joints.
Ligamentous and capsular laxity changes with age, exposing both
joints to greater strain, which may explain the rising incidence
of
Aim and Purpose of the study. The authors evaluate the efficacy of athrodiatasis as possible alternative to arthrodesis or arthroplasty in the treatment of ankle
We report the use of the reverse shoulder prosthesis in the revision of a failed shoulder hemiarthroplasty in 19 shoulders in 18 patients (7 men, 11 women) with severe pain and loss of function. The primary procedure had been undertaken for glenohumeral
1. Eight cases of monarticular brucellar
The CMI pyrocarbon implant is a unipolar arthroplasty for trapeziometacarpal joint
As an alternative to ankle replacement, ankle arthrodesis remains a mainstay in the treatment of end-stage
Purpose: Trapezium excision and arthroplasty combined with ligament reconstruction as a treatment for first carpometacarpal joint
We describe the mid-term clinical results of the surgical treatment of primary degenerative
Introduction: With the recent advancement, total ankle arthroplasty has been performed more frequently for painful end-stage ankle
We divided 309 patients with an inflammatory
1. High tibial osteotomy-above the tibial tubercle-gives good results in elderly patients disabled by
1. A case of
Purpose: 1/ To compare patients treated with both ankle arthroplasty or ankle fusion using validated functional outcome measures and a computerized motion analysis system that measures three-dimensional kinematics and temporal data. 2/ To compare the functional outcome and gait mechanics of ankle arthroplasty and ankle arthrodesis to a healthy control group. Methods: Fifteen patients underwent seventeen ankle arthroplasties with the Scandinavian Total Ankle Replacement (STAR), twenty-three patients underwent ankle arthrodesis, and twenty-three healthy control patients were enrolled in this study. Assessment included: 1/ Ankle Osteoarthritis Scale (AOS) and general health status (SF-36). 2/ Gait data, including temporal-spatial, kinematic, and kinetic parameters using a seven-camera VICON 370 system (Oxford Metrics, UK). Comparison between groups was done using one-way ANOVA post hoc Bonferroni (p<
0.05). Results: Kinematic gait parameters for post-op arthrodesis, post-op arthroplasty and a control group are summarized in Table 1. Postoperative arthrodesis patients had significantly reduced ankle range of motion in the sagittal and frontal plane when compared to both postoperative arthroplasty patients and a control group (p<
0.05). Forefoot range of motion was also significantly reduced in the sagittal and frontal planes for arthrodesis patients when compared to the control group, however there were no significant differences between patient groups or between arthroplasty patients and controls (p<
0.05).|Functional questionnaire (AOS) data for the three groups is summarized in Table 2. There were no significant differences in patient perception of pain and disability, however AOS scores compared between arthrodesis patients and a control group were significant (p<
0.05). No difference was noted in AOS scores between ankle arthroplasty and control patients at one year post operative. Conclusions: Functional outcome analysis of treatment methods of end-stage ankle
1. Experimental