There have been no studies assessing the acceptability of opioid tapering in the pre-arthroplasty setting. This qualitative study aimed to (1) explore barriers and facilitators to opioid tapering amongst patients with chronic non-cancer pain (CNCP), and (2) explore the similarities and differences in acceptability of opioid tapering between pre-arthroplasty patients and those participating in a biopsychosocial pain management program. From January 2021, adult participants diagnosed with CNCP and taking opioids daily (any dose at time of screening for a period of 3 months) were recruited from either Fairfield Orthopaedic Hip and Knee Service (FOHKS) or Liverpool Hospital Pain Clinic (LHPC). Semi-structured interviews underwent thematic analysis using the framework method. 17 participants were recruited (FOHKS, n=9, mean age 67, female 77%, LHPC, n=8, mean age 54, female 63%). Both groups had participants who; (i) were reluctant to use opioid medications and used them out of “necessity”, (ii) were reluctant to taper due to concerns of worsening pain, quality of life, (iii) believed opioids were “toxins” causing bodily harm. Some FOHKS participants believed tapering should be a post-operative focus, whilst others believed tapering opioids pre-operatively will assist in post-op pain management. Few LHPC participants felt dependent/addicted to opioids, thus driving their intention to taper opioids. The belief of tapering opioids causing worse pain was based on either previous experiences or concerns alone. Some FOHKS participants were more inclined to taper opioids if they were educated on the chronic and peri-operative risks associated with using opioids at time of arthroplasty. Opioid users recognise the harms associated with chronic opioid use and believe they are used out of desperation for adequate analgesia, function, and quality of life. Tapering opioids in the pre-arthroplasty context may need coupling with patient education highlighting the importance of opioid tapering pre-operatively.
Slipped capital femoral epiphysis (SCFE) is one of the most common hip diseases of adolescence that can cause marked disability, yet there is little robust evidence to guide treatment. Fundamental aspects of the disease, such as frequency, are unknown and consequently the desire of clinicians to undertake robust intervention studies is somewhat prohibited by a lack of fundamental knowledge. The study is an anonymized nationwide comprehensive cohort study with nested consented within the mechanism of the British Orthopaedic Surgery Surveillance (BOSS) Study. All relevant hospitals treating SCFE in England, Scotland, and Wales will contribute anonymized case details. Potential missing cases will be cross-checked against two independent external sources of data (the national administrative data and independent trainee data). Patients will be invited to enrich the data collected by supplementing anonymized case data with patient-reported outcome measures. In line with recommendations of the IDEAL Collaboration, the study will primarily seek to determine incidence, describe case mix and variations in surgical interventions, and explore the relationships between baseline factors (patients and types of interventions) and two-year outcomes.Aims
Methods
Abstract. Objective. Meta-analysis of clinical trials highlights that non-operative management of degenerative knee meniscal tears is as effective as surgical management. Surgical guidelines though support arthroscopic partial meniscectomy which remains common in NHS practice. Physiotherapists are playing an increasing role in triage of such patients though it is unclear how this influences clinical management and patient outcomes. Methods. A 1-year
Aims. Large-diameter metal-on-metal (MoM) total hip arthroplasty (THA) has demonstrated unexpected high failure rates and pseudotumour formation. The purpose of this prospective cohort study is to report ten-year results in order to establish revision rate, prevalence of pseudotumour formation, and relation with whole blood cobalt levels. Methods. All patients were recalled according to the guidelines of the Dutch Orthopaedic Association. They underwent clinical and radiographical assessments (radiograph and CT scan) of the hip prosthesis and whole blood cobalt ion measurements. Overall, 94 patients (95 hips) fulfilled our requirements for a minimum ten-year follow-up. Results. Mean follow-up was 10.9 years (10 to 12), with a cumulative survival rate of 82.4%. Reason for revision was predominantly pseudotumour formation (68%), apart from loosening, pain, infection, and osteolysis. The prevalence of pseudotumour formation around the prostheses was 41%, while our previous report of this
Abstract. Introduction. Total knee replacement (TKR) is a successful operation for many patients, however 15–20% of patients experience chronic post-surgical pain (CPSP). Many will experience neuropathic characteristics. We describe the prevalence and patterns of neuropathic pain in a
Periprosthetic joint infections (PJIs) centers are garnering the attention of different arthroplasty surgeons and practices alike. Nonetheless, their value has yet to be proven. Therefore, we evaluated weather PJI centers produce comparable outcomes to the national average of THA PJIs on a national
Aim. Culture negative (CN) prosthetic joint infections (PJI) account for approximately 10% of all PJIs and present significant challenges for clinicians. We aimed to explore the significance of CN PJI within a large prospective cohort study, and to compare their characteristics and outcomes with culture positive cases. Methods. The Prosthetic joint Infection in Australia and New Zealand Observational (PIANO) study is a prospective, binational, multicentre observational cohort study conducted at 27 hospitals between July 2014 and December 2017. We compared baseline characteristics and outcomes of all patients with culture negative (CN) prosthetic joint infection (PJI) from the PIANO
Aims. Use of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased in recent years due to proposed benefits, including a lower risk of dislocation and improved early functional recovery. This study investigates the dislocation rate in a non-selective, consecutive
We present a consecutive case
Most hip replacements are performed in an in-patient setting; however, there has been a shift in recent years in Canada towards doing more on an outpatient basis. In 2021–2022, 15.6% of hip replacements were performed as day surgeries compared to 0.7% in 2018–2019. This analysis will assess patient reported outcome measures of patients who had inpatient versus outpatient hip replacement surgery between 2018 and 2021. We analysed a retrospective sample of 4917 adult patients who had an elective primary unilateral hip replacement. Preoperative and three-month postoperative PROMs were completed - the Oxford Hip Score, EQD5L and patient satisfaction with the outcome were recorded. Patients who had an outpatient procedure were matched 1:1 with patients who are admitted to hospital for surgery based on age, sex and pre-COVID versus the COVID (March 15, 2020 as the start). Preoperative PROMs and Charlson Comorbidity Index were collected. T-tests and chi-square tests were used to assess the differences. The inpatient group on average was older, female and had a lower preoperative PROMs score and more comorbidities than the outpatient group. With
Introduction. Temporary spanning fixation aims to provide bony stability whilst allowing access and resuscitation of traumatised soft-tissues. Conventional monolateral fixators are prone to half-pin morbidity in feet, variation in construct stability and limited weight-bearing potential. This study compares traditional delta-frame fixators to a circular trauma frame; a virtual tibial ring block spanned onto a fine-wire foot ring fixation. Materials and Methods. The two
While Oxidized Zirconium (OxZr) femoral heads matched with highly cross-linked polyethylene (XLPE) have demonstrated the lowest rate of revision compared to other bearing couples in the Australian National Joint Registry, it has been postulated that these results may, in part, be due to the fact that a single company offers this bearing option with a limited combination of femoral and acetabular prostheses. The purpose of this study was to assess clinical and radiographic outcomes in a matched
Aims. The aim of this study was to determine the long-term risk of undergoing knee arthroplasty in a
Aims. Few risk factors for rotator cuff disease (RCD) and corresponding treatment have been firmly established. The aim of this study was to evaluate the relationship between numerous risk factors and the incidence of surgery for RCD in a large
The stem design in total hip arthroplasty (THA) is constantly evolving. The impact of the collar on the risk of periprosthetic fracture remains controversial. This study aimed to determine whether adding a collar to the femoral stem impacts the early periprosthetic fracture risk within 90 days of surgery. This retrospective study included 1,623 patients who underwent primary total hip arthroplasty in a single orthopedic department between January 2010 and December 2020. The inclusion criteria were uncemented stem with or without a collar, in a primary intention, without previous hip surgery with a similar “corail like” design. The assessed data were demographic characteristics (age, gender, number of obese (BMI > 30)), single or dual mobility, the surgical approach, the early complication, particularly the periprosthetic femoral fractures. Of the 1,623 patients, 1,380 received a collared stem (85%), and 243 received a collarless stem (15%). A multivariate analysis was performed to determine the collar's effect on the risk of early periprosthetic fracture (<90 days). Nine (0.55%) early periprosthetic fractures were identified in the whole
Introduction. Degenerative spondylosis (DS) represents a challenging condition to diagnose and treat. There are multiple modalities to investigate DS including X-ray, MRI and CT, but symptoms may not be equivocal to DS to support the clinical findings. The investigation of metastases commonly utilises SPECT/CT for identification of areas of increased osteoblastic activity to denote disease. The aim of the study was to analyse the prevalence of asymptomatic DS in a consecutive hospital
Patellofemoral instability (PFI) is a common cause of knee pain and disability in the paediatric population. Patella alta, lateralised tibial tubercle, medial patellofemoral ligament (MPFL) deficiency, genu valgum and trochlear dysplasia are well known risk factors. A prospective database was created including patients referred through our physiotherapy pathway following first-time patella dislocation. Patella alta and lateralisation of the tibial tuberosity was treated with a Fulkerson-type tibial tubercle osteotomy(TTO). Medial patellofemoral ligament was reconstructed using quads tendon autograft pull-down technique. A modified Sheffield protocol was used postoperatively allowing weightbearing in a hinged knee brace. Forty patients were identified with 8 patients having bilateral presentations. Male to female ratio was 12:28 with an age range of 4–17 years. Eight patients had congenital PFI, five patients acquired PFI through traumatic patella dislocation and twenty-seven patients developed PFI from recurrent dislocations. Structural abnormalities were found in 38(95%) of patients. Patella alta (Caton-Deschamps index >1.2) was identified in 19(47%) patients, genu valgum in 12(30%) patients, increased tibial tubercle-trochlear groove distance(TT-TG>20mm) was present in 9(22.5%) patients and persistent femoral anteversion(> 20 deg) in 7(17%) patients. Eight patients were treated with TTO and MPFL reconstruction, three patients with MPFL reconstruction alone and five patients had guided growth for genu valgum correction. Ten patients are awaiting surgery. No postoperative patients had recurrence of PFI at their latest follow up. PFI is a common problem in the adolescent paediatric population with identifiable structural abnormalities. Correcting structural pathology with surgery leads to predictable and safe outcomes.
Purposes and Background. Musculoskeletal disorders are leading causes of work disability. Our purpose was to develop a predictive model in a
Midfoot arthrodesis is the conventional surgical intervention for midfoot arthritis. Arthrodesis aims to stabilise, realign and fuse the affected joints, providing patients with improved pain and function. Current research neglects the measurement of patient reported outcomes. This study aimed to investigate objective, and patient reported outcomes of midfoot arthrodesis. The secondary aim was to identify variables predicting the development of non-union. An automated search of online patient records identified 108 eligible patients (117 feet). The rates of union, re-operations, and complications were calculated using radiographs and medical records. Logistic regression was used to model variables influencing the odds of non-union. All living patients were posted a Manchester Oxford Foot Questionnaire (MOx-FQ), a patient reported outcome assessment. Pre-operative MOx-FQ results were available in a minority of cases. Students t-test was used to compare pre- and post-operative MOx-FQ scores. The rate of union achieved was 74%. The rate of re-operations was 35%. The rate of complications was 14%. Bone grafts and staple fixation independently impacted the odds of non-union. Bone grafts decreased the odds of non-union, whilst staple fixation increased the odds. This finding agrees with the opinion of other researchers. We recommend the use of bone grafts, and the avoidance of fixation with staples. Previous attempts have been made to assess patient outcomes. However, this study is the first to use the MOx-FQ, a validated questionnaire. Therefore, this study establishes a baseline for improvements in patient reported outcomes.
Abstract. Objectives. Principal Component Analysis (PCA) is a useful method for analysing human motion data. The objective of this study was to use PCA to quantify the biggest variance in knee kinematics waveforms between a Non-Pathological (NP) group and individuals awaiting High Tibial Osteotomy (HTO) surgery. Methods. Thirty knees (29 participants) who were scheduled for HTO surgery were included in this study. Twenty-eight NP volunteers were recruited into the study. Human motion analysis was performed during level gait using a modified Cleveland marker set. Subjects walked at their self-selected speed for a minimum of 6 successful trials. Knee kinematics were calculated within Visual3D (C-Motion). The first three Principal Components (PCs) of each input variable were selected. Single-component reconstruction was performed alongside representative extremes of each PC to aid interpretation of the biomechanical feature reconstructed by each component. Results. Pre-operatively patient demographics included (age: 50.70 (8.71) years; height: 1.75 (.11) m; body mass: 90.57 (20.17) kg; mTFA: 7.75 (3.72) degrees varus; gait speed: 1.06 (0.23) m/s). The HTO
Reduced cervical spine canal AP diameter is linked to the development of spinal cord injury and myelopathy. This is of particular interest to clinicians in New Zealand, given a unique socio-ethnic make-up and prevalent participation in collision sport. Our study builds upon previous unpublished evidence, by analysing normal cervical spine CT scans to explore morphological differences in the sub-axial cervical spine canal, between New Zealand European, Māori and Paciāca individuals. 670 sub-axial cervical vertebrae (C3-C7) were analysed radiographically using high resolution CT trauma scans, showing no acute pathology with respect to the cervical spine. All measurements were made uPlising mulP-planar reconstruction software to obtain slices parallel to the superior endplate at each vertebral level. Maximal canal diameter was measured in the AP and transverse planes. Statistical analysis was performed using analysis of variance (ANOVA). We included 250 Maori, 250 NZ European and 170 Paciāca vertebrae (455 male, 215 female). Statistically and clinically signiācant differences were found in sagittal canal diameter between all ethnicities, at all spinal levels. NZ European vertebrae demonstrated the largest AP diameter and Paciāca the smallest, at all levels. Transverse canal diameter showed no signiācant difference between ethnicities, however the raatio of AP:transverse diameter was signiācantly different at all spinal levels except C3. Subjective morphological differences in the shape of the vertebral canal were noted, with Māori and Paciāca patients tending towards a flatter, curved canal shape. A previous study of 166 patients (Coldham, G. et al. 2006) found cervical canal AP diameter to be narrower in Māori and Paciāca patients than in NZ Europeans. Our study, evaluating the normal population, conārms these differences are likely reflecPve of genuine variation between these ethniciPes. Future research is required to critically evaluate the morphologic differences noted during this study.
Purpose. The success of total knee replacement (TKR) surgery can be attributed to improvements in TKR design, instrumentation, and surgical technique. Over a decade ago oxidized zirconium (OxZr) femoral components were introduced as an alternative bearing surface to cobalt-chromium (CoCr), based on strong in-vitro evidence, to improve the longevity of TKR implants. Early reports have demonstrated the clinical success of this material however no long-term comparative studies have demonstrated the superiority of OxZr implants compared to a more traditional CoCr implant. This study aims to compare long-term survivorship and outcomes in OxZr and CoCr femoral components in a single total knee design. Methods. We reviewed our institutional database to identify all patients whom underwent a TKA with a posterior stabilized OxZr femoral component with a minimum of 10 years of follow-up. These were then matched to patients whom underwent a TKA with the identical design posterior stabilized CoCr femoral component during the same time period by gender, age and BMI. All patients had their patella resurfaced. All patients were prospectively evaluated preoperatively and postoperatively at 6 weeks, 3 months, 12 months, 2 years and every 1 to 2 years thereafter. Prospectively collected clinical outcome measures included, Western Ontario and McMaster Universities osteoarthritis index (WOMAC), Short-Form 12 (SF-12) and Knee Society clinical rating scores (KSCRS). Charts and radiographs were reviewed to determine the revision rates and survivorship (both all cause and aseptic) at 10 years allowing comparison between the two
The purpose of this study was to compare intra-operative, clinical, functional, and patient-reported outcomes following revision anterior cruciate ligament reconstruction (ACL-R) with a matched
Recurrent patellar dislocation in combination with cartilage injures are difficult injuries to treat with confounding pathways of treatment. The aim of this study is to compare the clinical and functional outcomes of patients operated for patellofemoral instability with and without cartilage defects. 82 patients (mean age-28.8 years) with recurrent patellar dislocations, who underwent soft-tissue or bony procedures, were divided into 2 matched groups (age, sex, follow-up and type of procedure) of 41 each based on the presence or absence of cartilage defects in patella. Chondroplasty, microfracture, osteochondral fixation or Autologous Matrix-Induced Chondrogenesis(AMIC)-type procedures were done depending on the nature of cartilage injury. Lysholm, Kujala, Tegner and Subjective Knee scores of both groups were compared and analysed. Complications and return to theatre were noted.Background
Methods
Background. Cam morphology develops during adolescence and predisposes individuals to future hip pain and osteoarthritis. An improved understanding of cam development is required to determine whether the process is modifiable. Hypothesis/Purpose. The aim of this study was to characterise the risk factors, timing, and pathogenesis of cam formation. Study Design. Longitudinal prospective observational cohort study. Methods. Longitudinal observational cohort study over three years of individuals from football club academies and an age-matched control population, aged 9–18 years at baseline. Assessments include questionnaires, clinical examination, and MRI of both hips. Alpha angle and epiphyseal extension were measured on radial images. Results.
Introduction:. The role of total ankle replacements remains unproven within orthopaedic literature. We present a prospective series of patients who underwent a SALTO TAR (Tornier) between October 2006 and January 2014. Methods:. A
Introduction. Missile injuries are very serious injuries particularly in the cervical region. They are classified into high and low missile injuries when it involves the cervical spine. In modern guerrilla warfare, one must be aware of ballistic pathology with bullets as well as from explosives. In particular, improvised explosive devices commonly known as IED's play a new and important pathophysiology whether they are suicided vests or roadside bombs. They usually produce severe or lethal injuries and serious neurovascular deficit is frequent. We present the details of 40 patients with local experience on how to handle serious penetrating cervical missile injuries. Methods. All cases were collected from the record of Basrah University Hospital, Iraq. Healthy military gentlemen with ages ranging between 20–35 years were included. Results. 11 patients had bullet injuries and 29patients had fragments of shell injuries. The sites of injuries were 9: C2–C3, 12: C5–C6, 12: C4–C5 and 7: C7-T1. Bullet entrance was anterior in 23 patients, posterior in 7 patients and lateral in 10 patients. The cervical vertebrae were injured in 37 patients at body or lamina level while in 3 patients it was only neural tissue injuries. Missiles were retained in 13 patients. All injuries showed some degree of neurological deficit with quadriplegia in 26 patients. 9 patients presented with very serious injuries. No relation was found between the size of the missile and the extent of damage. Outcome of treatment in all patients was poor. Conclusion. Gunshot wounds only account for approximately one third of penetrating missile injuries in patients who survive and are well enough to receive medical treatment. 62% of patients'
Post-operative periprosthetic fracture of the femur (POPFF) is a growing problem associated with increased mortality. Most registry derived estimates of mortality only record patients who undergo revision and cohort studies are generally limited to a single center, which makes comparison for the purposes of service improvement difficult. The aim of this study is to perform a systematic review and meta-analysis of cohort studies reporting mortality following POPFF in the last decade. Study methodology was peer-reviewed (PROSPERO: CRD42020170819). Literature search was conducted using Medline and EMBASE. Primary exposure was the diagnosis of POPFF, and the primary outcome measure was all-cause mortality: whilst an inpatient, within 30-days, within 90-days and within one year of POPFF. Proportion of patients dying (95% CI [confidence interval]) was estimated using metaregression. Results were compared to mortality following neck of femur fracture (NOF) from international NOF registry data. 4841 patients from 35 cohort studies were included. Study quality was generally low with a majority limited to a single centre. Weighted mean follow-up was 2.3 years and the most common POPFF was UCS B. Pooled proportion dying as an inpatient was 2.4% (95% CI 1.6% to 3.4%). Pooled proportion dying within 30 days was 3.3% (95% CI 2.0% to 5.0%). Pooled proportion dying within 90 days was 4.8% (95% CI 3.6% to 6.1%). Pooled proportion dying within one year was 13.4% (95% CI 11.9% to 14.8%). Mortality following POPFF was similar to that of NOF up to 30 days, but better at one year. 3.3% of patients die following POPFF within 30 days of injury. Mortality is similar to that experienced by patients following NOF up to 30 days, but better at one year, which may represent the lower underlying risk of death in the POPFF
Given the high prevalence of psychiatric illness in the total joint arthroplasty (TJA) population, relatively little is known about how these two conditions affect each other. Therefore, the purpose of this study is to evaluate the role of major psychiatric illness on patient specific outcomes after TJA. We hypothesize that patients with major psychiatric illnesses will report inferior outcomes and have more complications after TJA compared to those without any psychiatric illness. We matched and compared two
Introduction. There is considerable interest in the orthopaedic community in understanding the multifactorial process of taper fretting corrosion in total hip arthroplasty (THA). Previous studies have identified some patient and device factors associated with taper damage, including length of implantation, stem flexural rigidity, and head offset. Due to the complexity of this phenomenon, we approached the topic by developing a series of matched cohort studies, each attempting to isolate a single implant design variable, while controlling for confounding factors to the extent possible. We also developed a validated method for measuring material loss in retrieved orthopaedic tapers, which contributed to the creation of a new international standard (ASTM F3129-16). Methods. Based on our implant retrieval collection of over 3,000 THAs, we developed independent matched cohort studies to examine (1) the effect of femoral head material (metal vs. ceramic, n=50 per cohort) and (2) stem taper surface finish (smooth vs. microgrooved, n=60 per cohort). Within each individual study, we adjusted for confounding factors by balancing implantation time, stem taper flexural rigidity, offset, and, when possible, head size. We evaluated fretting and corrosion using a four-point semiquantitative score. We also used an out-of-roundness machine (Talyrond 585) to quantify the material loss from the tapers. This method was validated in a series of experiments of controlled material removal on never-implanted components. Results. In the first study, the ceramic
Currently, gram-negative bacteria (GNB), including multidrug-resistant (MDR-GNB) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). To characterize the antimicrobial resistance patterns of Gram-negative bacteria (GNB) causing hip prosthetic joint infections in elderly patients treated at a Brazilian tertiary academic hospital. This is a retrospective, cross-sectional study of patients over 60 years of age undergoing hip arthroplasty from 2018 to 2023 at a tertiary academic trauma, which were diagnosed with hip prosthetic joint infection. PJI diagnosed was based on EBJIS criteria, in which intraoperative tissue cultures identified the pathogens. Demographics, reason for arthroplasty, type of implant and susceptibility patterns using disk diffusion method were analysed.Aim
Method
Surgical treatment of ankle fractures comes with a substantial risk of complications, including infection. An unambiguously definition of fracture-related infections (FRI) has been missing. Recently, FRI has been defined by a consensus group with a diagnostic algorithm containing suggestive and confirmatory criteria. The aim of the current study was to report the prevalence of FRI in patients operated for ankle fractures and to assess the applicability of the diagnostic algorithm from the consensus group. Records of all patients with surgically treated ankle fractures from 2015 to 2019 were retrospectively reviewed for signs of postoperative infections. Patients with suspected infection were stratified according to Aim
Method
We present a prospective two-year follow-up study of 1038 hip arthroscopies performed at a high volume tertiary referral centre for hip preservation. We feel that this manuscript is both pertinent and timely due to the advances in the field of hip preservation. We used four validated patient-reported outcome (PRO) scores along with the visual analog scale (VAS) and patient satisfaction scores to assess preoperative and postoperative outcomes in all patients undergoing hip arthroscopy. We divided the entire
Objectives. The primary aim of this study was to assess the reproducibility of the recalled preoperative Oxford Hip Score (OHS) and Oxford Knee Score (OKS) one year following arthroplasty for a
The purpose of this study was to define the risk and incidence of eventual ankle arthroplasty or fusion after documented ankle fracture in a large
Anterior cruciate ligament (ACL) rupture with associated meniscal pathology commonly occurs in a young, active population. Preserving a greater proportion of the meniscus may improve long-term outcomes by maintaining shock absorption and knee stability. However, meniscal repair procedures involve longer healing and rehabilitation than meniscal debridement, which could affect return to work and activity. The purpose of this study was to examine the functional outcomes and quality of life scores through two years in patients undergoing ACL reconstruction (ACL-R) who had meniscal repair, meniscal debridement, or no meniscal damage at the time of reconstruction. Data for 1814 skeletally mature patients with isolated primary ACL-R was prospectively collected at a single centre from January 2010 to December 2015. Functional testing of operative to non-operative limb performance was completed at one- and two-years following surgery and included single-leg balance, single-leg hop for distance, timed six-meter hop, triple-hop for distance, and triple cross-over hop for distance. ACL-Quality-of-life questionnaires (ACL-QoL) were completed pre-operatively and at 1- and 2-years post-operatively. Descriptive statistics were completed for patient demographics and intra-operative pathology. Unpaired t-tests using 95% confidence intervals were conducted to compare groups. The patient
In Norway total joint replacement after hip dysplasia
is reported more commonly than in neighbouring countries, implying
a higher prevalence of the condition. We report on the prevalence
of radiological features associated with hip dysplasia in a population
of
2081 19-year-old Norwegians. The radiological measurements used
to define hip dysplasia were Wiberg’s centre-edge (CE) angle at
thresholds of <
20° and <
25°, femoral head extrusion index
<
75%, Sharp’s angle >
45°, an acetabular depth to width ratio
<
250 and the sourcil shape assessed subjectively. The whole
cohort underwent clinical examination of their range of hip movement,
body mass index (BMI), and Beighton hypermobility score, and were
asked to complete the EuroQol (EQ-5D) and Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC). The prevalence of hip
dysplasia in the
Management of intra-articular calcaneal fractures remains a debated topic in orthopaedics, with operative fixation often held in reserve due to concerns regarding perioperative morbidity and potential complications. The purpose of this study was to identify the characteristics of patients who developed surgical complications to inform the future stratification of patients best suited to operative treatment for intra-articular calcaneal fractures and those in whom surgery was highly likely to produce an equivocal functional outcome with potential post-operative complications. All patients who underwent open reduction and internal fixation of calcaneal fractures utilizing the Sinus Tarsi approach between March 2014 and July 2018 were identified using theatre records. Patient imaging was used to assess pre- and post-operative fracture geometry with Computed Tomography (CT) used for pre-operative planning. Each patient's clinical presentation was established through retrospective analysis of medical records. Patients provided verbal consent to participation and patient reported outcome measures were recorded using the Maryland Foot Score.Aims
Methods
This is quite an innovative study that should lead to a multicentre validation trial. We have developed an FDG-PET/MRI texture-based model for the prediction of lung metastases (LM) in newly diagnosed patients with soft-tissue sarcomas (STSs) using retrospective analysis. In this work, we assess the model performance using a new prospective STS
A retrospective review of 57 military patients undergoing ankle arthroscopy between 1999 and 2011 was performed. A case-note review of medical records was undertaken pertaining to military role, ankle injury sustained, mechanism, presenting symptoms and their duration. Arthroscopic findings were compared to findings on radiographs and MRI scans. At first presentation 23 patients had features of arthritis on radiographs. We found MRI was both highly sensitive (97.7%) and specific (93.4%) in detecting osteochondral defects (OCD). 16 of the patients had evidence of osteochondral injury. All OCDs picked up on MRI were confirmed at arthroscopy. Ankle injury may not be a benign injury in military personnel, with over half of these young patients having radiological features of osteoarthritis at presentation. We found MRI an effective tool for identifying occult injuries not seen on radiographs. Lateral ligament injury with associated gutter scarring can be successfully treated with arthroscopic debridement. This suggests pseudoinstability rather than a true mechanical instability as the main cause for patient's symptoms in this
Osteoporosis can cause significant disability and cost to health services globally. We aim to compare risk fractures for both osteoporosis and fractures at the L1-L4 vertebrae (LV) and the neck of femurs (NOFs) in patients referred for DEXA scan in the North-West of England. Data was obtained from 31546 patients referred for DEXA scan in the North-West of England between 2004 and 2011. Demographic data was retrospectively analysed using STATA, utilising chi-squared and t-tests. Logistical models were used to report odds ratios for risk factors included in the FRAX tool looking for differences between osteoporosis and fracture risk at the LV and NOFs. In a study involving 2530 cases of LV fractures and 1363 of NOF fractures, age was significantly linked to fractures and osteoporosis at both sites, with a higher risk of osteoporosis at NOFs compared to LV. Height provided protection against fractures and osteoporosis at both sites, with a more pronounced protective effect against osteoporosis at NOFs. Weight was more protective for NOF fractures, while smoking increased osteoporosis risk with no site-specific difference. Steroids were unexpectedly protective for fractures at both sites, with no significant difference, while alcohol consumption was protective against osteoporosis at both sites and associated with increased LV fracture risk. Rheumatoid arthritis increased osteoporosis risk in NOFs and implied a higher fracture risk, though not statistically significant compared to LV. Results summarised in Table 1. Our study reveals that established osteoporosis and fracture risk factors impact distinct bony sites differently. Age and rheumatoid arthritis increase osteoporosis risk more at NOFs than LV, while height and steroids provide greater protection at NOFs. Height significantly protects LV fractures, with alcohol predicting them. Further research is needed to explore risk factors’ impact on additional bony sites and understand the observed differences’ pathophysiology. For any figures or tables, please contact the authors directly.
Critical shoulder angle (CSA), lateral acromial angle (LAA), and acromion index (AI) are common radiologic parameters used to distinguish between patients with rotator cuff tears (RCT) and those with an intact rotator cuff. This study aims to assess the predictive power of these parameters in degenerative RCT. This retrospective study included data from 92 patients who were divided into two groups: the RCT group, which included 47 patients with degenerative full-thickness supraspinatus tendon tears, and a control group of 45 subjects without tears. CSA, AI, and LAA measurements from standardized true anteroposterior radiographs were independently derived and analyzed by two orthopedic surgeons. Receiver operating characteristic (ROC) analyses were performed to determine the cutoff values. No significant differences were found between patients in the RCT and control groups in age ( We conclude that CSA and AI may be useful predictive factors for degenerative RCT in the Turkish population.
Background. Total ankle replacement (TAR) design has evolved greatly in recent years and offers a reasonable alternative to ankle arthrodesis in a select patient population with end-stage arthritis. Originator series’ report good longevity and excellent patient reported outcomes (PROMs). We report our outcomes in an independent, non-inventor
Aim. To assess clinical outcome of massive rotator cuff tear repair using triceps myotendinous flap. Method. This is a prospective
Purpose: Total knee arthroplasty is one of the most successful modern surgical interventions with excellent clinical outcomes and implant survivorship. Nevertheless, with the increasing numbers of primary knee replacements being performed and increasing life expectancy, the need for revision arthroplasty continues to grow and is expected to grow considerably in to the future. Stemmed implants are commonly used in revision knee arthroplasty to provide adequate support for the joint interfaces. Controversy exists amongst surgeons as to the relative merits of cemented versus uncemented stems in revision knee arthroplasty. Cementing stemmed components in revision knee arthroplasty surgery is well established, and has well documented success rates. Though in widespread use, there is little data published regarding the technique of cementing short stubby tibial stems in revision TKA. We describe modes of failure in knee arthroplasty, our technique for revision, and early outcomes for this patient
Hip fracture is a global public health problem.
The National Hip Fracture Database provides a framework for service evaluation
in this group of patients in the United Kingdom, but does not collect
patient-reported outcome data and is unable to provide meaningful
data about the recovery of quality of life. We report one-year patient-reported outcomes of a prospective
cohort of patients treated at a single major trauma centre in the
United Kingdom who sustained a hip fracture between January 2012
and March 2014. There was an initial marked decline in quality of life from baseline
measured using the EuroQol 5 Dimensions score (EQ-5D). It was followed
by a significant improvement to 120 days for all patients. Although
their quality of life improved during the year after the fracture,
it was still significantly lower than before injury irrespective
of age group or cognitive impairment (mean reduction EQ-5D 0.22;
95% confidence interval (CI) 0.17 to 0.26). There was strong evidence
that quality of life was lower for patients with cognitive impairment.
There was a mean reduction in EQ-5D of 0.28 (95% CI 0.22 to 0.35)
in patients <
80 years of age. This difference was consistent
(and fixed) throughout follow-up. Quality of life does not improve
significantly during recovery from hip fracture in patients over
80 years of age (p = 0.928). Secondary measures of function showed
similar trends. Hip fracture marks a step down in the quality of life of a patient:
it accounts for approximately 0.22 disability adjusted life years
in the first year after fracture. This is equivalent to serious
neurological conditions for which extensive funding for research
and treatment is made available. Cite this article:
Aims: To assess the failure rate at 5 years of the Elite Plus (DePuy) femoral stem and identify reasons for early failure. Particular attention was paid to the quality of the cement mantle. Methods: A
Background. Combined physical and psychological (CPP) programmes are widely recommended for Chronic Low Back Pain (CLBP) patients, but not often implemented. Patients with longstanding CLBP participating in a two-week CPP programme improve in functional status and quality of life and this is maintained at two-year follow up. One-year follow-up data is available of 955 participants. Purpose:. Evaluation of one-year follow-up outcomes of a large
We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice. Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed. Patients were invited to have their cobalt and chromium levels retested, and were provided an Oxford Hip Score. Serum ion levels were then compared between groups (28 mm, 36 mm, and 40 mm heads) and over time.Aims
Methods
In the young and highly active population of military patients, femoroacetabular impingement can be a source of serious disability as well as a threat to their career. This morbidity can be treated with hip arthroscopy with debridement of cam lesion, and excision or repair of a corresponding labral tear. We report on the long term outcomes (>1 year) of 26 military cases who underwent hip arthroscopy for femoroacetabular impingement, in a single surgeon's series. Twenty two patients (four bilateral cases) underwent hip arthroscopy as a day case procedure during the period February 2013 to October 2014. Non-Arthritic Hip Scores (NAHS) were obtained from patients pre-operatively, at two months, four months and at least one year post-operatively. There was a significant improvement in NAHS at two months (75.6)(p<0.05), four months (85.1)(p<0.001) and one year (84.8)(p<0.001), compared to pre-operative NAHS (65.8). There was no significant change in NAHS beyond four months. Only three out of the 22 patients were medically discharged secondary to persistent hip symptoms. Hip arthroscopy for femoroacetabular impingement is an effective, viable procedure for military patients. Mobility, pain and function is significantly improved after surgery. This improvement is sustained in the long term up to and beyond one year.
Introduction:. Total knee replacement (TKR) and total hip replacement (THR) reliably relieve pain, restore function, and ensure mobility in patients with advanced joint arthritis; however these results are not uniform across all patient populations. Moreover, it is well established that knee replacement patients have outcomes inferior to those undergoing hip replacement procedures with lower rates of dissatisfaction with post-operative function and pain relief. We compared baseline demographic and symptom profiles in patients from a US national
Introduction. A minority of patients with chronic low back pain (CLBP) account for a majority of disability and costs. This subgroup has potentially most to gain from effective treatment. The Groningen Spine
Background The minimum size required for a successful quadrupled hamstring autograft ACL reconstruction remains controversial. The risks of ACL re-tear in younger patients who tend to participate in a higher level of sports activity, and female athletes who have numerous predisposing factors, are poorly defined. Purpose To identify risk factors for graft re-tears within 2 years of ACL surgery. The hypotheses are that female sex, a smaller size graft, and younger patients will increase the odds of failure. Study Design Cohort Study. Level of evidence, 3. A
The reported prevalence of an asymptomatic slip
of the contralateral hip in patients operated on for unilateral slipped
capital femoral epiphysis (SCFE) is as high as 40%. Based on a population-based
cohort of 2072 healthy adolescents (58% women) we report on radiological
and clinical findings suggestive of a possible previous SCFE. Common
threshold values for Southwick’s lateral head–shaft angle (≥ 13°)
and Murray’s tilt index (≥ 1.35) were used. New reference intervals
for these measurements at skeletal maturity are also presented. At follow-up the mean age of the patients was 18.6 years (17.2
to 20.1). All answered two questionnaires, had a clinical examination
and two hip radiographs. There was an association between a high head–shaft angle and
clinical findings associated with SCFE, such as reduced internal
rotation and increased external rotation. Also, 6.6% of the cohort
had Southwick’s lateral head–shaft angle ≥ 13°, suggestive of a
possible slip. Murray’s tilt index ≥ 1.35 was demonstrated in 13.1%
of the
Purpose. Health literacy, the ability to seek, understand and utilise health information, is important for health and health-related decisions. Suboptimal health literacy is associated with poorer health outcomes in many chronic conditions although this has not been studied in chronic low back pain (CLBP). This study explored health literacy in a community
Summary Statement. This data may help explain the variability in physical function after primary TKR as compared to primary THR. Introduction. Total knee replacement (TKR) and total hip replacement (THR) reliably relieve pain, restore function, and ensure mobility in patients with advanced joint arthritis; however these results are not uniform across all patient populations. We compared baseline demographic and symptom profiles in patients from a US national
Hip fractures are a leading cause of hospital admission and an increasing problem within the ageing population. The two main treatment options for displaced intracapsular fractures are total hip arthroplasty and hemiarthroplasty. This service evaluation aims to compare the outcomes of patients over 80 years old with a younger
Aims: In 1999 we published a
Patellofemoral osteoarthritis (PFOA) affects 32% men and 36% women over the age of 60years and is associated with anterior knee pain, stiffness, and poor mobility. Patellofemoral arthroplasty (PFA) is a bone-sparing treatment for isolated PFOA. This study set out to investigate the relationship between patient-related outcome measures (PROMs) and measurements obtained from gait analysis before and after PFA. There are currently no studies relating to gait analysis and PFA available in the literature A prospective cohort study was conducted of ten patients known to have isolated PFOA who had undergone PFA compared to a gender and age matched control group. The patients were also asked to complete questionnaires (Oxford knee score (OKS), EQ-5D-5L) before surgery and one year after surgery. Gait analysis was done on an instrumented treadmill comparing Ground reaction force parameters between the control and pre and post-operative PFA patients The average age 60 (49–69) years with a female to male ratio of 9:1. Patient and healthy subjects were matched for age and gender, with no significant difference in BMI. Post-op PFA improvement in gait seen in ground reaction force at 6.5km/h. Base support difference was statistically significant both on the flat P=0.0001 and uphill P=0.429 (5% inclination) and P=0.0062 (10% inclination). PROMS response rate was 70%(7/10) pre-operative and 60%(6/10) post-operative. EQ-5D-5L scores reflected patient health state was better post-operatively. This study found that gait analysis provides an objective measure of functional gait and reflected by significant quality-of-life improvement of patients post PFA. Literature lacks studies relating to gait-analysis and PFA. Valuable information provided by this study highlights that PFA has a beneficial outcome reflected by PROMs and improvement in vertical ground reaction force and gait Further research is needed to assess how care-providers may use gait-analysis as part of patient care plans for PFOA patients.
Introduction and Aims: The role of tendon transfer in progressive hereditary motor sensory neuropathy (CMT) is controversial. This paper examines a large single surgeon
The primary aim of this study was to examine whether the use of iodine impregnated incision drape (IIID) decreased the risk of periprosthetic joint infections (PJIs). The secondary aim was to investigate whether intraoperative contamination could predict postoperative infection. PJI is a devastating incident for the patients and in a population that is getting older and the incidence of arthroplasty surgery is rising it is vital to keep the infection rate as low as possible. Despite prophylactic measures as pre-operative decontamination, antisepsis and prophylactic antibiotics the infection rate has been constant at 1–2%. We performed a transregional, prospective, randomized two arm study (IIID vs control group) of 1187 patients undergoing primary knee arthroplasty surgery. A database with patient demographics and surgical observations was established with the purpose of following the patients for ten years. Patients, who developed an infection within the first year of surgery were analyzed for correlation with the intraoperative bacterial findings and the use of IIID.Aim
Method
Many studies report the incidence and prevalence of surgical site infections (SSIs) following open fractures; however, there is limited information on the treatment and subsequent outcomes of superficial SSIs in open fracture patients. There is also a lack of clinical studies describing the prognostic factors that are associated with failure of antibiotic treatment (non-operative) for superficial SSI. To address this gap, we used data from the FLOW (Fluid Lavage in Open Fracture Wounds) trial to determine how successful antibiotic treatment was for superficial SSIs and to identify prognostic factors that could be predictive of antibiotic treatment failure. This is a secondary analysis of the FLOW trial dataset. The FLOW trial included 2,445 operatively managed open fracture patients. FLOW participants who had a non-operatively managed superficial SSI diagnosed in the 12 months post-fracture were included in this analysis. Participants were grouped into two categories: 1) participants whose superficial SSI resolved with antibiotics alone and 2) participants whose SSI did not resolve with antibiotics alone (defined as requiring surgical management or SSI being unresolved at final follow-up (12-months post-fracture for the FLOW trial)). Antibiotic treatment success and the date when this occurred was defined by the treating surgeon. A logistic binary regression analysis was conducted to identify factors associated with superficial SSI antibiotic success. Based on biologic rationale and previous literature, a priori we identified 13 (corresponding to 14 levels) potential factors to be included in the regression model. Superficial SSIs were diagnosed in168 participants within 12 months of their fracture. Of these, 139 (82.7%) had their superficial SSI treated with antibiotics alone. The antibiotic treatment was successful in resolving the superficial SSI in 97 participants (69.8%) and unsuccessful in resolving the SSI in 42 participants (30.2%). We found that superficial SSIs that were diagnosed later in follow-up were associated with failure of treatment with antibiotic alone (Odds ratio 1.05 for every week in diagnosis delay, 95% Confidence Interval 1.004–1.099; p=0.03). Age, sex, fracture severity, fracture pattern, wound size, time from injury to initial surgical irrigation and debridement were not associated with antibiotic treatment failure. Our secondary analysis of prospectively collected FLOW data found antibiotics alone resolved superficial SSIs in 69.8% of patients diagnosed with superficial SSIs. We also found that superficial SSIs that were diagnosed earlier in follow-up were associated with successful treatment with antibiotics alone. This suggests that if superficial SSIs are diagnosed and treated promptly, there is a higher probability that they will resolve with antibiotic treatment.
Aims: Nationwide, computer-based survey of all total joint arthroplasties performed in Finland has been carried out since January 1980. From these records a
An additional pathology should be considered for Achillodynia differentials – the intratendinous tear (ITT) – for which we describe symptoms, ultrasound findings and co-presenting pathology. Examinations of 740 Achillodynic patients in one specialist centre were reviewed. ITTs were defined as a clearly visualised echopoor area situated centrally and extending to, but not through the tendon periphery, with pain on palpation and no clinical findings consistent with Achilles rupture. Descriptive statistics were used to analyse differences between pathological sub-groups, and images described qualitatively.Introduction
Materials and Methods
Acute postoperative infection is reported to occur in 0.3–2% after arthroscopic rotator cuff repair. Few reports have addressed this dreaded complication although the costs are high both for the patient and for society. The aim of this prospective study was to describe incidence, treatment and outcome after acute postoperative infections following arthroscopic rotator cuff repair. Patients undergoing arthroscopic rotator cuff repair in our department have been prospectively registered since 2009. 11 out of 1072 patients undergoing surgery developed an acute postoperative infection. The patients were examined with an MRI scan and/or functional scores (Constant Murley (CM) and WORC) at final follow-up.Aim
Method
Hip resurfacing with metal-on-metal in patients with osteonecrosis (ON) raises concerns of early failure. This study addresses the hypothesis that osteonecrosis as a pre-operative diagnosis significantly increases the risk of failure following hip resurfacing. We analyzed data of 202 hips that underwent metal-on-metal hip resurfacing. In group 1 were 101 hips with a pre-operative diagnosis of osteonecrosis. In group 2 were 101 hips with other pre-operative diagnosis of osteoarthritis. Survival analysis with Cox regression was used to compare the revision risks of both groups. The mean age at operation was 42 years in osteonecrotic and 43 years in osteoarthritic group. The preoperative and postoperative hip scores were 62 and 96 for osteonecrotic group and 58 and 95 for osteoarthritic group, respectively. Survival analysis with revision for any reason as the endpoint was performed on the two groups which had identical follow-up periods. Survival at 10 years was 97.7% for osteonecrosis and 95.0% for osteoarthritis. The revision risk for patients with osteonecrosis was lower (0.37, 95% CI 0.07 – 1.82, Cox regression) but the difference was not significant (p = 0.19). Our study found no difference in revision risk in patients with osteonecrosis as compared to those with osteoarthritis
Seventy-four patients presented before the age of six months. Of these, fifteen required operative intervention. Of the thirty-eight patients presenting over the age of six months, twenty-four required operative intervention. The incidence of late presentation of DDH was 1.11 per 1000. Ten of the late referrals had risk factors for DDH. At the seven month assessment the health visitor successfully identified and referred thirteen patients.
Various arthroscopic techniques using differing graft materials have been described and present a potential alternative to arthroplasty for rotator cuff arthropathy. We describe the short-term outcomes of allograft reconstruction, having evolved of our surgical technique from graft interposition to superior capsule reconstruction (SCR). All patients with an irreparable tear, in the absence of clinical and radiograph evidence of osteoarthritis, who underwent an allograft (Graft JacketTM) reconstruction with either an arthroscopic interposition or SCR technique within our institution were included. A retrospective case note analysis was performed to ascertain perioperative details including total operating and consumable implant costs. 15 patients were in the interposition group, mean age 66 years (48–77). Mean postoperative follow-up time was 17 months (1.9 −27.8). The mean OSS improved from 30.6 to 35.7 (p<0.05). Additionally, mean pain scores out of 10 improved from 7.7 to 1.5 (p<0.01). Mean satisfaction for the surgery was 7.8 out of 10. Complications included 2 re-ruptures (13.3%), 1 infection (6.7%) and 1 case of no improvement (6.7%). In the SCR group, there were 10 patients, mean age 64.5 (56– 68 years). Half of these patients had previous rotator cuff surgery. Mean postoperative follow-up time was 8.7 months (1.9 – 16.3). The mean OSS improved from 24 to 32.9 (p<0.01). Similarly, pain scores decreased from 7.9 to 3.5 (p<0.01). Mean satisfaction was 7.2. Complications included 1 case of no improvement (10%) resulting in a reverse TSR and 1 re-rupture (10%). A formal, prospective comparison trial is advocated to determine if SCR is superior.
Purpose: The aim of this study was to follow a prospective
Metal-on-metal (MOM) hip arthroplasty, including resurfacing, has become the subject of recent research and debate. There is the perceived benefit of improved wear rates of bearing surfaces leading to superior durability and performance of these types of implant. An associated feature of MOM bearing surfaces is the generation of metal ions. These can have local and systemic cytotoxic effects. An immunoloigical response has been suggested, however, metal wear debris may cause direct damage to cellular DNA. Studies have shown that release of these ions is related to bearing diameter and component alignment. However, little is known about the relationship between metal ion levels and implant survivorship. The MHRA has published guidelines on the follow-up of patients with MOM implants including measurement of serum ion levels and cross sectional imaging. Between February 2001 and November 2009, 135 patients (164 hips) had MOM resurfacing arthroplasty at our institution. We report a retrospective analysis of the data generated by review of these patients. Of the 135 patients, 91 were identified for clinical review. Each patient had serum metal ion levels measured, plain AP radiographs of the pelvis examined and, in the presence of raised metal ions, a Metal Artefact Reduction Sequence (MARS) MRI performed. 27 patients (35 hips) had raised metal ion levels (Cobalt and Chromium). Patients with raised metal ion levels had a mean acetabular cup inclination of 52.7 degrees compared with a mean inclination of 48.6 degrees in patients with normal ion levels (p<0.05). MARS MRI in the raised ion group revealed 9 patients with appearances suggestive of ALVAL. A number of these patients had hip revision surgery with the remainder awaiting potential revision. These findings reflect current evidence suggesting a relationship between sub-optimal component position and raised metal ion levels and an increased rate of ALVAL.
Purpose. The prevalence of focal chondral lesions reported inthe literature during knee arhroscopy can be as high as 63%. Of these, more than half are either grade III or grade IV lesions (Outerbridge). Full thickness cartilage lesions ranging from 2cm2 to 10cm2 are the most challenging to treat. To goal of this study was to evaluate clinical outcomes of pain, function and quality of life, along with radiological outcomes of cartilage repair using microfracture, autologous minced cartilage and polymeric scaffold. Method. A
Proximal humerus fractures are a common fragility fracture in older adults. A variety of treatment options exist, yet longer term outcomes of newer surgical treatments have not been extensively researched. Additionally, intermediate term outcomes following both surgical and non-surgical initial treatment of these injuries have not been evaluated at a population level. The purpose of this study was to utilise administrative data from Ontario, Canada to evaluate intermediate term outcomes following initial treatment of proximal humerus fractures. We used data from the Canadian Institute for Health Information to identify all patients aged 50 and older who presented to an ambulatory care facility with a “main diagnosis” of proximal humerus fracture from April 1, 2004 to March 31, 2013. Intervention codes from the Discharge Abstract Database were used to categorise patients into fixation, replacement, reduction or non-surgically treated groups. We used intervention codes to identify instances of complication-related operations following initial treatment (including fixation, replacement, hardware removal, rotator cuff repair and irrigation and debridement [I&D]) at one year post initial treatment. The majority of patients (28,369, 86.6%, 95% confidence interval [95% CI] 86.2–87.0%) were initially treated non-surgically, while 2835 (8.7%, 95% CI 8.4–9.0%) underwent initial fixation, 1280 (3.9%, 95% CI 3.7–4.1%) received primary joint replacement, and 276 (0.8%, 95% CI 0.8–1.0%) were initially treated with a reduction procedure. In the year following the initial treatment period, 127 (0.4%, 95%CI 0.4–0.5%) non-surgically treated patients underwent a replacement surgery, 292 (1.0%, 95%CI 0.9–1.2%) underwent fixation, and 12 (0.04%, 95% CI 0.02–0.07%) underwent a reduction procedure. Of the 2835 patients who received initial fixation, 57 (2.0%, 95% CI 1.6–2.6%) returned for a shoulder replacement, 80 received secondary fixation (2.8%, 95% CI 2.3–3.5%), 57 (2.0%, 95%CI 1.6–2.6%) underwent rotator cuff repair, 300 (10.6%, 95% CI 9.5–11.8%) had their implants removed, and 16 (0.6%, 95% CI 0.4–0.9%) returned for I&D. Of the 1280 patients who underwent initial replacement surgeries, 30 (2.3%, 95% CI 1.7–3.3%) returned for a secondary replacement, nine (0.7%, 95% CI 0.4–1.3%) underwent rotator cuff repair, and seven (0.6%, 95% CI 0.3–1.1%) had their implant removed. In the group who received initial reduction, eight (2.9%, 95% CI 1.5–5.6%) underwent a fixation procedure, six (2.2%, 95% CI 1.0–4.7%) received replacement surgeries, and five (1.8%, 95% CI 0.8–4.2%) each received rotator cuff repair and I&D in the year following initial treatment. The majority of proximal humerus fractures in patients 50 and older in Ontario, Canada are treated non-surgically. Complication-related operations in the year following initial non-operative treatment are relatively low. The most commonly observed procedure following initial fixation surgery is hardware removal.
The aims of the study were primarily to establish the overall success of debridement, antibiotics and implant retention (DAIR) in the management of infected total hip replacements (THRs) and secondarily to identify risk factors for failure. Using a standardised and recognised study protocol (“Meta-analysis of observational studies in epidemiology (MOOSE) guidelines) a systematic review and meta-analysis of the literature was performed. The primary outcome measure of interest was treatment success. The search strategy and inclusion criteria plus quality assessment yielded 39 articles eligible for analysis. The proportion of success from the literature following DAIR in the management of infected THRs is improving over time – the pooled mean proportion of success is 84.5% in studies from 2011–15. There was improved success with early debridement (75.7%) compared with delayed debridement (48.1%) (p=0.006). The reported outcomes following DAIR appear to be improving with time. One of the most influential determinants of outcome is timing of debridement from onset of symptoms. Surgeons should have a low threshold for investigating deep infection when presented with an acutely symptomatic THR and be aware of the updated reported outcomes associated with DAIR when considering management options.
Although tension band wiring fixation of patellar fracture has been the most widely used technique, the metal implants related complications including implant loosening, postoperative pain are very common and additional surgeries are often necessary. A totally metal free technique of transosseous suturing method could outperform the traditional fixation technique.Introduction
Hypothesis
We report the results of cementless total hip arthroplasty using the Bi-metric titanium femoral stem at a minimum follow up of 10 years and a mean of 12.2 years (range 10–17). 64 hips (43 male/21 female) were implanted consecutively into 54 patients between 1988 and 1995. The mean age at operation was 54.3 years (range 42–65). All patients had a Bi-metric uncemented stem (Biomet UK). The first 13 patients received a metal backed screw in acetabular cup (TTAP-ST, Biomet UK) with the remainder receiving metal backed pressfit cups (Universal, Biomet UK). All patients were followed up annually and assessed using the Hip Society Score (HSS; max 40 points) to record pain, function and mobility. Survivorship was calculated using the Kaplan-Meier method. 57 hips were followed up for a minimum of ten years. There were 4 deaths (6 hips) before completion of follow up and 1 patient was lost to follow up. Using revision for any reason as the end point of the study; survivorship for the total hips at 10 years was 89.5% (95% confidence interval: 78.1–96.1%) with a mean Hip Society Score of 34.9 (range 20–40) compared to 14.5 (range 8–24) pre-operatively (p<
0.01 student t test). Survivorship for the femoral stem in isolation was 100% at 10 years (95% CI 93.7–100%) and there continues to be no revisions to date at a mean follow up of 12.2 years. The screw fix cup performed poorly with 3 acetabular revisions (including 1 liner change) before the 10 year follow up, a failure rate of 23.1%. There has sub-sequently been a further 4 acetabular revisions. Ten year survivorship for the pressfit cup is 93.5% (95% CI 82.0–98.8%) with 3 revisions (including 2 liner changes) at ten years. There has subsequently been one further acetabular revision and 9 further liner changes (29.5% failure rate). There have been no recorded infections and no instances of thigh pain. Radiographs at ten years showed all the femoral stems were stable with no evidence of migration. Two stems had small radiolucent lines at the bone-implant interface but no signs of loosening. One stem had an area of osteolysis in Gruen zone 7 but didn’t require revision. Rates of osteolysis were extremely low given the large amounts of particulate debris in the hip from the worn acetabular liners. In conclusion, although neither cup has proved to be particularly successful the Bi-metric stem has performed well at 10 year follow up and continues to do so. This is inspite of the fact they were implanted into a young and active group of patients.
Differentially loaded radiostereometric analysis (DLRSA) uses RSA whilst simultaneously applying load to the bones under investigation. This technique allows measurement of interfragmentary translations and rotations under measured weight bearing and joint movement. We have recently introduced this technique to monitor tibial plateau fracture healing. This paper presents our preliminary results. Twelve patients with a 41 B2, B3, C2, or C3 fracture were followed for a minimum of three months. RSA beads were inserted in the largest osteochondral fragment and the adjacent metaphysis. Knee flexion was restricted to 60° for 6 weeks. After partial weight bearing (20kg) between 2 and 6 weeks, patients progressed to full weight bearing. Follow up included clinical and radiological examinations and patient reported outcome scores (Lysholm, KOOS). DLRSA examinations included RSA radiographs in 60° flexion and under measured weight bearing. Significant interfragmentary displacement was defined as translations greater than 0.5mm and/or rotations greater than 1.5°. There was no loss to follow-up. Longitudinal RSA follow-up: Follow-up RSA radiographs were compared to postoperative examinations. Osteochondral fragment depression was less than 0.5mm in seven patients and between 2 and 4mm in the remaining five patients. Significant interfragmentary displacement after three months was recorded in three patients. DLRSA flexion results: Under 60° of flexion, translations over 0.5mm were recorded in five patients (one postoperatively; one at 2 weeks; two at 6 weeks; and one postoperatively, at 2 weeks and at 3 months). Rotations over 1.5° were recorded in six patients (one postoperatively; two at 2 weeks; one at 6 weeks; one at 2 weeks, 3 months and 4.5 months; and one postoperatively, at 2 weeks, 3 months and 6 months). DLRSA weight bearing results: Under partial weight bearing at two weeks, two patients recorded significant translations, one involving a significant rotation. Under weight bearing as tolerated, three patients recorded significant translations (one at 6 weeks; and two at 18 weeks) and four patients recorded significant rotations (one at 6 weeks; one at 18 weeks; and two at 12 and 18 weeks). Patient Reported Outcomes: Both the Lysholm and KOOS scores improved between 6 weeks and 3 months. DLRSA provides new insight and perspective in tibial plateau fractures. Some fractures take more than three months to heal. Our current rehabilitation protocol was safe in most patients, however significant interfragmentary displacement was encountered in 17% at the 2 week followup, raising questions about the quality of the initial stability.
Patients and methods: A total of 500 (430 primary THR and 70 revision THR) consecutive patients were included in the study performed between January 2004 and May 2005 in Frederiksborg County (Denmark). They were to be followed for 90 days after surgery. Patients were interviewed before surgery for medical history and on days 5 (while in hospital) and 90 (by telephone call) for signs and symptoms of acute myocardial infarction (AMI), pulmonary embolism (PE), deep-vein thrombosis (DVT), transitory cerebral ischemia (TCI)/stroke and retinal vein thrombosis (RVT). The validity of the events was confirmed using files from hospital, general practitioner and international criteria. Results: Overall, 498 patients were followed-up for 90 days, 2 patients having withdrawn consent. In-hospital pharmacological thromboprophylaxis was performed in 499 patients. Twenty-four patients (4.8%) experienced at least one serious TEC up to day 90: 2 (0.4%) patients died from surgical-related complications (no autopsy was performed); 1 (0.2%) patient experienced AMI, 5 (1.0%) had PE, 10 (2.0%) DVT, 4 (0.8%) TCI, and 2 (0.4%) RVT. Moreover, 2 patients experienced two TEC: AMI followed by TCI in a first patient, PE and TCI in a second patient. The first event occurred up to day 5 in 9 patients (38%) and after day 5 in 15 patients (62%). Five patients (1%) had clinically relevant bleeding complications: 3 patients had a single, minor, upper gastrointestinal bleeding episode while in hospital, one patient developed a huge expanding haematoma at the operation site treated with hip spica and another patient a peritoneal haematoma leading to re-operation. Conclusion: This study performed in an unselected population clearly shows that THR still results in serious TEC in spite of a wide use of modern anaesthesia techniques, thrombosis prophylaxis and early mobilisation. In the future, we need to better identify at-risk patients in order to optimise their management, in particular post-discharge care, and reduce the risk of serious TEC.
To evaluate the differences between spinopelvic parameters before and after sagittal malalignment correction and to assess the relationship between these radiologic parameters and clinical outcome scores. A prospective cohort study was performed over a 2-year period at a major tertiary referral centre for adult spinal deformity surgery. All consecutive patients requiring 2-stage corrective surgery were included (n=32). Radiographic parameters and clinical outcome measures were collected preoperatively and at 6 weeks, 6 months, 1 year and 2 years postoperatively. Radiographic parameters analysed included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis and sagittal vertical axis. Clinical outcome measures collected included EQ-5D, ODI, SRS 22 and VAS Pain Scores. Correction of sagittal malalignment was associated with significant improvements in HRQOL. Restoration of lumbar lordosis, pelvic tilt and sagittal vertical axis correlated with postoperative improvements in EQ-5D, ODI, SRS 22 and VAS Pain Scores at follow-up. This study demonstrates that the magnitude of sagittal plane correction correlates with the degree of clinical improvements in HRQOL. This further underlines the need for spinal surgeons to target complete sagittal plane deformity correction if they wish to achieve the highest rates of HRQOL benefit in patients with marked sagittal malalignment.
To observe the safety and efficacy of a minimally destructive decompressive technique without fusion in patients with lumbar stenosis secondary to degenerative spondylolisthesis. 30 patients with degenerative spondylolisthesis (DS) were consecutively managed by a single consultant spinal surgeon. All patients presented with neurogenic claudication secondary to DS. All patients were managed operatively with lumbar decompression utilising an approach technique of “spinous process osteotomy” (1). Briefly, this approach requires only unilateral muscle stripping with preservation of the interspinous ligament. A standard centrolateral decompression is then performed. Data consisting of VAS back and leg pain and ODI were collected pre and post-operatively.Purpose
Methods
The RR was significantly higher in men than in women after wrist fracture (p=0.002), but not after spine fracture (p=0.12).
THA as primary treatment for displaced femoral neck fractures in elderly still remains a prominent concern. Overall dislocation rate after total hip arthroplasty (THA) is reported form 1∼5%. But, it is quiet different in situation of femur neck fracture in elderly. The THA is associated with higher rates of dislocation (8%∼11%) in eldery compared to hemiarthroplasty even though THA showed better clinical and functional scores. Recently resurgence about THA using DMC comes after improvement of manufacturing technology. The aim of this prospective multicenter study is to assess the rates of dislocation and re-operation for displaced femoral neck fractures in elderly with THA with Dual Mobility Cup (DMC) and to review systematically comparison of previous reports. Up to our knowledge, this is first report from asian conutry about the clinical outcomes THA using DMC for displaced femur neck fracture in elderly. Prospective consecutive groups of patients treated for displaced femoral neck fractures by three surgeons at each three center were included. 131 hips underwent THA with DMC for acute displaced femoral neck fracture in patients aged older than 70 years. Data regarding rates of dislocation and re-operation were obtained by review of medical records. Additionally From 2009 which the US FDA first approved the DMC, the authors searched reports regarding to THA using DMC for displaced femur neck fracture in elderly using the MEDLINE including cases series and comparative studies with bipolar hemiarthroplasty and THA. Therefore, current report was compared with previous reports.INTRODUCTION
METHODS
The purpose of this prospective study was to evaluate the functional outcome of patients who underwent the Lapidus procedure as a treatment for moderate to severe metatarsus primus varus and hallux valgus deformities. Inclusion criteria were failure of non-surgical management for moderate or severe deformity, inter-metatarsal angles of more than 14° and hallux valgus angles of more than 30°. Exclusion criteria were any previous hallux valgus procedures, insulin-dependent diabetics, previous ankle or subtalar fusions, peripheral vascular disease or peripheral neuropathy. Bilateral procedures had to be at least six months apart to be included. The AOFAS Hallux Metatarsophalangeal Interphalangeal Scale (HMIS), Visual Analogue Pain Scale (VAPS), Musculoskeletal Function Assessment Scale, clinical examination and weight-bearing radiographs were used for assessment. All patients were followed up for at least six months. Patients lost to follow-up in less than a year were excluded from the analysis. For a mean of 3.7 years (1 to 6.2), 126 feet in 110 patients were followed up, 105 of them (91 patients) for at least one year. At most recent follow-up, HMIS scores increased from 52 preoperatively to 87 (p <
0.0001). VAPS improved from 5.3 to 1.3 (p <
0.0001). The hallux valgus angle improved from 37° to 16° and the intermetatarsal angle improved from 18° to 8.2°. At 3.7 years, 88.5% of patients were very satisfied, 5% somewhat dissatisfied and 1.5% dissatisfied. With proper technique and attention to detail, the Lapidus procedure is an excellent alternative for moderate to severe metatarsus primus varus and hallux valgus deformities.
Aims. Surgical site infection (SSI) after soft-tissue sarcoma (STS) resection is a serious complication. The purpose of this retrospective study was to investigate the risk factors for SSI after STS resection, and to develop a nomogram that allows patient-specific risk assessment. Methods. A total of 547 patients with STS who underwent tumour resection between 2005 and 2021 were divided into a development
There is a paucity of mid-term data on modular dual-mobility (MDM) constructs versus large (≥40 mm) femoral heads (LFH) in revision total hip arthroplasties (THAs). The purpose of this study was to update our prior series at 10 years, with specific emphasis on survivorships free of re-revision for dislocation, any re-revision, and dislocation. We identified 300 revision THAs performed at a single tertiary care academic institution from 2011 to 2014. Aseptic loosening of the acetabular component (n=65), dislocation (n=59), and reimplantation as part of a two-stage exchange protocol (n=57) were the most common reasons for index revision. Dual-mobility constructs were used in 124 cases, and LFH were used in 176 cases. Mean age was 66 years, mean BMI was 31 kg/m. 2. , and 45% were female. Mean follow-up was 7 years. The 10-year survivorship free of re-revision for dislocation was 97% in the MDM
Aims. Distraction osteogenesis with intramedullary lengthening devices has undergone rapid development in the past decade with implant enhancement. In this first single-centre matched-pair analysis we focus on the comparison of treatment with the PRECICE and STRYDE intramedullary lengthening devices and aim to clarify any clinical and radiological differences. Methods. A single-centre 2:1 matched-pair retrospective analysis of 42 patients treated with the STRYDE and 82 patients treated with the PRECICE nail between May 2013 and November 2020 was conducted. Clinical and lengthening parameters were compared while focusing radiological assessment on osseous alterations related to the nail’s telescopic junction and locking bolts at four different stages. Results. Osteolysis next to the telescopic junction was observed in 31/48 segments (65%) lengthened with the STRYDE nail before implant removal compared to 1/91 segment (1%) in the PRECICE
Iliopsoas tendonitis occurs in up to 30% of patients after hip resurfacing arthroplasty (HRA) and is a common reason for revision. The primary purpose of this study was to validate our novel computational model for quantifying iliopsoas impingement in HRA patients using a case-controlled investigation. Secondary purpose was to compare these results with previously measured THA patients. We conducted a retrospective search in an experienced surgeon's database for HRA patients with iliopsoas tendonitis, confirmed via the active hip flexion test in supine, and control patients without iliopsoas tendonitis, resulting in two
Aims. The number of patients undergoing surgery for degenerative cervical radiculopathy has increased. In many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals. The aim of this study was to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent. Methods. This was a comparative study using prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching. The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤ 15 points was considered equivalent. Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded. Results. The mean improvement from baseline to 12 months postoperatively of patients who underwent surgery in public and private hospitals was equivalent, both in the unmatched
Aims. This study investigates whether primary knee arthroplasty (KA) restores health-related quality of life (HRQoL) to levels expected in the general population. Methods. This retrospective case-control study compared HRQoL data from two sources: patients undergoing primary KA in a university-teaching hospital (2013 to 2019), and the Health Survey for England (HSE; 2010 to 2012). Patient-level data from the HSE were used to represent the general population. Propensity score matching was used to balance covariates and facilitate group comparisons. A propensity score was estimated using logistic regression based upon the covariates sex, age, and BMI. Two matched
A major cause of morbidity in lower limb amputees is phantom limb pain (PLP) and residual limb pain (RLP). This study aimed to determine if surgical interposition of nerve endings into adjacent muscle bellies at the time of major lower limb amputation can decrease the incidence and severity of PLP and RLP. Data was retrospectively collected from January 2015 to January 2021, including eight patients that underwent nerve interposition (NI) and 36 that received standard treatment. Primary outcomes included the 11-point Numerical Rating Scale (NRS) for pain severity, and Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity, behaviour, and interference. Secondary outcome included Neuro-QoL Lower Extremity Function assessing mobility. Cumulative scores were transformed to standardised t scores. Across all primary and secondary outcomes, NI patients had lower PLP and RLP. Mean ‘worst pain’ score was 3.5 out of 10 for PLP in the NI
Aims. The number of revision arthroplasties being performed in the elderly is expected to rise, including revision for infection. The primary aim of this study was to measure the treatment success rate for octogenarians undergoing revision total hip arthroplasty (THA) for periprosthetic joint infection (PJI) compared to a younger