Total temporomandibular joint (TMJ) replacements reduce pain and improve quality of life in patients suffering from end-stage TMJ disorders, such as osteoarthritis and trauma. Jaw kinematics measurements following TMJ arthroplasty provide a basis for evaluating implant performance and jaw function. The aim of this study is to provide the first measurements of three-dimensional kinematics of the jaw in patients following
Aims. The first aim of this study was to evaluate whether preoperative renal function is associated with postoperative changes in whole blood levels of metal ions in patients who have undergone a Birmingham Hip Resurfacing (BHR) arthroplasty with a metal-on-metal bearing. The second aim was to evaluate whether exposure to increased cobalt (Co) and chromium (Cr) levels for ten years adversely affected renal function. Methods. As part of a multicentre, prospective post-approval study, whole blood samples were sent to a single specialized laboratory to determine Co and Cr levels, and the estimated glomerular filtration rate (eGFR). The study included patients with 117 unrevised
Aims. The glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of posterior shoulder dislocations, approximately 50% to 79% of posterior glenohumeral dislocations are missed at initial presentation. The aim of this study was to systematically evaluate the most recent evidence involving the aetiology of posterior glenohumeral dislocations, as well as the diagnosis and treatment. Materials and Methods. A systematic search was conducted using PubMed (MEDLINE), Web of Science, Embase, and Cochrane (January 1997 to September 2017), with references from articles also evaluated. Studies reporting patients who experienced an acute posterior glenohumeral joint subluxation and/or dislocation, as well as the aetiology of posterior glenohumeral dislocations, were included. Results. A total of 54 studies met the inclusion criteria. In total, 182 patients were included in this analysis; study sizes ranged from one to 66 patients, with a mean age of 44.2 years (. sd. 13.7). There was a higher proportion of male patients. In all, 216 shoulders were included with 148
Aims. Morphological abnormalities are present in patients with developmental dysplasia of the hip (DDH). We studied and compared the pelvic anatomy and morphology between the affected hemipelvis with the unaffected side in patients with
To compare the efficacy of intra-articular and intravenous modes of administration of tranexamic acid in primary total knee arthroplasty in terms of blood loss and fall in haemoglobin level. Study Design: Randomized controlled trial. Duration of Study: Six months, from May 2019 to Nov 2019. Seventy-eight patients were included in the study. All patients undergoing
The aim of this study was to compare the outcome of bilateral sequential total ankle replacement (TAR) with that of
We wished to determine whether simultaneous bilateral sequential total knee replacement (TKR) carried increased rates of mortality and complications compared with
We investigated whether simultaneous bilateral sequential total hip replacement (THR) would increase the rate of mortality and complications compared with
Introduction. Most of patients with
We report a prospective case-series study to evaluate the results of non-operative and operative treatment of symptomatic
Background. Direct anterior approach (DAA), total hip arthroplasty (THA, performed with the patient in the supine position, creates a unique opportunity to do bilateral THA under one anesthesia. Previous studies evaluating this option are limited by small sample size or lack of control group. The purpose of this study is to compare early clinical outcomes of simultaneous bilateral,
To investigate the clinical results of capsular arthroplasty in the treatment of young patients with
Five vertebrae with
Hip resurfacing arthroplasty (HRA) became a popular procedure in the early 90s because of the improved wear characteristic, preserving nature of the procedure and the optimal stability and range of motion. Concerns raised since 2004 when metal ions were seen in blood and urine of patients with a MoM implant. Design of the prosthesis, acetabular component malpositioning, contact-patch-to-rim distance (CPR) and a reduced joint size all seem to play a role in elevated metal ion concentrations. Little is known about the influence of physical activity (PA) on metal ion concentrations. Implant wear is thought to be a function of use and thus of patient activity levels. Wear of polyethylene acetabular bearings was positively correlated with patient's activity in previous studies. It is hypothesized that daily habitual physical activity of patients with a
Traumatic
Aims. The aim of this study was to compare the cost-effectiveness of
treatment with an osseointegrated percutaneous (OI-) prosthesis
and a socket-suspended (S-) prosthesis for patients with a transfemoral
amputation. Patients and Methods. A Markov model was developed to estimate the medical costs and
changes in quality-adjusted life-years (QALYs) attributable to treatment
of
Methods. A retrospective review of 80 patients with
Between 1992 and 1997, we undertook a prospective, targeted clinical and ultrasonographic hip screening programme to assess the relationship between ultrasonographic abnormalities of the hip and clinical limitation of hip abduction. A total of 5.9% (2 of 34) of neonatal dislocatable hips and 87.5% (7 of 8) of ‘late’ dislocated hips seen after the age of six months, presented with
Posterior cruciate ligament deficiency (PCLD) leads to structural and proprioceptive impairments of the knee, affecting the performance of daily activities including obstacle-crossing. Therefore, identifying the biomechanical deficits and/or strategies during this motor task would be helpful for rehabilitative and clinical management of such patients. A safe and successful obstacle-crossing requires stability of the body and sufficient foot clearance of the swing limb. Patients with PCLD may face demands different from normal when negotiating obstacles of different heights. The objective of this study was thus to identify the biomechanical deviations/strategies of the lower limbs in
Introduction. Limb length discrepancy (LLD) is one of the major reasons of dissatisfaction after total hip arthroplasty(THR) and limb equalization after THR in
Background. Active therapeutic exercises during unstable and
With the increase in the elderly population, there is a dramatic increase in the number of spinal fusions. Spinal fusion is usually performed in cases of primary instability. However it is also performed to prevent iatrogenic instability created during surgical treatment of spinal stenosis in most cases. In literature, up to 75% of adjacent segment disease (ASD) can be seen according to the follow-up time. 1. Although ASD manifests itself with pathologies such as instability, foraminal stenosis, disc herniation or central stenosis. 1,2. There are several reports in the literature regarding lumbar percutaneous transforaminal endoscopic interventions for lumbar foraminal stenosis or disc herniations. However, to the best our knowledge, there is no report about the treatment of central stenosis in ASD. In this study, we aimed to investigate the short-term results of
Europeam Group of Neuro-orthopaedic (GLAENeO), Caracas, The prevention of a dislocated hip is one of the aims of early surgery in Cerebral Palsy children, specially those severely involved. We performed a retrospective study of those cerebral palsy patients operated of adductor tenotomy between 1975 and 1995 with a total of 1474 patients. We grouped them in those who had a
Introduction The decision to perform bilateral total knee replacement (TKR) either simultaneously or as a staged procedure is made depending on the level of disease severity, comorbidities, total anaesthetic time and cost. We compared the outcomes of these two bilateral groups of patients with
To compare the efficacy of intra-articular and intravenous modes of administration of tranexamic acid in primary Total Knee Arthroplasty in terms of blood loss and fall in haemoglobin level. This randomized controlled trial was conducted from 12th May 2017 to 11th May 2017. Seventy eight patients were included in the study. Patients were randomly divided into group A and B. Group A patients undergoing
We reviewed 16 patients with spina bifida and
Objectives. External fixators are the traditional fixation method of choice for contaminated open fractures. However, patient acceptance is low due to the high profile and therefore physical burden of the constructs. An externalised locking compression plate is a low profile alternative. However, the biomechanical differences have not been assessed. The objective of this study was to evaluate the axial and torsional stiffness of the externalised titanium locking compression plate (ET-LCP), the externalised stainless steel locking compression plate (ESS-LCP) and the
Aims: Cobalt (Co) and chromium (Cr) ion associated carcinogenesis and chromosomal damage in animals have raised concerns that metal-on-metal (MOM) total hip replacement (THR) in humans may produce the same effects over time. Considering that the risks may be related to the level of these ions in the body, this study compared the serum Co and Cr levels in patients with
Aims: Elevated serum cobalt and chromium ion levels associated with carcinogenesis and chromosomal damage in animals has raised concerns that metal-on-metal (MOM) total hip replacement (THR) in humans may produce the same effects over time. Considering that the risks may be related to the level of these ions in the body, this study compared the serum cobalt and chromium ion levels in patients with
We treated 36 patients with
Purpose: Metal-on-metal (MOM) bearing surfaces release ions locally and into the systemic circulation. This elevation raises concern about the long term effects of elevated metal ions. The goal of the present study was to monitor serum cobalt (Co) and chromium (Cr) levels in patients after MOM resurfacing hip arthroplasty with the Cormet 2000 prosthesis. We present here pilot data on Co and Cr levels in patients with bilateral versus
The number of hip arthroplasty procedures has steadily increased in the United States over the last decade [Wolford, et. al, 2015]. This trend will continue as this treatment is the most effective approach in relieving pain, improving mobility, reducing fall risk and improving the quality of life in patients with end-stage osteoarthritis. The effectiveness of recovery can be impacted by factors such as access to postoperative physical therapy regimens. During the recovery period, it is important for therapists to be guided in their therapeutic decision making by accurate data concerning the patient's performance on a variety of measures. This project is designed to map the gait recovery curves of individuals who have undergone
Introduction. In cases of
Aims: Cobalt (Co) and chromium (Cr) ion associated carcinogenesis and chromosomal damage in animals has raised concerns that metal-on-metal (MOM) total hip replacement (THR) in humans may produce the same effects over time. Considering that the risks may be related to the level of these ions in the body, this study compared the serum Co and Cr levels in patients with
Introduction:. The clinical significance of serum metal ion levels alone in patients with stemmed MoM hip arthroplasty remains uncertain. This study aims to measure the metal ion levels in patients with
Ring frames have the advantage of allowing progressive correction. However, the available frames for complex deformities are heavy and bulky leading to poor compliance by patients. Also, the mounting procedure requires considerable expertise and skill. On the other hand, a
The aim of this study was to investigate the
incidence of dysplasia in the ‘normal’ contralateral hip in patients
with
PURPOSE: There is an argument in the literature regarding the use of intramedullary nail or the external fixation followed by intramedullary nail in tibial fractures with severe damage of soft tissues, threatened compartment syndrome, open type IIIA fractures and in polytrauma patients. The purpose of this retrospective study was to evaluate the results of non-jointed external fixators as a definite treatment for these type of tibial shaft fractures. MATERIAL AND METHOD: 86 patients (91 tibial shaft fractures) were treated at the authors’ institute with a non-jointed external fixator. The mean patient age was 35 years (range, 15–80). There were 70 male and 16 female patients. The average time of surgery from the accident was 10 hours. The indications for application an external fixator was: severe damage of the soft tissues in 11 fractures, an incipient compartment syndrome in 12 fractures, open type III Gustilo fractures in 57, and 11 tibia fractures in polytrauma patients. According to AO classification 46 fractures were type A, 32 type B and 13 type C. RESULTS: The average follow up was 2.9 years (ranged, 1–5 years). The average operative time was 50 min. Complications included: 3 non-unions, 5 delayed unions, 1 malunions, 1 tibia shortening, 3 superficial infections of soft tissues in open fractures, 26 pin infections and 1 osteomyelitis in open fractures. In 2 patients fat embolism was diagnosed while pulmonary embolism was a complication in 2 patients. Deep venous thrombosis (DVT) developed in 5 patients. A re-operation was performed in 11 out of 91 fractures. Change of the method was necessary in 2 out of 91 fractures. The primary callus in 10 out of 91 fractures was due to the stiffness of the
Purpose: To compare the clinical and radiographic outcomes of a
Introduction: The aim of this research project was to establish a simple, reliable and repeatable externally fixed femoral fracture model. The rat was selected, as it was a suitable animal for use in a model of fracture repair and ovariectomy induced osteoporosis, both of which were to be investigated in future experiments. There are femoral fracture models described in the literature based on the insertion of an intramedullary nail prior to inducing a fracture. We felt, based on our experience of the
The purpose of this study was to investigate the efficacy and fusion rates of a
The risk of contra-lateral slip in patients with primary
We studied 50 patients before and after
The coronal plane lower limb alignment plays an important role in the occurrence and progression in knee osteoarthritis. There have been reports of the valgus knee in patients with
Rupture of an aneurysm of the common iliac artery is a rare cause of pain in the hip. We describe an elderly hypertensive patient with an aneurysmal rupture of the left common iliac artery who presented with
Increasing pressure to use rapid recovery care pathways when treating patients undergoing total hip arthroplasty (THA) is evident in current health care systems for numerous reasons. Patient autonomy and health care economics has challenged the ability of THA implants to maintain functional integrity before achieving bony union. Although collared stems have been shown to provide improved axial stability, it is unclear if this stability correlates with activity levels or results in improved early function to patients compared to collarless stems. This study aims to examine the role of implant design on patient activity and implant fixation. The early follow-up period was examined as the majority of variation between implants is expected during this time-frame. Patients (n=100) with
Posterior approach to the lumbar spine necessarily induces structural damage of paravertebral muscles. In order to avoid these changes, we have started to utilize a microscopic decompression of the spinal canal via an
Bilateral decompression of spinal stenosis may induce instability which compromises outcome. In an attempt to overcome this problem, bilateral decompression can be carried out through a
The purpose this prospective, randomized clinical trial was to determine if
Salter innominate osteotomy is an effective reconstructive
procedure for the treatment of developmental dysplasia of the hip
(DDH), but some children have a poor outcome at skeletal maturity.
In order to investigate factors associated with an unfavourable
outcome, we assessed the development of the contralateral hip. We retrospectively
reviewed 46 patients who underwent a
The aim of this study was to perform a comprehensive evaluation of the changes in function from pre- to post-surgery in total and
The success of lumbar spine fusion depends on good patient selection and bone grafting technique. Instrumentation of the fusion, now popular, improves fusion rates, eliminates the need for postoperative braces and allows early mobilisation. However, the stress shielding caused by rigid internal fixation is thought to lead to osteopoenia and degeneration of adjacent segments. Theatre times, intra-operative complications and costs are increased when pedicle screw fixation is added. This is a report of a pilot study of eight patients who had one-level fusion and
Aim: Surgical treatment for idiopathic clubfeet aims to realign the foot and allow plantigrade weight bearing with adequate joint motion. In spite of satisfying clinical and radiological results for both the physician and the parents shortly after the operation, deterioration may occur years after the surgery. The aim of this study was to evaluate gait characteristics of children with surgically treated
Introduction: Although there are several known causes of scoliosis, most are of unknown cause and develop during adolescence, making adolescent idiopathic scoliosis (AIS) the most common form. It has long been hypothesised that
Sagittal pelvic tilt (PT) has been shown to effect the functional position of acetabular components in patients with total hip replacements (THR). This change in functional component position may have clinical implications including increased likelihood of wear or dislocation. Surgeons can use computer-assisted navigation intraoperatively to account for a patient's pelvic tilt and to adjust the position of the acetabular component. However, the accuracy of this technique has been questioned due to the concern that PT may change after THR. The purpose of this study was to measure the change in PT after THR, and to determine if preoperative clinical and radiographic parameters can predict PT changes after THR. 138 consecutive patients who underwent
Hip arthroplasty is commonly used as the final treatment approach for patients experiencing end-stage osteoarthritis. The number of these patients needing this treatment is expected to grow significantly by year 2030 to more than 572000 patients [Kurtz et al., 2007]. One of the important outcomes of hip arthroplasty is to improve patients' functions postoperatively. The evaluation of walking can provide a wealth of information regarding the efficiency of this treatment in improving a patient's mobility. Assessing the kinematic features of gait collected with a motion capture system combined with the aid of a motor-driven treadmill provides the advantage of enabling the evaluator to collect precise information about a large number of strides in a short period of time. Body segment kinematics (i.e. joint motion) are most often represented in the form of time series data with the abscissa (X axis) representing time and the ordinate (y axis) representing the motion of a particular joint. Although a great deal of information can be gained from the analyses of time series data, non-linear analyses tools can provide an additional and important dimension to a clinician's assessment of gait recovery. In this study eight patients (4 females, mean age 64.9, SD 11.1) have currently been assessed after
We have attempted to identify the most important long-term prognostic factors in Perthes' disease by studying 61 patients affected
Background: Polytrauma patients with bilateral femur shaft fractures are known to have a higher rate of complications when compared with those who have sustained
Background. To determine the relative contributions of bilateral versus
Introduction: The recent UK national comparative audit of the use of blood in primary, elective,
Bilateral interlocking of the articular facets of the cervical spinal column results from excessive flexion.
Background: Joint replacements are being performed on ever younger patients at a time when average expectancy of life is continuing to rise. Any reduction in the strength and mass of periprosthetic bone could threaten the longevity of implant by predisposing to loosening and migration of prosthesis, periprosthetic fracture and problems in revision arthroplasty. Aims &
Objectives: This study aims to analyse the femoral periprosthetic stress-shielding following
Purpose of the study. To compare the effectiveness of
In the Unites States, approximately 24% of people undergoing primary total knee or total hip arthroplasty (TKA, THA) are chronic opioid users pre-operatively. Few studies have examined the incidence of opioid use prior to TKA/THA and whether it predicts outcomes post-surgery in the Australian context. The aim was to determine: (i) the proportion of TKA and THA patients who use opioids regularly (daily) pre-surgery; (ii) if opioid use pre-surgery predicts (a) complication and readmission rates to 6-months post-surgery, (b) patient-reported outcomes to 6-months post-surgery. A retrospective cohort study was undertaken utilising linked individual patient-level data from two independent databases comprising approximately 3500 people. Patients had surgery between January 2013 and June 2018, inclusive at Fairfield and Bowral Hospitals. Following data linkage, analysis was completed on 1185 study participants (64% female, 69% TKA, mean age 67 (9.9)). 30% were using regular opioids pre-operatively. Unadjusted analyses resulted in the following rates in those who Adjusted regression analyses controlling for multiple co-variates indicated no significant association between pre-op opioid use and adverse events/patient-reported outcomes. Pre-operative opioid use was high amongst this Australian arthroplasty cohort and was not associated with increased risk of adverse events post-operatively. Further research is needed in assessing the relationship between the amount of pre-op opioid use and the risk of post-operative adverse events.
Introduction: Total Hip Replacement (THR) is an effective procedure that improves Quality of Life (QoL) in patients with hip arthritis. Co-existing back pain is common in these patients. We assessed the impact of back pain on the medium term outcomes of patients undergoing
Introduction: Previous studies have suggested that bilateral total hip replacement (THR) is a safe and economically advantageous procedure. It has not become routine practice in many centres due to persisting concerns about complications and the patients’ ability to rehabilitate. In this study we compare one group of patients who underwent bilateral THR with another group who had only a
Anterior cruciate ligament deficiency (ACLD) affects the performance of walking in some patients (non-copers) while copers are able to minimize the effects via proper musculoskeletal compensations. Since many daily activities are more challenging than level walking, e.g., obstacle-crossing, it is not clear whether copers are able to cope with such a challenging task. A successful and safe obstacle-crossing requires not only sufficient foot clearance of the swing limb, but also the stability of the body provided mainly by the stance limb. Failure to meet these demands may lead to falls owing to loss of balance or tripping over obstacles. The purpose of the current study was to identify the motor deficits and/or biomechanical strategies in coper and non-coper ACLD patients when crossing obstacles of different heights for a better function assessment. Ten coper and ten non-coper ACLD patients were recruited in the current study. The non-coper ACLD subjects were those who had not been able to return to their pre-injury level activities, had at least once giving way during the last six months and their Lysholm knee scale was less than 70 [1]. Each subject walked and crossed obstacles of heights of 10%, 20% and 30% of their leg lengths at a self-selected pace. Kinematic and kinetic data were measured with a 7-camera motion analysis system (Vicon, Oxford Metrics, U.K.) and two force plates (AMTI, U.S.A.). The leading and trailing toe clearances were calculated as the vertical distances between the toe markers and the obstacle when the toe was directly above the obstacle. Joint angles of both limbs, and joint moments of the stance limb, were calculated. Peak extensor moments at the knee during stance phase and the corresponding joint angles were extracted for statistical analysis. A 3 by 2, 2-way mixed-model analysis of variance with one between-subject factor (group) and one within-subject factor (obstacle height) was performed (α=0.05). SAS version 9.2 was used for all statistical analysis. Compared with the copers, significantly reduced leading and trailing toe clearances were found in the non-coper group (P<0.05). The non-copers showed significantly decreased peak extensor moments (P<0.05) and flexion angle at the affected knee during the stance phase before leading limb crossing (P<0.05). Distinctive gait patterns were identified in coper and non-coper patients with
To present the results of surgical correction in patients with double or triple thoracic/lumbar AIS (Lenke types 2,3,4) with the use of a novel convex/convex
Previous studies have suggested that bilateral TKR is a safe and economically advantageous procedure. However, because of persistent concerns about complications and patients’ ability to rehabilitate, it has not yet become routine practice. Using data from the Scottish Arthroplasty Project, which has centrally collated data gathered prospectively between 1989 and 1999, we analysed 19 247 patients who underwent primary knee replacement. Any subsequent admission for TKR was noted. Deaths following an index procedure were identified from the General Register of Deaths. In 30% of patients a contralateral TKR was done within 5 years. The overall hospital stay for both
The purpose of this study was to investigate the energy cost of walking after total ankle arthroplasty (TAA), and to investigate if possible differences could be attributed to changes in external mechanical work required for the step-to-step transition. Eleven patients, 6 months to 4 years after successful
Although drains date back to the Hippocratic era, their routine use remains controversial in total hip arthroplasty. The literature suggests that they can provide a retrograde route for infection as well as decreasing the organism count required to develop an infection. The use of drains has not decreased the size of wound haematomas at day five on ultrasound or the incidence of massive wound haematomas. Neither have they been shown to significantly decrease wound infections. This consecutive prospective randomised study was designed to evaluate what role drains have in the management of patients undergoing hip arthroplasty. A total of 577 patients undergoing
Introduction: Total knee replacement commonly results in postoperative requirement of blood transfusion. Allogeneic blood transfusion carries transfusion related risks, continuing effort to reduce allogeneic blood transfusion is important. The purpose of this study was to asses the economic justification of the use of an autologous blood transfusion after total knee replacement and to determine whether it reduces allogeneic blood transfusion and length of postoperative hospital stay. Patients and Methods: Retrospectively, 149 patients undergoing primary
Many studies have evaluated bilateral versus
This is a case series of prospectively gathered
data characterising the injuries, surgical treatment and outcomes
of consecutive British service personnel who underwent a unilateral
lower limb amputation following combat injury. Patients with primary,
unilateral loss of the lower limb sustained between March 2004 and
March 2010 were identified from the United Kingdom Military Trauma
Registry. Patients were asked to complete a Short-Form (SF)-36 questionnaire.
A total of 48 patients were identified: 21 had a trans-tibial amputation,
nine had a knee disarticulation and 18 had an amputation at the
trans-femoral level. The median New Injury Severity Score was 24 (mean
27.4 (9 to 75)) and the median number of procedures per residual
limb was 4 (mean 5 (2 to 11)). Minimum two-year SF-36 scores were
completed by 39 patients (81%) at a mean follow-up of 40 months
(25 to 75). The physical component of the SF-36 varied significantly
between different levels of amputation (p = 0.01). Mental component
scores did not vary between amputation levels (p = 0.114). Pain
(p = 0.332), use of prosthesis (p = 0.503), rate of re-admission
(p = 0.228) and mobility (p = 0.087) did not vary between amputation
levels. These findings illustrate the significant impact of these injuries
and the considerable surgical burden associated with their treatment.
Quality of life is improved with a longer residual limb, and these
results support surgical attempts to maximise residual limb length. Cite this article:
A retrospective study was performed in 18 patients
with achondroplasia, who underwent bilateral humeral lengthening
between 2001 and 2013, using monorail external fixators. The mean
age was ten years (six to 15) and the mean follow-up was 40 months
(12 to 104). The mean disabilities of the arm, shoulder and hand (DASH) score
fell from 32.3 (20 to 40)
pre-operatively to 9.4 (6 to 14) post-operatively (p = 0.037). A
mean lengthening of 60% (40% to 95%) was required to reach the goal
of independent perineal hygiene. One patient developed early consolidation,
and fractures occurred in the regenerate bone of four humeri in
three patients. There were three transient radial nerve palsies. Humeral lengthening increases the independence of people with
achondroplasia and is not just a cosmetic procedure. Cite this article:
Aim: Patients treated with one-stage combined operations after walking age for developmental dysplasia of the hip (DDH), and whose follow-up revealed both clinical and radiological complete healing underwent flexor and extensor isokinetic muscle strength (IMS) measurements of the hip and results were evaluated in comparison with the contralateral hips. Methods: A total of 22 patients with
We reviewed, at an average age of 46 years, a series of 61 patients treated for
Aims: To compare rates of blood transfusion post knee arthroplasties for patients treated with and without tranexamic acid (TA) and assess for any haemoglobin change perioperatively between the groups. Methods: This retrospective observational study included 207 patients undergoing primary
Aim: Complete tenotomy was performed on the most important flexor hip muscle; namely the iliopsoas during open reduction in patients with developmental dysplasia of the hip (DDH). The iliopsoas and other flexor-extensor muscles in operated and contralateral hips were evaluated comparatively by magnetic resonance imaging (MRI). Methods: A total of 22 patients with
1. The relation of oxygen intake and walking speed has been investigated in a sixty-two-year-old patient before and after
In the majority of patients with slipped upper
femoral epiphysis only one hip is involved at primary diagnosis. However,
the contralateral hip often becomes involved over time. There are
no reliable factors predicting a contralateral slip. Whether or
not the contralateral hip should undergo prophylactic fixation is
a matter of controversy. We present a number of essential points
that have to be considered both when choosing to fix the contralateral
hip prophylactically as well as when refraining from surgery and
instead following the patients with repeat radiographs.
Severe kypho-scoliosis, lateral curvature and lordo-scoliosis are ultimately caused by disturbance of vertebral growth. The results of treatment by destroying the growth potential opposite the area of growth inhibition have been encouraging. When the operation has been adequate further deterioration has been prevented; in younger children there has been improvement with further growth. It is important that the growth arrest should be at the right site and that it should be sufficiently extensive. Accurate pre-operative diagnosis of the type and extent of the curve is important.
There has been much discussion and controversy in the media recently regarding metal toxicity following large head metal on metal (MoM) total hip replacement (THR). Patients have been reported as having hugely elevated levels of metal ions with, at times, devastating systemic, neurolgical and/or orthopaedic sequelae. However, no direct correlation between metal ion level and severity of metallosis has yet been defined. Normative levels of metal ions in well functioning, non Cobalt-Chrome hips have also not been defined to date. The Exeter total hip replacement contains no Cobalt-Chrome (Co-Cr) as it is made entirely from stainless steel. However, small levels of these metals may be present in the modular head of the prosthesis, and their effect on metal ion levels in the well functioning patient has not been investigated. We proposed to define the “normal” levels of metal ions detected by blood test in 20 well functioning patients at a minimum 1 year post primary Exeter total hip replacement, where the patient had had only one joint replaced. Presently, accepted normal levels of blood Chromium are 10–100 nmol/L and plasma Cobalt are 0–20 nmol/L. The UK Modern Humanities Research Association (MHRA) has suggested that levels of either Cobalt or Chromium above 7 ppb (equivalent to 135 nmol/L for Chromium and 120 nmol/L for Cobalt) may be significant. Below this level it is indicated that significant soft tissue reaction and tissue damage is less likely and the risk of implant failure is reduced. Hips were a mixture of cemented and hybrid procedures performed by two experienced orthopaedic consultants. Seventy percent were female, with a mixture of head sizes used. In our cohort, there were no cases where the blood Chromium levels were above the normal range, and in more than 70% of cases, levels were below recordable levels. There were also no cases of elevated plasma Cobalt levels, and in 35% of cases, levels were negligible. We conclude that the implantation with an Exeter total hip replacement does not lead to elevation of blood metal ion levels.
Purpose: To determine mortality and morbidity for bilateral total knee replacment compared to
The radiographs of 153 children suffering from Perthes' disease of one hip were studied to examine the bony outline of the femoral capital epiphysis in the unaffected hip. In 48.4 per cent of patients irregularity of the surface, flattening or dimpling, were noted; in the majority of instances (37.2 per cent) these changes were present in the initial anteroposterior radiograph. By contrast, these changes were present in only 10.4 per cent of a control series of 153 children in whom intravenous urography was being performed, these children being matched for age and sex with the children with Perthes' disease. A second unmatched control series of 49 children whose pelves were being radiographed after injury showed a 6.1 per cent incidence of contour irregularities in 98 femoral capital epiphyses. In the patients with Perthes' disease and in the control series obtained at urography the incidence of changes was inversely related to age. The possible cause and significance of contour irregularities in normal children and in those with Perthes' disease is disscussed.
1. A woman of seventy-four presenting with gigantism of the left hand and foot, lipomatosis, progressive arthropathy and psoriasis is described. 2. The associations of the various conditions are examined in the light of the previously reported cases and the differential diagnosis of this condition (macrodystrophia lipomatosa) from other causes of localised gigantism is discussed.
Previous systematic reviews have shown that patients experience low physical activity levels following total hip replacement (THR). However no previous systematic reviews have examined the changes between pre- and post-operative physical activity levels. AMED, MEDLINE, EMBASE, CENTRAL, CINHAL, openSIGLE, Introduction
Methods
Orthopaedic surgery accounts for about 10% of red cell transfusions used in hospital. In view of the recognized risks and decreasing availability of donor blood, every effort should be made to minimize inappropriate transfusions.
Studies describing the effect of body mass index (BMI) on the outcome of total hip replacement have been inconclusive and contradictory. We examined the effect of BMI on medium-term outcome in a cohort of 1617 patients who underwent a primary total hip replacement for osteoarthritis. These patients were followed prospectively for five years with the outcomes of dislocation, revision, duration of surgery and deep and superficial infection studied, as well as collecting Harris hip scores (HHS) and Short-Form 36 (SF-36) questionnaires pre-operatively and at review. A multivariate analysis was performed to see whether BMI is an independent predictor of poor outcome. We found that patients with a BMI of ? 35 kg/m2 have a 4.42 times higher rate of dislocation than those with a BMI <
25 kg/m2. Increasing BMI is also associated with superficial infection and poorer HHS and SF-36 scores at five years. These trends remain significant even when multivariate analysis adjusts for age, gender, prosthesis, operating consultant, pre-operative HHS and SF-36, and comorbidities including diabetes mellitus, cardiac disease and osteoporosis. Despite the increased risks, the five-year outcome scores indicate that obese patients have much to gain from total hip replacement. Thus total hip replacement should not be withheld from patients solely on the grounds of an elevated BMI. However, longer-term follow-up of this cohort is required to establish whether adverse outcomes become more evident with time.
The purpose of this study was to evaluate the role of patellar resurfacing in total knee replacement surgery. We reviewed 48 patients who had undergone bilateral knee replacement with patellar resurfacing on only one side. Follow-up was from 18 months to 9.5 years and the patients were assessed using the Knee Society rating, a clinical anterior knee pain score and BOA patient satisfaction score. Patients were also asked specifically if they had a preference for either knee. Assessment was performed without knowing which patella had been resurfaced. 52.1% of patients favoured the resurfaced knee, 8% the unresurfaced knee and 39.9% had no particular preference. The overall prevalence of anterior knee pain was 8.3% in the resurfaced cases (3 mild, 1 moderate) and 27.1% in the unresurfaced knees (8 mild, 3 moderate, 2 severe). No significant difference was found between knee scores. This study shows a significantly higher rate of anterior knee pain in unresurfaced patellae and preference for the resurfaced side.
Alumina Ceramic liners are increasingly used in patients undergoing Total Hip Replacement (THR). The rate of fracture of ceramic liner is decreasing with improved manufacturing techniques from 1st to 3rd generation alumina-ceramic liners. We report the first case of a fracture of a modern, 4th generation alumina bearing ceramic liner, which incorporates a metal sheath to help avoid fracture. Our case is a 60 years old female presenting two years and three months after a bilateral total hip replacement using Stryker Trident cup, securfit stem and alumina on alumina bearing ceramic liner. Ceramic liners are commonly used, especially in young patients because of their excellent biocompatibility, low wear rate and superior tribology. Although fracture of ceramic liner is a less common complication of modern total hip arthroplasty, it is a major concern with the use of ceramic on ceramic THR, the reason being brittleness of ceramic. Cases of 3rd generation ceramic liner fracture have been reported which might be associated with impingement due to excessive anteversion of the socket in Asian patients who habitually squat. Habitual squatting, sitting cross legged and kneeling were not characteristic of this case. The patient presented with complains of mechanical grinding in left hip. She also reported a past history of clicking sound from left hip on extension of left hip and long stride gait. There was no history of trauma or fall. On examination she had a nonantalgic gait and left hip had audible and palpable crepitations. The range of motion on left hip was intact with no subluxation. Right hip was symptom free and examination did not detect any abnormalities.Introduction
Methods
Old age, osteopaenia, alcohol abuse, and large cysts are risk factors for fractures. It has been suggested that performing a bilateral resurfacing puts the first side at risk of fracture from the force used in implanting the second resurfacing. Is this a true risk or a sampling error?
The low incidence of fractures (2/382, 0.5%) in this bilateral resurfacing series does not support the view that there is an increased risk of fracture from a bilateral procedure.
Slipped capital femoral epiphysis (SCFE) is the most common pediatric hip disorder. The most devastating complication is development of avascular necrosis of the femoral head. In order to reduce the potential for this complication occurring following delayed contralateral SCFE, there has been consideration in the literature of prophylactic pinning of the contralateral hip. The objective of this study was to determine the cost-effectiveness of this treatment strategy. The outcome probabilities and utilities utilised in a decision analysis of prophylactic pinning of the contralateral hip in SCFE, reported by Kocher et al, were used in this study. Costing data, reported in 2005 Canadian dollars, was obtained from our institution. Using this data, an economic evaluation was performed. The time horizon was four years, so as to follow the adolescents to skeletal maturity. Discounting was performed at 3% per year. Sensitivity analyses were conducted to determine the effect of variation of the outcome probabilities and utilities. In all analyses, prophylactic pinning resulted in cost savings but lower utility, compared to the currently accepted strategy of observation of the contralateral hip. The results were most sensitive to an increase in the probability of a delayed contralateral SCFE to 27%. Using the base case analysis, the incremental cost-effectiveness ratio was $7856.12 per utility gained. Using the most sensitive probability of a delayed contralateral SCFE of 27%, the incremental cost-effectiveness ratio was $27,252.92 per utility gained. The results of this study demonstrated overall cost savings with prophylactic treatment, however the utility was lower than the standard treatment of observation. For both the base case and sensitivity analysis, the incremental cost-effectiveness ratio was less than the accepted threshold of $50,000 per quality adjusted life year gained. It should be noted that the use of a four year time horizon excluded consideration of the costs related to total hip arthroplasty for the sequelae of AVN. A prospective, randomised controlled trial, with an accompanying economic evaluation, is required to definitively answer the question of the cost-effectiveness of this treatment. On the basis of this cost-effectiveness analysis, prophylactic pinning of the contralateral hip in SCFE cannot be recommended. A prospective, randomised controlled trial, with an accompanying economic evaluation, is required to definitively answer the question of the cost-effectiveness of this treatment.
Aims. This study aimed to investigate the incidence of ≥ 5 mm asymmetry in lower and whole leg lengths (LLs) in patients with
Arthroscopic hip procedures have increased dramatically over the last decade as equipment and techniques have improved. Patients who require hip arthroscopy for femoroacetabular impingement on occasion require surgery on the contralateral hip. Previous studies have found that younger age of presentation and lower Charlson comorbidity index have higher risk for requiring surgery on the contralateral hip but have not found correlation to anatomic variables. The purpose of this study is to evaluate the factors that predispose a patient to requiring subsequent hip arthroscopy on the contralateral hip. This is an IRB-approved, single surgeon retrospective cohort study from an academic, tertiary referral centre. A chart review was conducted on 310 primary hip arthroscopy procedures from 2009-2020. We identified 62 cases that went on to have a hip arthroscopy on the contralateral side. The bilateral hip arthroscopy cohort was compared to
Aims. The aim of the study was to compare two methods of calculating pelvic incidence (PI) and pelvic tilt (PT), either by using the femoral heads or acetabular domes to determine the bicoxofemoral axis, in patients with
Pelvic bone defect in patients with severe congenital dysplasia of the hip (CDH) lead to abnormalities in lumbar spine and lower limb alignment that can determine total hip arthroplasty (THA) patients' outcome. These variables may be different in uni- or bilateral CDH. We compared the clinical outcome and the spinopelvic and lower limb radiological changes over time in patients undergoing THA due to uni- or bilateral CHD at a minimum follow-up of five years. Sixty-four patients (77 hips) undergoing THA due to severe CDH between 2006 and 2015 were analyzed: Group 1 consisted of 51 patients with