Aims. Acquired
Aims.
Aims. Dystrophic calcification (DC) is the abnormal appearance of calcified deposits in degenerating tissue, often associated with injury. Extensive DC can lead to
Aims. In recent conflicts, most injuries to the limbs are due to blasts resulting in a large number of lower limb amputations. These lead to
Aims. Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition. Methods. Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD),
Aims.
Aims.
Aims. Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants. Methods. A total of 39 hip fusion conversions to THA were undertaken in 38 patients by a single surgeon employing a consistent surgical technique and uncemented implants. Parameters assessed included Harris Hip Score (HHS) for function, range of motion (ROM), leg length discrepancy (LLD), satisfaction, and use of walking aid. Radiographs were reviewed for loosening, subsidence, and
Aims. Calcium sulphate has traditionally been used as a filler of dead space arising during surgery. Various complications have been described following the use of Stimulan bio-absorbable calcium sulphate beads. This study is a prospective observational study to assess the safety profile of these beads when used in revision arthroplasty, comparing the complication rates with those reported in the literature. Methods. A total of 755 patients who underwent 456 revision total knee arthroplasties (TKA) and 299 revision total hip arthroplasties (THA), with a mean follow-up of 35 months (0 to 78) were included in the study. Results. A total of 32 patients (4.2%) had wound drainage, and this was higher with higher bead volumes and in McPherson grade C patients. There was also a significantly higher bead volume in the 41 patients who developed hypercalcaemia, two of which were symptomatic (p < 0.0001). A total of 13 patients (1.7%) had
This meta analysis address the relationship between infection developing after total hip arthroplasty (THA) and
Severe heterotopic ossification (grade III and IV) after contemporary total hip arthroplasty (THA) requiring excision is very uncommon. We performed a systematic review of the literature, and report a new case series with operative treatment after primary uncemented THA. A systematic review identified papers describing patients who had excision of
Aims. The aim of this study was to assess the efficacy of non-selective
and selective non-steroidal anti-inflammatory drugs (NSAIDs) in
preventing
Aim. The primary aim of this retrospective study was to identify the
incidence of
Aims. We aimed to assess the influence of ethnicity on the incidence
of
In this paper we propose a new classification
of neurogenic peri-articular
Aims. The classical longitudinal incision used for the direct anterior
approach (DAA) to the hip does not follow the tension lines of the
skin and can lead to impaired wound healing and poor cosmesis. The
purpose of this retrospective study was to determine the satisfaction
with the scar, and functional and radiographic outcomes comparing
the classic longitudinal incision with a modified skin crease ‘bikini’
when the DAA is used for total hip arthroplasty (THA). Patients and Methods. A total of 964 patients (51% female; 59% longitudinal, 41% ‘bikini’)
completed a follow-up questionnaire between two and four years postoperatively,
including the Oxford Hip Score (OHS), the University of North Carolina
‘4P’ scar scale (UNC4P) and two items for assessing the aesthetic
appearance of the scar and symptoms of numbness. The positioning
of the components, rates of
Abstract. Objectives. The term
Introduction and Objective. Interest for direct anterior approach (DAA) in hip hemiarthroplasty (HHA) has greatly increased in recent years, however which is the best surgical approach in hip replacement treating femoral neck fractures (FNFs) is already unclear. The aim of this study is to perform a radiographic and perioperative complications analysis by comparing the direct anterior approach (DAA) with the direct lateral approach (DLA) in patients treated with hemiarthroplasty for FNFs. Materials and Methods. Patients with FNFs surgically treated between 2016–2020 with HHA were enrolled. The radiographical outcomes of DAA and DLA are compared. Several peri-operative and post-operative variables were evaluated: mean surgery time, complications as periprosthetic fractures or episodes of dislocation, the average of post-operative diaphyseal filling of the stem (Canal Fill Index, CFI), the extent of
We retrospectively reviewed 89 consecutive patients
(45 men and 44 women) with a mean age at the time of injury of 58
years (18 to 97) who had undergone external fixation after sustaining
a unilateral fracture of the distal humerus. Our objectives were
to determine the incidence of
Electron Microscopy and Synchrotron analysis of
The incidence of clinically significant (Brooker stage 3–4)
The incidence of clinically significant (Brooker stage 3–4)
Background.
Previous reports of the prevalence of
Background.
Indomethacin is commonly administered for the prophylaxis of
Purpose. The ideal timing for a Total Hip Arthroplasty (THA) remains a highly controversial topic in the treatment of displaced acetabular fractures in the elderly with damage to the articular surface of the acetabulum or femoral head. Acute THA offers early rehabilitation but a high incidence of heterotopic ossification has been reported. Its incidence and consequences on the patient's function are not clear. The goal of this study is to compare the incidence of heterotopic ossification following acute THA of acetabular fractures compared to delayed THA, and to evaluate its functional effects on the patient. Method. In this retrospective consecutive case series of acetabular fractures; 20 patients were treated with acute THA and 20 patients were treated with delayed THA after failed conservative or surgical treatment. The incidence of heterotopic ossification (using Brooker's classification) was obtained and functional outcomes were evaluated using SF-12, WOMAC, Harris Hip Score surveys. Results.
Summary. Indomethacin has differential effects on chondrogencic outcome depending on differentiation stage. Introduction.
Aims: 1) to create a new and reproducible animal model to produce
Resurfacing arthroplasty of the hip is currently enjoying a resurgence in popularity. There are many reasons why resurfacing may be indicated, but one is that the absence of proximal femoral reaming at surgery may reduce the occurrence of
Introduction: As a result of the rapid increase in the number of hip resurfacing procedures performed, previously recognized complications have begun to recur; including, femoral neck fracture and heterotopic ossification. Hip resurfacing entails reaming of the femoral head to the appropriate size and significant bone debris produced, usually dispersed in the soft tissues. We advocate the use of a novel technique whereby the bone debris produced is collected and removed effectively without soft tissue spillage and ultimately reducing the incidence of heterotopic ossification. Materials and Methods: A 60-ml. plastic ‘galli pot’ is prepared by cutting the floor of the container, leaving behind a rim for collecting the bone debris. The container is placed over the femoral head and across the femoral neck. The femoral reamer is applied onto the femoral head with the container in-situ and reaming commenced. The bone debris produced is collected in the container, which is removed after completing the reaming process. Results: This technique was used effectively on patients undergoing hip resurfacing procedures using the Cormet hip (Corin Medical, Cirencester, UK) and the Birmingham Hip Resurfacing (Midland Medical Technologies, Birmingham, UK). The technique proved successful in collecting the bone debris produced and reducing bone debris in surrounding soft tissues. Discussion:
We have studied prospectively the effect of indomethacin on the development of
We have carried out a prospective, randomised study of prophylaxis for
Introduction:
Introduction. Stiffness after total knee arthroplasty (TKA) has been reported to occur due to component malpositioning and/or oversizing, improper femoral component (FC) flexion and tibial component (TC) slope, tight extension gap, inaccurate joint line placement, deficient posterior osteophyte resection,
Introduction: Bone phenotype, such as osteoarthritis (OA) pattern and development of osteolysis or
We report a prospective, randomised, blinded clinical comparison of the use of indomethacin or radiation therapy for the prevention of
Background: The phenomenon of
There is little in the literature reporting on the incidence of
Purpose: The purpose is to evaluate the clinical outcome of patients who underwent excision of motion-limiting radioulnar
The causes of a stiff elbow are numerous including: post-traumatic elbow, burns, head injury, osteoarthritis, inflammatory joint disease and congenital. Types of stiffness include: loss of elbow flexion, loss of elbow extension and loss of forearm rotation. All three have different prognoses in terms of the timing of surgery and the likelihood of restoration of function. Contractures can be classified into extrinsic and intrinsic (all intrinsic develop some extrinsic component). Functional impairment can be assessed medicolegally; however, in clinical practice the patient puts an individual value on the arc of motion. Objectively most functions can be undertaken with an arc of 30 to 130 degrees. The commonest cause of a Post-traumatic Stiff elbow is a radial head fracture or a complex fracture dislocation. Risk factors for stiffness include length of immobilisation, associated fracture with dislocation, intra-articular derangement, delayed surgical treatment, associated head injury, heterotopic ossification. Early restoration of bony columns and joint stability to allow early mobilisation reduces incidence of joint stiffness.
We aimed to determine whether development of
Anterior decompression and fusion has been standard treatment for cervical disc herniation and myelopathy with disc degeneration. Since cervical total disc replacement (TDR) has been introduced with early favorable results and ideal mechanism, it has gained its popularity recently. But varying degrees of
Introduction:
This study was designed to prospectively evaluate the efficacy of indomethacin as prophylaxis for
Tendon is a bradytrophic and hypovascular tissue, hence, healing remains a major challenge. The molecular key events involved in successful repair have to be unravelled to develop novel strategies that reduce the risk of unfavourable outcomes such as non-healing, adhesion formation, and scarring. This review will consider the diverse pathophysiological features of tendon-derived cells that lead to failed healing, including misrouted differentiation (e.g. de- or transdifferentiation) and premature cell senescence, as well as the loss of functional progenitors. Many of these features can be attributed to disturbed cell-extracellular matrix (ECM) or unbalanced soluble mediators involving not only resident tendon cells, but also the cross-talk with immigrating immune cell populations. Unrestrained post-traumatic inflammation could hinder successful healing. Pro-angiogenic mediators trigger hypervascularization and lead to persistence of an immature repair tissue, which does not provide sufficient mechano-competence. Tendon repair tissue needs to achieve an ECM composition, structure, strength, and stiffness that resembles the undamaged highly hierarchically ordered tendon ECM. Adequate mechano-sensation and -transduction by tendon cells orchestrate ECM synthesis, stabilization by cross-linking, and remodelling as a prerequisite for the adaptation to the increased mechanical challenges during healing. Lastly, this review will discuss, from the cell biological point of view, possible optimization strategies for augmenting Achilles tendon (AT) healing outcomes, including adapted mechanostimulation and novel approaches by restraining neoangiogenesis, modifying stem cell niche parameters, tissue engineering, the modulation of the inflammatory cells, and the application of stimulatory factors. Cite this article:
The aim of this study was to develop and internally validate a prognostic nomogram to predict the probability of gaining a functional range of motion (ROM ≥ 120°) after open arthrolysis of the elbow in patients with post-traumatic stiffness of the elbow. We developed the Shanghai Prediction Model for Elbow Stiffness Surgical Outcome (SPESSO) based on a dataset of 551 patients who underwent open arthrolysis of the elbow in four institutions. Demographic and clinical characteristics were collected from medical records. The least absolute shrinkage and selection operator regression model was used to optimize the selection of relevant features. Multivariable logistic regression analysis was used to build the SPESSO. Its prediction performance was evaluated using the concordance index (C-index) and a calibration graph. Internal validation was conducted using bootstrapping validation.Aims
Methods
The August 2023 Trauma Roundup360 looks at: A comparison of functional cast and volar-flexion ulnar deviation for dorsally displaced distal radius fractures; Give your stable ankle fractures some AIR!; Early stabilization of rib fractures – an effective thing to do?; Locked plating versus nailing for proximal tibia fractures: A multicentre randomized controlled trial; Time to flap coverage in open tibia fractures; Does tranexamic acid affect the incidence of heterotropic ossification around the elbow?; High BMI – good or bad in surgical fixation of hip fractures?
The February 2024 Shoulder & Elbow Roundup360 looks at: Does indomethacin prevent heterotopic ossification following elbow fracture fixation?; Arthroscopic capsular shift in atraumatic shoulder joint instability; Ultrasound-guided lavage with corticosteroid injection versus sham; Combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis; Are vascularized fibula autografts a long-lasting reconstruction after intercalary resection of the humerus for primary bone tumours?; Anatomical versus reverse total shoulder arthroplasty with limited forward elevation; Tension band or plate fixation for simple displaced olecranon fractures?; Is long-term follow-up and monitoring in shoulder and elbow arthroplasty needed?
Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors. Between January 2006 and June 2007, a total of 121 patients underwent THA using either an uncemented (Accolade I, made of Ti12Mo6Zr2Fe; Stryker, USA) or a cemented (ABG II, made of cobalt-chrome-molybdenum (CoCrMo); Stryker) femoral component, both with a V40 taper (Stryker). Uncemented acetabular components (Trident; Stryker) with crosslinked polyethylene liners and CoCr femoral heads of 36 mm diameter were used in all patients. At a mean folllow-up of 10.8 years (SD 1.1), 94 patients (79%) were eligible for follow-up (six patients had already undergone a revision, 15 had died, and six were lost to follow-up). A total of 85 THAs in 80 patients (mean age 61 years (24 to 75); 47 (56%) were female) underwent clinical and radiological evaluation, including the measurement of whole blood levels of cobalt and chrome. Metal artifact reduction sequence MRI scans of the hip were performed in 71 patients.Aims
Methods
Post-traumatic elbow stiffness is a disabling condition that remains challenging for upper limb surgeons. Open elbow arthrolysis is commonly used for the treatment of stiff elbow when conservative therapy has failed. Multiple questions commonly arise from surgeons who deal with this disease. These include whether the patient has post-traumatic stiff elbow, how to evaluate the problem, when surgery is appropriate, how to perform an excellent arthrolysis, what the optimal postoperative rehabilitation is, and how to prevent or reduce the incidence of complications. Following these questions, this review provides an update and overview of post-traumatic elbow stiffness with respect to the diagnosis, preoperative evaluation, arthrolysis strategies, postoperative rehabilitation, and prevention of complications, aiming to provide a complete diagnosis and treatment path. Cite this article:
Acute distal biceps tendon repair reduces fatigue-related pain and minimizes loss of supination of the forearm and strength of flexion of the elbow. We report the short- and long-term outcome following repair using fixation with a cortical button techqniue. Between October 2010 and July 2018, 102 patients with a mean age of 43 years (19 to 67), including 101 males, underwent distal biceps tendon repair less than six weeks after the injury, using cortical button fixation. The primary short-term outcome measure was the rate of complications. The primary long-term outcome measure was the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Secondary outcomes included the Oxford Elbow Score (OES), EuroQol five-dimension three-level score (EQ-5D-3L), satisfaction, and return to function.Aims
Methods
The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible.Aims
Patients and Methods
The aim of this study was to analyze the results of two radiocapitellar prostheses in a large case series followed prospectively, with medium-term follow-up. A total of 31 patients with a mean age of 54 years (27 to 73) were analyzed; nine had primary osteoarthritis (OA) and 17 had post-traumatic OA, three had capitellar osteonecrosis, and two had a fracture. Overall, 17 Lateral Resurfacing Elbow (LRE) and 14 Uni-Elbow Radio-Capitellum Implant (UNI-E) arthroplasties were performed. Pre- and postoperative assessment involved the Mayo Elbow Performance Score (MEPS), the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and the modified American Shoulder Elbow Surgeons (m-ASES) score.Aims
Patients and Methods
This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID. A cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed.Aims
Methods
To evaluate the outcomes of terrible triad injuries (TTIs) in mid-term follow-up and determine whether surgical treatment of the radial head influences clinical and radiological outcomes. Follow-up assessment of 88 patients with TTI (48 women, 40 men; mean age 57 years (18 to 82)) was performed after a mean of 4.5 years (2.0 to 9.4). The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Radiographs of all patients were analyzed. Fracture types included 13 Mason type I, 16 type II, and 59 type III. Surgical treatment consisted of open reduction and internal fixation (ORIF) in all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) was performed if reconstruction was not possible.Aims
Methods
Arthrofibrosis is a relatively common complication after joint injuries and surgery, particularly in the knee. The present study used a previously described and validated rabbit model to assess the biomechanical, histopathological, and molecular effects of the mast cell stabilizer ketotifen on surgically induced knee joint contractures in female rabbits. A group of 12 skeletally mature rabbits were randomly divided into two groups. One group received subcutaneous (SQ) saline, and a second group received SQ ketotifen injections. Biomechanical data were collected at eight, ten, 16, and 24 weeks. At the time of necropsy, posterior capsule tissue was collected for histopathological and gene expression analyses (messenger RNA (mRNA) and protein).Aims
Methods
Excision of the proximal femur for tumour with
prosthetic reconstruction using a bipolar femoral head places a considerable
load on the unreplaced acetabulum. We retrospectively reviewed the changes which occur around the
affected hip joint by evaluating the post-operative radiographs
of 65 consecutive patients who underwent proximal prosthetic arthroplasty
of the femur, and in whom an acetabular component had not been used.
There were 37 men and 28 women with a mean age of 57.3 years (17
to 93). Radiological assessment included the extent of degenerative
change in the acetabulum, heterotopic ossification, and protrusio
acetabuli. The mean follow-up was 9.1 years (2 to 11.8). Degenerative changes
in the acetabulum were seen in three patients (4.6%), Brooker grade
1 or 2 heterotopic ossification in 17 (26%) and protrusion of the
prosthetic head in nine (13.8%). A total of eight patients (12.3%) needed a revision. Five were
revised to the same type of prosthesis and three (4.6%) were converted
to a total hip arthroplasty. We conclude that radiological evidence of degenerative change,
heterotopic ossification and protrusion occur in a few patients
who undergo prosthetic arthroplasty of the proximal femur for tumour.
The limited extent of these changes and the lack of associated symptoms
do not justify the routine arthroplasty of the acetabulum in these patients. Cite this article:
The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury. The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (Aims
Patients and Methods
The aim of this study was to compare the functional and radiological
outcomes in patients with a displaced fracture of the hip who were
treated with a cemented or a cementless femoral stem. A four-year follow-up of a randomized controlled study included
141 patients who underwent surgery for a displaced femoral neck
fracture. Patients were randomized to receive either a cemented
(n = 67) or a cementless (n = 74) stem at hemiarthroplasty (HA;
n = 83) or total hip arthroplasty (THA; n = 58).Aims
Patients and Methods
The April 2015 Shoulder &
Elbow Roundup360 looks at: Distal clavicular resection not indicated in cuff repair?; Platelet-rich plasma in rotator cuff repair; Radial head geometry: time to change?; Heterotopic ossification in elbow trauma; Another look at heterotopic ossification in the humerus; Triceps on for total elbow arthroplasty?; Predicting outcomes in rotator cuff repair; Deltoid fatty infiltration and reverse shoulder arthroplasty
Patients with neuromuscular imbalance who require
total hip arthroplasty (THA) present particular technical problems
due to altered anatomy, abnormal bone stock, muscular imbalance
and problems of rehabilitation. In this systematic review, we studied articles dealing with THA
in patients with neuromuscular imbalance, published before April
2017. We recorded the demographics of the patients and the type
of neuromuscular pathology, the indication for surgery, surgical
approach, concomitant soft-tissue releases, the type of implant
and bearing, pain and functional outcome as well as complications
and survival. Recent advances in THA technology allow for successful outcomes
in these patients. Our review suggests excellent benefits for pain
relief and good functional outcome might be expected with a modest
risk of complication. Cite this article:
Early total hip replacement (THR) for acetabular
fractures offers accelerated rehabilitation, but a high risk of heterotopic
ossification (HO) has been reported. The purpose of this study was
to evaluate the incidence of HO, its associated risk factors and
functional impact. A total of 40 patients with acetabular fractures
treated with a THR weres retrospectively reviewed. The incidence
and severity of HO were evaluated using the modified Brooker classification,
and the functional outcome assessed. The overall incidence of HO
was 38%
(n = 15), with nine severe grade III cases. Patients who underwent
surgery early after injury had a fourfold increased chance of developing
HO. The mean blood loss and operating time were more than twice
that of those whose surgery was delayed (p = 0.002 and p <
0.001,
respectively). In those undergoing early THR, the incidence of grade
III HO was eight times higher than in those in whom THR was delayed
(p = 0.01). Only three of the seven patients with severe HO showed
good or excellent Harris hip scores compared with eight of nine
with class 0, I or II HO (p = 0.049). Associated musculoskeletal
injuries, high-energy trauma and head injuries were associated with
the development of grade III HO. The incidence of HO was significantly higher in patients with
a displaced acetabular fracture undergoing THR early compared with
those undergoing THR later and this had an adverse effect on the
functional outcome. Cite this article:
We live in troubled times. Increased opposition reliance on explosive devices, the widespread use of individual and vehicular body armour, and the improved survival of combat casualties have created many complex musculoskeletal injuries in the wars in Iraq and Afghanistan. Explosive mechanisms of injury account for 75% of all musculoskeletal combat casualties. Throughout all the echelons of care medical staff practice consistent treatment strategies of damage control orthopaedics including tourniquets, antibiotics, external fixation, selective amputations and vacuum-assisted closure. Complications, particularly infection and heterotopic ossification, remain frequent, and re-operations are common. Meanwhile, non-combat musculoskeletal casualties are three times more frequent than those derived from combat and account for nearly 50% of all musculoskeletal casualties requiring evacuation from the combat zone.
The aim of this study was to compare early functional and health
related quality of life outcomes (HRQoL) in patients who have undergone
total hip arthroplasty (THA) using a bone conserving short stem
femoral component and those in whom a conventional length uncemented
component was used. Outcome was assessed using a validated performance
based outcome instrument as well as patient reported outcome measures
(PROMs). We prospectively analysed 33 patients whose THA involved a contemporary
proximally porous coated tapered short stem femoral component and
53 patients with a standard conventional femoral component, at a
minimum follow-up of two years. The mean follow-up was 31.4 months
(24 to 39). Patients with poor proximal femoral bone quality were
excluded. The mean age of the patients was 66.6 years (59 to 77)
and the mean body mass index was 30.2 kg/m2 (24.1 to
41.0). Outcome was assessed using the Oxford Hip Score (OHS) and
the University College Hospital (UCH) hip score which is a validated
performance based instrument. HRQoL was assessed using the EuroQol
5D (EQ-5D).Aims
Patients and Methods
To evaluate the outcomes of cemented total hip arthroplasty (THA)
following a fracture of the acetabulum, with evaluation of risk
factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of
57 years (25 to 87) underwent cemented THA at a mean of 6.5 years
(0.1 to 25) following acetabular fracture. A total of 38 had undergone
surgical fixation and 11 had been treated non-operatively; 13 patients
died at a mean of 10.2 years after THA (0.6 to 19). Patients were
assessed pre-operatively, at one year and at final follow-up (mean
9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant
survivorship was assessed. An age and gender-matched cohort of THAs
performed for non-traumatic osteoarthritis (OA) or avascular necrosis
(AVN) (n = 98) were used to compare complications and patient-reported outcome
measures (PROMs).Aims
Patients and Methods
The last decade has seen a considerable increase
in the use of in total ankle arthroplasty (TAA) to treat patients
with end-stage arthritis of the ankle. However, the longevity of
the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment
algorithm for the painful TAA to be used when considering revision
surgery. Cite this article:
Heterotopic ossification occurring after the use of commercially available bone morphogenetic proteins has not been widely reported. We describe four cases of heterotopic ossification in patients treated with either recombinant bone morphogenetic protein 2 or recombinant bone morphogenetic protein 7. We found that while some patients were asymptomatic, heterotopic ossification which had occurred around a joint often required operative excision with good results.
The October 2015 Shoulder &
Elbow Roundup360 looks at: Culture time important in propionibacterium acnes; Microvascularisation of the cuff footprint; Degenerative cuff tears: evidence for repair; Middle ground in distal humeral fractures?; Haste needed in elbow heterotopic ossification; Iatrogenic frozen shoulder; Salvage of failed humeral fixation
Periprosthetic joint infection (PJI) is a devastating
complication for patients and results in greatly increased costs
of care for both healthcare providers and patients. More than 15
500 revision hip and knee procedures were recorded in England, Wales
and Northern Ireland in 2013, with infection accounting for 13%
of revision hip and 23% of revision knee procedures. We report our experience of using antibiotic eluting absorbable
calcium sulphate beads in 15 patients (eight men and seven women
with a mean age of 64.8 years; 41 to 83) as part of a treatment
protocol for PJI in revision arthroplasty. The mean follow-up was 16 months (12 to 22). We report the outcomes
and complications, highlighting the risk of hypercalcaemia which
occurred in three patients. We recommend that serum levels of calcium be routinely sought
following the implantation of absorbable calcium sulphate beads
in orthopaedic surgery. Cite this article:
A prospective, multi-centre study was carried out on 1421 total hip replacements between January 1999 and July 2007 to examine if obesity has an effect on clinical outcomes. The patients were categorised into three groups: non-obese (body mass index (BMI) <
30 kg/m2), obese (BMI 30 to 40 kg/m2) and morbidly obese (BMI >
40 kg/m2). The primary outcome measure was the change in Oxford hip score at five years. Secondary outcome measures included dislocation and revision rates, increased haemorrhage, deep infection, deep-vein thrombosis and pulmonary embolism, mean operating time and length of hospital stay. Radiological analysis assessing heterotopic ossification, femoral osteolysis and femoral stem positioning was performed. Data were incomplete for 362 hips (25.5%) There was no difference in the change in the Oxford hip score, complication rates or radiological changes at five years between the groups. The morbidly obese group was significantly younger and required a significantly longer operating time. Obese and morbidly obese patients have as much to gain from total hip replacement as non-obese patients.
We evaluated clinical and radiographic outcomes of total shoulder
arthroplasty (TSA) using the second-generation Trabecular Metal
(TM) Glenoid component. The first generation component was withdrawn
in 2005 after a series of failures were reported. Between 2009 and
2012, 40 consecutive patients with unilateral TSA using the second-generation
component were enrolled in this clinical study. The mean age of
the patients was 63.8 years (40 to 75) and the mean follow-up was
38 months (24 to 42). Patients were evaluated using the Constant score (CS), the American
Shoulder and Elbow Surgeons (ASES) score and routine radiographs.Aims
Methods
We present the early clinical and radiological results of Articular Surface Replacement (ASR) resurfacings in 214 hips (192 patients) with a mean follow-up of 43 months (30 to 57). The mean age of the patients was 56 years (28 to 74) and 85 hips (40%) were in 78 women. The mean Harris hip score improved from 52 (11 to 81) to 95 (27 to 100) at two years and the mean University of California, Los Angeles activity score from 3.9 (1 to 10) to 7.4 (2 to 10) in the same period. Narrowing of the neck (to a maximum of 9%) was noted in 124 of 209 hips (60%). There were 12 revisions (5.6%) involving four (1.9%) early fractures of the femoral neck and two (0.9%) episodes of collapse of the femoral head secondary to avascular necrosis. Six patients (2.8%) had failure related to metal wear debris. The overall survival for our series was 93% (95% confidence interval 80 to 98) and 89% (95% confidence interval 82 to 96) for hips with acetabular components smaller than 56 mm in diameter. The ASR implant has a lower diametrical clearance and a subhemispherical acetabular component when compared with other more frequently implanted metal-on-metal hip resurfacings. These changes may contribute to the higher failure rate than in other series, compared with other designs. Given our poor results with the small components we are no longer implanting the smaller size.
Systemic factors are believed to be pivotal for the development of heterotopic ossification in severely-injured patients. In this study, cell cultures of putative target cells (human fibroblastic cells, osteoblastic cells (MG-63), and bone-marrow stromal cells (hBM)) were incubated with serum from ten consecutive polytraumatised patients taken from post-traumatic day 1 to day 21 and with serum from 12 healthy control subjects. The serum from the polytraumatised patients significantly stimulated the proliferation of fibroblasts, MG-63 and of hBM cells. The activity of alkaline phosphatase in MG-63 and hBM cells was significantly decreased when exposed to the serum of the severely-injured patient. After three weeks in 3D cell cultures, matrix production and osteogenic gene expression of hBM cells were equal in the patient and control groups. However, the serum from the polytraumatised patients significantly decreased apoptosis of hBM cells compared with the control serum (4.3% Increased proliferation of osteoblastic cells and reduced apoptosis of osteoprogenitors may be responsible for increased osteogenesis in severely-injured patients.
Currently, there is no animal model in which
to evaluate the underlying physiological processes leading to the heterotopic
ossification (HO) which forms in most combat-related and blast wounds.
We sought to reproduce the ossification that forms under these circumstances
in a rat by emulating patterns of injury seen in patients with severe
injuries resulting from blasts. We investigated whether exposure
to blast overpressure increased the prevalence of HO after transfemoral
amputation performed within the zone of injury. We exposed rats
to a blast overpressure alone (BOP-CTL), crush injury and femoral
fracture followed by amputation through the zone of injury (AMP-CTL)
or a combination of these (BOP-AMP). The presence of HO was evaluated
using radiographs, micro-CT and histology. HO developed in none
of nine BOP-CTL, six of nine AMP-CTL, and in all 20 BOP-AMP rats.
Exposure to blast overpressure increased the prevalence of HO. This model may thus be used to elucidate cellular and molecular
pathways of HO, the effect of varying intensities of blast overpressure,
and to evaluate new means of prophylaxis and treatment of heterotopic
ossification. Cite this article:
Obesity is a risk factor for complications following
many orthopaedic procedures. The purpose of this study was to investigate
whether obesity was an independent risk factor increasing the rate
of complications following periacetabular osteotomy (PAO) and to
determine whether radiographic correction after PAO was affected
by obesity. We retrospectively collected demographic, clinical and radiographic
data on 280 patients (231 women; 82.5% and 49 men; 17.5%) who were
followed for a mean of 48 months (12 to 60) after PAO. A total of
65 patients (23.2%) were obese (body mass index (BMI) >
30 kg/m2).
Univariate and multivariate analysis demonstrated that BMI was an independent
risk factor associated with the severity of the complications. The
average probability of a patient developing a major complication
was 22% (95% confidence interval (CI) 11.78 to 38.21) for an obese
patient compared with 3% (95% CI 1.39 to 6.58) for a non-obese patient
The odds of a patient developing a major complication were 11 times
higher (95% CI 4.71 to 17.60, p <
0.0001) for an obese compared
with a non-obese patient. Following PAO surgery, there was no difference in radiographic
correction between obese and non-obese patients. PAO procedures
in obese patients correct the deformity effectively but are associated
with an increased rate of complications. Cite this article:
The June 2014 Hip &
Pelvis Roundup360 looks at: Modular femoral necks: early signs are not good; is corrosion to blame for modular neck failures; metal-on-metal is not quite a closed book; no excess failures in fixation of displaced femoral neck fractures; noise no problem in hip replacement; heterotopic ossification after hip arthroscopy: are NSAIDs the answer?; thrombotic and bleeding events surprisingly low in total joint replacement; and the elephant in the room: complications and surgical volume.
The June 2014 Children’s orthopaedics Roundup360 looks at: plaster wedging in paediatric forearm fractures; the medial approach for DDH; Ponseti – but not as he knew it?; Salter osteotomy more accurate than Pemberton in DDH; is the open paediatric fracture an emergency?; bang up-to-date with femoral external fixation; indomethacin, heterotopic ossification and cerebral palsy hips; lengthening nails for congenital femoral deformities, and is MRI the answer to imaging of the physis?
We report the case of an 82-year-old man who
underwent fasciectomy for a severe Dupuytren’s contracture, during which
an ossified lesion was encountered within the contracture and surrounding
the neurovascular bundle. The abnormal tissue was removed with difficulty
and heterotopic ossification was confirmed histologically. We believe this
is the first report of heterotopic ossification in Dupuytren’s disease.
Hip arthrodesis remains a viable surgical technique
in well selected patients, typically the young manual labourer with
isolated unilateral hip disease. Despite this, its popularity with
patients and surgeons has decreased due to the evolution of hip
replacement, and is seldom chosen by young adult patients today.
The surgeon is more likely to encounter a patient who requests conversion
to total hip replacement (THR). The most common indications are
a painful pseudarthrosis, back pain, ipsilateral knee pain or contralateral
hip pain. Occasionally the patient will request conversion because
of difficulty with activities of daily living, body image and perceived
cosmesis. The technique of conversion and a discussion of the results
are presented. Cite this article: