Aims. Post-traumatic osteoarthritis (PTOA) is a subset of osteoarthritis (OA). The gut microbiome is shown to be involved in OA. However, the effect of exercise on gut microbiome in PTOA remains elusive. Methods. A total of 18 eight-week Sprague-Dawley rats were assigned into three groups: Sham/sedentary (Sham/Sed), PTOA/sedentary (PTOA/Sed), and PTOA/treadmill-walking (PTOA/TW). PTOA model was induced by transection of the anterior cruciate ligament (ACLT) and the destabilization of the medial meniscus (DMM). Treadmill-walking (15 m/min, 30 min/d, five days/week for eight weeks) was employed in the PTOA/TW group. The response of cartilage, subchondral bone, serology, and gut microbiome and their correlations were assessed. Results. Eight-week treadmill-walking was effective at maintaining the integrity of cartilage-subchondral bone unit and reducing the elevated systematic inflammation factors and microbiome-derived metabolites. Furthermore, 16S ribosomal ribonucleic acid (rRNA) sequencing showed disease-relevant microbial shifts in PTOA animals, characterized by the decreased abundance of phylum TM7 and the increase of phylum Fusobacteria. At the genus level, the abundance of Lactobacillus, Turicibacter, Adlercreutzia, and Cetobacterium were increased in the PTOA animals, while the increase of Adlercreutzia and Cetobacterium was weakened as a response to exercise. The correlation analysis showed that genus Lactobacillus and Adlercreutzia were correlated to the structural OA phenotypes, while phylum Fusobacteria and genus Cetobacterium may contribute to the effects of exercise on the diminishment of serological inflammatory factors. Conclusion. Exercise is effective at maintaining the integrity of cartilage-subchondral bone unit, and the exercise-induced modification of disease-relevant microbial shifts is potentially involved in the mechanisms of exercise-induced amelioration of PTOA. Cite this article: Bone Joint Res 2022;11(4):214–225

Aims. The aim of this study was to report the pooled prevalence of post-traumatic osteoarthritis (PTOA) and examine whether the risk of developing PTOA after anterior cruciate ligament (ACL) injury has decreased in recent decades. Methods. The PubMed and Web of Science databases were searched from 1 January 1980 to 11 May 2022. Patient series, observational studies, and clinical trials having reported the prevalence of radiologically confirmed PTOA after ACL injury, with at least a ten-year follow-up, were included. All studies were analyzed simultaneously, and separate analyses of the operative and nonoperative knees were performed. The prevalence of PTOA was calculated separately for each study, and pooled prevalence was reported with 95% confidence intervals (CIs) using either a fixed or random effects model. To examine the effect of the year of injury on the prevalence, a logit transformed meta-regression analysis was used with a maximum-likelihood estimator. Results from meta-regression analyses were reported with the unstandardized coefficient (β). Results. The pooled prevalence of PTOA was 37.9% (95% CI 32.1 to 44) for operatively treated ACL injuries with a median follow-up of 14.6 years (interquartile range (IQR) 10.6 to 16.7). For nonoperatively treated ACL injuries, the prevalence was 40.5% (95% CI 28.9 to 53.3), with a median of follow-up of 15 years (IQR 11.7 to 20.0). The association between the year of operation and the prevalence of PTOA was weak and imprecise and not related to the choice of treatment (operative β -0.038 (95% CI -0.076 to 0.000) and nonoperative β -0.011 (95% CI -0.101 to 0.079)). Conclusion. The initial injury, irrespective of management, has, by the balance of probability, resulted in PTOA within 20 years. In addition, the prevalence of PTOA has only slightly decreased during past decades. Therefore, further research is warranted to develop strategies to prevent the development of PTOA after ACL injuries. Cite this article: Bone Joint J 2023;105-B(11):1140–1148

Fractures of the distal radius occurring in young adults are treated increasingly by open surgical techniques, partly because of concern that failure to restore the alignment of the fracture accurately may cause symptomatic post-traumatic osteoarthritis in future years. We reviewed 106 adults who had sustained a fracture of the distal radius between 1960 and 1968 and who were below the age of 40 years at the time of injury. We carried out a clinical and radiological assessment at a mean follow-up of 38 years (33 to 42). No patient had required a salvage procedure. While there was radiological evidence of post-traumatic osteoarthritis after an intra-articular fracture in 68% of patients (27 of 40), the disabilities of the arm, shoulder and hand (DASH) scores were not different from population norms, and function, as assessed by the Patient Evaluation Measure, was impaired by less than 10%. Ordinal logistic regression analysis showed a significant relationship between narrowing of the joint space and extra-articular malunion (dorsal angulation and radial shortening) as well as intra-articular injury. Multivariate analysis revealed that grip strength had fallen to 89% of that of the uninjured side in the presence of dorsal malunion, but no measure of extra-articular malunion was significantly related to either the Patient Evaluation Measure or DASH scores. While anatomical reduction is the principal aim of treatment, imperfect reduction of these fractures may not result in symptomatic arthritis in the long term, and this should be considered when counselling patients on the risks and benefits of the many treatment options available

To evaluate the therapeutic effect of Pulsed Electromagnetic Field (PEMF) in the treatment of meniscal tears in the avascular region. Seventy-two twelve-week-old male Sprague-Dawley rats with full-thickness longitudinal medial meniscal tears in the avascular region were divided into 3 groups: control group (G. con. ), treated with classic signal PEMF (G. classic. ), and high slew rate signal PEMF(G. HSR. ). The HSR signal has the same pulse and burst frequencies as the classic signal, but with a higher slew rate. Macroscopic observation and histological analysis of the meniscus and articular cartilage were performed to evaluate the meniscal healing and progressions of osteoarthritis. The synovium was harvested for histological and immunofluorescent analysis to assess the intra-articular inflammation. The meniscal healing, articular cartilage degeneration, and synovitis were quantitatively evaluated according to their respective scoring system. Dramatic degenerative changes of the meniscus and articular cartilage were noticed during gross observation and histological evaluation in the control group at 8 weeks. However, the menisci in the two treatment groups were restored to normal morphology with a smooth surface and shiny white color. Particularly, the HSR signal remarkably enhanced the fibrochondrogenesis and accelerated the remodeling process of the regenerated tissue. The meniscal healing scores of PEMF treatment groups were significantly higher than those in the control group at 8 weeks. Specifically, the HSR signal showed a significantly higher meniscal repair score than the classic signal at week 8 (P < .01). The degeneration score (G. con. versus G. classic. : P < .0001; Gcon versus G. HSR. : P < .0001) and synovitis score (G. con. versus Gclassic: P < .0001; G. con. versus G. HSR. : P = .0002) of the control groups were significantly higher than those in the two treatment groups. PEMF promoted the healing of meniscal tears in the avascular region and restored the injured meniscus to its structural integrity in a rat model. Compared to the classic signal, the HSR signal showed the increased capability to promote fibrocartilaginous tissue formation and modulate the inflammatory environment and therefore protected the knee joint from post-traumatic osteoarthritis development

The Motec cementless modular metal-on-metal ball-and-socket wrist arthroplasty was implanted in 16 wrists with scaphoid nonunion advanced collapse (SNAC; grades 3 or 4) and 14 wrists with scapholunate advanced collapse (SLAC) in 30 patients (20 men) with severe (grades 3 or 4) post-traumatic osteoarthritis of the wrist. The mean age of the patients was 52 years (31 to 71). All prostheses integrated well radiologically. At a mean follow-up of 3.2 years (1.1 to 6.1) no luxation or implant breakage occurred. Two wrists were converted to an arthrodesis for persistent pain. Loosening occurred in one further wrist at five years post-operatively. The remainder demonstrated close bone–implant contact. The clinical results were good, with markedly decreased Disabilities of the Arm Shoulder and Hand (DASH) and pain scores, and increased movement and grip strength. No patient used analgesics and most had returned to work. Good short-term function was achieved using this wrist arthroplasty in a high-demand group of patients with post-traumatic osteoarthritis

Purpose: To determine if an adenovirus vector expressing BMP-7 can alter the progression of post-traumatic osteoarthritis. Method: Preliminary dose-response studies were done in ovine metacarpal-phalangeal joints using 10^9, 10^10, and 10^11 virus particles (VP). In-vitro transfection efficiency studies were done using ovine synovial cells, chondrocytes and HEK293 cells. In-vivo studies were conducted in 16 sheep that underwent surgery to create bilateral contusive impact injuries to the medial femoral condyle. One week later 10^9 VP were injected into one joint of each sheep, while four sheep remained untreated bilateral controls. Three months later the sheep were sacrificed for assessments including histological scoring, cartilage glycosaminoglycan assays, and immunostaining for Col2 3/4 short collagen fragments that are generated by metalloproteinases during OA progression. Results: Transfection with 10^9 VP produced slightly longer expression than higher concentrations of VP. HEK293 cells expressed BMP-7 quickly but synoviocytes and chondrocytes expressed this protein at 48 and 96 hours. Knee joints that received Ad5-BMP-7 produced up to 2.5 ng of BMP-7 between day seven and 21. These joints had reduced cartilage degneration at the injury sites and less centrifugal progression of OA across the femoral condyle. Histological scores were reduced as was Col2 C3/4 short immunostaining. Conclusion: BMP-7 has a homeostatic role in cartilage and can be used therapeutically. 1. Ad5-BMP-7 transfection of synovial tissue produced sufficient BMP-7 to stop the progression of degenerative changes after trauma that would usually lead to OA. Adenoviral vectors can create inflammation and neutralizing antibodies but these complications were minimized by using a low (10^9) dose. Human trials using similar vectors are ongoing and the outcome of these will determine whether gene therapy will become a useful tool when patients are at risk of post-traumatic OA

Introduction. It is documented in the literature the very good results of lateral unicompartmental knee arthroplasty (UKA) when the standard accepted indications are followed. In our experience these indications can be extended to include post-traumatic osteoarthritis (OA) with malunion secondary to tibial plateau fracture. We report our results concerning 15 UKAs in these particular situations. Material and methods. From 1985 to 2009, we performed 15 lateral UKAs in 15 patients for post traumatic OA secondary to malunion following a tibial plateau fracture. 7 were female and 8 male. The mean age of the patients at the time of the index procedure was 45±17 years and the mean delay from initial trauma was 5.4 years. The average follow-up was 108 months (range 12–265 months). Results. Twelve patients (12 over 15) were satisfied or very satisfied (80%). At follow up 2 had undergone a second operation: 1 osteosynthesis for patellar fracture and 1 conversion to TKA for progression of OA (at 13.7 years after UKA) and one remained unsatisfied. No revision surgery was necessary for wear or infection. The average femoral-tibial alignment was 4° valgus (range −6° to 8°). The mean IKS knee score was 95.3 points and mean IKS function score was 92 points. Discussion. Our results in the medium term are excellent. They support that the selection criteria for UKA can be extended to include these indications. A longer follow up is required before they can be routinely included in the conventional selection criteria for UKA

Summary. The ideal therapy for post-traumatic osteoarthritis (PTOA) must be mechanism-based and target multiple anabolic and catabolic pathways. Our results suggest an innovative combination of known pro-anabolic and anti-catabolic biologics to treat post-traumatic cartilage degeneration. Introduction. Untreated joint injuries can result in cartilage wear and the development of PTOA. Previous studies identified the mechanisms that may govern the progression to PTOA. Here we hypothesised that targeted biologic interventions combined based on the type/time of cellular responses may constitute an effective novel treatment algorithm to arrest PTOA. Methods. Eleven human donor normal tali, age 19–71 yo, from the Gift of Hope Organ & Tissue Donor Network were impacted using a 4mm cylindrical indenter with the impulse of 1N as discribed. 8mm cartilage explants (4mm impacted core + 4mm non-impacted adjacent ring) were removed from the joint and cultured for 14 days in 5% fetal bovine serum with or without selected biologics. Treatment groups consisted of 1) Impacted control (IC), 2) Un-impacted control (UIC); 3–5) Impaction + three combinations of BMP-7/OP-1 (100ng/ml), P188 (8 ug/ml) and tumor necrosis factor-α (TNF-α) antagonist (100ng/ml) defined as Combo1, Combo2, and Combo3. All treatments were administered according to previously reported post-injury cellular responses. Combo1: P188 administered at day 0 for 48hrs + BMP-7 administered at day 0 for 48hrs and at days 7–14 + anti-TNF-α administered at days 0–7; Combo2: All three agents administered at day 0 for 48hrs and anti-TNF-α and BMP-7 administered again at day 7 for 48hrs; Combo3: All agents administered simultaneously at day 0 for 48hrs. Tissue and media were collected on days 0, 2, 7, and 14 and analyzed for cell viability, Safranin O staining, and proteoglycan (PG) synthesis. Results. A single impact to articular cartilage resulted in cell death within the superficial layer of impacted region, which if untreated, expanded to the adjacent non-impacted area. It reduced cell viability by more than 2-fold (p<0.01) and triggered elevation of pro-inflammatory mediators within the first 24–48 hrs and again around day 10. Initial anabolic responses characterised by the synthesis of superficial zone protein, endogenous BMP-7 and PGs were initiated at days 5–7. Cell survival in the superficial layer was improved under the individual or combined treatments with the most pronounced sustained effect under Combo1 & 2 (∼1.5-fold increase vs IC, p<0.05). Combo1 and to a lesser extend Combo 2 markedly improved cell survival in the entire cartilage thickness, which increased from 59% in IC to 84% in Combo1, p=0.006. Both Combo1 & 2 had a stronger effect on Safranin O staining and preservation of matrix integrity than Combo 3. Contrary, Combo3 exhibited the highest effect on PG synthesis (1.8-fold increase vs IC or other two combinations; p<0.05). Combo1 & 2 were less effective. Discussion. Current study reports two important findings: 1) the same combination of agents, but administered at various treatment regimens, can induce different effects. Prolonged administration of anti-TNF-α and BMP-7 (Combo1) had a strong effect on cell survival and matrix preservation, but was less effective in inducing chondrocyte synthetic activity suggesting that overstimulation/overdosing can have a detrimental effect on chondrocyte anabolism; 2) a window of opportunity exists to arrest cell death and delay/prevent cartilage degeneration

Osteoarthritis (OA) is the leading cause of pain and disability worldwide and is characterized by the degenerative changes of articular cartilage. Joint loading is required for cartilage maintenance; however, hyper-physiologic loading is a risk factor for OA. Mechanosensitive ion channels Piezo1 and Piezo2 synergistically transduce hyper-physiologic compression of chondrocytes, leading to chondrocyte death and onset of OA. This injury response is inhibited by Piezo channel loss of function, however the mechanistic role of Piezo channels in vivo is unknown. We examined the hypothesis that deletion of Piezo in chondrocytes will protect mice from joint damage and pain-related behaviors following a surgical destabilization of the medial meniscus (DMM), investigating a key mechanistic and mechanobiological role of these channels in the pathogenesis of OA.

Aggrecan-Cre Piezo1 and Piezo1/2 knockout mice ((Agc)1-CRE^ERT2;Piezo1^fl/flPiezo2^fl/fl) were generated and given a 5-day Tamoxifen regimen at 12-weeks of age (n=6–12/group/sex). Cre-negative mice served as controls. At 16-weeks, mice received DMM surgery on the left knee. 12-weeks following DMM prior to sacrifice, activity and hyperalgesia were measured using spontaneous running wheels and a small animal algometer. Structural changes in bone, cartilage, and synovium were characterized using microCT, histology, and Modified Mankin Score criteria.

Knockout of Piezo1/2 channels was chondroprotective in both sexes following DMM surgery as demonstrated by reduced Modified Mankin Score compared to control animals. Piezo1 KO was chondroprotective in only female mice, indicating a sexually dimorphic response. Piezo1 and Piezo1/2 KO was protective against pain in male mice, while females displayed no differences compared to controls. No changes were observed in bone morphology.

Chondrocyte-specific Piezo1/2 knockout protects the knee joint from structural damage, hyperalgesia and functional deficits in a surgical model of PTOA in male and female mice, illustrating the importance of Piezo channels in response to injury in vivo. Future work aims to interrogate potential sexually dimorphic responses to cartilage damage and investigating Piezo2 KO mice.

Introduction and Objective

Traditionally, osteoarthritis (OA) has been associated mostly with degradation of cartilage only. More recently, it has been established that other joint tissues, in particular bone, are also centrally involved. However, the link between these two tissues remains unclear. This relationship is particularly evident in post-traumatic OA (PTOA), where bone marrow lesions (BMLs), as well as fluctuating levels of inflammation, are present long before cartilage degradation begins. The process of bone-cartilage crosstalk has been challenging to study due to its multi-tissue complexity. Thus, the use of explant model systems have been crucial in advancing our knowledge. Thus, we developed a novel patellar explant model, to study bone cartilage crosstalk, in particular related to subchondral bone damage, as an alternative to traditional femoral head explants or cylindrical core specimens. The commonly used osteochondral explant models are limited, for our application, since they involve bone damage during harvest. The specifics aim of this study was to validate this novel patellar explant model by using IL-1B to stimulate the inflammatory response and mechanical stimulation to determine the subsequent developments of PTOA.

Osteoarthritis (OA) is the most common musculoskeletal disease in the EU and is characterized by cartilage degeneration, pain and restricted movement. Post-Traumatic OA (PTOA) is a specific disease subset that occurs subsequent to traumatic injury, such as ACL rupture and makes up 12% of the overall disease burden. Our current understanding PTOA is that initial injury affects multiple tissues, and many/all contribute to overall ‘joint failure.’ MRI scans show that subchondral bone marrow lesions (BMLs) are present in 80% of ACL rupture cases in the immediate aftermath of joint injury. Their presence indicates an acute consequence in subchondral bone. It has also been suggested that BMLs overlap with, or directly represent, bone microdamage. Microdamage is known to induce osteoclast-mediated remodelling in bone. Therefore, the inhibition of subchondral bone remodelling, particularly in the early phase post-injury, may be a candidate therapeutic approach for preventing PTOA. Finally, the contiguous link between subchondral bone and articular cartilage, can allow transport of small molecules across this boundary, this suggests that bone/cartilage crosstalk is likely to be a key factor in PTOA development after injury. This presentation will summarize recent advances in our understanding these phenomena in both animal and human studies.

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.

Aims

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.

The February 2024 Knee Roundup. 360. looks at: Do patients with hypoallergenic total knee arthroplasty implants for metal allergy do worse? An analysis of healthcare utilizations and patient-reported outcome measures; Defining a successful total knee arthroplasty; Incidence, microbiological studies, and factors associated with periprosthetic joint infection after total knee arthroplasty; A modified Delphi consensus statement on patellar instability; Cause for concern? Significant cement coverage in retrieved metaphyseal cones after revision total knee arthroplasty; Prevalence of post-traumatic osteoarthritis after anterior cruciate ligament injury remains high despite advances in surgical techniques; Cost-effectiveness of arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in patients aged under 45 years

Fractures of the proximal humerus can lead to malalignment of the humeral head, necrosis and post-traumatic osteoarthritis. In such cases surface replacement might be a promising option. A total of 28 shoulders with glenohumeral arthritis subsequent to a fracture underwent surface replacement arthroplasty of the humeral head in patients with a mean age of 60 years (35 to 83). On the basis of the inclination of the impacted head, post-traumatic arthritis was divided into three types: type 1, an impacted fracture of the head in an anatomical position (seven cases); type 2, a valgus impacted fracture (13 cases); type 3, a varus impacted fracture (eight cases). The outcome was measured by means of the Constant score. According to the Boileau classification of the sequelae of fractures of the proximal humerus, all 28 patients had a final result of intra-capsular category 1. The mean Constant score for the 28 shoulders increased from 23.2 points (2 to 45) pre-operatively to 55.1 points (20 to 89) at a mean of 31 months (24 to 66) post-operatively. Valgus impacted fractures had significantly better results (p < 0.039). Surface replacement arthroplasty can provide good results for patients with post-traumatic osteoarthritis of the shoulder. Their use avoids post-operative complications of the humeral shaft, such as peri-prosthetic fractures. Further surgery can be undertaken more easily as the bone stock is preserved

Aims. 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. Methods. 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. Results. BMI, the duration of stiffness, the preoperative ROM, the preoperative intensity of pain, and grade of post-traumatic osteoarthritis of the elbow were identified as predictors of outcome and incorporated to construct the nomogram. SPESSO displayed good discrimination with a C-index of 0.73 (95% confidence interval 0.64 to 0.81). A high C-index value of 0.70 could still be reached in the interval validation. The calibration graph showed good agreement between the nomogram prediction and the outcome. Conclusion. The newly developed SPESSO is a valid and convenient model which can be used to predict the outcome of open arthrolysis of the elbow. It could assist clinicians in counselling patients regarding the choice and expectations of treatment. Cite this article: Bone Joint J 2022;104-B(4):486–494

The ankle is one of the most resisting to arthritis joints of the body, and the development of degenerative changes in it, always due to a pathologic condition or trauma. The aim of this study is to demonstrate the late post- operative results and the development of post-traumatic osteoarthritis in a series of 144 patients with malleolar fractures who have been operated with the principles and methods of AO. To judge our results, we used subjective, objective and X-Ray criteria. The main follow up was 8,6 years, final results were excellent and good in 74,3%, satisfactory in 14,6 and poor in 11,1% while post-traumatic osteoarthritis developed in 22.2% of the cases. The installation of post-traumatic osteoarthritis in malleolar fractures seems to be influenced by factors like age, sex, severity of fracture, quality of reduction and existence of posterior bone fragment bigger than 25% of the joint surface

Introduction. Intra articular distal tibia fractures can lead to post-traumatic osteoarthritis. Joint distraction has shown promise in elective cases. However, its application in acute fractures remains unexplored. This pilot study aims to fill this knowledge gap by investigating the benefits of joint distraction in acute fractures. Materials & Methods. We undertook a restrospective cohort study comprising patients with intra-articular distal tibia and pilon fractures treated with a circular ring fixator (CRF) at a single center. Prospective data collection included radiological assessments, Patient-Reported Outcome Measures (PROM), necessity for additional procedures, and Kellgren and Lawrence grade (KL) for osteoarthritis (OA). 137 patients were included in the study, 30 in the distraction group and 107 in the non-distraction group. There was no significant difference between the groups. Results. Mean follow-up was 3.73 years. There was no significant difference between the groups in overall complications or need for further procedures. There was no significant difference in progression of KL between the groups (1.81 vs 2.0, p=0.38) mean follow up 1.90 years. PROM data was available for 44 patients (6 distraction, 38 non-distraction) with a mean follow-up of 1.71 years. There was no significant difference in EQ5D (p=0.32) and C Olerud-H Molander scores (p=0.17). Conclusions. This pilot study suggests that joint distraction is safe in the acute setting. However, the study's impact is constrained by a relatively small patient cohort and a short-term follow-up period. Future investigations should prioritise longer-term follow-ups and involve a larger patient population to more comprehensively evaluate the potential benefits of joint distraction in acute fractures

We aimed to determine the rate of and risk factors for post-traumatic osteoarthritis (PTOA) and total knee arthroplasty (TKA) requirement after operative management of tibial plateau fractures (TPF) in older adults. We conducted a retrospective cohort study of 182 operatively managed TPFs in 180 patients ≥60 years old over a 12-year period with minimum follow up 1 year. Data including patient demographics, clinical frailty scores, mechanism of injury, management, reoperation and mortality were recorded. Radiographs were reviewed for: Schatzker classification; pre-existing knee osteoarthritis (KOA); severe joint depression >15mm; and development of PTOA. Kaplan Meier survival analysis was performed. Regression analysis was used to identify risk factors for radiographic indication for TKA and actual TKA. Forty-seven percent were Schatzker II fractures. Radiographic KOA was present at fracture in 32.6%. Fracture fixation was performed in 95.6% cases and acute TKA in 4.4%. Thirteen patients underwent late TKA (7.5%). At five-years, 11.8% (6.0-16.7 95% CI) had required TKA and 20.9% (14.4-27.4 95% CI) had a radiographic indication for TKA. Severe joint depression and pre-existing KOA were associated with worse survival for endpoints radiographic indication for TKA and actual TKA. Severe joint depression (HR 2.49(1.35-4.61 95% CI), p=0.004), pre-existing KOA (HR 2.23(1.17-4.23), p=0.015) and inflammatory arthropathy (HR 2.4(1.04-5.53), p=0.039) were independently associated with radiographic indication for TKA. In conclusion, severe joint depression and pre-existing arthritis are independent risk factors for both severe PTOA and TKA after TPFs in older adults. These features should be considered as an indication for primary management with acute TKA

Post-traumatic osteoarthritis (PTOA) is a subset of osteoarthritis, which occurs secondary to traumatic joint injury which is known to cause pathological changes to the osteochondral unit. Articular cartilage degradation is a primary hallmark of OA, and is normally associated with end-stage disease. However, subchondral bone marrow lesions are associated with joint injury, and may represent localized bone microdamage. Changes in the osteochondral unit have been traditionally studied using explant models, of which the femoral-head model is the most common. However, the bone damage caused during harvest can confound studies of microdamage. Thus, we used a novel patellar explant model to study osteochondral tissue dynamics and mechanistic changes in bone-cartilage crosstalk. Firstly, we characterized explants by comparing patella with femoral head models. Then, the patellar explants (n=269) were subjected to either mechanical or inflammatory stimulus. For mechanical stimulus 10% strain was applied at 0.5 and 1 Hz for 10 cycles. We also studied the responses of osteochondral tissues to 10ng/ml of TNF-α or IL-1β for 24hrs. In general the findings showed that patellar explant viability compared extremely well to the femoral head explant. Following IL-1β or TNF-α treatment, MMP13, significantly increased three days post exposure, furthermore we observed a decrease in sulfate glycoaminoglycan (sGAG) content. Bone morphometric analysis showed no significant changes. Contrastingly, mechanical stimulation resulted in a significant decrease sGAG particularly at 0.5Hz, where an increase in MMP13 release 24hrs post stimulation and an upregulation of bone and cartilage matrix degradation markers was observed. Furthermore, mechanical stimulus caused increases in TNF-α, MMP-8, VEGF expression. In summary, this study demonstrates that our novel patella explant model is an excellent system for studying bone-cartilage crosstalk, which responds well to both mechanical and inflammatory stimulus and is thus of great utility in the study of PTOA

Over half of postpartum women experience pelvic ring or hip pain, with multiple anatomic locations involved. The sacroiliac joints, pubic symphysis, lumbar spine and pelvic girdle are all well documented pain generators. However, despite the prevalence of postpartum hip pain, there is a paucity of literature regarding underlying soft tissue intra-articular etiologies. The purpose of this systematic review is to document and assess the available evidence regarding underlying intra-articular soft tissue etiologies of peri- and postpartum hip pain. Three online databases (Embase, PubMed and Ovid [MEDLINE]) were searched from database inception until April 11, 2021. The inclusion criteria were English language studies, human studies, and those regarding symptomatic labral pathology in the peri- or postpartum period. Exclusion criteria were animal studies, commentaries, book chapters, review articles and technical studies. All titles, relevant abstracts and full-text articles were screened by two reviewers independently. Descriptive characteristics including the study design, sample size, sex ratio, mean age, clinical and radiographic findings, pathology, subsequent management and outcomes were documented. The methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) instrument. The initial search identified 2472 studies. A systemic screening and assessment of eligibility identified 5 articles that satisfied the inclusion criteria. Twenty-two females were included. Twenty patients presented with labral pathology that necessitated hip arthroscopy with labral debridement or repair with or without acetabuloplasty and/or femoroplasty. One patient presented with an incidental labral tear in the context of osteitis condensans illi. One patient presented with post-traumatic osteoarthritis necessitating a hip replacement. The mean MINORS score of these 5 non-comparative studies was 2.8 (range 0-7) demonstrating a very low quality of evidence. The contribution of intra-articular soft tissue injury is a documented, albeit sparse, etiology contributing to peri- and postpartum hip pain. Further research to better delineate the prevalence, mechanism of injury, natural history and management options for women suffering from these pathologies at an already challenging time is necessary to advance the care of these patients

Aims. Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. Methods. In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired t-test. Results. Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA). Conclusion. Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: Bone Joint J 2020;102-B(5):632–637

Introduction and Objective. Evidence in literature is contradicting regarding outcomes of total knee arthroplasty (TKA) in post-traumatic osteoarthritis (PTOA) and whether they are inferior to TKA in primary osteoarthritis (OA). The aim of this review was to find out if any difference exists in the results of TKA between the two indications. Materials and Methods. The electronic databases MEDLINE, EMBASE, The Cochrane Collaboration, and PubMed were searched and screened in duplicate for relevant studies. The selected studies were further subjected to quality assessment using the modified Coleman method. The primary outcome measure was patient reported outcome, and secondary outcome measures were infection, revision, stiffness, and patella tendon rupture. Results. A total of 18 studies involved 1129 patients with a mean age of 60.6 years (range 45.7–69) and follow up of 6.3 years. The time interval from index injury to TKA was 9.1 years. Knee Society Score (KSS) in PTOA reported in 12/18 studies showed functional improvement from 42.5 to 70 post-TKA exceeding minimally clinically important difference. In TKA for primary OA vs PTOA, deep peri-prosthetic joint infection (PJI) was reported in 1.9% vs 5.4% of patients, whilst revision of prosthesis at an average of 6 years post-operatively was performed in 2.6 vs 9.7% of patients. Conclusions. TKA is a successful treatment option for PTOA. However, the risk of significant complications like PJI and implant failure requiring revision is higher than primary OA cases. Patients should be counselled about those risks. Further well-designed comparative cohort-matched studies are needed to compare outcomes between the two populations

Although remnant-preserved ACL reconstruction (ACLR) restores knee joint stability and dampens the problem of acute ACL rupture-induced knee pain, an increasing number of patients still develop post-traumatic osteoarthritis (PTOA) after 10 to 15 years of ACLR. We previously found that remnant-preserved ACLR with concomitant medial and lateral meniscus repair may not prevent cartilage degeneration and weaken muscle strength, while the clinical features of PTOA are not clear. We hypothesized that remnant-preserved ACLR with concomitant medial and lateral meniscus tears is related to early cartilage damage, worse function recovery, patient-reported outcomes (PROs) and delayed duration to return to sports. The aim is to evaluate the remnant-preserved ACLR with complicated meniscal injuries in predicting which patients are at higher risk of osteoarthritic changes, worse function and limited activities after ACLR for 12 months. Human ethical issue was approved by a committee from Xi'an Jiaotong University. 26 young and active patients (24 male, 2 female) with ACL injuries (Sherman type I and II) with concomitant medial and lateral meniscus within 2 months were included from January 2014 to March 2022. The average age of the ACLR+ meniscus repair was 26.77±1.52 (8 right, 5 left) and isolated ACLR control was 31.92±2.61 years old (7 left, 6 right). Remnant-preserved ACLR with a 5- to 6-strand hamstring tendon graft was operated on by the same sports medicine specialists. MRI CUBE-T. 2. scanning with 48 channels was conducted by a professional radiologist. The volume of the ACL graft was created through 3 dimensional MRI model (Mimics 19, Ann Arbor). Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS) was applied to score visible cartilage damage. IKDC 2000 score and VAS were assessed by two blinded researchers. Results were presented as mean± SEM of each group. The cross-sectional area and 3D volume of the ACL graft were greater in the remnant-preserved ACLR+meniscus group compared with isolated ACLR (p=0.01). It showed that ACLR+ meniscus group had early signs of joint damage and delayed meniscus healing regarding ACLOAS compared to control group (p=0.045). MRI CUBE-T. 2. prediction of radiographic cartilage degeneration was not obvious in both groups post remnant-preserved ACLR over 12 months (p>0.05). However, higher VAS scores, lower IKDC scores, and long-last joint swelling were reported in the ACLR+ meniscus repair group at the end of 12 months follow-up. Although remnant-preserved ACLR+ meniscus was able to maintain the restore the knee function, it showed delayed timing (>12 months) to return to play at the pre-injury stage, while no difference between the timing of returning to the normal daily routine of their ACLR knee compared to control (p=0.30). The cost of ACLR+ meniscus (average 10,520.76$) was higher than the control group (6,452.92$, p=0.018). Remnants-preserved ACLR with concomitant injured medial and lateral meniscus repair shows a higher risk of cartilage damage, greater cost, worse functional performance, and longer time for young male patients to return to sports after 12-month follow-up compared to isolated ACLR. Further evidence and long-term follow-up are needed to better understand the association between these results and the risk of development of PTOA in this patient cohort

Aim: The results of operative treatment of acetabular fractures, as well as its role in the prevention of post-traumatic osteoarthritis are presented. Methods: From 1990 to 2000, þfty patients had an open reduction and internal þxation of an acetabular fracture. Thirty-two patients were male and eighteen were female, with an average age of 37,8 years (range: 18 to 71 years). The mechanism of injury was a motor vehicle accident in most cases (84%). 22 fractures were A-type, 24 B-type and 4 C-type according to the AO classiþcation, while according to the Letournel-Judet classiþcation 21 fractures were simple and 21 complex. Osteosynthesis was achieved with either lag screws alone or with a combination of lag screws and a buttress plate. Results: Follow-up ranged from 2–10 years (average: 5,8 years). Clinical evaluation according to the Dñ Aubigne-Postel scoring system gave 20 excellent (40%), 18 good (36%), 5 fair (10%) and 7 poor (14%) results. Early postoperative complications included 5 cases of common peroneal nerve palsy and 3 cases of wound infection. Late complications included 1 case of avascular necrosis of the femoral head, 12 cases of post-traumatic osteoarthritis (24%) and 5 cases of Brooker III heterotopic ossiþcation (10%). Conclusions: Operative treatment of ace-tabular fractures although demanding bears very good results. Post-traumatic arthritis remains a common complication, even if care is taken for the anatomic reduction of the fracture

Aims. Anterior cruciate ligament (ACL) rupture commonly leads to post-traumatic osteoarthritis, regardless of surgical reconstruction. This study uses standing MRI to investigate changes in contact area, contact centroid location, and tibiofemoral alignment between ACL-injured knees and healthy controls, to examine the effect of ACL reconstruction on these parameters. Methods. An upright, open MRI was used to directly measure tibiofemoral contact area, centroid location, and alignment in 18 individuals with unilateral ACL rupture within the last five years. Eight participants had been treated nonoperatively and ten had ACL reconstruction performed within one year of injury. All participants were high-functioning and had returned to sport or recreational activities. Healthy contralateral knees served as controls. Participants were imaged in a standing posture with knees fully extended. Results. Participants’ mean age was 28.4 years (SD 7.3), the mean time since injury was 2.7 years (SD 1.6), and the mean International Knee Documentation Subjective Knee Form score was 84.4 (SD 13.5). ACL injury was associated with a 10% increase (p = 0.001) in contact area, controlling for compartment, sex, posture, age, body mass, and time since injury. ACL injury was associated with a 5.2% more posteriorly translated medial centroid (p = 0.001), equivalent to a 2.6 mm posterior translation on a representative tibia with mean posteroanterior width of 49.4 mm. Relative to the femur, the tibiae of ACL ruptured knees were 2.3 mm more anteriorly translated (p = 0.003) and 2.6° less externally rotated (p = 0.010) than healthy controls. ACL reconstruction was not associated with an improvement in any measure. Conclusion. ACL rupture was associated with an increased contact area, posteriorly translated medial centroid, anterior tibial translation, and reduced tibial external rotation in full extension. These changes were present 2.7 years post-injury regardless of ACL reconstruction status. Cite this article: Bone Joint J 2021;103-B(9):1505–1513

The aim was to report operative complications, radiographic and patient-reported outcomes following lateral tibial plateau fracture fixation augmented with calcium phosphate cement (CPC). From 2007–2018, 187 patients (median age 57yrs [range 22–88], 63% female [n=118/187]) with a Schatzker II/III fracture were retrospectively identified. There were 103 (55%) ORIF and 84 (45%) percutaneous fixation procedures. Complications and radiographic outcomes were determined from outpatient records and radiographs. Long-term follow-up was via telephone interview. At a median of 6 months (range 0.1–138) postoperatively, complications included superficial peroneal nerve injury (0.5%, n=1/187), infection (6.4%, n=12/187), prominent metalwork (10.2%, n=19/187) and post-traumatic osteoarthritis (PTOA; 5.3%, n=10/187). The median postoperative medial proximal tibial angle was 89o (range 82–107) and posterior proximal tibial angle 82o (range 45–95). Three patients (1.6%) underwent debridement for infection and 27 (14.4%) required metalwork removal. Seven patients (4.2%) underwent total knee replacement for PTOA. Sixty percent of available patients (n=97/163) completed telephone follow-up at a median of 6yrs (range 1–13). The median Oxford Knee Score was 42 (range 3–48), Knee injury and Osteoarthritis Outcome Score 88 (range 10–100), EuroQol 5-Dimension score 0.812 (range −0.349–1.000) and Visual Analogue Scale 75 (range 10–100). There were no significant differences between ORIF and percutaneous fixation in patient-reported outcome (all p>0.05). Fixation augmented with CPC is safe and effective for lateral tibial plateau fractures, with a low complication rate and good long-term knee function and health-related quality of life. Percutaneous fixation offers a viable alternative to ORIF with no detriment to patient-reported outcome

Periarticular fractures of the proximal tibia are some of the most difficult fractures to manage as open reduction and internal fixation of the fractures is plagued with complications such as non-union, delayed union, infection and post-traumatic osteoarthritis. We evaluated the results of 16 consecutive periarticular tibial fractures stabilised with the AO hybrid fixator using the Oxford Knee Score, American Orthopaedic Foot and Ankle Score (AOFAS) and X-rays of the tibia. Two patients were lost to follow up and 1 patient refused to take part in the study whose latest radiographs showed grade 4 degenerative changes. The mean follow up was 34 months (range 12 to 57 months) and the mean age was 50 years. All fractures were closed and were graded as either Schatzker 5 or 6. The fixator was applied for an average of 12 weeks. The mean Oxford Knee score was 27.2/60 (mild to moderate knee arthritis) and the mean AOFAS was 71.9/100. There was no significant malunion however 37.5% had developed radiological evidence of grade 3 or 4 post-traumatic osteoarthritis with one requiring a total knee replacement. Forty four percent of patients developed a complication with pin site infection being the commonest complication and 25% required further surgery. There were 2 nonunions with one requiring a fibular osteotomy, which subsequently united. Eighty eight percent of patients were satisfied with the procedure while 80% would recommend the procedure if required in future. From our study we feel that hybrid fixation of proximal periarticular tibial fractures is satisfactory however preoperative counselling regarding complications and the possible need for further surgery must be emphasised to the patient prior to embarking on this type of fixation

Osteoarthritis is a slowly progressive disease which includes the intervention of several cytokines and macrophage metalleinoproteinases reaction, leading to the degradation of the local cartilage but also having an impact on the serum acute phase proteins (APPs). Subsequently, biomarkers seem to be essential to estimate its progression and the need for any surgical intervention such as total arthroplasty, but also can be used as therapeutic agents. Recently, among APPs, fetuin-A drew attention regarding its possible anti-inflammatory role in animal models but also as a therapeutic agent in the inflammatory joint disease in clinical trials. The purpose of this study is to investigate the possible attenuating role of the intra-articular administration of Fetuin-A in post-traumatic induced secondary osteoarthritis in rats, and also its effect on the systematic levels of IL-2,4,7, BMPs 2,4,7, CRP and Fetuin-A. 30 male Sprague Dawley rats were separated in two groups where post-traumatic osteoarthritis was induced surgically by Anterior Cruciate Ligament Transection and the transection of the Medial Collateral Ligament of the right knee. In the Control Group, only surgical intervention took place. In Fetuin Group, along with the induction of osteoarthritis, a single dose of bovine fetuin was administrated intra-articularly intra-operatively in 5 and 8 weeks of the experimental protocol. Both groups were examined for 8 weeks. The levels of interleukins, bone morphogenetic proteins, Fetuin-A and C-Reactive Protein were evaluated by ELISA of peripheral blood in three time periods: preoperatively, 5 and 8 weeks post-operatively. Knee osteoarthritic lesions were classified according to Osteoarthritis Research Society International Grading System and Modified Mankin Score, by histologic examination. IL-2 levels were significantly decreased in the Fetuin Group. No statistical difference was signed on the levels of IL-7, BMP-2,4,7 and Fetuin-A between the two groups. CRP levels were significantly increased in the Fetuin Group in 5 weeks of the experiment. Fetuin Group signed better scores according to the OARSI classification system and Modified Mankin Score, without any statistical significance. Intra-articular administration of Fetuin-A restrictively affected the progression of post-traumatic arthritis in rats, as only the levels of IL-2 were decreased as well as limited osteoarthritic lesions were observed on the Fetuin Group

We reviewed 116 patients who underwent 118 arthroscopic ankle arthrodeses. The mean age at operation was 57 years, 2 months (20 to 86 years). The indication for operation was post-traumatic osteoarthritis in 67, primary osteoarthritis in 36, inflammatory arthropathy in 13 and avascular necrosis in two. The mean follow-up was 65 months (18 to 144). Nine patients (10 ankles) died before final review and three were lost to follow-up, leaving 104 patients (105 ankles) who were assessed by a standard telephone interview. The pre-operative talocrural deformity was between 22° valgus and 28° varus, 94 cases were within 10° varus/valgus. The mean time to union was 12 weeks (6 to 20). Nonunion occurred in nine cases (7.6%). Other complications included 22 cases requiring removal of a screw for prominence, three superficial infections, two deep vein thromboses/pulmonary emboli, one revision of fixation, one stress fracture and one deep infection. Six patients had a subtalar fusion at a mean of 48 months after ankle fusion. There were 48 patients with excellent, 35 with good, 10 with fair and 11 with poor clinical results

Aims. Involvement of the posterior malleolus in fractures of the ankle probably adversely affects the functional outcome and may be associated with the development of post-traumatic osteoarthritis. Anatomical reduction is a predictor of a successful outcome. The purpose of this study was to describe the technique and short-term outcome of patients with trimalleolar fractures, who were treated surgically using a posterolateral approach in our hospital between 2010 and 2014. Patients and Methods. The study involved 52 patients. Their mean age was 49 years (22 to 79). There were 41 (79%) AO 44B-type and 11 (21%) 44C-type fractures. The mean size of the posterior fragment was 27% (10% to 52%) of the tibiotalar joint surface. Results. Reduction was anatomical in all patients with a residual step in the articular surface of ≤ 1 mm. In nine of the C-type fractures (82%), the syndesmosis was stable after fixation of the posterior fragment and a syndesmosis screw was not required. Apart from one superficial wound infection, there were no wound healing problems. At a mean radiological follow-up of 34 weeks (seven to 131), one patient with a 44C-type fracture had widening of the syndesmosis which required further surgery. Conclusion. We conclude that the posterolateral surgical approach to the ankle gives adequate access to the posterior malleolus, allowing its anatomical reduction and stable fixation: it has few complications. Take home message: Fixation of the posterior malleolus in trimalleolar fractures can be easily done via the posterolateral approach whereby anatomical reduction and stable fixation can be reached due to adequate visualisation of the fracture. Cite this article: Bone Joint J 2016;98-B:812–17

It is unclear why ACL rupture increases osteoarthritis risk, regardless of ACL reconstruction. Our aims were: 1) to establish the reliability and accuracy of a direct method of determining tibiofemoral contact in vivo with UO-MRI, 2) to assess differences in knees with ACL rupture treated nonoperatively versus operatively, and 3) to assess differences in knees with ACL rupture versus healthy knees. We recruited a convenience sample of patients with prior ACL rupture. Inclusion criteria were: 1) adult participants between 18–50 years old; 2) unilateral, isolated ACL rupture within the last five years; 3) if reconstructed, done within one year from injury; 4) intact cartilage; and 5) completed a graduated rehabilitation program culminating in return to sport or recreational activities. Participants were excluded if they had other ligament ruptures, osteoarthritis, an incompletely rehabilitated injury, were prohibited from undergoing MRI, or had a history of ACL re-rupture. Using the UO-MRI, we investigated tibiofemoral contact area, centroid location, and six degrees of freedom alignment under standing, weightbearing conditions with knees extended. We compared patients with ACL rupture treated nonoperatively versus operatively, and ACL ruptured knees versus healthy control knees. We assessed reliability using the intra-class correlation coefficient, and accuracy by comparing UO-MRI contact area with a 7Tesla MRI reference standard. We used linear mixed-effects models to test the effects of ACL rupture and ACL reconstruction on contact area. We used a paired t test for centroid location and alignment differences in ACL ruptured knees versus control knees, and the independent t test for differences between ACL reconstruction and no reconstruction. Analyses were performed using R version 3.5.1. We calculated sample size based on a previous study that showed a contact area standard deviation of 13.6mm2, therefore we needed eight or more knees per group to detect a minimum contact area change of 20mm2with 80% power and an α of 0.05. We recruited 18 participants with ACL rupture: eight treated conservatively and 10 treated with ACL reconstruction. There were no significant differences between the operative and nonoperative ACL groups in terms of age, gender, BMI, time since injury, or functional knee scores (IKDC and KOOS). The UO-MRI demonstrated excellent inter-rater, test-retest, and intra-rater reliability with ICCs for contact area and centroid location ranging from 0.83–1.00. Contact area measurement was accurate to within 5% measurement error. At a mean 2.7 years after injury, we found that ACL rupture was associated with a 10.4% larger medial and lateral compartment contact areas (P=0.001), with the medial centroid located 5.2% more posterior (P=0.001). The tibiae of ACL ruptured knees were 2.3mm more anterior (P=0.003), and 2.6° less externally rotated (P=0.010) relative to the femur, than contralateral control knees. We found no differences between ACL reconstructed and nonreconstructed knees. ACL rupture was associated with significant mechanical changes 2.7 years out from injury, which ACL reconstruction did not restore. These findings may partially explain the equivalent risk of post-traumatic osteoarthritis in patients treated operatively and nonoperatively after ACL rupture

It has been suggested that arthrodesis of the ankle leads to osteoarthritis of the joints of the ipsilateral hind- and midfoot. We believe these studies overlooked the presence of osteoarthritic changes in these joints before the arthrodesis. We reviewed the pre-operative radiographs of 70 patients with osteoarthritis of the ankle who underwent 71 ankle arthrodeses (one was bilateral). The talonavicular, calcaneocuboid, subtalar and naviculocuneiform joints were given an osteoarthritis score according to Kellgren and Lawrence. The mean age at operation was 54.9 years and the most common indication was for post-traumatic osteoarthritis (52 cases). A total of 68 patients showed pre-existing arthritis in either the hind- or mid-foot, with the subtalar joint the most commonly affected. Ipsilateral hind- and mid-foot arthritis is almost universally present in patients with arthritis of the ankle requiring arthrodesis. The presence of such changes may not be a consequence of this arthrodesis

Our aim was to evaluate the efficacy of a two-level reconstruction technique using subchondral miniscrews for the stabilisation of comminuted posterior-wall marginal acetabular fragments before applying lag screws and a buttress plate to the main overlying posterior fragment. Between 1995 and 2003, 29 consecutive patients with acute comminuted displaced posterior-wall fractures of the acetabulum were treated operatively using this technique. The quality of reduction measured from three standard plain radiographs was graded as anatomical in all 29 hips. The clinical outcome at a mean follow-up of 35 months (24 to 90) was considered to be excellent in five patients (17%), very good in 16 (55%), good in six (21%) and poor in two (7%). The use of the two-level reconstruction technique appears to provide stable fixation and is associated with favourable results in terms of the incidence of post-traumatic osteoarthritis and the clinical outcome. However, poor results may occur in patients over the age of 55 years

Aim. The aim of this study was to report the long-term outcome and implant survival of the lateral resurfacing elbow (LRE) arthroplasty in the treatment of elbow arthritis. Patients and Methods. We reviewed a consecutive series of 27 patients (30 elbows) who underwent LRE arthroplasty between December 2005 and January 2008. There were 15 women and 12 men, with a mean age of 61 years (25 to 82). The diagnosis was primary hypotrophic osteoarthritis (OA) in 12 patients (14 elbows), post-traumatic osteoarthritis (PTOA) in five (five elbows) and rheumatoid arthritis (RA) in ten patients (11 elbows). The mean clinical outcome scores including the Mayo Elbow Performance Score (MEPS), the American Shoulder and Elbow Surgeons elbow score (ASES-e), the mean range of movement and the radiological outcome were recorded at three, six and 12 months and at a mean final follow-up of 8.3 years (7.3 to 9.4). A one sample t-test comparing pre and postoperative values, and survival analysis using the Kaplan–Meier method were undertaken. Results. A statistically significantly increased outcome score was noted for the whole group at each time interval. This was also significantly increased at each time in each of the subgroups (OA, RA, and PTOA). Implant survivorship was 100%. Conclusion. We found that the LRE arthroplasty, which was initially developed for younger patients with osteoarthritis, is an effective form of surgical treatment for a wider range of patients with more severe degenerative changes, irrespective of their cause. It is therefore a satisfactory alternative to total elbow arthroplasty (TEA) and has lower rates of complications in the subgroups of patients we have studied. It does not require activities to be restricted to the same extent as following TEA. Based on this experience, we now recommend LRE arthroplasty rather than TEA as the primary form of implant for the treatment of patients with OA of the elbow. Cite this article: Bone Joint J 2018;100-B:338–45

We performed arthrodesis of the ankle in eight patients by arthroscopic joint excision and fixation with crossed tibiotalar compression screws. Two patients had rheumatoid arthritis and six had post-traumatic osteoarthritis. None had a serious deformity of the ankle. Clinical ankylosis was achieved in all cases and there was radiological evidence of bone fusion in four

We applied joint distraction using an Ilizarov apparatus in 11 patients with post-traumatic osteoarthritis of the ankle to try to delay the need for an arthrodesis. Distraction for three months resulted in clinical improvement in pain and mobility for a mean of two years, with an increase in the joint space. We considered that these effects may be produced by the absence of mechanical stress on the cartilage combined with the intra-articular hydrostatic pressures during distraction. We measured these pressures during walking with distraction, and found levels very similar to those reported to improve osteoarthritic cartilage when applied in vitro

Tibial plateau fractures are common intraarticular fractures. The principal long-term complication is post-traumatic osteoarthritis (PTOA) with the usual salvage procedure being total knee arthroplasty (TKA). Our aim was to define the incidence of PTOA requiring TKA following tibial plateau fractures and identify the risk factors. We looked at all tibial plateau fractures between 1995 and 2008. There were 888 tibial plateau fractures. 23% were Schatzker I, 25% II, 14% III, 22% IV, 8% V and 8% VI. To date 25 have undergone TKA (2.8%). The mean age of patients at time of fracture was 56 in the overall cohort and 65 in those requiring TKA; this was statistically significant (p=0.04). 4% of females with tibial plateau fractures required TKA in comparison to 2% of males. The Schatzker I fractures were the least likely to require TKA at 1% with the most likely requiring arthroplasty surgery being type III at 6%. Only 1% of the patients treated non-operatively later underwent TKA. The overall incidence of TKA after tibial plateau fractures was 3%. For displaced fractures requiring internal fixation this rose to 4%. Risk factors were increasing age, split depression fractures and female gender. Although tibial plateau fractures are commonly associated with degenerative radiographic changes, we concluded that the incidence of symptomatic OA severe enough to require TKA is low

Introduction. The incidence of osteochondral lesions following ankle fractures varies in the literature between 17-70%. They are commonly associated with chronic pain and swelling in patients diagnosed with such pathology. There is less evidence about the relationship between OCL and the development of post-traumatic osteoarthritis, the most common type of ankle arthritis. Methods. Through the use of MRI 8 weeks following ankle fractures, we investigated the incidence of OCL in patients treated both surgically and conservatively for ankle fractures of all AO subtypes. Results. 29 patients met our inclusion criteria, 16 females: 13 males with a mean age of 36 (range 16-64). Twelve patients required surgery with seventeen treated conservatively. The majority of patients (11) were classified as 44B1 fractures with the 44C1 and 44B2 the next most common. We did not detect any OCL in any patient but 65% of patients had both a tibiotalar effusion and associated bone bruising. Conclusion. Contrary to the current literature, we did not associate ankle fractures of any subtype with the development of OCL. Future evaluation of this same cohort will be necessary to evaluate the incidence of post traumatic ankle osteoarthritis

Introduction. In this study we decided to observe the incidence of osteoarthritis following ORIF of Lisfranc joint injury. We also intended to point out the influence of different factors such as late diagnosis of the fracture, co-fractures, and open or close fractures on the incidence of osteoarthritis. Methods. Patients with a dislocation more than 2 millimeters in simple AP, lateral and oblique radiograms of the foot who went through ORIF were included. Patients were classified according to: Anatomic or non-anatomic reduction, open or close fractures, presence of other fractures and early or late diagnosis (up to 6 weeks). The incidence of osteoarthritis was then compared in these groups. Results. In 20 patients (45%), post traumatic osteoarthritis occurred. In the 10 patients with non-anatomic reduction, 8 (80%) experienced osteoarthritis, when from the 34 patients with anatomic reduction 12(35%) did so (p = 0.004). Discussion. 9% of the cases were not diagnosed in the 1st visit and 22% attended the hospital with delay. According to the findings, having either open or close fracture or delayed diagnosis up to 6 weeks has no influence on the prevalence of osteoarthritis after trauma, and the only important factor affecting the prevalence of post-traumatic osteoarthritis is anatomic reduction

Total hip arthroplasty (THA) is frequently performed as a salvage procedure for the acetabular fracture when posttraumatic osteoarthritis, posttraumatic avascular necrosis, or fixation failure with subluxation develop. Special considerations for this situation include previous surgical exposure with dense scar tissue, the type and location of implants, the location and amount of heterotopic ossification, indolent infection, previous sciatic nerve palsy, and the pathoanatomy of existing acetabular defect. These factors can influence the choice of surgical exposure and the reconstructive method. The outcomes of THA after acetabular fracture are generally less favorable than those of the nontraumatic degenerative arthritis. Reason for this high failure is the low mean age and the high activity level of the patient. Other important reasons for failure include the problem of acetabular bone deficiency and compromised bone quality. We evaluated the results of cementless THA in patient who had previous acetabular fracture. We also compared this result with those of patients with posttraumatic avascular necrosis of the femoral head. Forty-five consecutive cementless THAs were performed for the treatment of post-traumatic osteoarthritis after acetabular fracture between December 1993 and December 2008. Of these patients, 15 patients were died or lost to follow-up monitoring before the end of the minimum one year follow-up period. This left 30 patients (30 hips) as the subjects of our retrospective review. We evaluated the clinical and radiographic results of these patients and compared with the results of THA in patients with post-traumatic AVN of the femoral head which had without acetabular damage. Two hips required revision of the cup secondary to early migration of the acetabular cup (1 hip) and postoperative deep infection (1 hip). There was no significant difference in clinical and radiographic results between two groups except implanted acetabular component size and required bone graft (p<0.05). The Kaplan-Meier ten-year survival rate, with revision as the end-point, was 90% and 96.7% with loosening of acetabular component as the end-point. Our series suggested that compared with cemented components, uncemented sockets may improve the results of arthroplasty after previous acetabular fracture. In conclusion, cementless THA following acetabular fracture presents unique challenge to the surgeon, careful preoperative assessment and secure component fixation with proper bone grafting is essential to minimize problems

We have reviewed 32 patients who sustained a substantial knee ligament injury during adolescence when their knee epiphyses were open. They were all treated non-operatively and re-examined and evaluated in detail after an average of eight years. There were 25 Grade II partial tears and seven Grade III complete tears. After Grade II injuries the functional results were excellent or good, though static instability had not improved from the initial post-traumatic examination. The long-term results of Grade III injuries were poor, because of chronic functional instability, with continuous symptoms and some post-traumatic osteoarthritis. The results of non-operative treatment for Grade III ligament injuries were not acceptable

INTRODUCTION. Since July 2008 we are experimenting a new cup with iliac screw fixation, developed on the idea of Ring and Mc Minn. Iliac fixation is permitted by a polar screw of large diameter, coated by HA, which allows a compression to bone and a firm primary stability. Moreover it's possible to increase primary stability with further smaller peripherals screws. We present this new cup and report the preliminary results. MATERIALS AND METHOD. Since July 2008 to April 2010, 51 cups were implanted. The diagnosis was aseptic loosening in 36 cases, septic loosening treated by two-stage revision in 7, hip congenital dislocation in 5, one case of post-traumatic osteoarthritis, one case of instability due to cup malposition and a case was an outcome of Girdlestone resection arthroplasty. Mean age was of 66 years (31-90). RESULTS. We report the results of our first 23 cases, with a minimal follow-up of 12 months. Patients were preoperatively evaluated from both clinical and radiological point of view. Bone defect was analyzed according to the system of Paprosky. In 7 cases bone defect belonged to type 2C, in 8 cases to type 3A and in 8 cases to type 3B. We didn't observe any case of early loosening nor mechanical failure of the implant. The functional outcome, evaluated by Harris Hip Score, was good with a mean score of 82 (72-91)

Introduction:. Although dislocation of the peroneal tendons (PT's) in association with calcaneal fractures has been described over 25 years ago, it frequently passes unrecognised by radiologists and orthopaedic surgeons. This retrospective study aims to determine the prevalence of PT dislocation in association with calcaneal fractures at a single institution and describe systematic steps to avoid missed diagnosis at each stage of management. Methods:. CT scans of all patients with calcaneal fractures from the Picture Archiving and Communications System (PACS) from 2010 were systematically reviewed. The senior author and a Musculoskeletal Radiologist analysed the images for concomitant dislocation or subluxation of the PT's, utilizing criteria as defined by Ho et al. Further to this we included patients who sustained calcaneal fractures with associated PT dislocation prior to June 2010 and were referred either for primary open reduction or later with post-traumatic osteoarthrosis of the subtalar joint. Results:. Over three years and nine months beginning in June 2010, 71 calcaneal fractures were identified on PACS. 15 of those had associated subluxation or dislocation of the peroneal tendons either on CT scan or at surgery (21%). 10 of our 71 patients exhibited a fleck sign on plain anteroposterior ankle x-ray (14.1%) suggesting potential avulsion of the superior peroneal retinaculum. The combined cohort comprised 28 patients, 23 men and 5 women, aged 21 to 82 years (average, 46.3 years). 22 (79%) of PT dislocations were not recognised at the original injury. In six patients undergoing operative fixation, five (83.3%) had dislocated PT's noted on CT scan. In one case (16.7%) the peroneal tendons were clinically dislocated. Conclusion:. The PT dislocation rate in this paper is comparable with the literature. Patients should undergo careful clinical examination, radiological assessment with x-ray and CT followed by probing at surgery to ensure the diagnosis is not missed

The late results of treatment of calcaneal fractures in 17 children (19 fractures) were reviewed at a mean of 16.8 years after injury. With the exception of one patient, all fractures had been treated conservatively. At follow-up there were few complaints. All but two patients had full or slightly reduced mobility of the subtalar joint and unrestricted foot function, including the ability to walk comfortably on uneven surfaces. Minor radiological abnormalities of the hindfoot were common; there were two cases of post-traumatic osteoarthritis. Clinical scoring of the ankle and hindfoot using the American Orthopaedic Foot and Ankle Society rating system averaged 96.2 points. The results suggest that up to 16.8 years after injury almost all children achieve excellent long-term functional results with conservative treatment of fractures of the os calcis. Open management may only be appropriate for adolescents with severe displacements

To assess the outcome of semi-constrained total elbow arthroplasty (TEA) in osteoarthritis and compare it to the rheumatoid group. Two groups of patients assessed. In group-one with the diagnosis of rheumatoid arthritis 40 replaced elbows in 31 patients (25 female and 1 male), with average age of 67 (49–82) were reviewed. Group-two consisted of 14 elbows in 14 patients (9 female and 5 male) with post-traumatic osteoarthritis. Average age in this group was 71 (54–84). Mayo elbow performance (MEPS) and Liverpool elbow scores (LES) were used as the outcome measure. The average follow up for group-one was 53 (20–90) and group-two 60 months (21–103). According to the MEPS 87.1% of patients in group 1 and 63.6% in group 2 had excellent or good outcome (p=0.09). Only one patient from group one and none in group two had the joint revised. No difference was observed in MEPS of group-one (86 ± 17) and group-two (77 ± 24), (p=0.25). Also the LES in the two groups were not different (p=0.85). The outcome of TEA is satisfactory in both groups. No statistically significant difference was noted in the two groups. The recommendation of TEA in patients with osteoarthritis is supported by this study

We reviewed the outcome of Agility total ankle replacements carried out in our institution between 2002 and 2006. Follow-up consisted of clinical and radiological review pre-operatively, at 6 weeks, 6 and 12 months, and annually until 10 years post-op. Clinical review included the American Orthopaedic Foot and Ankle Score, satisfaction and pain scores. 30 arthroplasties were performed in 30 consecutive patients. Pre-operative diagnosis was rheumatoid arthritis (16), primary osteoarthritis (12) and post-traumatic osteoarthritis (2). After a mean follow up of 6.2 years (1.4–10.1), 4 patients had died, and 20 out of the remaining 24 were available for follow-up. Complications included lateral malleoli fracture (3), superficial peroneal nerve injury (2), one early death, unrelated to the surgical procedure, delayed syndesmotic union (1), non-union (6) and deep infection (2), of which one underwent removal of the implant; the other receives long-term oral antibiotics. AOFAS scores improved from mean 40.4 pre-op to 83.5 post-op (p<0.001). Radiological assessment revealed 25 (93%) patients had lucency in at least one zone in the AP radiograph. We found a relatively high level of re-surgery and complications following Agility total ankle replacement. A 7% revision rate is much higher than would be tolerated in knee or hip arthroplasty, but compares favourably to other studies of TAR. Despite radiological loosening, and the high rate of re-surgery and complications; patients are generally satisfied with the procedure, reporting lower levels of pain and improved function. Overall, we feel that the Agility ankle is an acceptable alternative to arthrodesis, however patients should be warned of the risk of re-surgery

Purpose:. Interposition arthroplasty is a salvage procedure for patients with severe osteoarthritis of the elbow where conservative treatment failed. It is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. Although one of the oldest reconstructive options for elbow arthritis, the procedure is not without complications. There are only a few case series described in the literature. The purpose of our study is to review our cases and report their outcome. Method. We retrospectively reviewed 18 consecutive cases of interposition arthroplasty between 2001 and 2010. 2 cases were excluded due to incomplete records. The mean patient age was 41.3 (19.4–58.6) years at time of surgery. The primary diagnosis was post-traumatic osteoarthritis in 11 cases and inflammatory osteoarthritis in 5 cases. The mean follow up was 4.7 (0.4–10) years. Pre- and post-operative pain and function was evaluated using the Visual Analogue Scale (VAS) and Mayo Elbow Performance Score (MEPS). The complications and the number of re-operations and revisions were recorded. Summary of results:. In 12 (75%) cases at least one revision operation was performed, because of sepsis, ulnar nerve symptoms, instability and unsatisfactory clinical results. Sepsis rate was 25%. In 7 cases there was an unsatisfactory clinical result (i.e. ongoing pain and poor function), resulting in revision by total elbow replacement in 4 cases, arthrodesis in 2 cases and a re-do interposition in 1 case. The mean interval from the interposition to revision procedure was 2.6 (0.6–7.4) years. In 9 patients with the interposition currently in situ, mean VAS improved from 7.4 to 2.4 and mean MEPS from 42 (30–60) to 75 (40–100). Conclusion:. Interposition arthroplasty offered improvement in pain and function, but at a high cost. It is associated with a high rate of complications and need for revision surgery that we feel might be unacceptable

Background: The Rangeuil orthopaedics surgical team has developed a special installation using a rigid corset for the combine Kocher Languenbeck and ilioinguinal surgical treatment of complex acetabular fractures. The purpose of this study was to retrospectively evaluate the results of 53 complex acetabular fractures treated by open reduction and internal fixation with a combined double approach facilitated by this particular operative installation. Methods: A retrospective review of the cases was performed. The functional outcome, operative times, blood loss were recorded. Pre-operative, post-operative and last follow-up radiographs were assessed for fracture classification and adequacy of reduction. The development of heterotopic ossification, the presence of infection, avascular necrosis and post-traumatic osteoarthritis were also noted. Results: The mean follow-up was 5.2 years. The clinical outcome at the time of final follow-up was graded as excellent in 16 patients, good in 22, fair in 7 and poor in 8 The reduction of the fracture, as determined with plain radiography, was graded as anatomic in 32 patients, unperfect in 15 and unsatisfactory in 6. Bony union was achieved in all cases. 6 patients had Brooker 3 or 4 heterotopic ossifications. 9 patients developed osteoarthritis. 4 patients developed avascular necrosis. An arthroplasty was necessary for 10 patients. 3 patients had a delayed wound infection. Conclusions: The combined simultaneous approach remains a reliable surgical solution in selected complex acetabular fractures. The installation using the corset we developed considerably simplifies the operation and access to the operated site

Introduction. Malrotation of a femoral component is a cause of patellofemoral maltracking after total knee arthroplasty (TKA). We have developed a balanced gap technique in posterior stabilized total knee arthroplasty (PS-TKA) using an original tensor instrument. One of characteristics of this instrument is the ability to measure gaps even if there is a bone defect, because it has two paddles, and we can attach block augmentations. In addition it can measure the gap after a reduction of the patella with an offset mechanism. In the balanced gap technique, the femoral component rotation is decided by a tibial cut surface and ligaments balance using the tensor device. This study investigated retrospectively whether rotational alignment of femoral component rotation influenced patellofemoral joint congruency in PS- TKA. Material and Methods. We evaluated the radiographs of 52 knees of 42 patients, who underwent TKA (NexGen LPS-Flex, fixed surface, Zimmer) by one surgeon (S.A.) for osteoarthritis or rheumatoid arthritis. All procedures were performed through a medial parapatellar approach and a balanced gap technique using a developed versatile tensor device. We measured lateral patella tilt and lateral patella shift at post-op. 6 months. To assess the rotational alignment of femoral component rotation, condylar twist angle (CTA) was measured, and to assess the postoperative flexion gap balance, a condylar lift-off angle (LOA) was measured using the epicondylar view radiographs. Results. We performed the lateral release on 4 knees (7.6%). The average lateral patella tilt and CTA, and LOA were 3.00 ± 3.2°, 0.95 ± 2.5°, 1.50 ± 1°, respectively. There were two cases which had more than 10°tilt. We did not find any case of lateral patella shift. There was no statistical correlation with lateral patella tilt and CTA (r=0.17, p=0.2) (figure 1). There was no statistical correlation with the patella tilt and LOA (r=-0.1, p=0.9) (figure2). The case with 13.4°patella tilt was post-traumatic osteoarthritis (ACL and MCL injury). There were two cases which were cut patella obliquely, and each patella tilt was 13.0°and 3.3°. Discussion. Previously we reported that the rate of a lateral release decreased by a balanced gap technique compared with a conventional measured resection technique. Although the balanced gap technique resulted in a patient's specific wide variability for femoral component rotation, this variable rotation was not found to be associated with abnormal patella tilt and patella shift

Introduction. This project reports differences in outcome measures after total ankle arthroplasty (TAA) for patients with Osteoarthritis (OA), Rheumatoid Arthritis (RA) and Post-traumatic Osteoarthritis (PTOA). Materials and Methods. Patients who underwent TAA between March 2006 and May 2010 were included. Assessments including questionnaires (height, weight, Foot and Ankle Outcome Score, SF-36) and American Orthopaedic Foot and Ankle Score (AOFAS) were completed pre-operatively, 3, 6, and 12-months after surgery. Analyses of outcomes by diagnosis were adjusted for age, gender and BMI. Results. A total of 114 TAAs performed for OA (59), PTOA (35), and RA (20). OA patients were significantly older than PTOA (64 vs. 56, p=0.002) and more likely to be male than either RA or PTOA (78% vs. 35% and 54%, p=0.001). PTOA and OA patients had significantly higher BMI (30 and 29) than RA (25, p=0.002). There were significant improvements at 12-months for AOFAS scores for all groups 31 to 75 (OA), 29 to 77 (PTOA) and 24 to 80 (RA). No significant difference in AOFAS scores between the groups at any time. Despite no significant difference in preoperative patient-reported measures between groups, OA patients reported worse ankle-related pain and function outcomes compared to the RA and PTOA patients. This trend increases at each follow-up period and was significant at 1-year for pain (p=0.03) and function (p=0.018). PTOA patients had significantly better SF-36 scores at 1 year (p<0.05 for 5 domains). Conclusion. These early results comparing outcomes by diagnostic groups demonstrate that PTOA and RA patients have superior outcomes compared to patients with primary OA

We review our first 100 LCS rotating platform total knee arthroplasty (TKA) procedures. Done between July 1993 and December 1996, they are currently at four to seven year follow-up. The sample includes 100 TKAs done in 88 patients as unilateral or bilateral procedures. At operation the mean age of patients, 51% of whom were female and 49% male, was 67 years (47 to 84). The right side was replaced in 54% of cases and the left in 46%. Preoperative diagnoses included degenerative and post-traumatic osteoarthritis in 95 knees and rheumatoid arthritis in five. Two assessments are currently being carried out. They include the American Knee Society Clinical Rating Score, functional ability and radiographic evaluation of knee alignment and radiolucencies. Mean clinical and functional Knee Society ratings were 38 and 57 (sum 95 points) preoperatively and 88 and 84 (sum 172 points) postoperatively. Radiographs showed valgus alignment in 90 rays and varus alignment (1° to 7°) in 10. Limited areas of radiolucency were seen around three tibial components. Two cases have required revision, one for septic loosening and one to correct recurrent varus deformity

Of 81 elbow replacements performed over a seven-year period, 11 were total elbow revision (TER) procedures, which were done on two men and nine women with a mean age of 61 years (40 to 70). Seven of the patients had rheumatoid arthritis, three had post-traumatic osteoarthritis and one had haemophilia. The reason for revision was aseptic loosening in eight patients and aseptic loosening with fracture in the other three. The prostheses revised were the Souter in eight patients, the Kudo in one, the GSB I in one and the Dee in one. In revision TER, one long stem Souter prosthesis was used, two Pretoria, one GSB 3 and seven Morrey. The mean time from primary to revision TER was 10 years (2 to 31). At a mean follow-up of 30 months (6 to 48), all except one patient were pain-free and the arc of flexion had increased by 30°. Complications included one dislocation, one radial nerve palsy, which recovered after six months, and one aseptic loosening. There were no cases of sepsis. Revision TER is a technically demanding procedure with a high risk of complications. In this series patient satisfaction was high. Our policy is to use a hinged prosthesis, preferably the Morrey, in revision TER

Purpose: Total ankle arthroplasty remains a difficult procedure. Some patients require revision surgery for arthrodesis. Material and methods: We report nine patients with total ankle arthroplasties mainly implanted for post-traumatic osteoarthritis whose results deteriorated, requiring arthrodesis. One of these patients had rheumatoid arthritis. Revision surgery was performed six months to seven years after arthroplasty. Arthrodesis was required for pain related or not to implant loosening or talar necrosis. One patient developed a major deviation of the hind foot secondary to progressive loosening. One patient developed infection early. An iliac graft was used to fill the bone defect in eight patients. An anterior plate-screw fixation was used for six patients, crossed screws for one, a tibiotalar nail for one, and an external fixator for one (with infection). Results: Eight patients achieved bone healing with good pain relief. The functional result depended on the type of arthrodesis: talocrural alone or extended to the torsion couple. Discussion: The evolution of ankle prostheses toward better bone sparing has allowed, in our experience, for revision arthrodesis under relatively good conditions using an iliac graft. We have not preferred one standard type of fixation but the anterior plate fixation has provided excellent stability

Advances in implant design and instrumentation have led to total ankle replacement (TAR) becoming an attractive alternative to ankle fusion in selected cases. We present the short-term results for Mobility TAR with clinical and radiological findings. Methods: Prospective study from Dec 2004 to Dec 2007. Single surgeon, anterior approach to the ankle. Patients assessed clinically, radiologically and with pre and postoperative visual analogue (VAS) and American orthopaedic foot and ankle society (AOFAS) hindfoot score. Results: 34 patients, 36 TAR, 2 bilateral. Male 25, female nine. Mean age 66.9 years, range 43 to 89 years. 26 osteoarthritis, four rheumatoid arthritis, four post-traumatic osteoarthritis. Follow up 6 months to 3.5 yrs, mean 22 months. VAS pre-operative mean 8, postoperative mean 1.5. AOFAS score mean pre-operative 30, post-operative mean 85. No deep infections, 3 superficial infections, which settled with antibiotics. No nerve damage. Two medial malleolar fractures. Two lateral malleolar fractures. One talar malposition – one of first six cases, no surgery required outcome not affected. Three unexplained painful TAR. No revisions. 90% patients satisfied and would have operation again. Conclusion: Short-term results for TAR are encouraging. Implants and instrumentation are improving and patients are satisfied with the results. There is a steep learning curve of at least six cases. Surgical skill, technique and careful patient selection are paramount in achieving satisfactory results. With patient demands increasing TAR is a realistic alternative to ankle fusion

Background. Comminuted radial head fractures are challenging to treat with open reduction and internal fixation. Complicating matters further, radial head fractures are often associated with other elbow fractures and soft tissue injuries. Radial head arthroplasty is a favorable technique for the treatment of radial head fractures. The purpose of this study was to evaluate the functional outcomes of radial head arthroplasty using Modular Pyrocarbon radial head prosthesis in patients with unreconstructible radial head fractures. Methods. This single surgeon, single centre study retrospectively reviewed the functional and radiological outcomes of 21 consecutive patients requiring radial head arthroplasty for unreconstructible radial head fractures between July 2003 and July 2009. Patients were at least one year post-op and completed a Short-Form 36 (SF-36) questionnaire, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Mayo Elbow Performance Index (MEPI). These patients were independently physically examined and their post-operative radiographs were independently reviewed. Results. 21 patients (9 males and 12 females) were reviewed at a minimum of 12 months follow-up. The mean DASH score was 10.8 (0-34.1), the mean SF-36 physical score was 76.9 (35-96), the mean SF-36 mental score was 83.8 (60-94), and their MEPI score was 86.4 (70-100). Patients maintained 90% of their grip strength in their injured arm when compared to their un-injured arm and had 17. o. of fixed flexion in the affected arm. Radiologically, 14 cases had some degree of post-traumatic osteoarthritis, 12 cases had evidence of heterotrophic ossification, 5 had some evidence of periprosthetic lucency and 3 of our cases were radiologically but not functionally ‘overstuffed’. Conclusion. Radial Head Arthroplasty with Pyrocarbon Radial Head Prosthesis is a safe and effective option when treating unreconstructable comminuted radial head fractures yielding good functional and radiological outcomes and remains the treatment option of choice at our institution

Early methods of treating high-energy tibial plateau fractures by open reduction and internal fixation led to high infection rates and complications. Alternative treatment methods include minimally invasive techniques and implants, external fixator stabilisation (monolateral and circular) and temporary external fixation followed by delayed definitive surgery. A clear understanding of the different fracture types is critical in achieving optimum results with minimally invasive techniques. The Chertsey classification system is based on the direction of force at the time of injury and helps with surgical planning. There are three groups: valgus, varus or axial fracture patterns. 124 tibial plateau fractures have been surgically treated in our hospital since 1995; there were 62 valgus, 14 varus and 48 axial type fracture patterns. Seventy-nine underwent open reduction with internal fixation, and forty-five had an Ilizarov frame. For valgus fractures the average IOWA knee score was 88 if internally fixed or 86 with an Ilizarov frame, range of motion was 140 and 131 degrees and time to union was 81 versus 126 days respectively. Varus fractures had an IOWA score of 83 (ORIF) and 95 (Ilizarov), ROM of 138 and 130 degrees and time to union of 95 versus 82 days. For axial fractures the average IOWA knee score was 85 (ORIF) compared to 82 (Ilizarov), the ROM was 124 degrees for both groups and time to union was 102 days and 141 days respectively. Deep vein thrombosis occurred in 9% of cases with an Ilizarov and one patient required a total knee replacement for painful post-traumatic osteoarthritis. The infection rate for those internally fixed was 2.5%, three patients required a total knee replacement and 2.5% suffered a DVT. Our results are comparable to the literature and the Chertsey classification of tibial plateau fractures helps with surgical planning

Objective: To evaluate retrospectivelly the outcome of periarticular tibial pilon fractures treated by hybrid external fixation. Method: Between 1999–2003, 44 patients(44 fractures) were treated with a combination of hybrid external fixation and minimal internal fixation(k-wires or lag-screws). There were 31 men and 13 women with a mean age of 41 years. A high energy trauma( accident or fall from a height) was the mechanism of injury for 32(73%) patients. According with A.O. clasiffication 4 fractures were A1, 5-A2, 5-A3, 8-C1, 12-C2,10-C3. All fractures were treated within a 10 days from the initial injury (10(23%) of them were open and treated immediately). The use of bone grafts reguired in 8 cases. Primary postop mobilization of adjacent joints was performed in all cases. Fourty patients were available for clinical and radiographic evaluation(using Teeny’s and Wiss ancle score). The average follow-up was 26 months. Results: There were 9(23%) excellent, 12(30%) good, 10(25%) fair, and 9(23%) poor results. Union achieved in 40(92%) cases. Overall, 12(30%) complications reported: 6 pin track infections, 2 deep infections, 4 non-unions and 1 malunion. Post-traumatic osteoarthritis noticed in 11(28%) cases. Conclusions: Hybrid external fixation permits early mobilization of the ankle joint and decrease the soft tissue trauma. Poor results associated with the presence of infection, the degree of intraarticular involvement and the inability to achieve adeguate fracture reduction

Aims: To review the results from a series of GSB III total elbow arthroplasties performed at an independent centre. Between 1996 and 2004 the senior author performed 58 total elbow arthroplasties in 44 patients (10 males, 34 females) using the GSB III implant. These were reviewed and the outcome assessed through the use of a patient-answered questionnaire and clinical and radiological review. Mean age was 65 (49 to 84 years). Indications for surgery included rheumatoid arthritis (46 elbows) and post-traumatic osteoarthritis (11 elbows). Mean F/up was 4.1 years (0.8 to 8.5 years). 4 patients had died (6 elbows) and 4 patients (4 elbows) were unavailable for review. 2 of the implants had been revised (1x aseptic loosening, 1x deep infection), leaving a total of 46 elbows available for review. The survival rate at a mean of 4 years was 98% with aseptic loosening as the endpoint. Complications included 1 case of intraoperative fracture and 1 persistent ulnar neuritis. Overall patient satisfaction was high. The mean Mayo Elbow Performance Score was 83 out of 100 (range, 34 to 100) and mean Liverpool Elbow Score was 8 out of 10 (range, 1 to 10). Conclusion: Previous studies of outcome following total elbow arthroplasty using the GSB III elbow prosthesis at independent centres have shown satisfactory results, but have looked at small groups of patients. Our results offer more robust data to show that the medium term outcome following total elbow arthroplasty using the GSB III prosthesis is satisfactory

Aims: To review the results from a series of GSB III total elbow arthroplasties performed at an independent centre. Between 1996 and 2004, the senior author performed 58 total elbow arthroplasties in 44 patients (10 males, 34 females) using the GSB III implant. These were reviewed and the outcome assessed through the use of a patient-answered questionnaire and clinical and radiological review. Mean age was 65 (49 to 84 years). Indications for surgery included rheumatoid arthritis (46 elbows) and post-traumatic osteoarthritis (11 elbows). Mean F/up was 4.1 years (0.8 to 8.5 years). Four patients had died (six elbows) and four patients (four elbows) were unavailable for review. Two of the implants had been revised (1x aseptic loosening, 1x deep infection), leaving a total of 46 elbows available for review. The survival rate at a mean of four years was 98% with aseptic loosening as the endpoint. Complications included one case of intraoperative fracture and one persistent ulnar neuritis. Overall patient satisfaction was high. The mean Mayo Elbow Performance Score was 83 out of 100 (range, 34 to 100) and mean Liverpool Elbow Score was 8 out of 10 (range, 1 to 10). Conclusion: Previous studies of outcome following total elbow arthroplasty using the GSB III elbow prosthesis at independent centres have shown satisfactory results, but have looked at small groups of patients. Our results offer more robust data to show that the medium term outcome following total elbow arthroplasty using the GSB III prosthesis is satisfactory

Introduction. Between 2002–2009 we operatively treated 193 acetabular fracture. Among these 44 both-columns fractures according to the classification of Letournel and Judet have been reviewed in order to evaluate the results. These fractures are rare, difficult to treat and often have poor clinical results. Patients and Methods. 44 cases of ORIF of displaced both columns fractures have been studied at a mean 37 months follow-up (range, 13 to 76 months) after the injury. 40 hips were operated with the ilioinguinal approach alone, 1 with Kocker Langenbeck and Smith petersen combined. The 3 remaining hips were operated with a double Kocher-Langenbeck and ilioinguinal approach. Every case was evalueted on X-rays according to Matta criteria and clinically with the Harris hip score and the WOMAC score. Results. The mean Harris hip score has been 85,8% (range 30%–100%) while the mean WOMAC score has been 88,3 points (range 39,1–100). The main complications were 4 early post-traumatic arthritis operated by hip replacement. One patient instead developed a gastric carcinoma. Discussion. The rate of anatomical reduction decreased with the complexity of the fracture, the age, and the interval between the injury and the reduction. The clinical result was adversely affected by associated injuries of the femoral head, an older age of the patient. It was positively affected by an anatomical reduction and postoperative congruity between the femoral head and the acetabular roof. Conclusions. These findings indicate that in many patients who have a complex acetabular fracture the hip joint can be preserved and post-traumatic osteoarthritis can be avoided if an anatomical reduction is achieved. Both column acetabular fractures can be reduced with a combined surgical approaches or with ilioinguinal alone. We used the ilioinguinal approach alone in 91% of cases reaching good results, even comparing Letournel and Matta's results. Surgeon experience and a long learning curve can help in decision making and in obtaining an anatomical reduction with a low rate of post-operative complications

Purpose of the study: To present our experience in managing Sterno-Clavicular Joint (SCJ) problems. SCJ pain is caused by a number of pathological conditions that include primary, post-infection, and post-traumatic OsteoArthritis (OA), Sterno-Costo-Clavicular Hyperotosis (SCCH) and posttraumatic instability. Methods: All cases of painful SCJ problems treated surgically by the senior author over the past 20 years have been reviewed. Results: All operations have been carried out using a “necklace” thyroid type incision. OA in which the pain becomes chronic and disabling, has been treated surgically. Medial clavicle reshaping (2), or hemiarthroplasty with a radial head prosthesis (3), sometimes combined with an interpositional arthroplasty using a GraftJacket is a new technique, developed to obliterate dead space, improve wound cosmesis, and prevent regeneration of the medial clavicle. SCCH is strongly associated with seronegative spondyloarthropathy, and can from part of the SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis), Patients with severe excruciating pain and those with restricted motion resulting from complete fusion of the clavicle and sternum may be candidates for surgical treatment. Excision of the medial end of the clavicle (1), the whole clavicle (1) and replacement hemiarthroplasty using a radial head as well as a pectoralis major flap interposition between the first rib and the clavicle (1), is a technique that has not been described previously. Instability for persistent subluxation or dislocation of the SCJ has been treated with interposition with Graft-Jacket +/− medial clavicle resection (2) or a sterno-mastoid tendon stabilisation (2). Conclusions: Previous surgical treatment of SCJ problems has been disappointing. Rockwood’s success rate with excision of the medial end of the clavicle alone has been poor (40% good only) – these newer techniques show greater promise

Purpose: We assess the results of the surgical treatment of intra-articular fractures of the calcaneus using the Ilizarov external fixator. Materials and Methods: During the period of January 2004 to June 2009 we treated 72 intra-articular calcaneus fractures in 68 patients, 51 male and 17 female with a mean age of 34 (range 18–56). The mean follow –up period was 2 years and 10 months (range 3 months to 4 years). All patients received preoperative CT-scan to facilitate classification and pre-operative planning. Of the 72 fractures, 37 (51.4%) were Sanders type II, 30 (41.6%) were type III and 5 (7%) were type IV. The Ilizarov fixator used consisted of 2 rings positioned above the ankle joint and a foot plate. 1.5 and 1.8 mm wires were used, as well as 1.8 mm wires with an olive for the reduction of displaced fragments. Under image intensification and distraction the fracture was reduced and the articular surface was restored as close as possible. Results: The clinical outcome was excellent in 29 patients (40.4%), good in 32 (44.4%), moderate in 7 (9.7%) and poor in 4 (5.5%). As far as the complications are concerned, we had 17 cases of pin track infection treated with the removal of the pins, ankle joint stiffness in 12 patients treated with physiotherapy, 2 patients developed reflex sympathetic algodystrophy, 2 malunion, 8 developed post-traumatic osteoarthritis and 1 of them underwent subtalar arthrodesis. Conclusion: The use of the Ilizarov external fixator for the treatment of intra-articular calcanear fractures has proved itself to be an alternative method to O.R.I.F with similarly good results. Given the fact that the learning curve is relatively steep, it has proven, from our experience, to be a safe and valuable tool for the treatment of these challenging fractures

Introduction. Peri prosthetic fracture is a recognised complication following Total ankle arthroplasty (TAA). There is limited literature on post operative management following TAA and controversies exist based on surgeon preferences. This project reports the incidence of peri- prosthetic fractures in patients managed with 2 different post-operative protocols. Materials and Methods. Patients undergoing primary TAA with a diagnosis of Osteoarthritis (OA) or Post-traumatic Osteoarthritis (PTOA) were recruited into a randomized controlled trial. These patients did not require any additional procedures. Patients were consented for the trial and randomized to one of two treatment groups (Early mobilisation after surgery vs. immobilisation in a plaster cast for 6 weeks post operatively). Plaster group patients underwent a graduated physiotherapy program from 6-12 weeks and early mobilisation group patients from 1-12 weeks. Complications any were recorded at 2, 4, 6 and 12 weeks post-operatively. Results. A total of 16 ankle replacements were done for a diagnosis of OA (10) and PTOA (6). Mean age was 58 years (±11.75) for the plaster group and 64 years (± 9.32) for the early mobilisation group. 7 patients were randomized to the plaster group and 9 patients were randomized to the early mobilisation group. Of the plaster group 1 patient sustained an intra-operative fracture tibia and 2 patients reported with a fractured medial malleolus. Of the early mobilisation group, 1 patient reported with a peri prosthetic fracture tibia at 6 weeks and 3 patients reported a fractured medial malleolus at 3 months follow up. The percentage of fracture incidence between plaster versus early immobilisation group was 42.8% and 44.4 % respectively. Conclusions. These early results demonstrate no significant differences in the incidence of fracture rates between groups. Further studies of post-operative management are needed to study the correlation with peri-prosthetic fracture rates after TAA

Between 1978 and 1986, 59 patients received a GSB III elbow prosthesis, six of them in both elbows. Rheumatoid arthritis (RA) was the underlying cause in 51 of the patients and post-traumatic osteoarthritis (PTOA) in eight. Of these, 24 patients (28 prostheses) have since died; two, both operated on bilaterally, had had their implants for more than ten years and had already been assessed for inclusion in the long-term follow-up. Two patients, each with one elbow prosthesis, have been lost to follow-up and three males who are still living (two with PTOA, one with juvenile RA) had their prosthesis removed before ten years had elapsed. The remaining 32 patients (28 RA, 4 PTOA) with 36 GSB III elbows were examined clinically and radiologically after a mean period of 13.5 years. Pain was considerably reduced in 91.6%. Mobility was increased by 37° in those with RA and by 67° in those with PTOA. There were three cases of aseptic loosening and three of deep infection. The main complication was disassembly of the prosthetic component in nine elbows (13.8%). This last group included two patients with postoperative fractures unrelated to the operative technique and one with neuropathic arthritis. Ulnar neuritis occurred in two patients. Since 87.7% of all the GSB III prostheses implanted in this period remained in situ, our results are comparable with those for hip and knee arthroplasty

The aim of this study was to review the outcome of semi-constrained total elbow arthroplasty (TEA) in osteoarthritis and compare it to the rheumatoid group. This was performed on a single-surgeon, single-prosthesis (GSB III) series of patients. Two groups of patients assessed. In the first group with the diagnosis of rheumatoid arthritis 40 replaced elbows in 31 patients (25 female and 1 male), with average age of 67 (range 49–82) were reviewed. The second group consisted of 14 elbows in 14 patients (9 female and 5 male) with post-traumatic osteoarthritis. Average age in this group was 71 (range 54–84). All patients were recalled for clinical review. Fresh radiographs obtained and compared to the immediate postoperative images. Mayo elbow performance (MEPS) and Liverpool elbow scores (LES) were used as the outcome measure. Kaplan-Meier survival analysis for the two groups was performed. The average follow up for the first group was 53 (range 20–90) and second group 60 months (range 21–103). According to the MEPS 87.1% of patients in group 1 and 63.6% in group 2 had excellent or good outcome. This different was not statistically significant (p=0.09). Only one patient from group one and none in group two had the joint revised. No significant difference was observed in MEPS of group one (86 ± 17) and group two (77 ± 24), (p=0.25). Also the LES in the two groups were not different (p=0.85) (group one 8 ± 1 vs. group two 8 ± 2). The outcome of TEA is satisfactory in both groups. No statistically significant difference was noted in the two groups. The recommendation of TEA in patients with osteoarthritis is supported by this study

Purpose of the study: Revision shoulder arthroplasty is generally considered to be a difficult procedure yielding modest improvement. Material and methods: We report a prospective study of 45 patients, aged 69.8 years (range 49–85 years). Thirty-two patients had a simple humeral prosthesis and thirteen a total prosthesis. A reversed prosthesis was used for all revisions. The reasons for the revisions were classified into five groups: failure of prosthesis implanted for fracture (36%), glenoid problems of a total shoulder arthroplasty (24%), prosthetic instability (18%), failure of a hemiarthroplasty implanted for rotator cuff tear (11%), failure of a hemiarhtroplasty implanted for post-traumatic osteoarthritis (11%). The revision consisted in replacement with a reversed prosthesis. Patients were assessed pre and postoperatively using the Constant score for the clinical assessment and plain x-rays for the radiological assessment. Results: Forty-one patients were reviewed at mean follow-up of 42.1 months (range 24–92). The four other patients died during the first two postoperative years. Subjectively, 73% of patients were satisfied. The Constant score improved from 187.7 to 55.6 on average. The best gain was obtained for the pain and daily activities scores. Discussion: Revision shoulder arthroplasty provides only moderate improvement. Neer called a limited goal surgery. Results published on revision shoulder arthroplasty using a non-constrained prosthesis show that the functional gain is moderate. Revisio with a reversed total prosthesis gives better results because of the lesser impact of the cuff deficiency. The rate of complications after revision is greater than with first intention implantations. Conclusion: Use of a reversed total shoulder prosthesis for revision shoulder arthroplasty provides encouraging results in terms of the mid-term functional outcome

Aims: The aim of this paper was to evaluate the position of the endoprosthesis after standard and navigated insertion in both sagittal and frontal planes. Methods: From October 2000 to March 2002, 90 Search Evolution TKR were performed in 65 females and 25 males with mean age 68 years because of primary or post-traumatic osteoarthritis. Every third patient received this endoprosthesis without use of navigation. The study sample was so divided into two groups. The þrst group was constituted of 60 patients with TKRs inserted with use of navigation. The second group was formed by 30 patients with TKRs inserted with standard manner. All results were statistically analyzed. Results: The mean lateral tibiofemoral angle was in the 1st group 174,3¡ and in the 2nd group 174,9¡, the mean lateral distal femoral angle was in the 1st group 83,5¡ and in the 2nd group 83,7¡, the mean medial proximal tibial angle was in the 1st group 88,9¡ and in the 2nd group 89,2¡, the mean posterior distal femoral angle was in the 1st group 88,5¡ and in the 2nd group 86,6¡, the mean posterior proximal tibial angle was in the 1st group 88,9¡ and in the 2nd group 88,2¡. The femorotibial axis deviation from 174¡ was greater than 2¡ in the 1st group in 12,3% and in the 2nd group in 27,8% of cases. Conclusions: Kinematic navigation affords a possibility to place both femoral and tibial components more precisely than in implantation with standard manner. The more precise femoral component position in sagittal plane was achieved with navigation in this study

A linkage-based mathematical model was used to design a ligament-compatible prosthesis to keep certain ligament fibres isometric during passive motion. The sagittal plane talar component radius is about 50% longer than that of the normal talus, the tibial component is spherically convex. A fully conforming meniscal bearing is interposed between them. Experiments in cadaver specimens confirmed the mathematical prediction that the bearing moves forwards on both metal components during dorsi-flexion and backwards during plantar flexion. Between July 2003 and July 2008, the prosthesis was implanted into 250 patients at nine hospitals in Northern Italy. By November 2007, 158 in 156 patients were seen at least six months post-operatively. Mean age was 60.5 years. The diagnosis was post-traumatic osteoarthritis in 127, primary osteoarthritis in 17, rheumatoid arthritis in 10. The mean follow-up was 32.5 months. The pre-operative AOFAS score of 36.2 rose to 75.9, 79.3, 77.9, and 79.0 respectively at 12, 24, 36, 48 months. Dorsi-flexion increased from 0.1° to 9.7°, plantarflexion from 15.1° to 24.6°. In 30 patients at one hospital, the range of postoperative motion, 14° – 53°, was significantly correlated to the range of bearing movement on the tibial component, 2mm–11mm, measured radiologically, (r2 = 0.37, p < 0.0005). By December 2007, 2 revision operations had been performed at 24 months, one for unexplained pain not relieved by a successful arthrodesis, one in a patient with Charcot-Marie-Tooth disease. There were no device-related revisions (loosening, fracture, dislocation). The Kaplan-Meier survival rate (component-removal as end-point) at 4 years was 96% (Confidence interval 90–100%). Early clinical results have demonstrated safety and efficacy. The survival rate at four years compares well with multi-centre 5-year rates published by the Swedish (531 cases, survival 78%), Norwegian (257, 89%) and New Zealand (202, 86%) registries

Total Ankle Arthroplasty (TAA) using the uncemented three component mobile design has shown encouraging results. There is limited literature on the optimal postoperative management. In our centre, TAA patients are mobilised 48 hours after surgery without a short leg plaster. The aim of this prospective audit was to measure the outcomes of these patients to ascertain if this is a safe and effective protocol. Patients who underwent primary TAA between March 2006 and March 2008 were invited to participate in the audit. Assessment included patient questionnaires which collected demographics, height and weight, Foot and Ankle Outcome Score (FAOS) and Short-Form-36 (SF-36). Clinical examination collected American Orthopaedic Foot and Ankle Score (AOFAS). Data was collected pre-operatively and at 3 and 6 months after surgery. A total of 48 ankle replacements in 46 patients were included. Primary diagnosis was osteoarthritis (25), post-traumatic osteoarthritis (9), and rheumatoid arthritis (12). Mean age was 63 years (range 33 to 83) and the majority were males (29, 60%). The average body mass index was 28 (SD 5.3). There were significant improvements to 3-months after surgery for AOFAS (mean 29 to 76, p< 0.0001), FAOS (mean scores changes: Pain 36 to 72, Function 41 to 68, Stiffness 38 to 65, p< 0.001) and physical domains of the SF-36 (means score changes: Physical Functioning 25 to 39, Role Physical 27 to 40, Bodily Pain 29 to 48 and Vitality 42 to 50, p< 0.05). All outcome scores were maintained with a non-significant trend for better scores from 3 to 6 months. These early results demonstrate encouraging outcomes for TAA patients who are mobilised early after surgery without a short leg plaster. Further studies of post-operative management are needed to compare outcomes after TAA between patients undergoing this protocol and patients who are immobilised in plaster

Background Tibiotalocalcaneal (TTC) arthrodesis is a salvage procedure for patients with severe disease of the ankle and subtalar joints. Method We report a series of 26 consecutive patients (26 feet) operated on by a single surgeon, in a single centre, over a 4-year period, with average follow up of 26 months (range 6–50). Mean age of the patients was 57 years (range 28–72). Subjects included 17 male and 9 females. Previously the patients had undergone between 0 to 6 operations, which were unsuccessful. All these patients had combined ankle and subtalar joint arthrodesis by an intramedullary nail device. Indications for surgery were pain except the Charcot joints. Only five patients did not have severe deformity pre-operatively. Aetiology included post-traumatic osteoarthritis, rheumatoid arthritis, psoriatic arthropathy, avascular necrosis, Charcot Marie Tooth disease, primary osteoarthritis, failed ankle replacement and alcohol-and diabetic-induced Charcot neuroarthropathy. Patients were assessed radiologically and by American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, SF-12 and by patient satisfaction scores. Results Clinically and radiologically, 15 cases have solid union. Six patients have signs of radiological non-union/ delayed union but are clinically asymptomatic with no progressive deformity. Two patients required amputation (one non-union and one infected non-union). One patient is awaiting further surgery for infected non-union. Two patients have died of unrelated causes ~2 years post-surgery. Most patients (79%) are very satisfied with the procedure and 83% would undergo the procedure again. Conclusion These results suggest that salvage is possible in the majority of cases with combined ankle and subtalar joint arthrosis and severe deformity

Introduction: Complex acetabular fractures often require an extensile exposure to visualise the fracture adequately. Such extensile exposures have been associated with increased morbidity. Simultaneous iliofemoral and Kocher-Langenbeck approaches offer an alternative to such exposures and do not involve sectioning of the abductor tendons or a trochanteric osteotomy. We have used simultaneous anterior and posterior exposures for complex fractures in which the transverse component is transtectal and for selected both-column fractures. This study reports on the technique and reviews 51 cases performed between 1990 and 1998. Methods: Combined anterior and posterior surgical approaches were used in 51 of 397 acetabular fracture between 1990 and 1998. A retrospective review of the case notes of all 51 patients was performed and operative times, blood loss and complications were recorded. Pre-operative, post-operative and 12-month follow-up radiographs were assessed for fracture classification, adequacy of reduction and the development of heterotopic ossification. The presence of avascular necrosis and post-traumatic osteoarthritis were also noted. Results: The average duration of surgery was 4 hours and 40 minutes and the average blood loss was 1735ml. A reduction within 1mm of the anatomic position was achieved in 71% of cases and within 3mm of the anatomic position in 92% of cases. There were two deep infections and two post-operative sciatic nerve palsies. There were two patients who developed Brooker grade IV heterotopic ossification. Conclusions: Planned simultaneous iliofemoral and Kocher-Langenbeck exposures were performed with operation time, blood loss, fracture reduction and complications comparable with or better than other reported series using extensile exposures. We consider this approach a useful alternative particularly for complex fracture patterns of the acetabulum, which involve a displaced transtectal transverse component

Introduction: Ankle Arthroplasty is an alternative to arthrodesis for patients with disabling ankle arthritis. It aims to remove pain and preserve joint motion. We aimed to review the outcome of all total ankle replacements carried out in our institution between 2002 and 2006. Materials and Methods: We retrospectively reviewed the results of all patients who underwent the Agility ankle replacement performed by a single surgeon. Case notes and radiographs were reviewed and outcome assessment included standardised questionnaires. Results: 30 arthroplasties were performed in 30 consecutive patient. 11 males, 19 females, Pre operative diagnosis was rheumatoid arthritis (16), primary osteoarthritis (12) and post-traumatic osteoarthritis (2) with a mean age of 61.8 yrs. 8 patients required an additional procedure at the time of arthroplasty : tendoachilles lengthening (6); Calcaneal osteotomy (2); triple arthrodesis (2); tip post reconstruction (1). Intra operative technical complications included: Fracture of medial malleolus (3); nerve injury (3); tendon injury (1). 8 patients had wound problems: Delayed healing > 3/52 (8); Superficial infection (2); Deep infection (2). 1 patient had delayed union of the syndesmosis (> 6 months) and 6 had non-union (> 12 months). After a mean follow up of 3.2 years 2 patients had died and 9 patients had required further surgery: Implant removal for infection (1); Talar revision for loosening (1); Re-fusion of the syndemosis (4); Removal of syndesmosis screws (3); Calcaneal osteotomy for valgus hindfoot (1). Discussion: We found a high rate of complications which may be related to the surgeons learning curve, although some are specific to the design of implant which requires a tibio-fibular fusion. Conclusion: The first 30 agility ankle replacements performed in our centre demonstrates several potential complications and shows that there is often a need for subsequent surgery. Short term survivorship of the implant is acceptable and long term review is required

Patients who are less than 50 years old at the time of total hip arthroplasty (THA) have been known to have higher failure rates than patients who are older. Wearinduced osteolysis and associated component loosening is the most common mode of failure reported. The current investigation prospectively assessed the survivorship and clinical results of alumina ceramic-ceramic THA in patients younger than 50 years. 238 consecutive hips in 201 patients treated by alumina ceramic-ceramic THA were studied. The mean age at operation was 41.4 ± 7.5 years (range, 18 – 50 years). The preoperative Merle d’Aubigné score was 11.1 ± 1.6 (6 – 15). The preoperative diagnosis included primary osteoarthritis or impingement (105 hips, 44%), developmental dysplasia of the hip (90 hips, 38%), osteonecrosis of the femoral head (17 hips, 7%), post-traumatic osteoarthrosis (16 hips, 7%), and rheumatoid arthritis (6 hip, 3%). 144 hips (61%) were replaced with the use of surgical navigation for acetabular component positioning. The mean cup diameter was 51.8 ± 3.7 (range, 46 – 60 mm). 73 (31%) bearings were 28 mm and 165 (69%) bearings were 32 mm. At mean follow-up of 5.6 ± 2.3 years (2 – 11 years), the mean Merle d’Aubigné score was 17.4 ± 0.9 (14 – 18). There were no radiographic signs of osteolysis. There were two revisions (0.8%): one for acute cup displacement and one for a ceramic liner fracture. In addition, one hip was treated by I& D for acute infection and another with I& D but without evidence of infection. Other complications included one greater trochanter fracture and one calcar fracture, both repaired at surgery, and one transient peroneal nerve palsy. The 10-year Kaplan Meier survivorship of the implants (revision of any component for any reason) was 98.7% (95% confidence interval 96.3–100%). There were no hip dislocations. Results of THA in patients less than 50 years using alumina ceramic-ceramic bearings at two to eleven years follow-up are promising with no case of osteolysis or dislocation

Traditional total hip arthroplasty (THA) using metal-on-polyethylene bearings has been established as a reliable procedure but wear and wear debris-associated osteolysis are among the most frequent reasons for revision. Ceramic-ceramic bearings represent an alternative for THA with improved wear characteristics and low biological reactivity of wear particles. We investigated the clinical outcome of alumina ceramic-ceramic THA in a series of more than 400 THAs. A total 418 alumina ceramic-ceramic THAs performed in 360 patients treated between 1997 and 2007 were studied prospectively. All patients had an uncemented titanium acetabular component with a flush mounted alumina ceramic-ceramic bearing (Wright Medical Technology, Inc. and Ceramtec AG). The mean age at operation was 51.7 ± 12.3 years (range, 18 – 79 years). 47 cases (11%) had previous hip surgery. The indication for surgery included primary osteoarthritis or impingement (58%), developmental dysplasia of the hip (32%), osteonecrosis of the femoral head (5%), post-traumatic osteoarthrosis (2%), and other indications (3%). In 202 (48%) a minimally invasive approach, the superior capsulotomy, was used with the help of the surgical navigation for acetabular component placement. There were no cases of osteolysis or wear. We found 7 (1.1%) implant revisions: 1 acute cup displacement, 1 acetabular liner fracture, 1 case with failure of osseointegration of the cup, and 4 trochanteric wafer nonunions. A dislocation of the hip was found in 2 (0.5%) cases. The 10-year Kaplan Meier survivorship of the implants (revision of any component for any reason) was 98.4% (95% confidence interval 97.1–100%). The results of alumina ceramic-ceramic THA after one to ten years are promising, especially considering the young age and high incidence of previous surgery in this patient population. The data are especially encouraging since no hip has demonstrated osteolysis. In particular, we are not aware of any other bearing that has shown an absence of lysis and 10 years follow-up. Since many of these patients are quite young, we await further assessment at 15 and 20 years

BACKGROUND. Reverse total shoulder arthroplasty (RTSA) provides an alternative to standard total shoulder arthroplasty in the treatment of selected complex shoulder problems including failed shoulder replacements. The purpose of this report is to present outcome of RTSA using Comprehensive Reverse System (CRS) as either primary or revision treatment choice. PATIENTS AND MATERIALS. Between September 2010 and April 2012, 54 patients (36 females, 18 males) with the mean age of 68.4 (±10) underwent RTSA-CRS. In 27 patients RTSA-CRS was performed as a revision due to failed previous arthroplasty. Primary underlying conditions included AVN (2), massive irreparable rotator cuff tear (2), primary osteoarthritis (7), post-traumatic osteoarthritis (2), rheumatoid arthritis (6), and rotator cuff arthropathy (8). It was not possible to complete the operation in 6 patients (4 revisions group 2 AVN cases) due to substantial glenoid erosion. Preoperative CT scan was performed in 50% of patients to assess the bony stock of the glenoid. In some patients ultrasound and MRI were performed to acquire additional information. A total of 46 patients were followed-up by means of antroposterior and axial plain X-rays, pain and satisfaction level (VAS/0–10), stiffness, Constant Score, Oxford Shoulder Score, SF-12 (Physical and mental Subscales), and range of movement for a mean duration of 6.5 months (±4.2). RESULTS. The table presents the pre- and postoperative outcome variables for both primary and revision RTSA-CRS groups. The majority of outcome measures indicated a considerable improvement in both groups during the short term follow-up. Significant correlations were noted in-between some key outcome variables. However; due to the short period of follow-up and continuity of collecting data, we intend to produce a more realistic picture of the results s and outcome of the RTSA-CRS in coming years. COMPLICATIONS. There was no vascular complication. Disassociation of glenosphere from the base-plate happened in one patient 8 weeks post-op due to technical mistake, this was repaired later with a satisfactory outcome. One case had enormous hematoma formation 72 hours post-op due to anticoagulants administration leading to second stage evacuation and increased stiffness of shoulder. One patient sustained deltoid partial rupture due to recurrent falls and managed by conservatively. Another patient sustained a type C periprosthetic fracture and was later revised to custom-made stem prosthesis. CONCLUSION. The results of this short-term report indicate a satisfactory and acceptable outcome for RTSA-CRS as reflected in the assessment tools in both primary and revision cases, however with superior results in the primary group. Long-term follow-up is essential to have a more rational assessment of the clinical outcome as well as associated complications

Aim Post-traumatic osteoarthritis and osteochondral injuries can cause significant pain and morbidity. Appropriate MRI sequences combined with image analysis techniques can be used to reproducibly measure quantitative cartilage parameters, hence offering a tool for monitoring and detecting degenerative change earlier than previously possible. We demonstrate the performance of a directional gradient vector flow (dGVF) snake segmentation algorithm on an isotropic MR sequence, which allows segmentation of the full articular surfaces (including malleoli) of the ankle. Method Eight ankles were imaged using a 1.5T MRI scanner with an isotropic 3D T1 weighted FLASH sequence with water excitation, resolution 0.3 x 0.3 x 0.3 mm. A subset of five ankles were imaged four times with repositioning and re-shimming of the magnet between acquisitions. Images were interpolated to 0.15 mm3 and segmented using a dGVF snake. Following 3D reconstruction of the cartilage layers normal thickness from cartilage to bone was measured at each voxel on the cartilage surface. Results The mean cartilage thickness (±S.D) was 1.80 mm (±0.05 mm); 1.83 mm (±0.07 mm) and 1.81 mm (±0.07 mm) for the talus, tibia and cumulative ankle cartilage respectively. To measure the technical precision of the segmentation method we determined the coefficient of variation of the four repeated measurements in five ankles. The mean coefficients of variation (min-max) from the repeated measurements were 1.74% (0.69%–3.57%); 1.20% (0.26%–3.06%) and 1.52% (0.26%–3.57%) for the talus, tibia and cumulative ankle cartilage respectively. Conclusion We believe that the reported isotropic image sequence and segmentation algorithm is a valid tool for quantitative assessment of the entire ankle joint. A possible application is the early detection of cartilage injury and degenerative change due to injury or illness

Introduction: The goal of this study is to relate our experience about a third generation model of a Total Ankle Arthroplasty (TAA) Salto. ®. (Tornier™) by evaluating a prospective, homogenous and continuous serie of 130 TAA. Materials and Methods: From 1997 to 2002, 130 TAA had been implanted to 125 patients, mean age 57 year (19 to 84). This procedure was performed by two experimented surgeons. Indications for arthoplasty were post-traumatic osteoarthritis in 57%, osteoarthritis in chronic laxity in 15%, rheumatoïd arthritis in 12%, primitive osteoarthritis in 10%, and 6% other. Collection of preop, postop and follow up datas was prospective. Radiographs were numerised and treated by a specific software. We considered as a failure when the implant was removed. Results: After a mean follow up period of 44 months [12 – 108], 10 patients were lost to follow up, without complication, 4 patients died, without relationship to the TAA, but they had sufficient follow up, 9 arthroplasties were converted to arthrodesis, leaving a 92,5% success rate. Postoperative main complications were cutaneous problems (18/130). In one case, a skin necrosis led to a secondary infection that requested implant removal. Long folllow up showed that main complications were pain and bone cysts, which required arthrodesis in 8 cases. Survivorship analysis at 108 months were 83% [IC5%: 72–95]. At follow up, clinical AOFAS ankle score was significantly raised (31% preoperative to 84% at follow up). A SF36 quality of life score was available for 85 patients. Physical score was 60, mental score 66 and total score was 64. Discussion: This study has the avantages of being prospective and continuous. Clinical results and failure rate were encouraging. Infection rate less than 1% may be in relation with the low rate of patient with rheumatoïd arthritis. No significant difference of the result could be find according to the initial indication. Conclusion: These mid-term results are concordant with orther series of third generation TAA. We remain concerned because of bone trabeculation modification and pain without obvious anatomical abnormality: long term follow up is necessary. Mid term results confirm TAA as a therapeutic option for ankle pathology

Introduction. Total Hip Arthroplasty (THA) is currently one of the most widely performed surgical procedures in clinical orthopaedic practice. Despite the recorded number of uncemented implants has steadily increased in recent years, cemented fixation still remains the benchmark in THA, accounting for most of the procedures performed nowadays. The Friendly Short is a novel cemented short-stem that grants a less invasive and more bone conservative approach due to its shortened height and innovative cementing technique. It is indicated to treat elderly patients with the aim of preserving bone diaphysis while decreasing postoperative recovery times. Its instrument set allows to optimize the cement mantle thickness via an improved pressurization and stem centralization system. Objectives. Aim of this prospective study was to evaluate functional recovery and implant stability after THA with this cemented short-stem. Methods. Between June 2011 and October 2012, 96 consecutive patients (100 hips) underwent THA with the Friendly Short stem (Lima Corporate). All patients received DELTA-PF cups with UHMWPE cross-linked liners and CoCrMo femoral heads (Lima Corporate). A minimally invasive postero-lateral surgical approach was used in all cases. There were 60 women and 36 men, with a mean age and BMI of 72.6 ± 6.2 (59–85) years and of 26.6 ± 3.9 (18.7–35.6) kg/m2. Most patients were retired (87%) and led a moderately active lifestyle (79%). Underlying pathology was mostly primary coxarthrosis (94%), followed by aseptic necrosis (AVN) (4%) and post-traumatic osteoarthritis (2%). Radiographic and clinical evaluation (Harris Hip Score HHS, Oxford Hip Score OHS) were performed preoperatively, and postoperatively, at 45 days, and at 6, 12, and 24 months. Results. Mean HHS and OHS improved from 36.0 ± 11.3 (7–57) and 10.9 ± 4.9 (0–24) preoperatively, to 96.4 ± 6.1 (78–100) and 46.5 ± 3.1 (33–48) at 2 years. Most significant improvements were recorded already at 45 days after surgery, with a mean HHS of 78.6 ± 9.9 (27–100) and a mean OHS of 34.0 ± 7.4 (18–48). Despite old age, all patients reported remarkable early recovery, especially in terms of joint functionality [Mean flexion: preoperative 77.7 ± 11.1 (40–90), 101.7 ± 8.9 (70–110) at 45 days] and pain relief [Mean HHS pain domain: preoperative 9.6 ± 4.2 (0–20), 41.4 ± 3.6 (20–44) at 45 days); mean OHS pain sub-domain: preoperative 0.2 ± 0.5 (0–4), 3.4 ± 0.8 (1–4) at 45 days)]. X-rays demonstrated good implant stability thanks to optimal cement fixation; there was only 1 case of non-progressive 1-mm radiolucent lines, but no osteolytic areas, subsidence or loosening were observed. Absence of fatigue fractures in the cement mantle proved that there was good stress distribution. Acetabular cups were all stable: only 1 case of non-progressive 1-mm radiolucent lines was reported, but no case of either sclerosis or osteolysis was observed. No revision or implant failure occurred up to 2-year follow-up. Conclusions. Clinical and patient-subjective outcomes were very satisfactory, indicating a significant early functional recovery. Although longer follow-up is required, radiographic assessment demonstrated good implant stability already at 2 years as result of this innovative cementing technique

The intra-articular supracondylar fractures of the femur are difficult fractures that occur with increasing frequency in the last years. Their complex management is a source of controversy, since surgical outcome is not acceptable in all instances. In the last 6 years we treated 30 comminuted intra-articular supracondylar fractures of the femur (type-C). The mean age was 28 years (17– 65 years). We made any effort to apply a method which could guarantee reduction and articular reconstruction, rigid fixation and bridging of metaphysic-epiphysis, in order to achieve early mobilization and to avoid post-traumatic osteoarthritic lesions. The extra-articular portion of the fractures was fixed using DCS, condylar plates, Ô plates and in some cases the whole construct was protected by an external fixation device. In some other cases, stability was enhanced using a second bridging plate in the medial side or applying a massive cortical graft properly adapted and fixed to the plate. The articular surface was reconstructed using cancellous lag-screws. Intra-articular epiphyseal portions were regularly bone grafted when there was comminution and bone loss, Bone grafting was also carried out in cases of meta-diaphyseal severe comminution and major bone defects. Clinical and radiological outcome was evaluated. Radiological parameters (axial valgus deformity, shortening, development of post-traumatic osteoarthritis etc.) were correlated to the method of surgical treatment. There were major complications (such as infection, especially in open fractures, delayed healing, hardware failure, refracture etc.). In some instances re-operation was necessary. In problematic C3 supracondylar fractures of the knee, poor surgical results are associated to early complications and development of degenerative lesions. This handicap is particularly is particularly important since it occurs in a major weight bearing joint of young patients. Using meticulous surgical technique (including bone-grafting, minimal devitalization of the fragments etc.), and choosing the most appropriate implant in every case, reconstruction can be performed reliably with good results and a low rate of complications

Introduction: Deep infection continues to be the second most important early complication in hip arthroplasty. It is usual to apply standard prophylaxis to all patients, but it is not usual to use special measures in those of them who present a higher risk. Moreover, sometimes these patients are even not identified. Purpose: To analyse statistically significant risk factors for deep infection in patients with a hip arthroplasty. Patients and Methods:. Design: Case-control study. Observational and retrospective comparison of incidence or prevalence of all risk factors described in the literature. These factors have been classified according to the period of risk in: epidemiologic; pre, intra and postoperative; and distant infections. Case series: 47 consecutive patients with a deeply infected hip arthroplasty operated in the same Department of a University General Hospital. Control series: 200 randomly selected patients, operated in the same hospital and period of time, with no deep infection in their hip arthroplasty along follow-up. Pearson was used for comparison of qualitative variables and ANOVA for quantitative ones. Results: The following risk factors were significantly more frequent (p< 0.05) in the patients with an infected hip arthroplasty:. Epidemiologic characteristics: female gender, post-traumatic osteoarthritis (17% vs 3%). On the contrary, primary osteoarthritis is a “protective” factor. Preoperative conditions: previous surgery in the same hip (60% vs 6%), obesity (BMI> 30) (9% vs 1%), chronic therapy with glucocorticoids (13% vs 0%), immunosuppressive treatments, chronic liver diseases (20% vs 2%), alcohol addiction (13% vs 0%) and intravenous drug abuse. Patients in this case-control did not present a significant difference in the prevalence of diabetes (a recognised risk factor for spine and knee surgery) or rheumatoid arthritis. Intraoperative facts: a prolonged surgical time is the only significant risk factor (133 min vs 98 min), but differences were not found in the amount of bleeding, need for transfusion or intraoperative fractures. Postoperative events: secretion of the wound longer than 10 days (46% vs 8%), palpable deep haematoma (27% vs 1%), dislocation of the prosthesis (40% vs 6%), and need for new surgery in the hip (21% vs 1%). Distant infections (risk for haematogenous seeding): deep cutaneous (30% vs 8%), upper and lower urinary tract (36% vs 2%), pneumonias and bronchopneumonias (23% vs 5%), and diverse abdominal focus (14% vs 3%). On the contrary, significant differences were not found in the prevalence of severe oral or dental infections. Conclusion: To identify significative risk factors for deep infection in hip arthroplasty is important:. to control and minimize these risk factors when present. when this is not possible not possible, to implement additional prophylactic measures

Introduction. In rheumatoid patients the use of a long intramedullary stem in ipsilateral shoulder and elbow replacement carries the risk of humeral fracture of the small area of unviolated bone between the implants. Healing may be compromised. Because of this a short stemmed humeral head prosthesis was designed which rests on the bone surface after resection of the humeral head instead to be fixed in the shaft of the humerus. Since 1994 this prosthesis, specially designed for the rheumatoid patients has been in use in our clinic. The design rationale and the clinical results will be presented. Result. Since 1994 the short stemmed shoulder prosthesis has been inserted by the author in 54 shoulders. 8 Patients had osteoarthritis, 42 patients rheumatoid arthritis, 3 patients osteonecrosis and 1 patient a post-traumatic osteoarthritis. The average age was 65 years (range 32–83). In 19 shoulders a total shoulder arthroplasty was performed and the 36 shoulders a hemiarthroplasty. 32 Patients had a follow-up of more than 1 year and the average follow-up in this group is 2. 5 years (range 1-5. 5). All patients were scored clinically with the HSS score and the Constant score and radiographically before the operation, 1 year after the operation and after that at regular intervals. At follow-up pain decreased in all patients but more than 50% of the shoulders still had some mild or moderate pain during daily activities. Pre-operatively active forward flexion averaged 61°, external rotation 10° and abduction 50°. Postoperatively the active forward flexion increased to 75°, the external rotation to 19° and the abduction to 67°. The gain in ROM is similar to a group of patients operated in the same time period with another shoulder prosthesis. Discussion. The short stem shoulder prosthesis is a good alternative for a shoulder prosthesis with a long intra medullary stem. The clinical results with regards to pain reflief and gain in ROM are similar. The long term fixation of short sem humeral prosthesis remains good, without signs of radiolucency or migration. The advantage of a short stem prosthesis are:. easy technique to reconstruct the anatomical position of the humeral head. bone sparing. no stress shielding of the shaft. no surgical problems when a long stemmed elbow prosthesis is used. possibility for revision

The use of the Dynastab K external fixator in the treatment of the tibial plateau fractures. The aim of the study was the assessment of the clinical use of Dynastab K (knee) external fixator in the treatment of intraarticular fractures of the proximal tibia. The study was conducted in the Department of Orthopaedics and Rehabilitation Warsaw Medical University. Between November 2004 and December 2007, 29 patients were included in the study (12 females and 17 males). In the experimental group, consisting of 15 patients (7 females and 8 males) open reduction and fixation of the fracture was performed. After that Dynastab K external fixator was implanted to the femur and tibia with the use of pins. On the second day after the surgery rehabilitation of the knee joint was started. Fixator was being held on the lower limb for 6 – 8 week. In the control group (14 patients – 5 females and 9 males) after open reduction and fixation of the fracture, knee orthosis was applied. Orthosis was set up in 15 degrees flexion. After that time the rehabilitation was started. The final follow up visit was performed about 34 weeks after the surgery. The amount of articular depression, the range of motion of the knee joint, the amount of pain and the condition of soft tissues around pins were assessed during the study. The clinical and radiological outcomes were determined according to Rasmussen’s system and the condition of soft tissues with the use of Dahl’s scale. Resnick and Niwoyama criteria were used for grading of post-traumatic osteoarthrosis and Visual Analogue Scale for pain intensity. Subjective evaluation of knee function was performed by the self-made scale. There were no statistically important differences in the amount of articular depression before the operation, after reduction and on the last follow-up visit, between the experimental and control group. The mean range of motion of the knee joint was 127,5 degrees in the experimental group and 118,3 degrees in the control group. In the experimental group the amount of pain around the knee was gradually diminished after the operation, whereas in the control group the amount of pain was sharply reduced, but after unblocking the orthosis rised significantly. There were not noticed any pin site infection. 10 patients (66,7%) from the experimental group and 7 (50%) from the control group achieved very good results in the radiological scale. The results in the clinical scale were very good at 6 patients (40,0%) from the experimental group and at 3 patients (21,4%) from the control group. During the last follow-up visit the subjective evaluation of the knee joint function was 0,64 points better in the group treated with the Dynastab K external fixator

Hardware in or about the knee joint presents a number of challenges to the surgeon in performance of Total Knee Arthroplasty (TKA). Conventional instrumentation usually requires a modification of technique or removal of the metallic implants. Computer-Assisted TKA (CAOS) is another option, but adds complexity and time to the procedure. MRI-based Patient-Specific Instrumentation (PSI) cannot be used as metal causes unwanted artifact and renders the images for planning, useless. However, CT scans are not affected by metal and thus CT-based PSI can be used in TKA patients with pre-existing hardware. The present IRB approved study evaluates 12 consecutive knees (10 patients) with pre-existing hardware using CT-based PSI (MyKnee®, Medacta International, SA, Castel San Pietro, Switzerland). In this technique, CT scan of the lower extremity is obtained, and from these images, the knee is reconstructed 3-dimensionally. Surgical and implant-size planning are performed according to surgeon preference, with the goal to create a neutral mechanical axis. Once planned and approved, the blocks are made [Fig 1]. During surgery, the PSI cutting block is registered on the femur first and secured with smooth pins. The distal femoral resection is performed directly through the block. An appropriate sized 4-in-1 block is placed and the remaining femoral resections are performed. The tibial resection block is registered and resection performed. Final bone preparation, patella resurfacing, and trialing is performed as is standard to all surgical techniques. Of the 12 TKAs, there were 5 left and 7 right knees performed in 6 females and 6 males. The average BMI was 33.19 and average age was 53 (range 44–63). All diagnoses were either osteoarthritis or post-traumatic osteoarthritis. Follow-up averaged 59 weeks (range 18.6–113.7). Nine patients had pre-operative varus deformities with HKA deformities average of 171.9° (range 154°–178.5°). One patient had pre-operative valgus deformity of 184.5°. Two patients were neutral (180°). Post-operative alignment for all patients (n = 11) was 179° (range 177°–180°). All patients were within 3° neutral, post operatively. Four patients measured 180°, 4 measured at 179°, 2 measured at 178°, and only one at 177°. Hardware consisted of 5 patients with femur or tibia staples, 3 with plate(s) and screws [Fig. 2], 3 patients with ACL interference screws, and one titanium rod. No hardware was removed unless necessary for implantation. Only 3 patients required some hardware removal. The pre-operative Range of Motion (ROM) averaged 2.9° to 98.3° (Extension range 0–15° and flexion range 30–115°). Post-operative ROM was 2.9° to 101.3°. (Extension range 0–5° and flexion range 65–125°). Knee Society Score (KSS) improved from 42.3 to 82.3, and KSS Function Score improved from 52.1 to 77.5. No intraoperative complications were recorded. Average tourniquet time was 42.1 minutes (range 28–102). Regardless of the deformity, the patient's post-operative mechanical axes HKA averaged 179° (range 177–180). Clinical scores were typical for TKA patients with improvement in both KSS and ROM. In conclusion, early results using PSI in patients with pre-existing hardware in or about the joint, is safe, efficient, and accurate in performance of TKA

Introduction and Aims: Non-union following triple arthrodesis has been significant, up to 23%. Iliac crest bone grafting and internal fixation has reduced this to 0–4%. Harvesting bone graft incurs significant donor site morbidity and may be unnecessary. We present the results of 100 triple arthrodeses performed with local graft, avoiding donor site complications. Method: Between January 1993 and July 2002 the senior author performed 112 triple arthrodeses. We performed a retrospective chart review, evaluating the incidence of union and the post-operative complications, with a minimum follow-up of six months. For this study, we excluded all (seven) revision fusions, and all (five) fusions using iliac crest or other donor site graft (e.g. calcaneus or tibia). One hundred fusions were performed using a standard technique with internal fixation and without supplementary bone graft. All patients were reviewed until fusion had occurred or non-union declared. Results: Ninety-six patients had one hundred triple arthrodeses, with an average age of 58 years. Fifty fusions were performed for posterior tibial tendon deficiency, 20 for rheumatoid arthritis, seven for osteoarthritis and 12 for post-traumatic osteoarthritis. The remaining 11 cases included: tarsal coalition, psoriatic arthritis and polio. There were 26 males and 74 females, with 37 fusions performed on the right foot and 73 on the left. The average time to union was 5.4 months (range 3–24) with three patients developing non-unions. Of the three patients diagnosed with a non-union, two had fair outcomes and elected to be treated non-operatively. The third non-union had a poor result, and achieved a successful outcome following revision. Overall, there were 74 good outcomes, 22 fair and four poor results. The complications following surgery included: nine wound infections, one DVT, one malunion and seven cases of prominent screws, requiring removal. The one patient with malunion was successfully revised at two years. Conclusion: The majority of authors advocate the use of iliac crest bone graft during triple arthrodesis. However, harvesting iliac crest graft has a significant short and long-term morbidity. This study indicates that comparable rates of union are achieved without the need for supplementary bone graft and thereby avoiding donor site morbidity

Hardware in or about the knee joint presents a number of challenges to the surgeon in performance of Total Knee Arthroplasty (TKA). Conventional instrumentation usually requires a modification of technique or removal of the metallic implants. Computer-Assisted TKA (CAOS) is another option, but adds complexity and time to the procedure. MRI-based Patient-Specific Instrumentation (PSI) cannot be used as metal causes unwanted artifact and renders the images for planning, useless. However, CT scans are not affected by metal and thus CT-based PSI can be used in TKA patients with pre-existing hardware. The present IRB approved study evaluates 12 consecutive knees (10 patients) with pre-existing hardware using CT-based PSI (MyKnee®, Medacta International, SA, Castel San Pietro, Switzerland). In this technique, CT scan of the lower extremity is obtained, and from these images, the knee is reconstructed 3-dimensionally. Surgical and implant-size planning are performed according to surgeon preference, with the goal to create a neutral mechanical axis. Once planned and approved, the blocks are made. During surgery, the PSI cutting block is registered on the femur first and secured with smooth pins. The distal femoral resection is performed directly through the block. An appropriate sized 4-in-1 block is placed and the remaining femoral resections are performed. The tibial resection block is registered and resection performed. Final bone preparation, patella resurfacing, and trialing is performed as is standard to all surgical techniques. Of the 12 TKAs, there were 5 left and 7 right knees performed in 6 females and 6 males. The average BMI was 33.19 and average age was 53 (range 44–63). All diagnoses were either osteoarthritis or post-traumatic osteoarthritis. Follow-up averaged 59 weeks (range 18.6–113.7). Nine patients had pre-operative varus deformities with HKA deformities average of 171.9° (range 154°–178.5°). One patient had pre-operative valgus deformity of 184.5°. Two patients were neutral (180°). Post-operative alignment for all patients (n=11) was 179° (range 177°–180°). All patients were within 3° neutral, post operatively. Four patients measured 180°, 4 measured at 179°, 2 measured at 178°, and only one at 177°. Hardware consisted of 5 patients with femur or tibia staples, 3 with plate(s) and screws, 3 patients with ACL interference screws, and one titanium rod. No hardware was removed unless necessary for implantation. Only 3 patients required some hardware removal. The pre-operative Range of Motion (ROM) averaged 2.9° to 98.3° (Extension range 0–15° and flexion range 30–115°). Post-operative ROM was 2.9° to 101.3°. (Extension range 0–5° and flexion range 65–125°). Knee Society Score (KSS) improved from 42.3 to 82.3, and KSS Function Score improved from 52.1 to 77.5. No intraoperative complications were recorded. Average tourniquet time was 42.1 minutes (range 28–102). Regardless of the deformity, the patient's post-operative mechanical axes HKA averaged 179° (range 177–180). Clinical scores were typical for TKA patients with improvement in both KSS and ROM. In conclusion, early results using PSI in patients with pre-existing hardware in or about the joint, is safe, efficient, and accurate in performance of TKA

Introduction:. In 1994 Kofoed and Stürup already confirmed that within a follow-up of 10 years total ankle arthroplasty demonstrated a significant clinical improvement for the patients. In recent studies a 12 – year survival rate even of 84% was described (Kofoed, 1995). Methods:. In a retrospective study we evaluated the short – and midterm results in 44 patients with unconstrained total ankle arthroplasty and cementless fixation. These ankle replacements were performed between 8/1997 and 12/2000. A critical assessment concerning the indications and contraindications of this arthroplasty was performed due to the fact, that this surgical technique is not yet mentioned as a routinely performed surgical procedure of the ankle. The advantages in comparison to the open or arthroscopically assisted arthrodesis of the ankle were described. As initial diagnosis rheumatoid arthritis (n:16), post-traumatic osteoarthritis (n:10) or idiopathic osteoarthritis of the ankle (n:18) was mentioned. The patients age varied from 24 to 78 years; the 24 years old patient suffered from a posttraumatic osteoarthritis, in the 78 years old patient contralateral total ankle arthroplasty was performed 13 years ago. Results:. There was a delay in superficial wound healing in 11 cases, in 4 cases soft tissue revision and once plastic surgery had to be performed. One female patient with RA had a postoperative deep infection after preoperative radiosynoviorthesis of the ankle. Additionally osteosynthetical reconstruction of the fibula (n:2) and the talus (n:1) was necessary. One patient underwent revisional surgery due to progressive wear and fracture of the polyethylene inlay. Furthermore three patients suffered from continuing instability, that one had a secondary open arthrodesis and two a syndesmoplasty combined with revision of the PE inlay. The radiological examination offered migration and progredient radiolucency lines especially near to the tibial part of the prosthesis in three cases. Nevertheless more than 80% of the patients were satisfied or very satisfied with their ankle arthroplasty, only 4 patients now would have denied the surgical procedure. As main improvements reduction of pain and increased mobility (ROM: > 40°) were mentioned. Conclusions:. The success of total ankle arthroplasty may depend on exact technique, correct hindfoot alignment and sufficient capsuloligamentous stability of the ankle. So this surgical procedure may provide a high rate of functional improvement for the patients and may prevent the probably necessary arthrodesis

Purpose: We report our experience with 23 Coonrad-Morrey total elbow prostheses. Material and methods: Between July 1997 and February 2001, we implanted 34 Coonrad-Morrey total elbow pros-theses in 33 patients. Twenty-three patients (23 implants) were reviewed at a mean 24 months follow-up, maximum 40 months. There were three men and 20 women, mean age 62 years (42–69). Twelve patients had rheumatoid polyarthritis, the principal indication. There were also four recent fractures of the distal humerus, two nonunions, and one patient with post-traumatic osteoarthritis. One patient had sequelar osteoarthritis since childhood. Finally three revisions were performed for loosening of a GUEPAR prosthesis in two cases and a GSBIII prosthesis in one. Results were assessed with the Mayo Clinic score. We searched for lucent lines around the implants, polyethylene wear, and incorporation of the bone graft behind the anterior wing of the implant on plain radiographs. Results: At last follow-up, the mean Mayo Clinic score had improved from 25 to 89 points (70–100). Before surgery, 17 patients had severe pain. At last follow-up, eight patients had occasional pain. Extension was improved by 10°, flexion by 27° giving a postoperative amplitude of 29° to 132°. Prona-tion supination progressed by 37° giving a rotation amplitude of 127°. The function score improved from 4 to 21 points. Sixteen of the 23 patients had normal elbow function. Outcome was excellent in 13 patients, good in eight, and fair in two. There were no lucent lines visible on the radiographs. There was no sign of polyethylene wear. The bon graft was incorporated behind the implant in 20 cases and was not visible in three. Complications included one peroperative fracture, one cutaneous dehiscence, one post-operative fracture of the olecranon due to a fall, and persistent ulnar paresthesia in four patients requiring secondary neurolysis in one. Discussion, conclusion: The Coonrad-Morrey semi-constrained prosthesis provides a response to a large range of situations. The dominant indication is rheumatoid polyarthritis, but trauma patients can benefit from this reliable therapeutic solution giving a satisfactory rate of success. A satisfactory functional amplitude is generally achieved with this implant and the elbow is generally pain free

Introduction. Trabecular Titanium™ is a highly porous biomaterial with a regular hexagonal cell structure, which has shown excellent mechanical properties. Several in vitro studies reported promising data on its osteoinductive and osteoconductive properties. Furthermore, it has demonstrated in vivo to enhance bone in-growth. Aim of this multicentre prospective study was to assess Trabecular Titanium™ osseointegration by measuring change in bone mineral density (BMD) around a cementless DELTA-TT cup with dual-emission X-ray absorptiometry (DXA). Methods. 89 patients (91 hips) underwent primary THA with DELTA-TT cups (Lima Corporate) between 2009 and 2010. There were 46 (52%) men and 43 (48%) women, with a median (IQR) age of 67 (57–70) years and a median (IQR) BMI of 26 (24–29) kg/m. 2. Right side and left side were affected in 44 (48%) and 47 (52%) cases, respectively. Underlying pathology was primary osteoarthritis in 80 (88%) cases, osteonecrosis in 5 (6%), post-traumatic osteoarthritis in 3 (3%), developmental dysplasia of the hip in 2 (2%) and oligoarthritis in 1 (1%). BMD was determined by DXA using DeLee and Charnley 3 Regions of Interest (ROI) at 7 days, 3, 6, 12 and 24 months. Clinical evaluation (Harris Hip Score, HHS), patient health status survey (SF-36) and radiographic assessment were performed preoperatively and at the same time-points. Data were analyzed using non-parametric tests (Mann-Whitney, Wilcoxon signed-rank) and a p < 0.05 as threshold for statistical significance. Results. Excellent results were observed in terms of pain relief and functional recovery. Median (IQR) HHS improved from 48 (39–62) before surgery, to 99 (96–100) at 24 months, with a statistical significant increase of 96% (p < 0.05, Wilcoxon signed-rank). Median (IQR) SF-36 improved from 49 (37–62) preoperatively to 86 (79–92) at 24 months, with a statistical significant increase of 95% (p < 0.05, Wilcoxon signed-rank), indicating a considerable improvement in patients' quality of life. After an initial decrease of BMD values from baseline at 7 days (median [IQR] ROI I: 1.44 [1.21–1.67]; ROI II: 1.23 [0.99–1.49]; ROI III: 1.11 [0.85–1.48] g/cm. 2. ) to 6 months (ROI I: 1.27 [1.08–1.52]; ROI II: 1.14 [0.89–1.37]; ROI III: 1.05 [0.73–1.35] g/cm. 2. ), BMD slightly increased in ROI I, the most loaded area, and stabilized in ROI III. BMD in ROI II increased after 12 months and stabilized at 24 months (ROI I: 1.30 [1.11–1.55]; ROI II: 1.12 [0.96–1.36]; ROI III: 1.04 [0.80–1.25] g/cm. 2. ). Radiographic analysis showed evident signs of bone remodeling and osseointegration, with presence of supero-lateral and infero-medial bone buttress and of radial trabeculae perpendicular to the cup surface in ROI I/II. No radiolucent lines, loosening or osteolysis were observed. All cups were stable and no revision was carried out. Conclusion. BMD patterns and radiographic evaluation showed signs of an effective osseointegration around DELTA-TT cups at 24 months. Although clinical outcomes, functional recovery and stability are very satisfactory, longer follow-ups are necessary to assess survivorship

Between 1997 and 2000, 25 Schatzker type-V and VI tibial plateau fractures were treated at our hospitals with the Ortho-fix ring fixator and followed up for between 10 months and four years. We chose this form of treatment for three reasons. First, because these are usually high-energy injuries, open reduction and internal fixation has to be done on admission or when the swelling has reduced, which can take up to three weeks. Secondly, internal fixation usually requires bone grafting at the same time. Thirdly, there is a high incidence of sepsis following conventional treatment with double plate and bone graft. There were 20 closed or grade-I compound fractures and five grade-II compound fractures. The mean age of the 22 men and three women was 45.3 years (30 to 71). One patient had a head injury. There were ipsilateral femoral fractures in two patients, one of whom also had a comminuted distal radial fracture on the contralateral side, and one patient had a contralateral tibial plafond fracture. We routinely placed patients on a traction table and reduced the fracture, using Bohler’s method of traction and elastic bandaging. If necessary we made a limited incision and held the fragment with a large fragment screw under C-arm control. Using three or ideally four proximal wires, we made sure that the most proximal went through the fibular head. With local patients the frame was applied within 24 hours of admission. In patients who were referred from other parts of Africa, the frame was applied up to 10 days after the accident, irrespective of the amount of swelling. Continuous passive motion from 0° to 90° was started immediately postoperatively and maintained for a minimum of five days. Patients were then given crutches and mobilised touch weight-bearing in the frame. When the frame was removed, patients were fitted with a DonJoy hinged knee brace with no limitation of knee flexion or extension. All but two patients attained 90° of flexion within 10 days of application of the frame. Four patients failed to achieve full extension. Grade-I pin-tract sepsis developed in 12 patients and grade-II in four. All infections settled with treatment. One proximal wire needed to be resited. The mean time to removal of the frame was 4.5 months. No bone grafting was required. We concluded that the amount of swelling is not a critical issue and that the ring fixator can be applied within 10 days of the injury. Probably because there was minimal interference with soft tissues, deep-seated sepsis did not occur. Even in osteoporotic bone, wire fixation gives excellent stability. There is still uncertainty about long-term follow-up, development of post-traumatic osteoarthritis and the possibility of sepsis if total knee arthroplasty is undertaken later

Purpose: The purpose of this study is to analyze the anatomo-radiological results, the clinical results, and complications of minimally displaced fractures of the proximal humerus, treated by immediate, ambulatory self-passive mobilization, followed by a strengthening and propioceptive training program. Materials and Methods: 12 patients, 7 females and 5 males, mean age 56.91 (SD: 15.76) were reviewed retrospectively at a mean of 28.33 months follow-up. All the patients were mobilized the day after the first visit, i.e. the day after the fracture in 7 patients (58.3%), up to 7 days after the fracture in 4 patients and 3 weeks after the fracture in one late referral. Over an average period of 5.8 months, an average 45.41 (SD: 20.83) sessions of rehabilitation, with a therapist, for each patient, were recorded. The patients were recommended to perform four sessions of self rehabilitation a day. Clinical evaluation included a questionnaire covering subjective evaluation, Activities of Daily Living (ADL) by means of the ASA index and the Constant’s score, and type and duration of rehabilitation. The radiological evaluation included review of the X-rays, from the initial traumatic event to the last follow up X-ray. An AP view with three rotations, outlet view and axillary view were performed for each patient. The fracture type, displacement, interval for union, glenohumeral osteoarthritis (according to the Samilson classification), type of acromion and osteoporosis, were recorded. Special attention was paid in detecting joint stiffness, algodystrophy, neurological impairment, malunion, further displacement, signs of avascular necrosis and post-traumatic osteoarthritis. Results: The mean non adjusted Constant’s score at last follow up was 88.33 over 100 (SD: 11.45) an average of 96.01% compared to the contralateral side. 83% of patients were pain free, and 17% reported mild pain. Active motion was very satisfactory averaging 96.23% in forward flexion, 89.86% in external rotation with the hand at the side, and 90.22% in external rotation at 90° abduction, and a difference of 1.46 vertebral levels in active internal rotation, as compared to the contralateral shoulder. Passive motion was also analyzed in the same way. Power of the affected shoulder in forward elevation was on average 90.19% of the contralateral side. Impingement was tested by the Neer, Hawkins and Yocum signs: 4 patients (33.3%) reported at least one positive sign of impingement. The Jobe and Palm up tests were negative in 100% of patients. 11 patients were very satisfied and 1 patient satisfied. Joint stiffness developed in one case (8.3%), with 100° of forward elevation, 50° external rotation with the hand at the side, 50° external rotation at 90° abduction. No algodystrophy, no neurological impairment, no further displacement, no signs of avascular necrosis, no post-traumatic progression of osteoarthritis, were observed in any case. Union was achieved in all the 12 patients, in 2 cases with some degree of angulation. Conclusions: Very good functional and radiological results were obtained with immediate passive mobilization of minimally displaced fractures of the proximal humerus. It is a safe method as all the fractures united and the rate of complication was very low especially without joint stiffness or RSD and with very good patient satisfaction

The purpose of this study was to review the total ankle arthroplasties performed in consecutive series of 78 ankles and to determine the short-term results in cases with over 12 months follow-up. Preoperative diagnoses were post-traumatic osteoarthritis in 40 ankles (51.3%), primary osteoarthritis in 32 ankles (41.0%), and systemic arthritis in six ankles (7.7%). HINTEGRA. ®. (Newdeal SA, Lyon, France) total ankle system was used in all cases. Fifty-five total ankle arthroplasties including four revision cases, followed up for over 12 months (range, 13~49 months) were included in this study. Ankles were divided into three groups according to the coronal plane deformity in preoperative standing ankle AP radiograph; Varus (≥10°; 20 ankles (39.2%)), neutral (< 10° varus or valgus; 25 ankles (49%)), and valgus (≥10° valgus; 6 ankles (11.8%)). Various additional surgeries were performed simultaneously with the arthroplasty to correct the deformities; deltoid ligament release (25 cases), posterior tibialis tendon lengthening (2 cases), peroneus longus tendon transfer to brevis (5 cases), lateral ankle reconstruction with modified Broström procedure (4 cases), lateral closed-wedge calcaneal osteotomy (3 cases), percutaneous heel cord lengthening (19 cases), and gastrocnemius recession (1 case). In one patient with severe valgus deformity, staged total ankle arthroplasty was conducted after primary triple arthrodesis. Preoperative and postoperative visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, range of motion (ROM), as well as patient’s satisfaction and willingness to receive the operation again were evaluated The results were compared among the three groups. Serial radiographs were reviewed for any radiological changes. AOFAS score has improved from 54.3 ± 11.4 pre-operatively to 79.2 ± 11.4 at last follow-up. VAS has decreased from 6.8 ± 1.6 to 3.2 ± 1.6. Mean improvement in ROM was 15.6 ± 16.2 degrees. Forty-eight cases (873%) were satisfied with excellent or good results and 49 cases (89.1 %) were willing to receive the operation again. No significant differences in the postoperative VAS (p=0.14), AOFAS score (p=0.79), and ROM (p=0.06) were found among the three groups. Hetero-topic ossifications were observed in 12 cases (23.5%) and periosteal reactions proximal to medial malleolus occurred in four cases (7.8%). Perioperative complications include one intraoperative medial malleolus fracture which was successfully managed with two cannulated-screws, and one medial malleolar stress fracture at six weeks after surgery which has healed spontaneously. One case with osteolysis around tibial screws was managed with bone graft. One case with deep fungal infection was converted to arthrodesis after infection control. Four ankles had to be revised including three cases of polyethylene bearing change due to dislocation, and one case of tibial component and bearing change due to loosening. The patient with revised tibial component was converted to arthrodesis due to recurred loosening. The Kaplan-Meier cumulative survival rate was 90.9% at 12 months and 87.8% at 49 months postoperatively. The short term clinical results of HINTEGRA ankles showed favorable results. No significant differences were observed among different groups of coronal plane deformities when adequate additional surgeries were performed simultaneously. Long term follow-up study is required

Aims:. The interposition arthroplasty using dura mater has been applied by us as an alternative method to implantation of the prosthesis since 1997. This new surgical method was developed on the basis of ulnohumeral arthroplasty according to Kashiwagi to aspire to preserve the integrity of the joint. We used for interposition instead of lyophilized dura mater the Tutoplast° dura graft, which is treated with osmotic solvent and in this way differs from the lyophilised graft, as its tensile and pulling strength is greater, since it preserves its collagen structure and its three-dimensional fibrin structure. Material and methods:. The dura mater interposition was applied with 23 patients in 24 cases (one bilateral), from May 1997 up to July 2000, in 17 occasions on the dominant side. The average age of the patients was 52. 2 years (24–75 years). The basic diagnosis was rheumatoid arthritis in 83. 3 percent, juvenile chronic arthritis in 8. 3 percent and post-traumatic osteoarthritis in 8. 3 percent. All the patients appeared at the follow up examination and the average duration of the follow-up was 26. 6 months (from 8 to 45 months). The clinical evaluation was based on the Mayo performance score. Results:. Praeoperatively 71 percent of the twenty four patients had severe pain, while none of them had it at the follow up examination. 50 percent of patients were painless, 29. 2 percent had moderate and 21 percent of them had mild pain. The average decrease of point of Mayo performance score for pain was 5. 8 points, the difference is significant (p< 0. 001). Increase of range of movement is also remarkable. Praeoperatively only 4. 2 percent of the twenty four patients had an arc of 100 degrees or more, at the follow up examination this proportion improved to 66. 7 percent. Mean value of the increase was 28. 5 degrees, the difference is significant (p< 0. 001). Range of motion of supination and pronation improved significantly (p< 0. 001). Sixty seven percent of our patients were stable prae-operatively, this value decreased to 50 percent at the follow up. Grossly instability was observed 21 percent praeoperatively and 33 percent at follow up examination. Mean decrease of stability was 4. 2 degrees, the difference is significant (p< 0. 026). We have to notice at the same time that five of the eight grossly unstable patients had the same measurement of instability prae-operatively too, two had moderate instability and only one of them was stable before operation. The quality of life – as far as the basic vital functions are concerned- improved with 91. 6 percent. It is very important to notice at the evaluation of Mayo performance score that 95. 8 percent of patients falled to the group with poor classification before operation, but this value decreased to 12. 5 percent at the follow up, moreover 50 percent of patients had excellent and 79. 2 percent had excellent or good classification. Mean increase of Mayo performance score evaluated to 53. 2 points, the difference is significant (p< 0. 001). Conclusion:. One of the most serious complication of interposition arthroplasties is the absorption of the bone structures. Hence we mainly observed the radiological signs of this and employed the evaluation method of Ljung et al. reported by them in 1996. We observed the measurement of absorption of the trochlea with anteroposterior radiographs and the thinning of the olecranon with lateral radiographs. Ljung et al performed 35 joint preserver interposition arthroplasties with collegene membrane and observed 8 millimeters bone loss of humeral and 5 millimeters bone loss of ulnar part of the elbows. In our patient’s material the absorption of the trochlea occured in 33. 3 percent, in 5 occasions it was partial, and in 1 case in full degree. The rate of the partial absorption was 2. 2 mm on average. Thinning of the olecranon happened in 12. 5 percent, its average degree was 1. 6 mm. Consequently the value of the partial absorption is smaller in the case of trochlea and of the ulna too, like it was reported by Ljung et al. On the basis of the short-term clinical and radiological results the interposition using dura mater as an alternative way to the implant arthroplasty, may be applied with good results

Aims

Treatment of Weber B ankle fractures that are stable on weightbearing radiographs but unstable on concomitant stress tests (classified SER4a) is controversial. Recent studies indicate that these fractures should be treated nonoperatively, but no studies have compared alternative nonoperative options. This study aims to evaluate patient-reported outcomes and the safety of fracture treatment using functional orthosis versus cast immobilization.

The February 2023 Foot & Ankle Roundup³⁶⁰ looks at: Joint inflammatory response in ankle and pilon fractures; Tibiotalocalcaneal fusion with a custom cage; Topical application of tranexamic acid can reduce blood loss in calcaneal fractures; Risk factors for failure of total ankle arthroplasty; Pain catastrophizing: the same as pain forecasting?.

Aims

The purpose of this study is to determine an individual’s age-specific prevalence of total knee arthroplasty (TKA) after cruciate ligament surgery, and to identify clinical and genetic risk factors associated with undergoing TKA.

The June 2024 Foot & Ankle Roundup³⁶⁰ looks at: First MTPJ fusion in young versus old patients; Minimally invasive calcaneum Zadek osteotomy and the effect of sequential burr passes; Comparison between Achilles tendon reinsertion and dorsal closing wedge calcaneal osteotomy for the treatment of insertional Achilles tendinopathy; Revision ankle arthroplasty – is it worthwhile?; Tibiotalocalcaneal arthrodesis or below-knee amputation – salvage or sacrifice?; Fusion or replacement for hallux rigidus?.

There is a disparity in sport-related injuries between sexes, with females sustaining non-contact musculoskeletal injuries at a higher rate. Anterior cruciate ligament ruptures are between two and eight times more common than in males, and females also have a higher incidence of ankle sprains, patellofemoral pain, and bone stress injuries. The sequelae of such injuries can be devastating to an athlete, resulting in time out of sport, surgery, and the early onset of osteoarthritis. It is important to identify the causes of this disparity and introduce prevention programmes to reduce the incidence of these injuries. A natural difference reflects the effect of reproductive hormones in females, which have receptors in certain musculoskeletal tissues. Relaxin increases ligamentous laxity. Oestrogen decreases the synthesis of collagen and progesterone does the opposite. Insufficient diet and intensive training can lead to menstrual irregularities, which are common in female athletes and result in injury, whereas oral contraception may have a protective effect against certain injuries. It is important for coaches, physiotherapists, nutritionists, doctors, and athletes to be aware of these issues and to implement preventive measures. This annotation explores the relationship between the menstrual cycle and orthopaedic sports injuries in pre-menopausal females, and proposes recommendations to mitigate the risk of sustaining these injuries.

Cite this article: Bone Joint J 2023;105-B(7):723–728.

The December 2022 Hip & Pelvis Roundup³⁶⁰ looks at: Fix and replace: simultaneous fracture fixation and hip arthroplasty for acetabular fractures in older patients; Is the revision rate for femoral neck fracture lower for total hip arthroplasty than for hemiarthroplasty?; Femoral periprosthetic fractures: data from the COMPOSE cohort study; Dual-mobility cups and fracture of the femur; What’s the deal with outcomes for hip and knee arthroplasty outcomes internationally?; Osteochondral lesions of the femoral head: is costal cartilage the answer?