Aims. The primary aim was to assess whether preoperative health-related quality of life (HRQoL) was associated with postoperative mortality following total hip arthroplasty (THA) and knee arthroplasty (KA). Secondary aims were to assess whether patient demographics/comorbidities and/or joint-specific function were associated with postoperative mortality. Methods. Patients undergoing THA (n = 717) and KA (n = 742) during a one-year period were identified retrospectively from an arthroplasty register. Patient demographics, comorbidities, Oxford score, and EuroQol five-dimension (EQ-5D) were recorded preoperatively. Patients were followed up for a minimum of seven years and their mortality status was obtained. Cox regression analysis was used to adjust for confounding. Results. During the study period, 111 patients (15.5%) undergoing THA and 135 patients (18.2%) undergoing KA had died at a mean follow-up of 7.5 years (7 to 8). When adjusting for confounding, the preoperative EQ-5D was associated with postoperative mortality, and for each 0.1 difference in the utility there was an associated change in mortality risk of 6.7% (p = 0.048) after THA, and 6.8% (p = 0.047) after KA. Comorbidities of connective tissue disease (p ≤ 0.026) and diabetes (p ≤ 0.028) were associated with mortality after THA, whereas MI (p ≤ 0.041), diabetes (p ≤ 0.009), and pain in other joints (p ≤ 0.050) were associated with mortality following KA. The preoperative Oxford score was associated with mortality, and for each one-point change in the score there was an associated change in mortality risk of 2.7% (p = 0.025) after THA and 4.3% (p = 0.003) after KA. Conclusion. Worse preoperative HRQoL and joint specific function were associated with an increased risk of postoperative mortality. Both HRQoL and joint-specific function decline with longer waiting times to surgery for THA and KA and therefore may result in an increased postoperative mortality risk than would have been expected if surgery had been undertaken earlier. Cite this article: Bone Jt Open 2022;3(12):933–940

Aims. The aim of this study was to investigate the association between fracture displacement and survivorship of the native hip joint without conversion to a total hip arthroplasty (THA), and to determine predictors for conversion to THA in patients treated nonoperatively for acetabular fractures. Methods. A multicentre cross-sectional study was performed in 170 patients who were treated nonoperatively for an acetabular fracture in three level 1 trauma centres. Using the post-injury diagnostic CT scan, the maximum gap and step-off values in the weightbearing dome were digitally measured by two trauma surgeons. Native hip survival was reported using Kaplan-Meier curves. Predictors for conversion to THA were determined using Cox regression analysis. Results. Of 170 patients, 22 (13%) subsequently received a THA. Native hip survival in patients with a step-off ≤ 2 mm, > 2 to 4 mm, or > 4 mm differed at five-year follow-up (respectively: 94% vs 70% vs 74%). Native hip survival in patients with a gap ≤ 2 mm, > 2 to 4 mm, or > 4 mm differed at five-year follow-up (respectively: 100% vs 84% vs 78%). Step-off displacement > 2 mm (> 2 to 4 mm hazard ratio (HR) 4.9, > 4 mm HR 5.6) and age > 60 years (HR 2.9) were independent predictors for conversion to THA at follow-up. Conclusion. Patients with minimally displaced acetabular fractures who opt for nonoperative fracture treatment may be informed that fracture displacement (e.g. gap and step-off) up to 2 mm, as measured on CT images, results in limited risk on conversion to THA. Step-off ≥ 2 mm and age > 60 years are predictors for conversion to THA and can be helpful in the shared decision-making process. Cite this article: Bone Joint J 2023;105-B(9):1020–1029

Aims. The aims of this study were to determine if an increasing serum cobalt (Co) and/or chromium (Cr) concentration is correlated with a decreasing Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) in patients who received the Articular Surface Replacement (ASR) hip resurfacing arthroplasty (HRA), and to evaluate the ten-year revision rate and show if sex, inclination angle, and Co level influenced the revision rate. Methods. A total of 62 patients with an ASR-HRA were included and monitored yearly postoperatively. At follow-up, serum Co and Cr levels were measured and the HHS and the HOOS were scored. In addition, preoperative patient and implant variables and the need for revision surgery were recorded. We used a linear mixed model to relate the serum Co and Cr levels to different patient-reported outcome measures (PROMs). For the survival analyses we used the Kaplan-Meier and Cox regression model. Results. We found that an increase of one part per billion (ppb) in serum Co and Cr levels correlated significantly with worsening of the HHS in the following year. This significant correlation was also true for the HOOS-Pain and HOOS-quality of life sub scores. The overall ten-year survival rate in our cohort was 65% (95% confidence interval (CI) 52.5 to 77.6). Cox regression analysis showed a significant hazard ratio (HR) of 1.08 (95% CI 1.01 to 1.15; p = 0.028) for serum Co level. No significance was found with sex or inclination angle. Conclusion. This study shows that increasing serum Co and Cr levels measured in patients with an ASR-HRA are predictive for deterioration in HHS and HOOS subscales in the following year. Increasing serum Co and Cr should forewarn both surgeon and patient that there is a heightened risk of failure. Continued and regular review of patients with an ASR-HRA implant by measurement of serum Co/Cr levels and PROMs remains essential. Cite this article: Bone Joint J 2023;105-B(7):775–782

Aims. The aim of this study was to report the long-term prognosis of patients with multiple Langerhans cell histiocytosis (LCH) involving the spine, and to analyze the risk factors for progression-free survival (PFS). Methods. We included 28 patients with multiple LCH involving the spine treated between January 2009 and August 2021. Kaplan-Meier methods were applied to estimate overall survival (OS) and PFS. Univariate Cox regression analysis was used to identify variables associated with PFS. Results. Patients with multiple LCH involving the spine accounted for 15.4% (28/182 cases) of all cases of spinal LCH: their lesions primarily involved the thoracic and lumbar spines. The most common symptom was pain, followed by neurological dysfunction. All patients presented with osteolytic bone destruction, and 23 cases were accompanied by a paravertebral soft-tissue mass. The incidence of vertebra plana was low, whereas the oversleeve-like sign was a more common finding. The alkaline phosphatase was significantly higher in patients with single-system multifocal bone LCH than in patients with multisystem LCH. At final follow-up, one patient had been lost to follow-up, two patients had died, three patients had local recurrence, six patients had distant involvement, and 17 patients were alive with disease. The median PFS and OS were 50.5 months (interquartile range (IQR) 23.5 to 63.1) and 60.5 months (IQR 38.0 to 73.3), respectively. Stage (hazard ratio (HR) 4.324; p < 0.001) and chemotherapy (HR 0.203; p < 0.001) were prognostic factors for PFS. Conclusion. Pain is primarily due to segmental instability of the spine from its destruction by LCH. Chemotherapy can significantly improve PFS, and radiotherapy has achieved good results in local control. The LCH lesions in some patients will continue to progress. It may initially appear as an isolated or single-system LCH, but will gradually involve multiple sites or systems. Therefore, long-term follow-up and timely intervention are important for patients with spinal LCH. Cite this article: Bone Joint J 2023;105-B(6):679–687

Aims. The aim of this study was to investigate if there are differences in outcome between sliding hip screws (SHSs) and intramedullary nails (IMNs) with regard to fracture stability. Methods. We assessed data from 17,341 patients with trochanteric or subtrochanteric fractures treated with SHS or IMN in the Norwegian Hip Fracture Register from 2013 to 2019. Primary outcome measures were reoperations for stable fractures (AO Foundation/Orthopaedic Trauma Association (AO/OTA) type A1) and unstable fractures (AO/OTA type A2, A3, and subtrochanteric fractures). Secondary outcome measures were reoperations for A2, A3, and subtrochanteric fractures individually, one-year mortality, quality of life (EuroQol five-dimension three-level index score), pain (visual analogue scale (VAS)), and satisfaction (VAS) for stable and unstable fractures. Hazard rate ratios (HRRs) for reoperation were calculated using Cox regression analysis with adjustments for age, sex, and American Society of Anesthesiologists score. Results. Reoperation rate was lower after surgery with IMN for unstable fractures one year (HRR 0.82, 95% confidence interval (CI) 0.70 to 0.97; p = 0.022) and three years postoperatively (HRR 0.86, 95% CI 0.74 to 0.99; p = 0.036), compared with SHS. For individual fracture types, no clinically significant differences were found. Lower one-year mortality was found for IMN compared with SHS for stable fractures (HRR 0.87; 95% CI 0.78 to 0.96; p = 0.007), and unstable fractures (HRR 0.91, 95% CI 0.84 to 0.98; p = 0.014). Conclusion. This national register-based study indicates a lower reoperation rate for IMN than SHS for unstable trochanteric and subtrochanteric fractures, but not for stable fractures or individual fracture types. The choice of implant may not be decisive to the outcome of treatment for stable trochanteric fractures in terms of reoperation rate. One-year mortality rate for unstable and stable fractures was lower in patients treated with IMN. Cite this article: Bone Joint J 2022;104-B(2):274–282

Aims. To explore the effect of different durations of antibiotics after stage II reimplantation on the prognosis of two-stage revision for chronic periprosthetic joint infection (PJI). Methods. This study involved a retrospective collection of patients who underwent two-stage revision for chronic PJI and continued to use extended antibiotic prophylaxis in two regional medical centres from January 2010 to June 2018. The patients were divided into a short (≤ one month) or a long (> one month) course of treatment based on the duration of antibiotics following stage II reimplantation. The difference in the infection control rate between the two groups was compared, and prognostic factors for recurrence were analyzed. Results. A total of 105 patients with chronic PJI were enrolled: 64 patients in the short course group and 41 patients in the long course group. For 99 of the patients, the infection was under control during a follow-up period of at least 24 months after two-stage revision. For the short course group, the mean duration of antibiotic prophylaxis after stage II reimplantation was 20.17 days (SD 5.30) and the infection control rate was 95.3%; for the long course group these were 45.02 days (SD 15.03) and 92.7%, respectively. There was no significant difference in infection control rates between the two groups (p = 0.676). Cox regression analysis found that methicillin-resistant staphylococcus infection (p = 0.015) was an independent prognostic factor for recurrence. Conclusion. After stage II reimplantation surgery of two-stage revision for chronic PJI, extended antibiotic prophylaxis for less than one month can achieve good infection control rate. Cite this article: Bone Joint Res 2021;10(12):790–796

Aims. This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality. Methods. Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population. Results. Mean age was 80.2 years (SD 11.4) and 67.5% (n = 25,251) were female. Patient factors (male sex, increasing comorbidity (American Society of Anesthesiologists grade and Charlson Comorbidity Index)), socioeconomic factors (low income, low education level, living in a healthcare facility), and healthcare factors (hip fracture volume, availability of orthogeriatric services) were associated with increased mortality. Non-modifiable risk factors were more strongly associated with mortality than modifiable risk factors. The SMR analysis suggested that cumulative excess mortality among hip fracture patients was 16% in the first year and 41% at six years. SMR was 2.48 for the six-year observation period, most pronounced in the first year, and fell from 10.92 in the first month to 3.53 after 12 months and 2.48 after six years. Substantial differences in median survival time were found, particularly for patient-related factors. Conclusion. Socioeconomic, patient-, and healthcare-related factors all contributed to excess mortality, and non-modifiable factors had stronger association than modifiable ones. Hip fractures contributed to substantial excess mortality. Apparently small survival differences translate into substantial disparity in median survival time in this elderly population. Cite this article: Bone Joint J 2022;104-B(7):884–893

Aims. The purpose of this study was to assess mid-term survivorship following primary total knee arthroplasty (TKA) with Optetrak Logic components and identify the most common revision indications at a single institution. Methods. We identified a retrospective cohort of 7,941 Optetrak primary TKAs performed from January 2010 to December 2018. We reviewed the intraoperative findings of 369 TKAs that required revision TKA from January 2010 to December 2021 and the details of the revision implants used. Kaplan-Meier analysis was used to determine survivorship. Cox regression analysis was used to examine the impact of patient variables and year of implantation on survival time. Results. The estimated survivorship free of all-cause revision was 98% (95% confidence interval (CI) 97% to 98%), 95% (95% CI 95% to 96%), and 86% (95% CI 83% to 88%) at two, five, and ten years, respectively. In 209/369 revisions there was a consistent constellation of findings with varying severity that included polyethylene wear and associated synovitis, osteolysis, and component loosening. This failure mode, which we refer to as aseptic mechanical failure, was the most common revision indication. The mean time from primary TKA to revision for aseptic mechanical failure was five years (5 months to 11 years). Conclusion. In this series of nearly 8,000 primary TKAs performed with a specific implant, we identified a lower-than-expected mid-term survivorship and a high number of revisions with a unique presentation. This study, along with the recent recall of the implant, confirms the need for frequent monitoring of patients with Optetrak TKAs given the incidence of polyethylene failure, osteolysis, and component loosening. Cite this article: Bone Joint J 2023;105-B(3):277–283

Aims

The aims of this study were to evaluate the incidence of reoperation (all cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following a hemiarthroplasty incorporating a cemented collarless polished taper slip stem (PTS) for management of an intracapsular hip fracture.

Aims

This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality.

Aims

The incidence of bone metastases is between 20% to 75% depending on the type of cancer. As treatment improves, the number of patients who need surgical intervention is increasing. Identifying patients with a shorter life expectancy would allow surgical intervention with more durable reconstructions to be targeted to those most likely to benefit. While previous scoring systems have focused on surgical and oncological factors, there is a need to consider comorbidities and the physiological state of the patient, as these will also affect outcome. The primary aim of this study was to create a scoring system to estimate survival time in patients with bony metastases and to determine which factors may adversely affect this.

Aims. There is a lack of evidence about the risk factors for local recurrence of a giant cell tumour (GCT) of the sacrum treated with nerve-sparing surgery, probably because of the rarity of the disease. This study aimed to answer two questions: first, what is the rate of local recurrence of sacral GCT treated with nerve-sparing surgery and second, what are the risk factors for its local recurrence?. Methods. A total of 114 patients with a sacral GCT who underwent nerve-sparing surgery at our hospital between July 2005 and August 2017 were reviewed. The rate of local recurrence was determined, and Kaplan-Meier survival analysis carried out to evaluate the mean recurrence-free survival. Possible risks factors including demographics, tumour characteristics, adjuvant therapy, operation, and laboratory indices were analyzed using univariate analysis. Variables with p < 0.100 in the univariate analysis were further considered in a multivariate Cox regression analysis to identify the risk factors. Results. The rate of local recurrence of sacral GCT treated with nerve-sparing surgery was 28.95% (33/114). Multivariate Cox regression analysis showed that large tumour size (> 8.80 cm) (hazard ratio (HR) 3.16; 95% confidence interval (CI) 1.27 to 7.87; p = 0.014), high neutrophil-to-lymphocyte ratio (NLR) (> 2.09) (HR 3.13; 95% CI 1.28 to 7.62; p = 0.012), involvement of a sacroiliac joint (HR 3.09; 95% CI 1.06 to 9.04; p = 0.039), and massive intraoperative blood loss (> 1,550 ml) (HR 2.47; 95% CI 1.14 to 5.36; p = 0.022) were independent risk factors for local recurrence. Conclusion. Patients with a sacral GCT who undergo nerve-sparing surgery have a local recurrence rate of 29%. Large tumour size, high NLR, involvement of a sacroiliac joint, and massive intraoperative blood loss are independent risk factors. Cite this article: Bone Joint J 2020;102-B(10):1392–1398

This study compares outcomes of fixation of subtrochanteric femoral fractures using a single lag screw (Gamma3 nail, GN) with a dual lag screw device (InterTAN nail, IN). The primary outcome was mechanical failure, defined as lag screw cut-out, back-out, nail breakage or peri-implant fracture. Technical factors associated with mechanical failure were also identified. All adult patients (>18yrs) with a subtrochanteric femoral fracture treated in a single centre were retrospectively identified using electronic records. Included patients underwent surgical fixation using either a long GN (2010–2017) or IN (2017–2022). Cox regression analysis was used to determine the risk of mechanical failure and technical predictors of failure. The study included 587 patients, 336 in the GN group (median age 82yrs, 73% female) and 251 in the IN group (median age 82yrs, 71% female). The IN group exhibited a higher prevalence of osteoporosis (p=0.002) and CKD□3 (p=0.007). There were no other baseline differences between groups. The risk of any mechanical failure was increased two-fold in the GN group (HR 2.51, p=0.020). Mechanical failure comprising screw cut-out (p=0.040), back-out (p=0.040) and nail breakage (p=0.51) was only observed in the GN group. The risk of peri-implant fracture was similar between the groups (HR 1.10, p=0.84). Technical predictors of mechanical included varus >5° for cut-out (HR 15.61, p=0.016), TAD>25mm for back-out (HR 9.41, p=0.020) and shortening >1cm for peri-implant fracture (HR 6.50, p=<0.001). Dual lag screw designs may reduce the risk of mechanical complications for patients with subtrochanteric femoral fractures

Several different algorithms attempt to estimate life expectancy for patients with metastatic spine disease. The Skeletal Oncology Research Group (SORG) has recently developed a nomogram to estimate survival of patients with metastatic spine disease. Whilst the use of the SORG nomogram has been validated in the international context, there has been no study to date that validates the use of the SORG nomogram in New Zealand. This study aimed to validate the use of the SORG nomogram in Aotearoa New Zealand. We collected data on 100 patients who presented to Waikato Hospital with a diagnosis of spinal metastatic disease. The SORG nomogram gave survival probabilities for each patient at each time point. Receiver Operating Characteristic (ROC) Area Under Curve (AUC) analysis was performed to assess the predictive accuracy of the SORG score. A calibration curve was also performed, and Brier scores calculated. A multivariate Cox regression analysis was performed. The SORG score was correlated with 30 day (AUC = 0.72) and 90-day mortality (AUC = 0.71). The correlation between the SORG score and 90-day mortality was weaker (AUC = 0.69). Using this method, the nomogram was correct for 79 (79%) patients at 30-days, 59 patients (59%) at 90-days, and 42 patients (42%) at 365-days. Calibration curves demonstrated poor forecasting of the SORG nomogram at 30 (Brier score = 0.65) and 365 days (Brier score = 0.33). The calibration curve demonstrated borderline forecasting of the SORG nomogram at 90 days (Brier score = 0.28). Several components of the SORG nomogram were not found to be correlated with mortality. In this New Zealand cohort the SORG nomogram demonstrated only acceptable discrimination at best in predicting life 30-, 90- or 356-day mortality in patients with metastatic spinal disease

The aims were to assess whether vitamin D deficiency influenced mortality risk for patients presenting with a hip fracture. A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels were assessed. Patient demographics and perioperative variables and mortality were collected. Cox regression analysis (adjusting for confounding) was utilised to determine the independent association between serum vitamin D level and patient mortality. The cohort consisted of 2075 patients with a mean age of 80.7 years and 1471 (70.9%) were female. 1510 (72.8%) patients had a serum vitamin D level taken, of which 876 (58.0%) were deficient (<50nmol/l). The median follow up was 417 (IQR 242 to 651) days. During follow up there were 464 (30.7%) deaths. Survival at 1 year was significantly (p = 0.003) lower for patients who were vitamin D deficient (71.7%, 95% confidence intervals (CI) 68.6 to 74.9) compared to those who were not (79.0%, 95% CI 75.9 to 82.3). Vitamin D deficiency was also independently associated with an increased mortality risk at 2-years (HR 1.42, 95% CI 1.17 to 1.71, p = 0.03), but not at 1-year (p = 0.08). Hip fracture patients with vitamin D deficiency had an increased mortality risk. This risk was independent of confounders at 2 years. The role of measuring vitamin D levels in these patients is unclear. Improved public health policy about vitamin D may be required to reduce deficiency in this patient population

The aims were to assess whether vitamin D deficiency influenced mortality risk for patients presenting with a hip fracture. A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels were assessed. Patient demographics and perioperative variables and mortality were collected. Cox regression analysis (adjusting for confounding) was utilised to determine the independent association between serum vitamin D level and patient mortality. The cohort consisted of 2075 patients with a mean age of 80.7 years and 1471 (70.9%) were female. 1510 (72.8%) patients had a serum vitamin D level taken, of which 876 (58.0%) were deficient (50nmol/l). The median follow up was 417 (IQR 242 to 651) days. During follow up there were 464 (30.7%) deaths. Survival at 1 year was significantly (p=0.003) lower for patients who were vitamin D deficient (71.7%, 95% confidence intervals (CI) 68.6 to 74.9) compared to those who were not (79.0%, 95% CI 75.9 to 82.3). Vitamin D deficiency was also independently associated with an increased mortality risk at 2-years (HR 1.25, 95% CI 1.03 to 1.53, p=0.025), but not at 1-year (p=0.057). Hip fracture patients with vitamin D deficiency had an increased mortality risk. This risk was independent of confounders at 2 years. The role of measuring vitamin D levels in these patients is unclear. Improved public health policy about vitamin D may be required to reduce deficiency in this patient population

Subtrochanteric femoral fractures are a subset of hip fractures generally treated with cephalomedullary nail fixation\[1\]. Single lag screw devices are most commonly-used, but integrated dual screw constructs have become increasingly popular\[2,3\]. The aim of this study was to compare outcomes of fixation of subtrochanteric femoral fractures using a single lag screw (Gamma3 nail, GN) with a dual screw device (InterTAN nail, IN). The primary outcome was mechanical failure, defined as lag screw cut-out, back-out, nail breakage or peri-implant fracture. Consecutive adult patients (18yrs) with subtrochanteric femoral fracture treated in a single centre were retrospectively identified using electronic records. Patients that underwent surgical fixation using either a long GN (2010–2017) or IN (2017–2022) were included. Medical records and radiographs were reviewed to identify complications of fixation. Cox regression analysis was used to determine the risk of mechanical failure and secondary outcomes by implant design. Multivariable regression models were used to identify predictors of mechanical failure. The study included 622 patients, 354 in the GN group (median age 82yrs, 72% female) and 268 in the IN group (median age 82yrs, 69% female). The risk of any mechanical failure was increased two-fold in the GN group (HR 2.44 \[95%CI 1.13 to 5.26\]; _p=0.024_). Mechanical failure comprising screw cut-out (_p=0.032_), back-out (_p=0.032_) and nail breakage (_p=0.26_) was only observed in the GN group. Technical predictors of failure included varus >5° for cut-out (OR 19.98 \[2.06 to 193.88\]; _p=0.01_), TAD;25mm for back-out (8.96 \[1.36 to 58.86\]; p=0.022) and shortening 1cm for peri-implant fracture (7.81 \[2.92 to 20.91\]; _p=<0.001_). Our results demonstrate that an intercalated screw construct is associated with a lower risk of mechanical failure compared with the a single lag screw device. Intercalated screw designs may reduce the risk of mechanical complications for patients with subtrochanteric femoral fractures

Arthrofibrosis is a less common complication following anterior cruciate ligament (ACL) reconstruction and there are concerns that undergoing early surgery may be associated with arthrofibrosis. The aim of this study was to identify the patient and surgical risk factors for arthrofibrosis following primary ACL reconstruction. Primary ACL reconstructions prospectively recorded in the New Zealand ACL Registry between April 2014 and December 2019 were analyzed. The Accident Compensation Corporation (ACC) database was used to identify patients who underwent a subsequent reoperation with review of operation notes to identify those who had a reoperation for “arthrofibrosis” or “stiffness”. Univariate Chi-Square test and multivariate Cox regression analysis was performed. Hazard ratios (HR) with 95% confidence intervals (CI) were computed to identify the risk factors for arthrofibrosis. 9617 primary ACL reconstructions were analyzed, of which 215 patients underwent a subsequent reoperation for arthrofibrosis (2.2%). A higher risk of arthrofibrosis was observed in female patients (adjusted HR = 1.67, 95% CI 1.22 – 2.27, p = 0.001), patients with a history of previous knee surgery (adjusted HR = 1.97, 95% CI 1.11 – 3.50, p = 0.021) and when a transtibial femoral tunnel drilling technique was used (adjusted HR = 1.55, 95% CI 1.06 – 2.28, p = 0.024). Patients who underwent early ACL reconstruction within 6 weeks of their injury did not have a higher risk of arthrofibrosis when compared to patients who underwent surgery more than 6 weeks after their injury (3.5% versus 2.1%, adjusted HR = 1.56, 95% CI 0.97 – 2.50, p = 0.07). Age, graft type and concomitant meniscal injury did not influence the rate of arthrofibrosis. Female sex, a history of previous knee surgery and a transtibial femoral tunnel drilling technique are risk factors for arthrofibrosis following primary ACL reconstruction

Aims. Guided growth has been used to treat coxa valga for cerebral palsy (CP) children. However, there has been no study on the optimal position of screw application. In this paper we have investigated the influence of screw position on the outcomes of guided growth. Methods. We retrospectively analyzed 61 hips in 32 CP children who underwent proximal femoral hemi epiphysiodesis between July 2012 and September 2017. The hips were divided into two groups according to the transphyseal position of the screw in the coronal plane: across medial quarter (Group 1) or middle quarter (Group 2) of the medial half of the physis. We compared pre- and postoperative radiographs in head-shaft angle (HSA), Reimer’s migration percentage (MP), acetabular index (AI), and femoral anteversion angle (FAVA), as well as incidences of the physis growing-off the screw within two years. Linear and Cox regression analysis were conducted to identify factors related to HSA correction and risk of the physis growing-off the screw. Results. A total of 37 hips in Group 1 and 24 hips in Group 2 were compared. Group 1 showed a more substantial decrease in the HSA (p = 0.003) and the MP (p = 0.032). Both groups had significant and similar improvements in the AI (p = 0.809) and the FAVA (p = 0.304). Group 1 presented a higher incidence of the physis growing-off the screw (p = 0.038). Results of the regression analysis indicated that the eccentricity of screw position correlated with HSA correction and increases the risk of the physis growing-off the screw. Conclusion. Guided growth is effective in improving coxa valga and excessive femoral anteversion in CP children. For younger children, despite compromised efficacy of varus correction, we recommend a more centered screw position, at least across the middle quarter of the medial physis, to avoid early revision. Cite this article: Bone Joint J 2020;102-B(9):1242–1247

Dual-mobility (DM) bearings are effective to mitigate dislocation in revision total hip arthroplasty (THA). However, data on its use for treating dislocation is scarce. Aim of this study was to compare DM bearings, standard bearings and constrained liner (CL) in revision THA for recurrent dislocation and to identify risk factors for re-dislocation. We reviewed 100 consecutive revision THAs performed for dislocation from 2012 and 2019. 45 hips (45%) received a DM construct, while 44 hips (44%) and 11 hips (11%) had a standard bearing and CL, respectively. Rates of re-dislocation, re-revision for dislocation and overall re-revision were compared. Radiographs were assessed for cup positioning, restoration of centre of rotation, leg length and offset. Risk factors for re-dislocation were determined by cox regression analysis. Modified Harris hip scores (mHHS) were calculated. Mean follow-up was 53 months (1 to 103). DM constructs were used more frequently in elderly patients (p=0.011) and hips with abductor deficiency (p< 0.001). The re-dislocation rate was 11.1% for DM bearings compared with 15.9% for standard bearings and 18.2% for CL (p=0.732). Revision-free survival for DM constructs was 83% (95% CI 0.77 – 0.90) compared to 75% (95% CI 0.68 – 0.82) for standard articulations and 71% (95% CI 0.56 – 0.85) for CL (p=0.455). Younger age (HR 0.91; p=0.020), lower comorbidity (HR 0.42; p=0.031), smaller heads (HR 0.80; p=0.041) and cup retention (HR 8.23; p=0.022) were associated with re-dislocation. Radiological analysis did not reveal a relationship between restoration of hip geometry and re-dislocation. mHHS significantly improved from 43.8 points to 65.7 points (p<0.001) with no differences among bearing types. Our findings suggest that DM bearings do not sufficiently prevent dislocation in revision THA for recurrent dislocation. Reconstruction of the abductor complex may play a key role to reduce the burden in these high-risk patients

Abstract. Objectives. Total hip replacement (THR) is one of the most successful and cost-effective interventions in orthopaedic surgery. Dislocation is a debilitating complication of THR and managing an unstable THR constitutes a significant clinical challenge. Stability in THR is multifactorial and is influenced by surgical, patient and implant related factors. It is established that larger diameter femoral heads have a wider impingement-free range of movement and an increase in jump distance, both of which are relevant in reducing the risk of dislocation. However, they can generate higher frictional torque which has led to concerns related to increased wear and loosening. Furthermore, the potential for taper corrosion or trunnionosis is also a potential concern with larger femoral heads, particularly those made from cobalt-chrome. These concerns have meant there is hesitancy among surgeons to use larger sized heads. This study presents the comparison of clinical outcomes for different head sizes (28mm, 32mm and 36mm) in primary THR for 10,104 hips in a single centre. Methods. A retrospective study of all consecutive patients who underwent primary THR at our institution between 1st April 2003 and 31st Dec 2019 was undertaken. Institutional approval for this study was obtained. Demographic and surgical data were collected. The primary outcome measures were all-cause revision, revision for dislocation, and all-cause revision excluding dislocation. Continuous descriptive statistics used means, median values, ranges, and 95% confidence intervals where appropriate. Kaplan-Meier survival curves were used to estimate time to revision. Cox proportional hazard regression analysis was used to compare revision rates between the femoral head size groups. Adjustments were made for age at surgery, gender, primary diagnosis, ASA score, articulation type, and fixation method. Results. 10,104 primary THRs were included; median age 68.6 years with 61.5% females. A posterior approach was performed in 71.6%. There were 3,295 hips with 28 mm heads (32.6%), 4,858 (48.1%) with 32 mm heads and 1,951 (19.3%) with 36 mm heads. Overall rate of revision was 1.7% with the lowest rate recorded for the 36mm group (2.7% vs. 1.3% vs. 1.1%). Cox regression analysis showed a decreased risk of all-cause revision for 32mm & 36mm head sizes as compared to 28mm; this was statistically significant for the 32mm group (p = 0.01). Risk of revision for dislocation was significantly reduced in both 32mm (p = 0.03) and 36mm (p = 0.03) head sizes. Analysis of all cause revision excluding dislocation showed no significant differences between head sizes. Conclusion. There was a significantly reduced risk of revision for all causes, but particularly revision for dislocation with larger head sizes (36mm & 32mm vs. 28mm). Concerns regarding increased risk of early revision for aseptic loosening, polyethylene wear or taper corrosion with larger heads appear to be unfounded in this cohort of 10,104 patients with a mean of 6.0-year follow-up. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Aims. There is little information in the literature about the use of dual-mobility (DM) bearings in preventing re-dislocation in revision total hip arthroplasty (THA). The aim of this study was to compare the use of DM bearings, standard bearings, and constrained liners in revision THA for recurrent dislocation, and to identify risk factors for re-dislocation. Methods. We reviewed 86 consecutive revision THAs performed for dislocation between August 2012 and July 2019. A total of 38 revisions (44.2%) involved a DM bearing, while 39 (45.3%) and nine (10.5%) involved a standard bearing and a constrained liner, respectively. Rates of re-dislocation, re-revision for dislocation, and overall re-revision were compared. Radiographs were assessed for the positioning of the acetabular component, the restoration of the centre of rotation, leg length, and offset. Risk factors for re-dislocation were determined by Cox regression analysis. The modified Harris Hip Scores (mHHSs) were recorded. The mean age of the patients at the time of revision was 70 years (43 to 88); 54 were female (62.8%). The mean follow-up was 5.0 years (2.0 to 8.75). Results. DM bearings were used significantly more frequently in elderly patients (p = 0.003) and in hips with abductor deficiency (p < 0.001). The re-dislocation rate was 13.2% for DM bearings compared with 17.9% for standard bearings, and 22.2% for constrained liners (p = 0.432). Re-revision-free survival for DM bearings was 84% (95% confidence interval (CI) 0.77 to 0.91) compared with 74% (95% CI 0.67 to 0.81) for standard articulations, and 67% (95% CI 0.51 to 0.82) for constrained liners (p = 0.361). Younger age (hazard ratio (HR) 0.92 (95% CI 0.85 to 0.99); p = 0.031), lower comorbidity (HR 0.44 (95% CI 0.20 to 0.95); p = 0.037), smaller heads (HR 0.80 (95% CI 0.64 to 0.99); p = 0.046), and retention of the acetabular component (HR 8.26 (95% CI 1.37 to 49.96); p = 0.022) were significantly associated with re-dislocation. All DM bearings which re-dislocated were in patients with abductor muscle deficiency (HR 48.34 (95% CI 0.03 to 7,737.98); p = 0.303). The radiological analysis did not reveal a significant relationship between restoration of the geometry of the hip and re-dislocation. The mean mHHSs significantly improved from 43 points (0 to 88) to 67 points (20 to 91; p < 0.001) at the final follow-up, with no differences between the types of bearing. Conclusion. We found that the use of DM bearings reduced the rates of re-dislocation and re-revision in revision THA for recurrent dislocation, but did not guarantee stability. Abductor deficiency is an important predictor of persistent instability. Cite this article: Bone Joint J 2024;106-B(5 Supple B):89–97

Background. Total hip arthroplasty (THA) is increasingly used for active patients with displaced intracapsular hip fractures. Dislocation rates in this cohort remain high postoperatively compared to elective practice, yet it remains unclear which patients are most at risk. The aim of this study was to determine the dislocation rate for these patients and to evaluate the contributing patient and surgeon factors. Methods. A five-year retrospective analysis of all patients receiving THA for displaced intracapsular hip fractures from 2013–18 was performed. Data was collected from the institutions' hip fracture database, including data submitted to the National Hip Fracture Database (NHFD). Cox regression analysis and log-rank tests were implemented to evaluate factors associated with THA dislocation. Patient age, sex, ASA grade, surgeon seniority, surgical approach, femoral head diameter and acetabular cup type were all investigated as independent factors. Results. A total of 196 patients, with a mean age of 72 (range 49–90), received THA for hip fracture between 2013–18. A posterior approach, using standard cemented acetabular components and a 28mm femoral head, was used in 133 cases (72%). Fourteen dislocations (7%) were observed during this period, with 5 patients requiring revision surgery. Of these dislocations, all were performed through posterior approaches with standard cemented cups. 28mm femoral heads were used in all cases except one, which used a 32mm femoral head. In Cox regression analysis, ASA grade, but not age or sex, was significantly associated with dislocation (hazard ratio = 4.5; 95% confidence interval 2.0–10.0; p<0.001). On log rank testing no statistically, significant association was found between dislocation and surgeon grade (p=0.85), surgical approach (p=0.31), femoral head size (p=0.85) or cup type (p=0.30). Discussion. This study demonstrates an increased risk of dislocation following THA for hip fracture with higher ASA grades. It may be appropriate to offer more stable implants to this cohort of patients

The primary aim was to assess survival of the opening wedge high tibial osteotomy (HTO) for medial compartment osteoarthritis. The secondary aim was to identify independent predictors of early (before 12 years) conversion to total knee arthroplasty (TKA). During the 18-year period (1994–2011) 111 opening wedge HTO were performed at the study centre. Mean patient age was 45 years (range 18–68) and the majority were male (84%). Mean follow-up was 12 (range 6–21) years. Failure was defined as conversion to TKA. Kaplan-Meier, Cox regression and receiver operating curve (ROC) analyses were performed. Forty (36%) HTO failed at a mean follow-up of 6.3 (range 1–15) years. The five-year survival rate was 84% (95% confidence interval (CI) 82.6–85.4), 10-year rate 65% (95% CI 63.5–66.5) and 15-year rate 55% (95% CI 53.3–56.7). Cox regression analysis identified older age (p<0.001) and female gender (hazard ratio (HR) 2.37, 95% CI 1.06–5.33, p=0.04) as independent predictors of failure. ROC analysis identified a threshold age of 47 years above which the risk of failure increased significantly (area under curve 0.72, 95% CI 0.62–0.81, p<0.001). Cox regression analysis, adjusting for covariates, identified a significantly greater (HR 2.49, 95% CI 1.26–4.91, p=0.01) risk of failure in patients aged 47 years old or more. The risk of early conversion to TKA after an opening wedge HTO is significantly increased in female patients and those older than 47 years old. These risk factors should be considered pre-operatively and discussed with patients when planning surgical intervention for isolated medial compartment osteoarthritis

Aims. Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. Patients and Methods. In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m. 2. (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. Results. Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. Conclusion. Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356–1361

Aims. The aim of this large registry-based study was to compare mid-term survival rates of cemented femoral stems of different designs used in hemiarthroplasty for a fracture of the femoral neck. Patients and Methods. From the Norwegian Hip Fracture Register (NHFR), 20 532 primary cemented bipolar hemiarthroplasties, which were undertaken in patients aged > 70 years with a femoral neck fracture between 2005 and 2016, were included. Polished tapered stems (n = 12 065) (Exeter and CPT), straight stems (n = 5545) (Charnley, Charnley Modular, and Spectron EF), and anatomical stems (n = 2922) (Lubinus SP2) were included. The survival of the implant with any reoperation as the endpoint was calculated using the Kaplan–Meier method and hazard ratios (HRs), and the different indications for reoperation were calculated using Cox regression analysis. Results. The one-year survival was 96.0% (95% confidence interval (CI) 95.6 to 96.4) for the Exeter stem, 97.0% (95% CI 96.4 to 97.6) for the Lubinus SP2 stem, 97.6% (95% CI 97.0 to 98.2) for the Charnley stem, 98.1% (95% CI 97.3 to 98.9) for the Spectron EF stem, and 96.4% (95% CI 95.6 to 97.2) for the Charnley Modular stem, respectively. The hazard ratio for reoperation after one year was lower for Lubinus SP2 (HR 0.77, 95% CI 0.60 to 0.97), Charnley (HR 0.64, 95% CI 0.48 to 0.86), and Spectron EF stems (HR 0.44, 95% CI 0.29 to 0.67) compared with the Exeter stem. Reoperation for periprosthetic fracture occurred almost exclusively after the use of polished tapered stems. Conclusion. We were able to confirm that implant survival after cemented hemiarthroplasty for a hip fracture is high. Differences in rates of reoperation seem to favour anatomical and straight stems compared with polished tapered stems, which had a higher risk of periprosthetic fracture

Background. Reduced dislocation rates using lipped polyethylene (PE) liners in modular uncemented acetabular components has been shown, yet there may be increased wear because of impingement, which may lead to aseptic loosening. We used New Zealand Joint Registry (NZJR) data to compare survival rates, revision rates for dislocation and aseptic loosening between lipped and neutral liners. Methods. 31,247 primary THAs using the four commonly used uncemented modular cups were identified (January 1, 1999 to December 31, 2018). The lipped liner group comprised 49% males vs 42% in the neutral group (p < 0.001); 96% had OA vs 95% in the neutral group (p < 0.001). There was no difference in other patient characteristics. Mean follow-up was 5.1 years (SD 3.9); longest follow-up 19.3 years. Kaplan Meier survival rates were compared (20,240 lipped and 11,007 neutral PE liners). Highly cross-linked PE was used in 99% of lipped liner cups vs 85% of neutral liner cups. Associated hazard ratios were calculated using a Cox regression analysis. Results. KM survival at 10 years for lipped PE liners was 96% for lipped (95%CI 95.4%-96.2%) and 95% for neutral liners (95%CI 94.7%-95.9%). Controlling for age, gender approach, head size, image guidance, the all-cause revision risk was greater for neutral liner (HR 1.17 [95% CI 1.06 to 1.36]; p = 0.032). There was a higher risk of revision for dislocation in those with neutral liners (HR 1.84 [95%CI 1.41–2.41]; p < 0.001) but no difference in the revision rate for aseptic acetabular loosening (HR 0.85 [95%CI 0.52–1.38]; p = 0.511). Conclusions. Using lipped PE liners is not associated with a higher rate of aseptic loosening in patients who undergo primary THA. Lipped PE liners are associated with lower rates of dislocation and lower all-cause revision rates without any increased association with revision rates for wear and aseptic loosening

Background. Improving positioning and alignment by the use of computer assisted surgery (CAS) might improve longevity and function in total knee replacements. This study evaluates the short term results of computer navigated knee replacements based on data from a national register. Patients and Methods. Primary total knee replacements without patella resurfacing, reported to the Norwegian Arthroplasty Register during the years 2005–2008, were evaluated. The five most common implants and the three most common navigation systems were selected. Cemented, uncemented and hybrid knees were included. With the risk for revision due to any cause as the primary end-point, 1465 computer navigated knee replacements (CAS) were evaluated against 8214 conventionally operated knee replacements (CON). Kaplan-Meier survival analysis and Cox regression analysis with adjustment for age, sex, prosthesis brand, fixation method, previous knee surgery, preoperative diagnosis and ASA category were used. Results. Kaplan-Meier estimated survival at two years was 97.9% (95% CI: 97.5–98.3) in the CON group and 96.4% (95% CI: 95.0–97.8) in the CAS group. The adjusted Cox regression analysis showed a statistically significantly higher risk for revision in the CAS group (relative risk = 1.7, 95% CI: 1.1–2.5, p = 0.019). The LCS complete knees had a significantly higher risk for revision with CAS, compared to CON (relative risk = 2.1 (95% CI 1.3–3.4, p = 0.004)). Mean operating time was 15 minutes longer in the CAS group. Conclusion. Survivorship at two years of computer navigated primary total knee replacements was inferior compared to conventionally operated knees. Therefore, an extensive use of CAS in primary total knee replacement surgery cannot be encouraged until proven superior in long term register studies and clinical trials

Background. There are few studies of total knee replacements with cemented tibia and uncemented femur (hybrid). Previous studies have not shown any difference in revision rate between different fixation methods, but these studies had few hybrid prostheses. This study evaluates the results of hybrid knee replacements based on data from the Norwegian Arthroplasty Register (NAR). Patients and Methods. Primary total knee replacements without patella resurfacing, reported to the NAR during the years 1999–2009, were evaluated. Hinged-, posterior stabilized- and tumor prostheses were excluded. LCS- and Profix prostheses with conforming plus bearing were included. With the risk for revision at any cause as the primary end-point, 2945 hybrid knee replacements (HKR) were evaluated against 20838 cemented knee replacements (CKR). Kaplan-Meier survival analysis and Cox regression analysis with adjustment for age, sex and preoperative diagnosis were used. Results. Kaplan-Meier estimated survival at 8 years was 94.0% (95% CI: 93.6–94.4) in the CKR group and 97.0% (95% CI: 96.0–98.0) in the HKR group. The HKR group was made op of three brands of prosthesis, LCS, LCS-complete and Profix. Profix was the only brand with a statistically significant difference between cemented and hybrid fixation. Kaplan-Meier estimated survival at 8 years was 97.7% (95% CI: 96.7–98.7) in hybrid Profix group (HPG) and 95.5% (95% CI: 94.7–96.3) in the cemented Profix group (CPG). The adjusted Cox regression analysis showed a statistically significantly lower risk for revision in the HPG group (relative risk=0.44, 95% CI: 0.39–0.59, p<0.001). Mean operating time was 15 minutes longer in the CKR group. Conclusion. Survivorship at 8 years of the hybrid primary total knee replacements was the same or superior compared to cemented total knee replacements depending on prosthesis brand Hybrid fixation seems to be a safe alternative to cemented fixation in total knee replacement surgery

Aims. The aim of this study was to explore the prognostic factors for postoperative neurological recovery and survival in patients with complete paralysis due to neoplastic epidural spinal cord compression. Patients and Methods. The medical records of 135 patients with complete paralysis due to neoplastic cord compression were retrospectively reviewed. Potential factors including the timing of surgery, muscular tone, and tumour characteristics were analyzed in relation to neurological recovery using logistical regression analysis. The association between neurological recovery and survival was analyzed using a Cox model. A nomogram was formulated to predict recovery. Results. A total of 52 patients (38.5%) achieved American Spinal Injury Association Impairment Scale (AIS) D or E recovery postoperatively. The timing of surgery (p = 0.003) was found to be significant in univariate analysis. In multivariate analysis, surgery within one week was associated with better neurological recovery than surgery within three weeks (p = 0.002), with a trend towards being associated with a better neurological recovery than surgery within one to two weeks (p = 0.597) and two to three weeks (p = 0.055). Age (p = 0.039) and muscle tone (p = 0.018) were also significant predictors. In Cox regression analysis, good neurological recovery (p = 0.004), benign tumours (p = 0.039), and primary tumours (p = 0.005) were associated with longer survival. Calibration graphs showed that the nomogram did well with an ideal model. The bootstrap-corrected C-index for neurological recovery was 0.72. Conclusion. In patients with complete paralysis due to neoplastic spinal cord compression, whose treatment is delayed for more than 48 hours from the onset of symptoms, surgery within one week is still beneficial. Surgery undertaken at this time may still offer neurological recovery and longer survival. The identification of the association between these factors and neurological recovery may help guide treatment for these patients. Cite this article: Bone Joint J 2019;101-B:872–879

Purpose was to evaluate the incidence of complication in lower limb reconstructions with modular prostheses comparing cemented versus uncemented stems in two different orthopedic tumor Centers. Methods: retrospective analysis of implant survival, complications and functional results assessed according to MSTS system of the Rizzoli and Moffitt series of modular megaprosthesis in lower limb. From 2002 and 2007, 238 modular prostheses of same design with a rotating hinge knee, were implanted in the lower limb as primary reconstruction in these two Centers. In 130 cases the prosthesis was implanted with cemented stems and in 108 cases with uncemented stems. Sites included: 120 distal femur, 61 proximal femur, 46 proximal tibia, 10 total femur and in 1 case both distal femur and proximal tibia. Histologic diagnoses included: 89 osteosarcoma, 13 Ewing sarcoma, 21 chondrosarcoma, 19 sarcoma, 55 metastasis, 17 TGC, 7 MFH, 11 other diagnoses and 6 non oncologic cases. Major prostheses-related complications were analysed and functional results according to Muscolo Skeletal Tumor Society system, at a mean follow up of 2.03 yrs. Also a statistical evaluation with Kaplan Meier curves, a comparative statistical analysis with Wilcoxon test and multivariate Cox regression analysis were performed. Results: Outcome in 223 evaluated oncologic pts, showed: 121 pts continuously disease free, 26 NED after treatment of relapse, 54 AWD, 16 DWD. Margins were wide in 94.3% (214/227 pts) of evaluated pts. Complications causing implants failure were: infections in 20/238 (8.41%), aseptic loosening in 7/238 (2.95%). No breakages of prosthetic components were observed. Infections occurred at mean time of 1.3 yrs, sites included: 9 distal femurs, 4 proximal femurs, 5 proximal tibias, 2 total femurs. Aseptic loosening occurred at mean time of 2.3 yrs, sites included: 3 proximal tibias, 2 distal femurs, 2 proximal femurs. Rate of aseptic loosening was higher for cemented stems 5/130 (3.85%) vs uncemented 2/108 (1.85%). This difference is not statistically significant. Infection rate was 10% (13/130) for cemented stems and 6.5% (7/108) for uncemented stems. This difference is statistically significant at comparison of survival curves logrank test. Average MSTS function score was 83.5%. Multivariate Cox regression analysis showed that the significant factor favourable reluted with lower incidence of complications was the use of uncemented stems. Conclusions: lower limb modular prostheses with both cemented and uncemented stems gave good results and a low complication rate. Better results were observed with uncemented stems and statistically confirmed, but this needs to be further investigate in a future study at long term

The aim of the study was to describe the failure rate of locking plates used for internal fixation of distal femoral fractures and to identify independent predictors of failure. A consecutive series of 147 patients presenting to the study unit during an 8 year period with a distal femoral fracture were identified from a prospectively compiled trauma database. There were 117 females and 30 males, with a mean age of 70.7 years (13 to 99 years), of which 77 were periprosthetic fractures and 70 were supracondylar fractures around native knees. There were 35 failures of fixation. The commonest cause was non-union (n=31). The survival of the plate 2 years post-surgery was 74percnt; (95percnt; CI 64percnt; to 84percnt;), which remained static to a mean follow of 5 years. There was no difference in failure of fixation according to gender (p=0.32) or if there was a periprosthetic fracture (p=0.8). Younger age (61.8 vs. 73.6 years, p=0.004), increasing level of comorbidity (p=0.02), and fracture comminution (p=0.001) were all significant predictors of failure of fixation. Cox regression analysis confirmed younger age (p=0.04), increasing comorbidity (p=0.002), and fracture comminution (p=0.002) as independent predictors of failure of fixation and non-union after adjusting for confounding. The failure of locking plates for distal femoral fractures occurs in more than one in five patients. The independent predictors could be used to identify those patients at greatest risk of failure of the locking plate, who may benefit from alternative methods of fixation, primary bone grafting, or interventions that may aid union

Background. The treatment of femoral neck fracture with internal fixation (IF) is recommended in younger patients and has compared to arthroplasty the advantage of retaining the femoral head. A big problem with osteosynthesis is though failure. Finding predictors for fixation failure is still an ongoing process and osteoporosis has been suggested as a predictor. Aim. To correlate bone mineral density (BMD) in regard to failure of IF in osteosynthesized femoral neck fractures. Material and method. In a health technology assessment study from 2005–2006 at Odense University Hospital, Department of Orthopaedic Surgery and Traumatology, 175 patients with femoral neck fractures accepted DEXA - scanning of the hip and lumbar spine assessing BMD. Final follow-up were 01.08.2010 and 141 patients with IF comprised the final cohort. The cohort consisted of 105 females and 36 males with a mean (CI) age of 77,2 (75,4–79,0). Failure is defined as revision surgery or new fracture. Results. 69 patients had a t-score (total hip) below −2,5 SD as defined for osteoporosis. At 1 year the overall (dislocated) failure rate was 34,5 % (44,7 %), at 2 years 45,4 % (60,0 %) and at end of follow-up 49,6 % (62,8 %). In the cox regression analysis the following factors for failure were significant: dislocated fracture, osteosynthesis placement and prior fracture. There were no associations for total hip BMD, neck BMD, age, sex, quality of fracture reduction, walking disability, independent living, alcohol or smoking. A cox regression sub analysis of the undisplaced fractures showed significant result only for osteosynthesis placement. Conclusion. There is no association between BMD and failure of internal fixation in osteosynthesized femoral neck fractures

There is an ongoing discussion on what bearing surfaces to use in different age groups of total hip replacement patients. We report results from uncemented total hip arthroplasty using ceramic on ceramic bearings reported to the Norwegian Arthroplasty Register in the period 1997–2014. Kaplan Meier and Cox regression analysis adjusting for age, gender and diagnosis was used to assess prosthesis survival at 10 and 15 years after primary operation and to report relative risk of revision. Endpoint was any revision. Comparison with the cemented Charnley prosthesis (n=17180), with metal-on-polyethylene articulations from the same time period was done. Results in age groups <55, 55–64, 65–74, >=75 were investigated. The following femur/cup combinations were used; Filler/Igloo (n=2590), Corail/Pinnacle (n=783), Corail/Duraloc (n=467), SCP Unique/Trilogy (n=363), Polar/R3 (n=253), ABGII/ABGII (n=131), other combinations (n=339). Alumina bearing was used in 3807 hips and Alumina-Zirconium composite bearings in 1119 hips. The overall ten and fifteen years unadjusted Kaplan Meier survivals were 94.8 % and 92.0 % respectively with no statistically significant difference between the brands. The cemented Charnley hip arthroplasty had 93.6 % survival at 15 years, and was not statistically significant different from the uncemented ceramic/ceramic group. The 10 years survival in the age groups <55, 55–64, 65–74, >=75 for the uncemented ceramic/ceramic group was 93.7%, 95.3%, 96.0% and 95.4% respectively with no difference between the uncemented brands and the cemented Charnley prosthesis. We found less revisions in patients >=75 in the Charnley group. In the ceramic on ceramic group 11 head fractures and 3 liner fractures were reported. The 15 years result of uncemented hip replacement with ceramic on ceramic bearing was good, and not different from the Charnley cemented arthroplasty in the age groups <75 years

The Low Contact Stress (LCS) mobile-bearing total knee replacement (TKR) was designed to minimize polyethylene wear, aseptic loosening and osteolysis. However, registry data suggests there is a significantly greater revision rate associated with the LCS TKR. The primary aim of this study was to assess long-term survivorship of the LCS implant. Secondary aims were to assess survival according to mechanism of failure and identify predictors of revision. We retrospectively identified 1091 LCS TKRs that were performed between 1993 and 2006. There was incomplete data available 33 who were excluded. The mean age of the cohort was 69 (SD 9.2) years and there were 577 TKRs performed in females and 481 in males. Mean follow up was 14 years (SD 4.3). There were 59 revisions during the study period: 14 for infection, 18 for instability, and 27 for polyethylene wear. 392 patients died during follow up. All cause survival at 10-year was 95% (95%CI 91.7–98.3) and at 15-year was 93% (95%CI 88.6–97.8). Survival at 10-years according to mechanism of failure was: infection 99% (95%CI 94–100%), instability 98% (95%CI 94–100%), and polyethylene wear 98% (95%CI92–100). Of the 27 with polyethylene wear only 19 had associated osteolysis requiring component revision, the other 8 had simple polyethylene exchanges. Cox regression analysis, adjusting for confounding variables, identified younger age was the only predictor of revision (hazard ratio 0.96, 95%CI 0.94–0.99, p=0.003). The LCS TKR demonstrates excellent long-term survivorship with a low rate of revision for osteolysis, however the risk is increased in younger patients

Aims

The prevalence of scoliosis is not known in patients with idiopathic short stature, and the impact of treatment with recombinant human growth hormone on those with scoliosis remains controversial. We investigated the prevalence of scoliosis radiologically in children with idiopathic short stature, and the impact of treatment with growth hormone in a cross-sectional and retrospective cohort study.

Skeletal metastases from hepatocellular carcinoma are highly destructive vascular lesions which severely reduce the quality of life. Pre-existing liver cirrhosis presents unique challenges during the surgical management of such lesions. We carried out a retrospective study of 42 patients who had been managed surgically for skeletal metastases from hepatocellular carcinoma affecting the appendicular skeleton between January 2000 and December 2006. There were 38 men and four women with a mean age of 60.2 years (46 to 77). Surgery for a pathological fracture was undertaken in 30 patients and because of a high risk of fracture in 12. An intralesional surgical margin was achieved in 36 and a wide margin in six. Factors influencing survival were determined by univariate and multivariate analyses. The survival rates at one, two and three years after surgery were 42.2%, 25.8% and 19.8%, respectively. The median survival time was ten months (95% confidence interval 6.29 to 13.71). The number of skeletal metastases and the Child-Pugh grade were identified as independent prognostic factors by Cox regression analysis. The method of management of the hepatocellular carcinoma, its status in the liver, the surgical margin for skeletal metastases, the presence of a pathological fracture and adjuvant radiotherapy were not found to be significantly related to the survival of the patient, which was affected by hepatic function, as represented by the Child-Pugh grade

Recent studies have reported on non-metal-on-metal hip arthroplasty (non-MoMHA) patients requiring revision surgery for adverse reactions to metal debris (ARMD). Although the outcomes following revision surgery for ARMD in MoMHA patients are known to generally be poor, little evidence exists regarding outcomes following non-MoMHA revision surgery performed for ARMD. We determined the outcomes following non-MoMHA revision surgery performed for ARMD, and identified predictors of re-revision. We performed a retrospective observational study using data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. All primary non-MoMHA patients who subsequently underwent revision surgery for ARMD between 2008–2014 were included (n=185). Outcome measures following ARMD revision were intraoperative complications, mortality, and re-revision surgery. Predictors of re-revision surgery were identified using Cox regression analysis. Intra-operative complications occurred in 6.0% (n=11) of ARMD revisions. The cumulative 4-year patient survival rate was 98.2% (95% CI=92.9–99.5%). Re-revision surgery was performed in 13.5% (n=25) of hips at a mean time of 1.2 years (range 0.1–3.1 years) following ARMD revision. Infection (32%), dislocation/subluxation (24%), and aseptic loosening (24%) were the commonest re-revision indications. The cumulative 4-year implant survival rate was 83.8% (95% CI=76.7%-88.9%). Significant predictors of re-revision were: multiple revision indications (Hazard Ratio (HR)=2.78; 95% CI=1.03–7.49; p=0.043), incomplete revision procedures (including modular component exchange only) (HR=5.76; 95% CI=1.28–25.9; p=0.022), and ceramic-on-polyethylene revision bearings (HR=3.08; 95% CI=1.01–9.36; p=0.047). Non-MoMHA patients undergoing ARMD revision have a high short-term risk of re-revision. Infection, dislocation/subluxation, and aseptic loosening were the commonest re-revision indications. Furthermore, important and potentially modifiable predictors of future re-revision were identified. Although the poor prognostic factors identified require validation in future studies, our findings may be used to counsel patients about the risks associated with ARMD revision surgery, and guide decisions about the reconstructive procedure

Aims

The primary aim of this study was to determine the ten-year outcome following surgical treatment for femoroacetabular impingement (FAI). We assessed whether the evolution of practice from open to arthroscopic techniques influenced outcomes and tested whether any patient, radiological, or surgical factors were associated with outcome.

Aims

Patients with femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) have an almost ten-fold increased risk of dislocation compared to patients undergoing elective THA. The surgical approach influences the risk of dislocation. To date, the influence of differing head sizes and dual-mobility components (DMCs) on the risk of dislocation has not been well studied.

Aims

This study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an intramedullary nail (IMN) or sliding hip screw (SHS). The primary endpoint was 30-day mortality, with secondary endpoints at 0 to 1, 2 to 7, 8 to 30, 90, and 365 days.

Aims

Hip fractures are some of the most common fractures encountered in orthopaedic practice. We aimed to identify whether perioperative hypotension is a predictor of 30-day mortality, and to stratify patient groups that would benefit from closer monitoring and early intervention. While there is literature on intraoperative blood pressure, there are limited studies examining pre- and postoperative blood pressure.

Aims

Uncemented implants are now commonly used at reimplantation of a two-stage revision total hip arthoplasty (THA) following periprosthetic joint infection (PJI). However, there is a paucity of data on the performance of the most commonly used uncemented femoral implants – modular fluted tapered (MFT) femoral components – in this setting. This study evaluated implant survival, radiological results, and clinical outcomes in a large cohort of reimplantation THAs using MFT components.

Aims

The aim of this study was to determine both the incidence of, and the reoperation rate for, postoperative periprosthetic femoral fracture (POPFF) after total hip arthroplasty (THA) with either a collared cementless (CC) femoral component or a cemented polished taper-slip (PTS) femoral component.

Aims

Although there are various pelvic osteotomies for acetabular dysplasia of the hip, shelf operations offer effective and minimally invasive osteotomy. Our study aimed to assess outcomes following modified Spitzy shelf acetabuloplasty.

Aims

Septic arthritis of the hip often leads to irreversible osteoarthritis (OA) and the requirement for total hip arthroplasty (THA). The aim of this study was to report the mid-term risk of any infection, periprosthetic joint infection (PJI), aseptic revision, and reoperation in patients with a past history of septic arthritis who underwent THA, compared with a control group of patients who underwent THA for OA.

Aims

Although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (PROMs) are still unclear. Accordingly, we assessed hip survival and PROMs at 20 years after transpositional osteotomy of the acetabulum (TOA).

Aims

The modified Glasgow Prognostic Score (mGPS) uses preoperative CRP and albumin to calculate a score from 0 to 2 (2 being associated with poor outcomes). mGPS is validated in multiple carcinomas. To date, its use in soft-tissue sarcoma (STS) is limited, with only small cohorts reporting that increased mGPS scores correlates with decreased survival in STS patients.

Most surgeons favour removing forearm plates in children. There is, however, no long-term data regarding the complications of retaining a plate. We present a prospective case series of 82 paediatric patients who underwent plating of their forearm fracture over an eight-year period with a minimum follow-up of two years. The study institution does not routinely remove forearm plates. A total of 116 plates were used: 79 one-third tubular plates and 37 dynamic compression plates (DCP). There were 12 complications: six plates (7.3%) were removed for pain or stiffness and there were six (7.3%) implant-related fractures. Overall, survival of the plates was 85% at 10 years. Cox regression analysis identified radial plates (odds ratio (OR) 4.4, p = 0.03) and DCP fixation (OR 3.2, p = 0.02) to be independent risk factors of an implant-related fracture. In contrast ulnar plates were more likely to cause pain or irritation necessitating removal (OR 5.6, p = 0.04). The complications associated with retaining a plate are different, but do not occur more frequently than the complications following removal of a plate in children.

We present 346 consecutive revision procedures for aseptic loosening with acetabular impaction bone grafting (AIBG) and a cemented polyethylene cup. Defects were contained with mesh alone. Mean follow up of 6.6 years, range 8 days-13 years. The Oxford Hip (OHS) and Harris Hip (HHS) scores were collected prospectively. Radiological definition of cup failure was either > 5mm displacement, or > 5° rotation. Cox regression analysis was performed on ten separate patient and surgical factors to determine their significance on survivorship. Kaplan Meier survivorship at 10 years (42 cases remaining at risk) for aseptic loosening was 87% (95% confidence Interval (CI): 81.6 to 92.2) and 85.6% (95% CI: 80.3 to 90.9) for all revisions. These results are comparable to other reported series utilising AIBG. However, there were 88 cases (25%) that exceeded the radiological migration parameters, but their functional scores were not significantly different to the non-migrators: OHS p=0.273, HHS p=0.16. The latest post-operative mean OHS was 33 (SD 10.66). Female gender (p=0.039), increasing graft thickness (p=0.006) and the use of mesh (p=0.037) were significant risk factors for revision, but differing techniques in graft preparation, including artificial graft expanders (p=0.73), had no significant effect when analysed using Cox regression

The February 2023 Shoulder & Elbow Roundup³⁶⁰ looks at: Arthroscopic capsular release or manipulation under anaesthesia for frozen shoulder?; Distal biceps repair through a single incision?; Distal biceps tendon ruptures: diagnostic strategy through physical examination; Postoperative multimodal opioid-sparing protocol vs standard opioid prescribing after knee or shoulder arthroscopy: a randomized clinical trial; Graft healing is more important than graft technique in massive rotator cuff tear; Subscapularis tenotomy versus peel after anatomic shoulder arthroplasty; Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty; Conservative versus operative treatment of acromial and scapular spine fractures following reverse total shoulder arthroplasty.

Aims

We aimed to assess the cumulative risk of total hip arthroplasty (THA) from in situ fixation for slipped capital femoral epiphysis (SCFE) after a follow-up of almost 50 years.

Aims

Dislocation remains a leading cause of failure following revision total hip arthroplasty (THA). While dual-mobility (DM) bearings have been shown to mitigate this risk, options are limited when retaining or implanting an uncemented shell without modular DM options. In these circumstances, a monoblock DM cup, designed for cementing, can be cemented into an uncemented acetabular shell. The goal of this study was to describe the implant survival, complications, and radiological outcomes of this construct.

The aim was to identify when primary amputation was used as primary treatment and to describe outcomes in patients managed with modern chemotherapy. A detailed review of the electronic patient records was undertaken. Statistical analysis was performed with univariate analysis using Kaplan-Meier curves and Chi. 2. testing, whilst multivariate analysis was performed using Cox regression analysis. There were 354 osteosarcomas. 93 patients presented with metastases and 192 subsequently developed metastases at a mean of 46 months. Amputation was performed as the primary surgical treatment in 101 patients. Endoprosthetic reconstruction was used in 253 patients. Amputation was performed as a secondary procedure on 15 patients. The 5 and 10 year survival data for all patients, including those with metastatic disease were 60% and 60% for amputation with good chemotherapy response (>89% necrosis), 65% and 63% for limb salvage and good response, 21% and 21% for amputation and poor response (⋋90% necrosis) and 51% and 30% for limb salvage with poor response. Local recurrence occurred both with amputation (10.8%) or limb salvage (9%), with no significant differences between the two. Univariate analysis demonstrated that the extent of response to chemotherapy induced necrosis significantly affected survival, whether the patient had an amputation or not. Whether or not amputation or LSS was used in the surgical management of patients, local recurrence rates where similar between the two groups. Further assessment of chemotherapy-induced necrosis is a key factor in determining subsequent limb salvage or amputation management strategies

Aims

There are limited long-term studies reporting on outcomes of the Zimmer Modular Revision (ZMR) stem, and concerns remain regarding failure. Our primary aim was to determine long-term survival free from all-cause revision and stem-related failure for this modular revision stem in revision total hip arthroplasty (THA). Secondary aims included evaluating radiological and functional outcomes.

The February 2024 Foot & Ankle Roundup³⁶⁰ looks at: Survival of revision ankle arthroplasty; Tibiotalocalcaneal nail for the management of open ankle fractures in the elderly patient; Accuracy of a patient-specific total ankle arthroplasty instrumentation; Fusion after failed primary ankle arthroplasty: can it work?; Treatment options for osteochondral lesions of the talus; Managing hair tourniquet syndrome of toe: a rare emergency; Ultrasound-guided collagenase therapy for recurrent plantar fibromatosis: a promising line of therapy?.

Aims

To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation.

The objective of this study was to compare the results of two consecutive series of patients with either intra-medullary uncemented stems (UCS) distal femoral endoprosthetic replacement or the Compress. ®. (CMP) distal femoral implant. Patients were divided into two groups: those who received UCS prosthesis (Group-1: 54 patients) and those who received CMP prosthesis (Group-2: 42 patients).The most frequent diagnosis was osteosarcoma. Age and gender were similar both groups. In Group-1, at a mean follow-up of 144 months, 37 prostheses were still in place. The overall Kaplan-Meier prosthetic survival rates were 79% at five and 62 % at ten years. Most of failures were long term complications. Aseptic loosening was the primary cause of late prosthetic failure. On Cox regression analysis, prosthetic stem diameter under 13mm was a significant negative prognostic factor for prosthetic survival (p=0.016). In Group-2, at a mean follow-up of 84 months, 36 prostheses were still in place. The overall rate of CMP prosthesis survival was 86% at 5 years. All complications were during the first postoperative year, being femoral fracture the main revision cause. The patients who retained the prosthesis had mainly good or excellent MSTS functional results in both groups

Aims

This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis.

Aims

The present study aimed to investigate whether patients with inflammatory bowel disease (IBD) undergoing joint arthroplasty have a higher incidence of adverse outcomes than those without IBD.

Aims

This study aims to determine the rate of and risk factors for total knee arthroplasty (TKA) after operative management of tibial plateau fractures (TPFs) in older adults.

Introduction. Dislocation is one of the most important complications after primary total hip replacement (THR). The low incidence of this finding makes it difficult to analyse the possible risk factors. The surgical technique can also influence this rate through cup position or an adequate reconstruction of the hip. We assessed the demographic data and radiological reconstruction of the hip related to the appearance of dislocation after primary THR. Material and Methods. 1414 uncemented THRs were recorded from our Local Joint Registry. The mean age of the patients was 60.1 years old (range, 14 to 95), and the mean weight was 73.3 kg (42 to 121). There were 733 men and 974 patients were classified with an activity level of 4 or 5 according to Devane. The most frequent diagnosis was primary osteoarthritis, 795 hips, followed by avascular necrosis 207 hips. An alumina-on-alumina THR was implanted in 703 hips and a metal-on-polyethylene THR in 711 hips. A femoral head size of 28 mm was used in 708 hips and 32 mm in 704. Radiological cup position was assessed using the acetabular abduction angle, the height of the center of the hip, and the horizontal distance of the cup. Cup anteversion was measured according to Widmer and the reconstruction of the center of rotation of the hip according to Ranawat. The radiographic reconstruction of the abductor mechanism was measured using two variables: the lever arm and the height of the greater trochanter. Results. There were 38 dislocations (2.6%) and 11 hips were revised for recurrent instability (0.8%). The probability of not having a dislocation at 20 years was 97.3%. 22 hips that had dislocated were within a box for a cup position of a version between 10º to 25º and an acetabular abduction angle between 35º to 55º (p<0.001). The probability of not having a dislocation at 20 years was 98.48% for the cups within the box and 93.9% for cups outside the box (p<0.001, Log Rank test). 21 hips that had dislocated were within a box for a height of the greater trochanter between −2 mm to 5 mm and a lever arm between 56 to 64 mm (p<0.001). The probability of not having a dislocation at 20 years was 98.33% for the hips within the box and 94.6% for hips outside the box (p<0.001, Log Rank test). Adjusted Cox regression analysis showed that alumina-on alumina THR tended to dislocate less than metal-on-polyethylene THRs (p=0.061, Hazard Ratio: 2.238, Confidence Interval 95% 0.964–5.195), and hips outside the box evaluated for cup position and outside the lever arm and height of the greater trochanter box) had a higher risk for dislocation (p<0.001, HR: 3.418, CI 95% 1.784–6.549, and, p<0.001, HR:2.613, CI 95% 1.357–5.032, respectively). Conclusions. A proper reconstruction of the hip is essential to decrease the risk for dislocation after primary THR. The choice of the bearing surface may affect this risk. The weakness of the abductor muscles of the hip may be one of the most important causes for dislocation

We studied 55 patients with stage-IIB osteosarcoma around the knee with respect to the expression of matrix metalloproteinase (MMP)-9 in the surviving tumour cells in surgical resection specimens. They were followed up for a minimum of 2.5 years. Factors significantly associated with poor overall survival were a high serum level of alkaline phosphatase at diagnosis and tumour cells expressing MMP-9 in the resection specimens. The only factor strongly associated with disease-free survival was the immunohistochemical status of tumour cells for MMP-9 in the resection specimens. The percentage of necrosis after chemotherapy failed marginally to reach statistical significance. On Cox regression analysis only MMP-9 remained significant for overall and disease-free survival

Aims

Clear cell sarcoma (CCS) of soft-tissue is a rare melanocytic subtype of mesenchymal malignancy. The aim of this study was to investigate the clinical and therapeutic factors associated with increased survival, stratified by clinical stage, in order to determine the optimal treatment.

Metal on metal hip resurfacing (MMHR) is a popular procedure for the treatment of osteoarthritis in young patients. Several centres have observed masses, arising from around these devices, we call these inflammatory pseudotumours. They are locally invasive and may cause massive soft tissue destruction. The aim of this study was to determine the incidence and risk factors for pseudotumours that are serious enough to require revision surgery. In out unit, 1,419 MMHRs were performed between June 1999 and November 2008. All revisions were identified, including all cases revised for pseudotumour. Pseudotumour diagnosis was made by histological examination of samples from revision. A Kaplan-Meier survival analysis was performed, Cox regression analysis was used to estimate the independent effects of different factors. The revision rate for pseudotumour increased with time and was 4% (95% CI: 2.2% to 5.8%) at eight years. Female gender was a strong risk factor: at eight years the revision rate for pseudotumours in men was 0.5% (95% CI 0% to 1.1%), in women over 40 it was 6% (95% CI 2.3% to 10.1%) and in women under 40 it was 25% (95% CI 7.3% to 42.9%) (p< 0.001). Other factors associated with an increase in revision rate were, small components (p=0.003) and dysplasia (p=0.019), whereas implant type was not (p=0.156). We recommend that resurfacings are undertaken with caution in women, especially those younger than 40 years of age, but they remain a good option in men. Further work is required to understand the patho-aetiology of pseudotumours so that this severe complication can be avoided

Aims

Registry studies on modified acetabular polyethylene (PE) liner designs are limited. We investigated the influence of standard and modified PE acetabular liner designs on the revision rate for mechanical complications in primary cementless total hip arthroplasty (THA).

Aims: To calculate one-year survival after dislocated intracapsular femoral neck fractures and to assess factors associated with increased risk of death. Patients: 2045 patients treated for dislocated intracapsular femoral neck fractures during 2005 were registered in The Norwegian Hip Fracture Registry and were included in the present study. Methods: Almost all hospitals in Norway reported proximal femoral fractures to the Registry using standard forms filled in by the operating surgeons. Survival was calculated using Kaplan Meier survival analyses, and the impact of factors possibly influencing the survival was estimated using Cox regression analysis. Mortality data for all patients were obtained from Statistics Norway. Results: 2045 patients having dislocated intracapsular femoral neck fractures operated with 2 pins/screws (1071) and bipolar hemiprosthesis (974) were enrolled in the Registry during 2005. Among these, 333 patients died within the first year after the operation; 2 pins/screws (170) and bipolar hemiprosthesis (163). Factors adversely associated with survival included high age, male gender, dementia and with an increase in preoperative ASA classification. No statistically significant difference was found regarding preoperativ delay or for the two different treatment methods. Conclusion: After one year there is no difference in risk of death between operation methods; 2 pins/screws and hemiprosthesis, for dislocated femoral neck fractures

Introduction: During the last decade the treatment regime for dislocated femoral neck fractures has switched towards more arthroplasties. There has been apprehensions regarding long-term results for arthroplasties. The opinion has been put forward that preserving the femoral head is preferable to performing total hip arthroplasty. Methods: 409 of the 450 patients in a randomized study 1995–97 had valid follow-up at 4 months, 1, 2, 5, and 10 years (or until deceased). Mentally intact, independently living and walking patients over 70 years were included and randomized to osteosynthesis (n=217) or arthroplasty (n=192). Results: After 10 years 168 patients (77 percent) were deceased and there were 99 failures (46 percent) in the osteosynthesis group. In the arthroplasty group 145 patients (76 percent) were deceased and there were 17 failures (9 percent) after 10 years. Both groups had the same rate of failure between 2 and 10 years. There was significantly better results regarding pain and function in the arthroplasty group at 4 months. At 10 years the results were still not superior for osteosynthesis. A Cox regression analysis regarding sex, age, time to surgery, smoking, osteoporosis, trauma type, preoperative function and choice of skin incision comparing the patients without hip complications at 10 years with the patients with failures in each group revealed no risk factor for failure. Discussion: Arthroplasty for hip fracture show a reliable long-term result while osteosynthesis leads to a high rate of complications and is not superior regarding pain and function even when successful. Both methods have the same mortality

Background. Red cell distribution width (RDW), an automated measure of variability in red blood cell size on full blood count (FBC), has recently emerged as a strong independent predictor of mortality in large population studies as well as several disease states. We wanted to determine the prognostic value of RDW in patients following a hip fracture - a condition associated with high mortality. This relationship has not been assessed to date. Methods. We examined the relationship between admission RDW and all-cause mortality on 1-year follow-up, in consecutive hip fracture cases who presented between January 2007 and November 2009. We used Cox regression analysis to adjust for baseline Haemoglobin (Hb), Mean corpuscular Volume (MCV), creatinine, age, gender, ASA grade, Charlson index, pre-morbid independence level, Mental test score (MTS), delay to surgery and post-operative cardio-respiratory complication. Results. Of 577 consecutive patients there were 377 females, 199 males; median age 81.4y. Seventeen (3%) were lost to follow-up at 1-year but were coded as survivor. One-year mortality was 23% overall. Unadjusted mortality was 12%, 15%, 29% and 35% in quartiles of increasing RDW. Along with age, gender, MTS, post-op cardiac or respiratory complication, Charlson index and ASA score, RDW remained a significant independent predictor of 120-day mortality (adjusted hazard ratio (HR): 1.211, 95% CI: 1.062–1.380, p=.004), as well as 1-year mortality (HR: 1.142, 95% CI: 1.032–1.263, p=.01). We repeated analysis excluding those lost to follow-up and this did not alter its predictive value. A third analysis in non-anaemic patients (n=464) showed that RDW remained an independent predictor of mortality on multivariate analysis (HR: 1.201, 95% CI: 1.039–1.389, p=.013). Conclusion. RDW, a widely-available parameter on full blood count, is a significant independent predictor of short and long-term mortality following hip fracture, regardless of age, co-morbidity or anaemia status

Aims

Total hip arthroplasties (THAs) are performed by surgeons at various stages in training with varying levels of supervision, but we do not know if this is safe practice with comparable outcomes to consultant-performed THA. Our aim was to examine the association between surgeon grade, the senior supervision of trainees, and the risk of revision following THA.

Aims

The last decade has seen a marked increase in surgical rib fracture fixation (SRF). The evidence to support this comes largely from retrospective cohorts, and adjusting for the effect of other injuries sustained at the same time is challenging. This study aims to assess the impact of SRF after blunt chest trauma using national prospective registry data, while controlling for other comorbidities and injuries.

The Norwegian Arthroplasty Register has shown that several designs of uncemented femoral stems give good or excellent survivorship. The overall findings for uncemented total hip replacement however, have been disappointing because of poor results with the use of metal-backed acetabular components. In this study, we exclusively investigated the medium-to long-term performance of primary uncemented metal-backed acetabular components. A total of 9113 primary uncemented acetabular components were implanted in 7937 patients between 1987 and 2007. These were included in a prospective, population-based observational study. All the implants were modular and metal-backed with ultra-high-molecular-weight polyethylene liners. The femoral heads were made of stainless steel, cobalt-chrome (CoCr) alloy or alumina ceramic. In all, seven different designs of acetabular component were evaluated by the Kaplan-Meier survivorship method and Cox regression analysis. Most acetabular components performed well up to seven years. When the endpoint was revision of the acetabular component because of aseptic loosening, the survival ranged between 87% and 100% at ten years. However, when the endpoint was revision for any reason, the survival estimates were 81% to 92% for the same implants at ten years. Aseptic loosening, wear, osteolysis and dislocation were the main reasons for the relatively poor overall performance of the acetabular components. Prostheses with alumina heads performed slightly better than those with stainless steel or CoCr alloy in subgroups. Whereas most acetabular components performed well at seven years, the survivorship declined with longer follow-up. Fixation was generally good. None of the metal-backed uncemented acetabular components with ultra-high-molecular-weight polyethylene liners in our study had satisfactory long-term results because of high rates of wear, osteolysis, aseptic loosening and dislocation

Purpose: The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability. Methods: This prospective population-based cohort study included 143 patients above 18 years with acute distal radius fracture treated at one emergency hospital with either closed reduction and cast (55 patients) or with closed reduction and external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (inquiring about disabilities before fracture) and at 6, 12 and 24 months after the fracture. The 12-month follow-up also included the SF-12 health status questionnaire as well as clinical and radiographic examination. The patients were classified according to the degree of malunion (defined as dorsal tilt > 10 degrees or ulnar variance > 0 mm) into three groups; no malunion, malunion involving either dorsal tilt or ulnar variance, and malunion involving both dorsal tilt and ulnar variance. A Cox regression analysis was performed to determine the relationship between the 1-year DASH score (≥ 15 or < 15) and malunion adjusting for age, sex, fracture AO type, and treatment method and the relative risk (RR) of obtaining the higher DASH score was calculated. The number needed to harm (NNH) associated with malunion was calculated. Results: The mean DASH score at 1 year after fracture was about 10 points worse with each degree of increased malunion. The degree of malunion also correlated with SF-12 score, grip strength and supination. The regression analysis showed significantly higher disability with each degree of malunion compared to no malunion; for malunion involving either dorsal tilt or ulnar variance the RR was 2.4 (95% CI 1.0–5.7; p=0.038), and for malunion involving both dorsal tilt and ulnar variance the RR was 3.2 (95% CI 1.4–7.5; p=0.007). The NNH was 2.5 (95% CI 1.8–5.4). Conclusion: Malunion after distal radius fracture was associated with higher arm-related disability

Objectives. To determine whether a delay to surgery (>36Hours) affects mortality rate, length of stay and post-operative complications following hip fracture surgery. Methods. Data collected by dedicated Audit staff using a proforma designed in accordance with the ‘Standardised Audit of Hip Fractures in Europe’ (SAHFE). A prospective Observational Study, all patients (n=7207) admitted and who underwent surgery during a 10-year period from May 1999 to May 2009 have been considered. Chi square tests and independent sample t tests were used for basic statistical analyses. Mortality data were analysed using Kaplan Meier survival analysis and cox regression analysis. p < 0.05 was considered significant. Results. The 30-day mortality was 9.5%. At 90 days, mortality was 18.9% and at 1 year it was 31.4%. In patients declared fit for surgery on admission (n=5665), 30-day mortality was 7.5% in those operated on without delay, rising to 10.3% at over 4 days delay (p=0.117). However, in those operated on after 5 days delay, 30-day mortality equalled 13.6% (p=0.009). Those declared fit for surgery on admission stayed a total 14.5 days if operated within 36 hours, rising to 16 days with over 36 hours delay (p< 0.001). An increase in the rate of urinary tract infection (3.9 vs. 5.9%, p< 0.001) was seen in patients delayed by over 36 hours. However, when considering all patients together, an increase in both urinary tract infection (3.9% vs. 6.1%, p< 0.001) and chest infections (7.9% vs. 11.3%, p< 0.001) was seen with over 36 hours delay to surgery. Conclusions. The 30-day mortality following hip fracture surgery is 9.5%. Patients admitted without co-morbidities have significantly increased mortality when surgery is delayed by over 5 days. A 36 hour delay to surgery significantly increases length of stay. Urinary tract infection was the only post-operative morbidity to rise with delay to surgery in fit patients

Current opinion is divided as to whether carpal tunnel syndrome requiring operative decompression can be caused by an occupation. The aims of this study were to define the lamb freezing worker population who acquire carpal tunnel syndrome and to confirm or refute lamb boning as an occupational cause for carpal tunnel syndrome. Roles, gender age and exposure periods of all workers who had carpal tunnel decompressions over the past six seasons at the largest lamb Freezing Works in the world were examined. Kaplan-Meier survival analysis for boners, slaughter men and non-knife labourers was performed and tested for significance. Chi-square analysis and ANOVA were performed for gender and age. Age and gender-adjusted Cox regression analysis was performed to establish relative risks/hazard ratios for each of the three groups developing carpal tunnel syndrome. Incidences for boners and non-knife hands were calculated. Comparison of this population and a standard carpal tunnel population was performed. Two hundred and eighty five carpal tunnel decompressions were performed in workers who failed conservative management at the largest lamb freezing works in the world by a single surgeon after neurophyiological-test confirmation of the diagnosis. Of those having surgery 79% were men: 21% female and this was significant with Chi square testing (p< 0.01). At decompression boners were significantly younger than non-knife hands (p< 0.01). Adjusting for age and gender boners were 120% more likely to need decompression than non-knife labourers (p< 0.01). The median survival for a lamb boner’s carpal tunnel at five years was 44%. The incidence of carpal tunnel syndrome in lamb boners was 10% (person-seasons). This population is entirely different to the published idiopathic population requiring carpal tunnel decompression which is predominantly female with meanage of 55. To our knowledge this is the first study to provide sound evidence that carpal tunnel syndrome can be caused by an occupation. We have quantified this and welcome ideas for further work in this fascinating a uniquely New Zealand population

Introduction. An aneurysmatic bone cyst (ABC) is a benign cystic lesion of bone composed of blood-filled spaces separated by connective septa. The most common treatment is curettage with or without bone grafting. Curettage with bone grafting and Ethibloc injection therapy have a comparable recurrence rate. Ethibloc is a radiopaque alcohol solution of corn protein which is percutaneously injected in the ABC. Objective. To compare percutaneous Ethibloc injection (ETHI) with curettage with bone grafting (CUBG) in the treatment of ABC. Methods. We conducted a retrospective cohort study of 73 treatments on 56 patients with ABC, between 1985 and 2007. The number of treatments were divided in two groups, one consisting of treatments with ETHI (n=35) and the other of treatments with CUBG (n=38). Both groups are comparable for the number of primary lesions; ETHI (n=17) and CUBG (n=21) or recurrences; ETHI (n=18) and CUBG (n=17). Radiological and clinical outcomes were assessed pre- and post-operatively. We evaluated the outcome measures of ETHI and of CUBG during a mean of 24.7 (range: 2–48) months. We evaluated the recurrence rate in both groups for a maximum period of 4 years to prevent the influence of outliers. Recurrence was defined as a radiological progression/recurrence of the lesion or progression/persistence of symptoms (pain, tumor, function impairment). Statistical analysis included a Kaplan Meier survival analysis, a cox-regression analysis to account for potential confounders and a chi-square test. Results. A survival analysis showed no difference in recurrence rate between both groups. A cox regression analysis showed that type of treatment, after correcting for size of tumor, location and previous treatment, had no influence on recurrence rate. There was no significant difference in clinical outcome in both groups; complete relief of all symptoms was found after ETHI and CUBG n=30 (86%) and n=33 (87%) respectively. Radiologically, 24 (69%) of the treatments with ETHI were effective (no recurrence) in 24 months (range: 3–48) and 28 (74%) of the treatments with CUBG in 23 months (range: 2–48). There was no significant difference between the ETHI vs. CUBG in the number of effective treatments in both primarily treated ABC's (10 vs. 15, p=0.3) as in ABC's with previous treatments (14 vs. 13, p=0.6). Complications after ETHI consisted of 2 fistulas and after CUBG of an AVN and failure of reconstruction. Discussion. This study shows that the relatively simple, percutaneous Ethibloc injection is comparable to curettage with bone grafting, regarding both clinical and radiological outcome. Recurrence rate was not influenced by type of treatment, location or size of tumour. We recommend Ethibloc injection as the first-choice treatment of primary and recurrent ABC's

Introduction: The treatment of asymptomatic osteonecrosis of the femoral head (ONFH) is controversial. The primary aim of this study was to define the optimal management of osteonecrotic lesions in patients with asymptomatic ONFH by determining the incidence of disease progression and the factors that might predict its occurrence. In order to assess the indications and timing for surgical intervention in these patients, the secondary aim was to determine whether or not pain precedes subchondral fracture in patients with asymptomatic disease. Methods: The subjects in this study were patients with asymptomatic ONFH who were derived from two separate prospective, institutional review board-approved investigations in our institution. We determined the incidence of pain development and radiographic evidence of fracture and the temporal relationship of these events. Statistical analyses were performed to determine what factors affected either radiographic progression or the appearance of symptoms. Results: Of the 37 hips, 12 (32%) were symptomatic at 2 years. Of these painful hips, six (50%) were associated with the simultaneous presence of a subchondral fracture. When analyzing the relationship of pain with fracture, 5 of 6 hips developed symptoms at an average of 8.1 months (1 to 28 months) prior to fracture. Three symptomatic patients had spontaneous resolution of the ONFH. Cox regression analysis revealed that an index of necrosis of > 50 and a greater extent of radiographic involvement correlate with a higher risk for developing symptoms and a subchondral fracture. If an index of necrosis of 50 is set as the lower limit for intervention, 78% of hips that fractured and 93% of hips that did not were identified. Discussion: Asymptomatic ONFH with small lesions are amenable to observation, and intervention may be withheld until the appearance of symptoms. Asymptomatic ONFH with extensive femoral head involvement has a high probability of early progression to symptomatic ONFH and subchondral fracture. In these cases, early intervention may be beneficial in preventing fractures which may occur without any preceding symptoms. An index of necrosis of 50 is proposed as a threshold for intervention, as it is a good discriminator between those that did and did not fracture, and had a positive predictive value of 77.8%. The only independent predictor of both pain and collapse was the extent of femoral head involvement

Purpose: Matrix metalloproteinases are important for matrix turnover in development of metastasis and angiogenesis. Our purpose was to investigate the expression of MMP-9 and itsb prognostic significance in knee osteosarcomas. Patients: 55 patients with osteosarcoma IIB of the knee area have been studied with respect to the expression of MMP-9 in the surviving tumour cells in the surgical resection specimens. Patients were followed up for at least two and a half years. Methods: We studied the MMP-9 expression in the resection specimens using immunohistochemistry. The importance of the prognostic factors was assessed using single (log rank test) and multiple variable (Cox regression) analysis. Independence between the factors found significant using the log rank test was studied using the yf test. Significance was set at P< 0.05. Results: On single variable analysis factors significantly associated with poor survival were high alkaline phosphatase at diagnosis and tumour cells expressing MMP-9 in the resection specimens. The only factor strongly associated with disease free survival was immunohistochemical status of tumour cells for MMP-9 in the resection specimens. Percentage of necrosis after chemotherapy failed marginally to reach statistical significance. On Cox regression analysis only MMP-9 remained significant for overall and disease free survival. Discussion: Once new blood vessels penetrate a microscopic primary tumour or a distant metastasis, the lesions acquire the potential to grow into larger and potentially life threatening tumours. MMP-9 is a factor associated with matrix remodeling during angiogenesis and is also associated with leaky vessels because of its ability to degrade basement membranes. These two properties are very important for tumour growth and development of haematogenous metastases and we believe may explain our findings

Since 1984, more than 1000 Bernese periacetabular osteotomies (PAO) have been performed for the treatment of developmental dysplasia of the hip (DDH) in adolescents and adults at the institution where this technique was developed. We present a concise 20-year follow-up of the first 75 PAOs whose initial and 10-year results had been published previously. A retrospective study of the first 75 consecutive hips (63 patients) treated with PAO for DDH between April 1984 and December 1987 was performed. The mean patient age at surgery was 29.3 years ± 11.4 (13 – 56) and in 31% of all hips a previous surgical attempt to achieve sufficient coverage had been performed. Preoperatively, 58% of all hips presented with osteoarthritis and 49% with dysplasia Class 4 or higher according to Severin. Four patients (5 hips) were lost-to-follow-up and 1 patient (2 hips) died unrelated to surgery. The remaining 58 patients (68 hips) were followed for a mean of 20.4 years ± 1.1 (18.8 – 22.9) and 41 hips (60%) were preserved at last follow-up. Regarding the surviving hips with preoperatively no or slight osteoarthritis (52 hips), the survivor ship rate was 75%. Twenty-seven hips were converted to a THA (26 hips) or hip arthrodesis (1 hip) which were defined as endpoints. The cumulative Kaplan-Meier survivorship at 20 years was 61%. The Cox regression analysis was performed to detect predictive factors for poor outcome and to calculate the corresponding hazard ratios. Six predictive factors for poor outcome were found: age over 30, a preoperative Merle d’Aubigné score less than 15, a positive preoperative anterior impingement test and limp, preoperative OA grade of more than 1, and a postoperative extrusion index of more than 20%. Despite the fact that this series represented the learning curve of a technically demanding intervention of a very inhomogeneous patient group with various previous surgical attempts to achieve sufficient coverage and several concomitant intertrochanteric osteotomies, the 20-year results on the first 75 hips are promising. Increased survivorship rates are expected for more recent series after identification of relative contraindications based on or analysis. PAO is an effective and successful surgical technique for correction of DDH

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. Methods. We conducted a prospective cohort study including all metal-on-metal and conventional polyethylene (PE)-ceramic THAs with an uncemented cup (Morscher press-fit cup), a 28mm head and operated upon via a lateral approach at our University hospital between 1/1999 and 12/2008. Only THAs for primary osteoarthritis were included. The study population is part of the Geneva Hip Arthroplasty Registry, a prospective cohort followed since 1996. The following outcomes were compared between the two groups (metal-on-metal=group 1 vs. PE-ceramic bearing=group 2): (1) Complication rates with respect to infection, dislocation and revision, (2) Radiographic outcomes (presence of linear or focal femoral osteolysis, loosening), and (3) Clinical outcomes (Harris Hip score increase, SF-12, activity and patient satisfaction evaluation, presence of groin pain). Patients operated between 1/1999 and 12/2004 were evaluated five years postoperatively by an independent assessor. Cox regression analysis was used to compare incidence rates while adjusting for differences in baseline characteristics. Results. 1988 THAs were included, 544 with a metal-on-metal and 1444 with a PE-ceramic bearing. The two groups differed significantly with respect to gender distribution (men 56% vs. 41%), mean age (66 vs. 73 years), co-morbidities and type of stem (uncemented 16% vs. 2%). Crude incidence rates for complications were: 0.16 vs. 0.11 cases/100 person-years for infection; 0.37 vs. 0.35 cases/100 person-years for dislocation; and 0.29 vs. 0.16 cases/100 person-years for all-cause revision (incidence rate ratio 1.8, 95% CI 0.7; 4.6). After adjusting for baseline differences the slightly higher risks for infection and revision in group 1 were attenuated. Osteolytic lesions were found in 3.7% of metal-on-metal vs. 4.7% of PE-ceramic THAs. After adjustment for age, gender and activity the OR was 0.6 (95% CI 0.2;2.1). Five years postoperative, 176 THAs of group 1 and 695 THAs of group 2 were seen at follow-up. Clinical outcomes were similar among the two groups with a mean Harris Hip score increase of 39.2 vs. 40.9 points. SF-12 mental and physical health, patient satisfaction (9.3 vs. 8.9 on visual analogue scale) as well as the incidence of groin pain (1.7% vs. 1.2%) was also similar among the two groups. The activity level was significantly higher in group 1 (6.4 vs. 5.4, p<0.001). Conclusion. Mid-term results with respect to complications, revision rates, presence of osteolysis and clinical outcomes were similar among patients with metal-on-metal and PE-ceramic total hip arthroplasties

Materials and methods: Based on data from the Norwegian Arthroplasty Register, we reviewed the results of uncemented femoral stems in Norway in the period 1987 to 1. April 2002. We compared these results to the results of the cemented Charnley monoblock stem, which still is the most commonly used femoral stem in Norway. Only prostheses used in more than one hundred hips were included. Based on these criteria, we identified a total of 7 856 primary total hip prostheses in fifteen different uncemented stems. With the Kaplan-Meier method, the survival of the primary prostheses were calculated and compared with each other and with the Charnley stem. The endpoint was revision in which the whole prostheses or the stem alone was removed or exchanged. The Cox regression analysis was used to adjust for differences in age, gender, diagnosis, former operations and profylactic antibiotics. Separate analyses for patients younger than 60 years and for stems with follow-up less than ten years were done. Reasons for revision in the uncemented Corail stem and the cemented Charnley stem was analysed. Results: The Corail stem, wich is the most commonly used uncemented stem in Norway (n=3590), had excellent long term results. 10 years survival in patients younger than 60 years was for the Corail 97,5% and for the Charnley 90,2% (p=0,001). Reasons for revision of the Corail were in most cases pain and repeated dislocations. Aseptic loosening was the dominant cause of failure of the Charnley stem. Several uncemented stems have results which are as good as or superior to the Charnley. The Femora, the Biofit, the Parhofer and the Harris Galante stems all had inferior results. Many uncemented stems with less than 10-years of follow-up have excellent 5 years survival. The 10 years survival of uncemented total hip arthroplasties, however was inferior to the all-cemented Charnley. Cup revisions due to aseptic loosening, and wear and/or osteolysis were the reasons for this. Discussion: The Corail stem has excellent long term results. Several newer stems have promising short- and medium term results. Due to inferior results of unce-mented cups, however, most Norwegian orthopaedic surgeons use cemented primary hip replacements

Aims

The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld.

Introduction: Chondrosarcoma has always been treated with respect by oncology surgeons, given that it is relatively resistant to chemotherapy and radiotherapy. The importance of the adequacy of surgical resection margins has been previously reported, however, the aim of the study was to study the outcomes of surgery for Chondrosarcoma and determine the role of initial surgical margins and local recurrence on final outcome. Methods: Electronic patient records were retrieved on all patients seen at a tertiary referral musculoskeletal oncology centre with Chondrosarcoma of bone with a minimum of 2 years follow up. A total of 532 patients were seen with Chondrosarcoma between 1970 and 1/1/2006. Patients were excluded if they had initial treatment in another unit (20 patients), a subdiagnosis of dedifferentiated Chondrosarcoma (due to very poor prognosis, 43 patients), metastases at presentation (6 patients) and if they presented with disseminated metastases prior to local recurrence (12 patients). This left 451 patients in the study group and the clinicopathological records were reviewed on these patients. Results: Of the 451 patients, the mean age was 48 years old at diagnosis (range 6–89 years) with the most commonly sites of presentation being in the pelvis in 132 patients (29%), proximal femur in 81 patients (18%), distal femur in 40 patients (9%) and proximal humerus in 40 patients (9%). Grade at presentation was grade 1 in 44%, grade 2 in 44% and grade 3 in 12%. Surgical margins were wide in 45%, marginal in 28% and incisional (including curettage procedures) in 27%. Local recurrence occurred in 88 patients (19.5%). Local recurrence rates were significantly different for surgical margins on Fisher exact testing (p=0.003), which held true even when stratified by presenting grade of tumour. Local recurrence occurred at a mean of 2.8 years, however, 12.5% occurred more than 5 years from diagnosis. There was a significant difference in survival compared between those patients with local recurrent disease and those without on Kaplan Meier analysis; 10 year survival for those without recurrence was 73.1% compared to 41% for those with local recurrence(p< 0.0001, Logrank). On cox regression analysis significant factors affecting survival were pelvic location (p=0.004), local recurrence (p=0.007), age at presentation (p=0.01), marginal margins (p=0.04) and initial tumour grade (p=0.043). There was no significant difference between survival and initial surgical margin when stratified by grade of tumour, possibly as further surgery to improve adequacy of margins. Further sub-analysis is being performed. Conclusions: There is a complex relationship between surgical margins, local recurrence and margins. It appears that long term survival is possible in approximately 1/3 patients who have local recurrence in intermediate and high grade chondrosarcomas and therefore ever effort should be made to regain local control following local recurrence

Carpal tunnel syndrome requiring decompression is common at the world’s largest lamb processing plant. However there is little to guide us in advising patients on return to heavy manual work postoperatively. The purpose of this study was to establish current New Zealand practice and whether expeditious return to work was possible. Following informed consent a retrospective review of those with neurophysiologically-confirmed carpal tunnel syndrome requiring decompression over four seasons was performed. Open, day-case surgery was performed in all cases by the senior author. Patient demographics, time to return to work, further absenteeism, pain-free interval and complications were examined. A prospective study in the subsequent season was then performed. Additional information gathered for previous seasons pre and 6 week postoperatively included QuickDASH, SF36, grip-strength visual analogue pain, paraesthesiae and numbness scores. Student’s t-test was used for statistical analysis. An email survey of the NZOA was also performed. One hundred percent follow-up was achieved. In the retrospective group 281 in 187 patients were performed. The average time to return to light duties/rehabilitation was 11 (9 – 42) days. The mean pain free interval was 24 (10 – 63) days. Return to full-duties was on average 28 (10 – 70) dayswith three patients (1% of the total cohort) requiring further time off. Ninety-nine percent returned to their previous role. There were two infections. In the prospective group in this study, 26 hands underwent decompression in 13 patients. The average return to light duties/rehabilitation was 13 (10–25) days and to full duties 32 (21–56) days. Ninety-two percent returned to their previous role and there was one superficial infect ion. The improvement in mean total QuickDASH scores (total score possible 300) were from 140 points (standard deviation 63: 95% CI 101–178) to 68 (standard deviation 54; 95% CI 34–100) and this was statistically significant (p< 0.01). The difference in Short Form 36 scores was not statistically significant (p = 0.6). The differences in numbness, pain and paraesthesiae visual analogue scores were all statistically significant at 6 weeks after surgery (p< 0.01, p< 0.01 and p=0.01 respectively). All patients felt that the operation had been overall worthwhile and at the time of submission none had taken any further time off work. Examining lamb boners as a separate group and using Survival and Cox regression analysis the average return to full working duties for lamb boners was 29 days which is significantly different to New Zealand Orthopaedic surgical practice. The unique population at this plant has allowed a culture to develop whereby early return to light duties after removal of sutures is expected. This culture, good patient education, and coordinated efforts at all levels of the care pathway are undoubtedly necessary for this level of achievement

Aim of Prospective Study To assess the long-term survival of Souter-Strathclyde replacements and determine the causes of failure. Materials and Methods: Between 1977–97, 445 Souter-Strathclyde replacements were undertaken by the presenting author in 321 patients, ranging in age from 25–81 years (mean 59). The Larsen X-ray grading at the time of surgery was Gd III-2%, Gd IV-43%, Gd V-55%. The standard humeral component was used in 76% and the long-stemmed model in 24% of cases, the standard ulna in 91%, and the long-stemmed in 9%. Clinical and radiological assessments were carried out before surgery and at 6 months and one year after surgery and annually thereafter until the death of the patient or the revision of one or both components, the mean follow-up being 8.9 years (S.D. 5.6). The survival statistics are based on Kaplan-Meier survival curves and Cox regression analysis applied to 3 Groups with differing end-points: 1) Revision of one or both components of the prosthesis 2) Ditto or the development of a complication, seriously threatening the survival of the arthroplasty and 3) As in (2) or definite evidence of progressive radiological loosening. Results Very satisfactory pain relief was achieved in 90% of cases. Mean flexion improved from 129° to 144°, pronation from 42° to 59°, and supination from 43° to 62°. Once achieved, these results were well maintained. Mean extension was slightly reduced after surgery (47° to 52°). For Group 1: the survivorship at 5, 10, 15 & 20 years was 95, 89, 82, & 81% respectively; for Group 2: 93, 87, 76 & 69%; and for Group 3: 91, 84, 72, & 68%. In Group 1, indications for revision or removal of one or both components were persistent dislocation (5), fracture (5), aseptic loosening complicated in some cases by fracture (20) and infection (14). In Group 2 the threatening complications included instability (2), un-united fracture of the ulna (4), infection (7), and clinical loosening (2). Conclusions This method of elbow replacement offers very successful and durable pain relief and restoration of function in the adult rheumatoid patient. Survivorship in the first decade after surgery is very acceptable. Later, due to increasing disability and reliance on crutches, resulting from multi-joint involvement, more problems are likely to arise from aseptic loosening, fracture and infection

Objective- To review the 10-year results of 269, cemented total hip arthroplasties performed using matte surface finish Harvard femoral stem that is almost similar to Charnley femoral stem. Design- Retrospective cross sectional survivorship study. Patients and Methods- We retrospectively reviewed the results of 269 cemented total hip arthroplasties performed using Harvard femoral stem in 257 patients (M:F, 93:164. Mean age 71.2 years) between 1990–1994. We also reviewed a group of 51 patients who had hip arthroplasty performed on the contralateral side using cemented Charnley femoral stem. Radiographs were reviewed to evaluate following parameters: type of osteoarthritis, cement mantle thickness, alignment of the components, presence of aseptic loosening and radiolucent lines. Kaplan-Meier survival analysis was performed to calculate the survival of Harvard and Charnley femoral stem using various end points. Cox proportional-hazard analysis was performed to evaluate the impact of various radiological parameters on the prosthesis survival. Results- Out of the 248 eligible patients (260 hips), 6 patients (7 hips) were lost to follow up and 67 patients were dead at the time of the study. 36 hips (35 patients) underwent revision surgery for aseptic failure (Median duration: 60 months, range: 12–125 months) and 11 hips were revised for septic failure (Median duration: 24 months, range: 10–53 months) from the index procedure. Femoral component was revised in all patients whereas acetabular component was revised in 27 patients. 10 year survival for the femoral and acetabular components using aseptic loosening (with and without revision surgery) as an end point was 77.5% (71.5%-83.5%) and 91.1% (87.2%-95%) respectively. Cox regression analysis did not reveal statistically significant (p> 0.05) impact of various radiological parameters on survival rate. The 10 year survival in the bilateral hip arthroplasty group for the Charnley femoral component (Median follow up 138 months) and Harvard femoral component (Median follow up 120 months) using aseptic loosening as an end point was 95.2% (92.4%-98%) and 77.2% (69.2%-85.2%) respectively. Conclusion- Our results suggest that the matte surface finish femoral component has less satisfactory long-term survival rate compared to smooth surface femoral stem with similar geometry

Purpose: Although arthroscopic Bankart repair is yet an established procedure in the treatment of traumatic anterior shoulder instability, it is still not known whether it reproduces the good results of the open repair procedure. Aim of this investigation was to compare the functional and subjective outcome between open and arthroscopic Bankart repair. Material and methods: A retrospective cross sectional study design on the comparison of open and arthoscopic Bankart treatments between 1995 and 2004 was implemented at the Dresden Orthopedic Surgery Department. In this period a total of 223 patients underwent surgery due to anterior shoulder instability, among which 212 patients had posttraumatic instability. A diagnostic arthroscopy was performed in all patients, but only 40 patients with intact capsulolabral complex and without capsular laxity were treated arthroscopically, the remaining 183 patients underwent an open Bankart procedure. A total of 186 patients with posttraumatic anterior instability could be clinically re-examined within 1 to 5 years after initial surgery, among which 147 patients underwent an open and 39 patients an arthroscopic Bankart procedure. The median age of this sample was 27 years (interquartile range 21 – 37 years) at initial surgery, 21% of these patients were female. Results: After open surgery 11 of 147 patients (8%) and 6 of 39 (15%) after arthroscopic surgery reported one or more re-dislocation after initial treatment, which occurred after a mean dislocation free time of 62 versus 40 months, respectively (95% confidence intervals 59 – 65 versus 36 – 44 months). Both a univariate analysis (Logrank test p=0.012) and a multivariate Cox regression analysis (Likelihood Ratio p=0.023) confirmed a statistically significant difference in the time between initial surgery to first reluxation. 4 of the 11 re-dislocations after open and 1 of 6 after arthroscopic surgery occurred after a new accident. That makes a re-dislocation rate without new adequate trauma of 5% after open and 13% after arthroscopic treatment. ROM showed no difference between open and arthroscopic Bankart procedure for abduction and a mild difference for external rotation. 21 of 115 (18%) patients had an external rotation lag of 20° or more after open surgery versus 1 of 34 (3%) after arthroscopic treatment (Fisher p=0,027). The Rowe score demonstrated “good” or “excellent” functional results in 102 of 117 (87%) patients versus 28 of 35 (80%) patients after open versus arthroscopic treatment (Fisher p=0,285). Conclusion: In this sample arthroscopic Bankart repair demonstrated more frequently and significantly earlier re-dislocation after initial surgery than did the open treatment alternative. External rotation lags of at least 20° occured more frequently after the open procedure

Aims

The aim of this study was to determine if uncemented acetabular polyethylene (PE) liner geometry, and lip size, influenced the risk of revision for instability or loosening.

Aims

The COVID-19 pandemic posed significant challenges to healthcare systems across the globe in 2020. There were concerns surrounding early reports of increased mortality among patients undergoing emergency or non-urgent surgery. We report the morbidity and mortality in patients who underwent arthroplasty procedures during the UK first stage of the pandemic.

Aims

The primary aim was to determine the influence of COVID-19 on 30-day mortality following hip fracture. Secondary aims were to determine predictors of COVID-19 status on presentation and later in the admission; the rate of hospital acquired COVID-19; and the predictive value of negative swabs on admission.

Aims

Debate continues regarding the optimum management of periprosthetic distal femoral fractures (PDFFs). This study aims to determine which operative treatment is associated with the lowest perioperative morbidity and mortality when treating low (Su type II and III) PDFFs comparing lateral locking plate fixation (LLP-ORIF) or distal femoral arthroplasty (DFA).

Aims

While a centralized system for the care of patients with a sarcoma has been advocated for decades, regional variations in survival remain unclear. The aim of this study was to investigate regional variations in survival and the impact of national policies in patients with a soft-tissue sarcoma (STS) in the UK.

Aims

Chondrosarcoma is the second most common primary sarcoma of bone: conventional chondrosarcoma accounts for 85% of all cases. Conventional chondrosarcoma may be central or peripheral. Most studies group central and peripheral chondrosarcomas together, although there is growing evidence that their clinical behaviour and prognosis differ. The aims of this study were to analyze any differences in characteristics between central and peripheral chondrosarcomas and to investigate the incidence and role of different syndromes.

Aims

During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery.

Aims

Local recurrence remains a challenging and common problem following curettage and joint-sparing surgery for giant cell tumour of bone (GCTB). We previously reported a 15% local recurrence rate at a median follow-up of 30 months in 20 patients with high-risk GCTB treated with neoadjuvant Denosumab. The aim of this study was to determine if this initial favourable outcome following the use of Denosumab was maintained with longer follow-up.

Aims

The primary aim of this study was to assess the independent association of the coronavirus disease 2019 (COVID-19) on postoperative mortality for patients undergoing orthopaedic and trauma surgery. The secondary aim was to identify factors that were associated with developing COVID-19 during the postoperative period.

Aims

To investigate the benefits of denosumab in combination with nerve-sparing surgery for treatment of sacral giant cell tumours (GCTs).

Aims

The primary aim was to assess the independent influence of coronavirus disease (COVID-19) on 30-day mortality for patients with a hip fracture. The secondary aims were to determine whether: 1) there were clinical predictors of COVID-19 status; and 2) whether social lockdown influenced the incidence and epidemiology of hip fractures.