We aim to analyze the role of patient-related factors on the yield of progenitor cells in the bone marrow aspiration concentrate (BMAC). We performed a
Mechanical failure of spine posterior fixation in the lumbar region Is suspected to occur more frequently when the sagittal balance is not properly restored. While failures at the proximal extremity have been studied in the literature, the lumbar distal junctional pathology has received less attention. The aim of this work was to investigate if the spinopelvic parameters, which characterize the sagittal balance, could predict the mechanical failure of the posterior fixation in the distal lumbar region. All the spine surgeries performed in 2017-2019 at Rizzoli Institute were retrospectively analysed to extract all cases of lumbar distal junctional pathology. All the revision surgeries performed due to the pedicle screws pull-out, or the breakage of rods or screws, or the vertebral fracture, or the degenerative disc disease, in the distal extremity, were included in the junctional (JUNCT) group. A total of 83 cases were identified as JUNCT group. All the 241 fixation surgeries which to date have not failed were included in the control (CONTROL) group. Clinical data were extracted from both groups, and the main spinopelvic parameters were assessed from sagittal standing preoperative (pre-op) and postoperative (post-op) radiographs with the software Surgimap (Nemaris). In particular, In JUNCT, the main failure cause was the screws pull-out (45%). Spine fixation with 7 or more levels were the most common in JUNCT (52%) in contrast to CONTROL (14%). In CONTROL, PT, TPA, SS and PI-LL were inside the recommended ranges of good sagittal balance. For these parameters, statistically significant differences were observed between pre-op and post-op (p<0.0001, p=0.01, p<0.0001, p=0.004, respectively, These results showed that failure is most common in long fused segments, likely due to long lever arms leading to implant failure. If the sagittal balance is not properly restored, after the surgery the balance is expected to worsen, eventually leading to failure: this effect was confirmed by the worsening of all the spinopelvic parameters before the revision surgery in JUNCT. Conversely, a good sagittal balance seems to avoid a revision surgery, as it is visible is CONTROL. The mismatch PI-LL after the fixation seems to confirm a good sagittal balance and predict a good correction. The linear regression of PT vs PI suggests that the spine deformity and pelvic conformation could be a predictor for the failure after a fixation.
Chordoma of the cervical spine is a rare but life-threatening disease with a relentless tendency towards local recurrence. Wide en bloc resection is recommended, but it is frequently not feasible in the cervical spine. Radiation therapy including high-energy particle therapy is commonly used as adjuvant therapy. The goal of this study was to examine treatment and outcome of patients with chordoma of the cervical spine. Patients affected by cervical spine chordoma who underwent surgery at the Rizzoli Institute and University Hospital of Modena, between 2007 and 2021 were identified. The clinical, pathologic, and radiographic data were reviewed in all cases. Patient outcomes including local recurrence and disease-specific survival (DSS) were analyzed using chi-square test and Kaplan-Meier survival analysis. Characteristics of the 29 patients (10 females; 19 males) included: median age at surgery 52.0 years (IQR 35.5 - 62.5 years), 10 (35%) involved upper cervical spine, 16 (55%) with tumors in the mid cervical spine, and 4 in the lower cervical spine (10%). Median tumor volume was 16 cm3 (IQR 8.7 - 20.8). Thirteen patients (45%) were previously treated surgically while 9 patients (31%) had previous radiation therapy. All patients underwent surgery: en bloc resection was passible in 4 patients (14 %), seventeen patients (59%) were treated with gross total resection while 8 patients (27%) underwent subtotal resection. Tumor volume was associated with a significantly higher risk of intraoperative complications (p < 0.01). Nineteen patients (65%) received adjuvant high-energy particle therapy. The median follow-up was 26 months (IQR 11 - 44). Twelve patients (41%) had local recurrence of disease. Patients treated with adjuvant high-energy particle therapy had a significant higher local control than patients who received photons or no adjuvant treatment (p = 0.01). Recurrence was the only factor significantly associated with worse DSS (p = 0.03 – OR 1.7), being the survival of the group of patients with recurrent disease 58.3% while the survival of the group of patients with no recurrent disease was 100%. Post-operative high-energy particle therapy improved local control in patients with cervical chordoma after surgical resection. Increased tumor volume was associated with increased risk of intraoperative complications. Recurrence of the disease was the only factor significantly associated with disease mortality.
Up to 20% of patients can remain dissatisfied following TKR. A proportion of TKRs will need early revision with aseptic loosening the most common. The ATTUNE TKR was introduced in 2011 as successor to its predicate design The PFC Sigma (DePuy Synthes, Warsaw, In). However, following reports of early failures of the tibial component there have been ongoing concerns of increased loosening rates with the ATTUNE TKR. In 2017 a redesigned tibial baseplate (S+) was introduced, which included cement pockets and an increased surface roughness to improve cement bonding. Given the concerns of early tibial loosening with the ATTUNE knee system, this study aimed to compare revision rates and those specific to aseptic loosening of the ATTUNE implant in comparison to an established predicate as well as other implant designs used in a high-volume arthroplasty centre. The Attune TKR was introduced to our unit in December 2011. Prior to this we routinely used a predicate design with an excellent long-term track record (PFC Sigma) which remains in use. In addition, other designs were available and used as per surgeon preference. Using a prospectively maintained database, we identified 10,202 patients who underwent primary cemented TKR at our institution between 01/04/2003–31/03/2022 with a minimum of 1 year follow-up (Mean 8.4years, range 1–20years): 1) 2406 with ATTUNE TKR (of which 557 were S+) 2) 4652 with PFC TKR 3) 3154 with other cemented designs. All implants were cemented using high viscosity cement. The primary outcome measures were all-cause revision, revision for aseptic loosening, and revision for tibial loosening. Kaplan-Meier survival analysis and Cox regression models were used to compare the primary outcomes between groups. Matched cohorts were selected from the ATTUNE subsets (original and S+) and PFC groups using the nearest neighbor method for radiographic analysis. Radiographs were assessed to compare the presence of radiolucent lines in the Attune S+, standard Attune, and PFC implants.Abstract
Objective
Methods
Objectives. Intramedullary fixation is considered the most stable treatment for pertrochanteric fractures of the proximal femur and cut-out is one of the most frequent mechanical complications. In order to determine the role of clinical variables and radiological parameters in predicting the risk of this complication, we analysed the data pertaining to a group of patients recruited over the course of six years. Methods. A total of 571 patients were included in this study, which analysed the incidence of cut-out in relation to several clinical variables: age; gender; the AO Foundation and Orthopaedic Trauma Association classification system (AO/OTA); type of nail; cervical-diaphyseal angle; surgical wait times; anti-osteoporotic medication; complete post-operative weight bearing; and radiological parameters (namely the lag-screw position with respect to the femoral head, the Cleveland system, the tip-apex distance (TAD), and the calcar-referenced tip-apex distance (CalTAD)). Results. The incidence of cut-out across the sample was 5.6%, with a higher incidence in female patients. A significantly higher risk of this complication was correlated with lag-screw tip positioning in the upper part of the femoral head in the anteroposterior radiological view, posterior in the latero-lateral radiological view, and in the Cleveland peripheral zones. The tip-apex distance and the calcar-referenced tip-apex distance were found to be highly significant predictors of the risk of cut-out at cut-offs of 30.7 mm and 37.3 mm, respectively, but the former appeared more reliable than the latter in predicting the occurrence of this complication. Conclusion. The tip-apex distance remains the most accurate predictor of cut-out, which is significantly greater above a cut-off of 30.7 mm. Cite this article: G. Caruso, M. Bonomo, G. Valpiani, G. Salvatori, A. Gildone, V. Lorusso, L. Massari. A six-year
Purpose: Surgery is the mainstay treatment for chondro-sarcoma. About 35–40% of these tumours are located in the pelvis. Treatment requires significant sacrifices to ensure acceptable survival. Material and methods: This
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 cohort. We performed a retrospective review of patient data available on PearlDiver from 2015 – 2021. PJI THA cases were identified through ICD-10 and CPT codes. Patients treated by 6 fellowship trained arthroplasty surgeons from a PJI center were matched based on age, gender, Charlson Comorbidity Index and Elixhauser comorbidity index at a 1:1 ratio to patients from the national cohort. Compared outcomes included LOS, ED visits, number of patients readmitted, total readmissions. Sample sized did not allow the evaluation of amputation, fusion or explantation. Normality was tested through the Kolmogorov-Smirnov test. And comparisons were made with Students t-tests and Chi Square testing. A total of 33,001 THA PJIs and were identified. A total of 77 patients were identified as treated by the PJI center cohort and successfully matched. No differences were noted in regard to age, gender distribution, CCI or ECI (p=1, 1, 1 and 0.9958 respectively). Significant differences were noted in mean LOS (p<0.43), number of patients requiring readmissions (p=0.001) and total number of readmission events (p<0.001). No difference was noted on ED visits. Our study demonstrates that a PJI for THA cases may be beneficial for the national growing trend of arthroplasty volume. Future data, that allows comparison of patient's specific data will allow for further validation of PJI centers and how these can play a role in helping the national PJI growing problem.
Until today it is unknown whether preservation of the joint capsule positively affects patient reported outcome (PROs) in DAA-THA. A recent RCT found no clinical difference at 1 year. Since 2015 we preserve the capsule suture it at the end. We here evaluate whether this change had any effect on PROs and revisions, 2 years post-operatively. Two subsequent cohorts operated by the senior author were compared. The capsule was resected in the first cohort (January 2012 – December 2014) and preserved in the second cohort (July 2015 – December 2017). No other technical changes have been introduced between the two cohorts. Patient demographics, Charlson Comorbidity Index (CCI), and surgical data were collected from our clinical information system. 2-years PROs questionnaires (OHS, COMI Hip) were obtained. Data was analyzed with generalized multiple regression analysis. 430 and 450 patients were included in the resected and preserved cohorts, respectively. Demographics, CCI surgical time and length of stay were equal in both groups. Blood loss was less in the preserved cohort (p<.05). Four patients had a revision (1 vs 3, n.s.). Once corrected for demographics, capsule preservation had significant worse PROs: +0.24 COMI (p<.001) and −1.6 OHS points (p<.05), however, effects were much smaller than the minimal clinically important difference (0.95 and 5 respectively). The date of surgery (i.e. surgeon's age) was not a significant factor. In this large retrospective study, we observed statistically significant, but probably clinically not relevant, worse PROs with capsule preservation. It might be speculated that the not resected hypertrophied capsule could have caused this difference.
There has been significant interest in day-case and rapid discharge pathways for unicompartmental knee replacements (UKR). Pathways to date have shown this to be a safe and feasible option; however, no studies to date have published results of rapid-discharge pathways using the NAVIO robotic system. To date there is no published experience with rapid discharge UKR patients using the NAVIO robotic system. We report an initial experience of 11 patients who have safely been discharged within 24 hours. With the primary goal of investigating factors that led to rapid discharge and a secondary goal of evaluating the safety of doing so. All patients were discharged within 24 hours; there were no post-operative complications and no readmissions to hospital. The mean length of stay was 16.9 hours (SD=7.3), with most patients seen once on average by physiotherapy. Active range of motion at 6 weeks was 0.7o to 130.5 o, with all patients mobilising independently. The average 6-month post-operative Oxford Knee Score was 43.5 out of 48. There were no readmission or complications in any of our patients. This initial feasibility study identified that patients could be safely discharged within 24 hours after UKR using the NAVIO robotic system. With growing uptake of robotic procedures, with longer operative durations than traditional procedures, it is essential to ensure a rapid discharge to reduce healthcare cost whilst ensuring that patients are discharged home in a safe manner.
Purpose: This
The coronavirus (Covid-19) pandemic, first identified in China in December 2019, halted daily living with mandatory lockdowns imposed in Israel in March 2020. This halt induced a sedentary lifestyle for most citizens as well as a decreased physical activity time. These are both common risk factors for the development of low back pain (LBP) which is considered a major global medical and economical challenge effecting almost 1 in 3 people and a leading cause of Emergency Department (ED) visits. It is hypothesized that prevalence of minor LBP episodes during the first total lockdown should have increased compared to previous times. However, due to “Covid-19 fear” we expect a decrease in ED visits. We also speculate that rate of visits due to serious spinal illness (causing either immediate hospitalization or spinal surgery within 30-days of presentation) did not change. Retrospective study based on patients visiting the ED in Tel Aviv Sourasky Medical Center During the first pandemic stage in 2020 compared to parallel periods in 2018 and 2019 due to LBP.Introduction and Objective
Materials and Methods
Distal femur fracture fixation in elderly presents significant challenges due to osteoporosis and associated comorbidities. There has been an evolution in the management of these fractures with a description of various surgical techniques and fixation methods; however, currently, there is no consensus on the standard of care. Non-union rates of up to 19% and mortality rates of up to 26 % at one year have been reported in the literature. Delay in surgery and delay in mobilisation post-operatively have been identified as two main factors for high rate of mortality. As biomechanical studies have proved better stability with dual plating or nail-plate combination, a trend has been shifting for past few years towards rigid fixation to allow early mobilisation. Our study aims to compare outcomes of distal femur fractures managed with either single plate (SP), dual plating (DP) or nail-plate construct (NP). A retrospective review of patients aged above 65 years with distal femur fractures (both native and peri-prosthetic) who underwent surgical management between June 2020 and May 2023 was conducted. Patients were divided into three groups based on mode of fixation - single plate or dual plating or nail-plate construct. AO/OTA classification was used for non-periprosthetic, and Unified classification system (UCS) was used for periprosthetic fractures. Data on patient demographics, fracture characteristics, surgical details, postoperative complications, re-operation rate, radiological outcomes and mortality rate were evaluated. Primary objective was to compare re-operation rate and mortality rate between 3 groups at 30 days, 6 months and at 1 year.Introduction
Methods
Acute ankle injuries are commonly seen in musculoskeletal practice. Surgical management is the gold standard for lateral ligament injury in those with failed conservative treatment for a minimum of six months. Several studies have shown good functional outcome and early rehabilitation after MBG repair with an internal brace augmentation which is a braided ultrahigh molecular weight polyethylene ligament used to enhance the repair that acts as a secondary stabiliser. Hence the aim of the study was to compare the results with and without augmentation. A single centre retrospective review conducted between November 2017 and October 2019 and this included 172 patients with symptomatic chronic lateral ligament instability with failed conservative management. The diagnosis was confirmed by MRI. All patients had an ankle arthroscopy followed by open ligament repair. Patients were grouped into isolated MBG and internal brace groups for analyses and all had dedicated rehabilitation.Introduction
Methods
Introduction. In recent years, there has been an increase in hip joint replacement surgery using short bone-preserving femoral stem. However, there are very limited data on postoperative periprosthetic fractures after cementless fixation of these stem although the periprosthetic fracture is becoming a major concern following hip replacement surgery. The purpose of this study is to determine incidence of postoperative periprosthetic femoral fractures following hip arthroplasty using bone preserving short stem in a large multi-center series. Materials & Methods. We retrospectively reviewed 897 patients (1089 hips) who underwent primary total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA) during the same interval (2011–2016) in which any other cementless, short bone-preserving femoral stem was used at 7 institutions. During the study, 1008 THAs were performed and 81 BHAs were performed using 4 different short femoral prostheses. Average age was 57.4 years (range, 18 – 97 years) with male ratio of 49.7% (541/1089). Postoperative mean follow-up period was 1.9 years (range, 0.2 – 7.9 years). Results. Overall incidence of postoperative periprosthetic femoral fractures was 1.1% (12/1089). The mean age of these 12 patients were 71.2 year (range, 43 – 86 years). Seven patients were female and other 5 were male. Time interval between primary arthroplasty and fracture were mean 1.1 years (range, 0.1 – 4.8 years). Injury mechanism is a slip in 10 fractures and fall from 1m or less in 2. Three fractures occurred after BHA while 9 occurred after THA. Four fractures were in type AG and other 8 were in type B1 according to Vancouver classification. Of the 4 with AG type, 2 underwent open reduction and internal fixation and 2 took conservative management. Of the 8 with B1 type, 6 underwent open reduction and internal fixation and 2 took conservative management. Conclusion. The prevalence of postoperative periprosthetic femoral fractures was 1.1% in a multicenter
In the United Kingdom (UK), the fastest growing population demographic is the over 85 years of age, but despite this, outcomes achieved in the octogenarian population with a Unicompartmental Knee Replacement (UKR) are underrepresented in the literature. The Elective Orthopaedic Centre, Epsom, has an established patient reported outcome measures (PROMs) programme into which all patients are routinely enrolled. We aim to investigate the outcome of medial UKR using the oxford phase 3 implant in octogenarians. We retrospectively reviewed our database for patients aged 60–89 years, who underwent a medial unicompartmental Knee Replacement (UKR) using the oxford phase 3 implant, between June 2007-December 2012 (N=395). The patients were stratified into 3 groups based on age, 60–69 (N=188), 70–79(N=149), and 80–89(N=58). Oxford Knee Scores (OKS), Euro-quol (EQ-5D) scores, revision rates, and mortality were compared.Background
Methods
Purpose: This
Purpose: A
Open talus fracture are notoriously difficult to manage and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, thus definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons, however, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion. A review of electronic hospital records for open talus fractures from 2014-2021 returned foureen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient's age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was four years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data was analysed using the software PRISM. Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score ( FUSION is typically used as second line to ORIF or failed ORIF. However, there are a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time, that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate, and quality-of-life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.
The aim of this study was to assess the incidence the microbiological spectrum and clinical outcome of hip and knee revision arthroplasties with unexpected-positive-intraoperative-cultures (UPIC) at a single center with minimum follow up of 2 years. We retrospectively analyzed our prospectively maintained institutional arthroplasty registry. Between 2011 and 2020 we performed presumably aseptic rTHA (n=939) and rTKA (n= 1,058). Clinical outcome, re-revision rates and causes as well as the microbiological spectrum were evaluated.Aims
Methods
Purpose of the study: Fracture dislocations are complex injuries compromising elbow stability and functional potential. The treatment of these injuries should restore the exact anatomy of the joint, the only guarantee for a good functional outcome. The purpose of our work was to analyse our results and review the literature in order to establish an evidence-based therapeutic algorithm essentially based on the type of associated fracture. Material and methods: This was a
Fracture and deformity after frame removal is a known risk in 9–14.5% of patients after circular frame treatment. The aims of this study were to assess the effectiveness of our staged protocol for frame removal and risk factors for the protocol failure. We identified 299 consecutive patients who underwent circular frame fixation for fracture or deformity correction in our unit from our prospective database. All 247 patients who followed the staged frame removal protocol were included in this study. We reviewed the electronic clinical record and radiographs of each patient to record demographics, risk factors for treatment failure and outcome following frame removal. We defined failure of the protocol as a re-fracture or change in bony alignment within 12 weeks of frame removal. Results underwent statistical analysis using Chi square analysis.Introduction
Methods and materials
Rib fractures (RF) represent the most common bone fracture after blunt trauma, occurring in 10–20% of all trauma patients and leading to concomitant injuries of the inner organs in severe cases. However, a standardized classification system for serial rib fractures (SRF) does still not exist. Basic knowledge about the facture pattern of SRF would help to predict organ damage, support forensic medical examinations, and provide data for in vitro and in silico studies regarding the thoracic stability. The purpose of our study was therefore to identify specific SRF patterns after blunt chest trauma. All SRF cases (≥3 subsequent RF) between mid-2008 and end of 2015 were extracted from the CT database of our University Hospital (n=383). Fractures were assigned to anterior, antero-lateral, lateral, postero-lateral, and posterior location within the transverse plane (36° each) using an angular measuring technique (reliability ±2°). Rib level, fracture type (transverse, oblique, multifragment, infracted), as well as degree of dislocation (none, </≥ rib width) were recorded and each related to the cause of accident. In total, 3747 RF were identified (9.7 per patient, ranging from 3 (n=25) to 33 (n=1)). On average, most RF occurred in crush/burying injuries (15.9, n=13) and pedestrian accidents (12.2, n=14), least in car/truck accidents (8.8, n=76). Altogether, RF gradually increased from rib 1 (n=140) towards rib 5 (n=517) and then decreased towards rib 12 (n=49), showing a bell-shaped distribution. More RF were detected on the left thorax (n=2027) than on the right (n=1720). Overall, most RF were found in the lateral (33%) and postero-lateral (29%) segment. Posterior RF mostly occurred in the lower thorax (63%), whereas anterior (100%), antero-lateral (87%), and lateral (63%) RF mostly appeared in the upper thorax. RF were distributed symmetrically to the sagittal plane, showing a hotspot (up to 98 RF) at rib levels 4 to 7 in the lateral segment and rib level 5 in the antero-lateral segment. In the car/truck accident group, 47% of all RF were in the lateral segment, in case of frontal collision (n=24) even 60%. Fall injuries (n=141) entailed mostly postero-lateral RF (35%). In case of falls >3 m (n=45), 48% more RF were detected on the left thorax compared to the right. CPR related SRF (n=33) showed a distinct fracture pattern, since 70% of all RF were located antero-laterally. Infractions were the most observed fracture type (44%), followed by oblique (25%) and transverse (18%) fractures, while 46% of all RF were dislocated (15% ≥ rib width). SRF show distinct fracture patterns depending on the cause of accident. Additional data should be collected to confirm our results and to establish a SRF classification system.
Objective: Diagnostic delay is well recognised in soft tissue sarcoma (STS). The aim of this paper is to assess whether symptom duration/time to diagnosis, has any impact on patient survival and also if patient and tumour-related factors are related to the duration of symptoms prior to presentation. Method: We performed a
Objective To analyse RTA admissions to BMH Shaibah with respect to seatbelt usage, position in vehicle, age, type of injury and mechanism of injury. Design
Objectives. This paper describes the outcomes obtained from a 12 hour group based multidisciplinary functional restoration programme for patients with persistent low back pain who presented with psychosocial obstacles to recovery. The programme was designed to address modifiable psychosocial obstacles to recovery over a four week period, reduce pain related disability, improve pain self-efficacy and reduce patients' reliance on analgesic medication. Design. A single group
Bumps and lumps of the hand are a common cause for consultation in general practice. However not all of these lesions are of true neoplastic nature and malignant tumours are a rarity in this location. The records of all tumours of the hand and wrist treated surgically at our institution in the period 1994 to 2009 were reviewed. Because of their non-neoplastic nature typical lesions of the hand such as ganglion cysts or palmar fibromatosis and the like were not included in this study. Histological entity, location, radiographic and clinical findings were analysed; malignant tumours were followed up by X-ray and MRI.Aim
Method
Due to limitations of existing pharmacological therapies for the management of chronic pain in osteoarthritis (OA), surgical interventions remain a major component of current standard of care, with total joint replacements (TJRs) considered for people who have not responded adequately to conservative treatment. This study aimed to quantify the economic burden of moderate-to-severe chronic pain in patients with OA in England prior to TJR. A retrospective, longitudinal cohort design was employed using Clinical Practice Research Datalink GOLD primary care data linked to Hospital Episode Statistics secondary care data in England. Patients (age ≥18 years) with an existing OA diagnosis of any anatomical site (Read/ICD-10) were indexed (Dec-2009 to Nov-2017) on a moderate-to-severe pain event (which included TJR) occurring within an episode of chronic pain. 5-year TJR rates from indexing were assessed via Kaplan-Meier estimates. All-cause healthcare resource utilisation and direct medical costs were evaluated in the 1–12 and 13–24 months prior to the first TJR experienced after index. Statistical significance was assessed via paired t-tests. The study cohort comprised 5,931 eligible patients (57.9% aged ≥65 years, 59.2% female). 2,176 (36.7%) underwent TJR (knee: 54.4%; hip: 42.8%; other: 2.8%). The 5-year TJR rate was 45.4% (knee: 24.3%; hip: 17.5%; other: 6.8%). Patients experienced more general practitioner consultations in 1–12 months pre-TJR compared with 13–24 months pre-TJR (means: 12.13 vs. 9.61; p<0.0001), more outpatient visits (6.68 vs. 3.77; p<0.0001), more hospitalisations (0.74 vs. 0.62; p=0.0032), and more emergency department visits (0.29 vs. 0.25, p=0.0190). Total time (days) spent as an inpatient was higher in 1–12 months pre-TJR (1.86 vs. 1.07; p<0.0001). Mean total per-patient cost pre-TJR increased from £1,771 (13–24 months) to £2,621 (1–12 months) (p<0.0001). Resource-use and costs incurred were substantially greater in the 12 months immediately prior to TJR, compared with 13–24 months prior. Reasons for increased healthcare and economic burden in the pre-TJR period deserve further exploration as potential targets for efforts to improve patient experience and efficiency of care.
This study aims to describe our department experience with single stage revision (SSR) for chronic prosthetic-joint infection (PJI) after total hip arthroplasty (THA) between 2005 and 2014 and to analyze success rates and morbidity results of patients submitted to SSR for infected THA according to pathogen. We retrospectively reviewed our 10 years of results (2005–2014) of patients submitted to SSR of the hip combined with IV and oral antibiotic therapy for treatment of chronic PJI (at least 4 weeks of symptoms), with a minimum follow-up of four years (n=26). Patients were characterized for demographic data, comorbidities, identified germ and antibiotic therapy applied (empiric and/or targeted). Outcomes analyzed were re-intervention rate (infection-related or aseptic), success rate (clinical and laboratory assessment), length of stay, morbidity and mortality outcomes.Aim
Method
The Postel Merle d’Aubigné score was used to assess clinical outcome and all patients responded to a self administered questionnaire. Radiographically, we searched for signs of instability (tilt, displacement) and implant wear using precise digitalized measurements on successive digitalized x-rays with MetrOs software. We searched for qualitative radiological signs of bone reaction in contact with the implant.
Outcomes were assessed by overall subjective satisfaction, Visual Analogue Scale (VAS) for pain, functional scores, range of motion and radiographic evaluation.
6 patients (9%) complained of persisting mild to moderate pain and swelling in the joint. 2 patients (3%) were not happy with the level of deformity correction. All the above 8 patients declined to have joint arthrodesed. 2 patients (3%) had deep infection requiring implant removal. 1 patient had osteolysis on the x-rays but remain asymptomatic. Although radiographic deterioration of the implant was demonstrated in a lot of implants, this deterioration did not correlate with patient satisfaction. We conclude that silastic first metatarsophalangeal joint replacement is a proven procedure that not only provides long- term pain relief but also satisfactory range of movement. Therefore it should still be considered as an option in patients with end-stage hallux rigidus.
Fifteen to twenty percent of patients presenting for total hip arthroplasty (THA) have bilateral disease. While simultaneous bilateral THA is of interest to patients and surgeons, debate persists regarding its merits. The majority of previous reports on simultaneous bilateral THA involve patients in the lateral decubitus position, which require repositioning, prepping and draping, and exposure of a fresh wound to pressure and manipulation for the contralateral THA. The purpose of this study was to compare complications, component position, and financial parameters for simultaneous versus staged bilateral THAs using the direct anterior approach (DAA). Medical records were reviewed for patient demographics, medical history, operative time, estimated blood loss (EBL), change in hemoglobin, transfusion, tranexamic acid (TXA) use, length of stay (LOS), discharge disposition, leg length discrepancy, acetabular cup position, and perioperative complications. Cost and reimbursement data were analyzed.Background
Methods
To evaluate functional and oncological outcomes following resection of sacral tumours and discuss the strategies for instrumentation. Primary malignant tumours of the sacrum are rare, arising from bony or neural elements, or bone marrow in haematological malignancies. Management of such lesions is dictated by anatomy and the behaviour of tumours. Three key issues which arise are the adequacy of tumour resection, mechanical stabilisation and the need for colostomy. Stabilisation is often extensive and can be challenging.Objective
Introduction
Surgical Site Infection (SSI) is one of the most frequent nosocomial infections and depends on many factors: patient, microorganism, antiseptic solution use, antibiotic prophylaxis, hand scrubbing, wound care or hospital stay lenght. With the present paper the authors aim to study the SSI incidence after Total Knee (TKA) or Hip Arthroplasty (THA). All patients who underwent primary TKA or THA between January 2011 and May 2012 at our institution were considered. Patients who died within 1 year after the procedure of unrelated causes were excluded. Data collected included ASA classification, type of procedure, total and post-operative hospital stay, type and duration of antibiotic prophylaxis. Data were collected from the consultation at 1 month and 1 year post-operative, clinical registries and telephone interview. SSI was defined according to the Centers for Disease Control and Prevention criteria. Suspected cases of SSI included antibiotic administration longer than 5 days or absence of antibiotic prescription, hospital stay after the procedure longer than 9 days, patient referring infection symptoms, and clinical data reports of infection or re-intervention. During the studied period and after exclusion of 5 cases, a total of 251 surgeries (104 TKA, 147 THA) were performed, of which 2 were urgent. For both TKA and THA, the average total hospital stay was 9 days (8 days post-operative). The majority were American Society of Anesthesiologists (ASA) classification 2 and 3. There were 4 SSI (1,60%), 2 TKA (1,92%) and 2 THA (1,36%), all of them after discharge. Their average total hospital stay was 10,5 days. Antibiotic prophylaxis was used in 93% of the patients (97,4% a cephalosporin), with an average length of 5,7 days. Recommended hospital stay after a TKA or THA is about 5 days. On HELICS-CIRURGIA 2006–2010 report it was 10 days, similar to ours. In infected patients, our total hospital stay was lower (10,5 vs 26). Recommended duration of antibiotic prophylaxis is 24h. On HELICS-CIRURGIA more than 50% had it for more than 24h, which also happened with us; our antibiotic coverage was similar. Comparing to HELICS-CIRURGIA, the predominance of ASA 2 and 3 classifications was similar, but the overall SSI rate was lower (1,6% vs 2,24%). We conclude we must reduce hospital stay and antibiotic duration and keep the surveillance of SSI after TKA or THA.
The records of 82 patients (129 feet) with resistant clubfoot deformity treated surgically by means of different releases were retrospectively reviewed. There are many treatment regimes for clubfoot. Some authors recommend manipulation with minimal multi-stage surgery, whereas others recommend neonatal corrective surgery. However, objective comparison of different treatment programs is not easy because different criteria are used to evaluate the results. Teratologic or neuromuscular clubfeet were not included in this revision. Between 1982 and 1998, 82 patients (27 girls, 55 boys) with 129 clubfeet underwent surgical treatment. All feet were initially treated with a serial long-leg cast for a minimum of four months. Mean age at the time of first surgery was 5.5 months (range 3.5 to 24). Minimum follow-up was two years. Primary posterior release was performed on 105 feet. Subsequent medial release was performed on 16 feet, posteromedial release on three, and a subtalar (Cincinnati) release on three. Primary isolated posteromedial release was performed on 14 feet, and two of these required a subsequent subtalar (Cincinnati) release. Primary isolated medial release was performed on seven feet. Primary isolated lateral release was performed on one foot and primary isolated subtalar (Cincinnati) release was performed on two feet. Subsequent derotative tibial osteotomy was performed in seven cases, wedge tarsectomy on four feet, triple arthrodesis on five, and calcaneocuboid fusion on one foot. Residual varus was present in seven feet. Calcaneal gait caused by overlengthening of the Achilles tendon occurred in one foot, and residual equinus in two feet. Residual valgus heel was observed in three feet. The surgeon must assess each foot and plan the surgery accordingly. A total release is not required for every foot.
We retrospectively audited outcomes from 97 patients aged over 40 who had undergone arthroscopy in the last 4 years in this orthopaedic unit. The audit was carried out by way of questionnaires which were sent out to patients with the results inputted to a database combined with a review of patients charts, in particular the operative note from the arthroscopy. A standardised proforma was used to record both patient’s details and operative findings. The questionnaires were sent out to 165 patients. Of that number 102 were returned, five of which were excluded due to inadequate information. The average wait for surgery was 10 months and 6 patients noticed an improvement in symptoms while waiting for surgery. 80% of those waiting less than 1 year experienced an improvement compared to 73% of those waiting more than 1 year. The results showed that post-operative symptoms in 74 out of the 97 (77%) patients were improved, 12 (12%) remained unchanged with 11 (11%) experiencing a worsening in symptoms. The age group 60+ had the best outcomes with 23 out of 26 (89%) experiencing some improvement in symptoms; males also experienced a better outcome with 51 out of 63 (81 %) achieving some improvement, compared to females where only 23 out of 34 (67%) showed improvement. We did not have routine access to an MRI scanner so only 23 of the patients had a pre-operative scan. We have insufficient numbers to comment on the accuracy or otherwise of positive MRI findings. Pre-operative symptoms of pain, swelling, locking and instability were recorded and their correlation to successful outcome analysed. This showed that the presence of these symptoms did not predict a post-operative improvement in symptoms as an equal number of those with any of these symptoms compared to those without derived benefit from the procedure. This finding is significant in that these symptoms are commonly used in clinical practice to predict the likely benefit from arthroscopy. A pre-operative history of locking was a specific predictive symptom for meniscal injury in that 27 out of 33 (82%) patients with true locking as a symptom had a meniscal injury but only 27 out of 58 (47%) patients with a meniscal injury experienced locking as a symptom implying that it is not a sensitive indicator of meniscal damage. We also enquired about the presence of a definite acute injury associated with the onset of symptoms. This also had no predictive value as to the potential benefit of surgery. A significant negative from the study was the fact that a history of an acute injury gave no indication as to the presence of a meniscal injury and even if a meniscal injury was present the patient’s outcomes were not significantly better than if no injury was present. In conclusion 77% of patients aged 40+ derived benefit from arthroscopy, possibly due to the effects of washing out the knee rather than any active intervention. A history of locking, pain swelling or an acute injury did not offer an accurate prediction of benefit from arthroscopy, therefore the elderly and those without a history of locking or acute injury should not be dissuaded from undergoing this procedure. This study is confined to those over 40 years of age and the findings are quite different to the findings in younger patients. These findings surprised the surgeons at our unit and therefore we feel may be an interesting and stimulating presentation at the B.A.S.K. meeting.
Aims. This study evaluated the definitions developed by the European Bone and Joint Infection Society (EBJIS) 2021, the International Consensus Meeting (ICM) 2018, and the Infectious Diseases Society of America (IDSA) 2013, for the diagnosis of periprosthetic joint infection (PJI). Methods. In this single-centre,
Background. Post operative analgesia is an important part of Total Knee Arthroplasty (TKA) to facilitate early mobilisation and patient satisfaction. We investigated the effect of periarticular infiltration of the joint with chirocaine local anaesthetic (LA) on the requirement of analgesic in the first 24 hrs period post op. Methods.
Aims. The burden of revision total hip arthroplasty (rTHA) continues to grow. The surgery is complex and associated with significant costs. Regional rTHA networks have been proposed to improve outcomes and to reduce re-revisions, and therefore costs. The aim of this study was to accurately quantify the cost and reimbursement for a rTHA service, and to assess the financial impact of case complexity at a tertiary referral centre within the NHS. Methods. A
Our goals were to minimize the invasiveness of the revision hip arthroplasty approach in order to accelerate the patient's rehabilitation, shorten the length of hospitalization and reduce the postoperative complications, especially the rate of joint dislocation. Our study aimed to prove whether and under which conditions the less invasive approach is preferable in revision arthroplasty. The modified revision technique differs from the conventional approach in the following main aspects: Oncologic: applying larger hip balls and inserts, after expanding the variety of the available articulating joint components in 4 mm steps (28–40 mm), sparing and reconstructing the joint capsule, whereby the integrity of its acetabular origin is crucial. That procedure was combined with tissue dissection strictly parallel to the direction of the muscle fibers. The transgluteal approach after Bauer was applied. The small skin incision was closed by running subcuticular technique. The inpatient postoperative phase after revision total hip arthroplasty was evaluated in the last 6.5 years. All patients completed a questionnaire.Aim
Material and Methods
A series of 116 patients surgically treated, with exclusion of arthroplasty, between December 1996 and December 2002 for a fracture of the proximal humerus, was retrospectively reviewed. Only 44 patients (45 shoulders) were available for clinical and radiological follow-up, 21 were deceased, 36 refused to participate and 14 could not be traced. The mean age was 60 y (15–93 y), the mean follow up was 44 months (15–78 m.); 28 were women, 16 men. The fractures were classified according the Neer-classification but also according the different types of surgery they underwent: percutaneous or retrograde pinning without opening the fracture site, osteosynthesis with plate and screws, osteosynthesis with screws alone, bone-graft and osteosutures or a combination of two or more methods. Two-part fractures (10 out of 13 fractures), but also 9 of the 15 three-part fractures, were treated by pinning, whereas the remaining 2 and 3-part, the isolated fractures of tuberculi and two 4-part fractures needed open surgery and fixation. A plate was used in only 3 cases, screws alone in 6 cases, a cortical bone-graft with osteosutures in 4 cases and a combination of open fixation in 8 cases. Whenever possible a minimal invasive technique was thus preferred. 16 patients (35,7%) had complications: 6 were minor (pin migration, slight secondary displacement or impingement as a consequence of protruding hardware), but one non-union, 4 CRPS and 5 avascular necrosis occurred. Only one of the latter underwent shoulder-arthroplasty at time of review. Major complications occurred mainly in the more complex fracture types (3 or 4 part fractures) Mean values of Constant score, ASES-score, Neerscore, UCLA score and Simple Shoulder test were not statistically different, neither between fracture types nor between surgical techniques. Using a correlation analyses we found a negative correlation between age and scoring systems: the older the patient, the lower the score. Patient satisfaction was higher in the percutaneous or retrograde pinning group than the other types of open surgery. We can conclude that although no statistical differences could be observed in our series, minimal invasive surgical techniques, less prone to complications, are preferable in the treatment of two and three part fractures of the proximal humerus and 4-part fractures of the younger population.
Conflict in Afghanistan demonstrated predominantly lower extremity and pelvi-perineal trauma secondary to Improvised Explosive Devices (IEDs). Mortality due to pelvic fracture (PF) is usually due to exsanguination. This study group comprised 169 military patients who sustained a PF and lower limb injury. There were 102 survivors and 67 fatalities (39% mortality). Frequent fracture patterns were a widened symphysis (61%) and widening of the sacroiliac joints (SIJ) (60%). Fatality was 20.7% for undisplaced SIJs, 24% for unilateral SIJ widening and 64% fatality where both SIJs were disrupted, demonstrating an increase in fatality rate with pelvic trauma severity. A closed pubic symphysis was associated with a 19.7% mortality rate versus 46% when widened. Vascular injury was present in 67% of fatalities, versus 45% of survivors. Of PFs, 84% were associated with traumatic amputation (TA) of the lower limb. Pelvic fracture with traumatic lower limb amputation presents a high mortality. It is likely that the mechanism of TA and PF are related, and flail of the lower limb(s) is the current hypothesis. This study prompts further work on the biomechanics of the pelvic-lower limb complex, to ascertain the mechanism of fracture. This could lead to evidence-based preventative techniques to decrease fatalities.
Aims. This aim of this study was to analyze the detection rate of rare pathogens in bone and joint infections (BJIs) using metagenomic next-generation sequencing (mNGS), and the impact of mNGS on clinical diagnosis and treatment. Methods. A
Aims. Osteoarticular reconstruction of the distal femur in childhood has the advantage of preserving the tibial physis. However, due to the small size of the distal femur, matching the host bone with an osteoarticular allograft is challenging. In this study, we compared the outcomes and complications of a resurfaced allograft-prosthesis composite (rAPC) with those of an osteoarticular allograft to reconstruct the distal femur in children. Methods. A
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
The aim of this study was to analyze the frequency and reveal the most common reasons of the endoprosthetic instability in patients with malignant bone tumors. From 1992 – 2008, 625/515 patients, endoprosthetic replacement of major joints were performed. The median age of the patients was 30.3 years (13 to 72 years). Aseptic instability was observed after 3/71(4.2%) humeral joint replacement out of total operations at this location, after 4/80 (5%) hip prosthesis, after 19/133 (14%) proximal tibial prostheses, after 44/299 (14.7%) distal femoral prostheses and after 2/37 (5.4%) total femur replacements. The retrospective analyses has shown that the reasons of instability were the following: aseptic loosening of the stems of endoprosthesis in 26 cases (24.4%), stem break in 31 (36.1%), endoprosthetic unit destruction in 10 (11.6%), untwistment of fixational screws in 10 (11,6%), migration of hip endoprosthesis components in 2 (2.3%) and endoprosthesis dislocation in 12 (14%). The timing of endoprosthetic instability ranged from 7 days to 12.2 years (average 26.2 months). Statistic analyses was performed in a group of patients with aseptic endoprosthesis instability developed after proximal tibia and distal femur resection. We conclude that the most frequent reason of aseptic instability was endoprosthetic stem break. The instability rate was actually lower among the patients who had underwent 5–10cm distal tibia resection comparing with the group of 10–15cm bone mass resection (p=0.05). Femoral resection enhanced the instability frequency comparing with proximal tibia resection in the group of 5–10cm bone mass resection (p=0.05).
Aims. The purpose of this study was to assess the prevalence of depression and anxiety symptoms in patients undergoing shoulder surgery using the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety computer adaptive tests, and to determine the factors associated with more severe symptoms. Additionally, we sought to determine whether PROMIS Depression and Anxiety were associated with functional outcomes after shoulder surgery. Methods. This was a
Recent NICE guidelines suggest that Total Hip Arthroplasty (THA) be offered to all patients with a displaced intracapsular neck of femur fracture who: are able to walk independently; not cognitively impaired and are medically fit for the anaesthesia and procedure. This is likely to have significant logistical implications for individual departments. Data from the National Hip Fracture Database was analysed retrospectively between January 2009 and November 2011. The aim was to determine if patients with displaced intracapsular neck of femur fractures admitted to a single tertiary referral orthopaedic trauma unit received a THA if they met NICE criteria. Case notes were then reviewed to obtain outcome and complication rates after surgery. Five hundred and forty-six patients were admitted with a displaced intracapsular neck of femur fracture over the described time period. Sixty-five patients met the NICE criteria to receive a THA (mean age 74 years, M:F = 16: 49); however, 21 patients had a THA. The other patients received either a cemented Thompson or bipolar hemiarthroplasty. Within the THA cohort there were no episodes of dislocation, venous thromboembolism, significant wound complications or infections that required further surgery. Within the hemiarthroplasty cohort there was 2 mortalities, 2 implant related infections, 1 dislocation and 2 required revision to a THA. There is evidence to suggest better outcomes in this cohort of patients, in terms pain and function. There is also a forecasted cost saving for departments, largely due to the relative reduction in complications. However, there were many cases (44) in our department, which would have been eligible for a THA, according to the NICE guidelines, who received a hemiarthroplasty. This is likely a reflection of the increased technical demand, and larger logistical difficulties faced by the department. We did note more complications within the hemiarthroplasty group, however, the numbers are too small to address statistical significance, and a longer follow up would be needed to further evaluate this. There is a clear scope for optimisation and improvement of infrastructure to develop time and resources to cope with the increased demand for THA for displaced intracapsular neck of femur fractures, in order to closely adhere to the NICE guidelines.
Aims. Clear cell sarcoma (CCS) of soft-tissue is a rare melanocytic subtype of mesenchymal malignancy. The aim of this study was to investigate the clinical and therapeutic factors associated with increased survival, stratified by clinical stage, in order to determine the optimal treatment. Methods. The study was a
Local recurrence of Giant cell tumours of bone (GCT) is considered the main complication of surgical treatment (50%). Intra-lesional curettage with adjuvants like phenol or polymethylmethacrylate (PMMA) is recommended as initial treatment, decreasing the risk of recurrence. However, risk factors for local recurrence in skeletal GCT have not yet been firmly established and a golden standard for treatment remains controversial. Aim of this study is identification of risk factors for recurrence in GCT, specifically after intra-lesional curettage with or without adjuvants. In a retrospective single-institution study 191 patients treated for GCT between 1964 and 2009 were included. Mean follow-up was 111 months (range 12-415). The recurrence-free survival and hazards for different treatment strategies and various patient and tumour characteristics were determined.Introduction
Methods
To evaluate functional and oncological outcomes following sacral resection Retrospective review of 97 sacral tumours referred to spinal or oncology units between 2004 and 2009.Objective
Methods
A retrospective review of 51 consecutive patients undergoing fixation of Scaphoid fractures by two surgeons in a single institution was conducted. Twenty-four patients were treated with a Herbert screw and twenty-seven with an Acutrak screw. This included six patients who underwent acute fixation, three in each group. The remaining cases were for the treatment of non-union and delayed union. There were no significant differences between the two groups in terms of age, side of injury, and mechanism of injury. Fractures were classified as proximal, middle and distal thirds of the Scaphoid and there was no significant difference between the groups regarding the types of fractures treated. The only significant difference between the groups was the time from injury to fixation when considering the cases of delayed union and non union which was greater in the Herbert screw group (7.5 months vs 4 months p=<0.05). There was no significant difference in outcome between the two methods of fixation. Union rates for all cases were 79% for Herbert screws and 81% for Acutrak screws and 82% and 83% respectively when only considering the delayed union/non-union procedures. There was no difference in terms of time to union, further surgery or clinical outcome between the two groups. The Acutrak screw required removal in five patients and the Herbert screw in two due to symptoms from screw prominence. This was not statistically significant. In conclusion there is no significant difference in surgical outcome between these two methods of fixation for Scaphoid fractures. The authors feel that this supports the view that biological factors are more important than the method of fixation in obtaining union of Scaphoid fractures.
Bone marrow edema is a common cause of pain of the locomotor apparatus. We reviewed 50 patients (28 male, 22 female) with bone marrow edema of the knee. The patients mean age was 56.2 12.8 years. 8 cases were estimated to have an idiopathic BME, 10 posttraumatic and the other 32 ones to be secondary to an activated osteoarthritis or to mechanic stress. Iloprost is a vasoactive prostacyclin analogue. Therapy consisted of a series of five infusions with either 20 or 50g of iloprost given over 6 hours on 5 consecutive days each. Pain at rest as well as under stress were assessed with a semi quantitative scale from before and 4 months after therapy. MRI investigations were done before and repeated 4 months after therapy. At the clinical follow-up 4 months after therapy, pain level at rest had diminished 84% (p <
0.0001). 70% of patients referred about a reduction, 30% about no change. Pain under stress decreased 57%, (p <
0.0001). 76% of patients showed lower pain under activity, 24% no change from baseline. There was no increase of pain level in any patient. In MRI in 85% a significant reduction of the BME size or complete restitution could be observed, 15% showed no change. Response rate to iloprost infusions came to 100% in idiopathic, 100% in posttraumatic and 66% in secondary BME. A significant reduction of side effects could be reached by lowering the daily dosage from 50 to 20g. The authors conclude that parenteral application of iloprost might be a viable method in the treatment of BME of different origins.
This report compares midterm results of open neck osteoplasty +
neck osteotomy vs arthroscopic osteoplasty for severe Slipped Capital Femoral Epiphysis (SCFE). Database from 2006 to 2013 identified 22 patients out of 187 operations for SCFE. 12 underwent Open Neck Osteotomy (ONO) and osteoplasty by Ganz surgical dislocation approach. 10 underwent Arthroscopic Osteoplasty (AO). The mean follow-up for the ONO and AO groups were 59 (46 – 70), 36.1 (33 – 46) months respectively.Purpose
Method
We present a retrospective comparative review of the radiological outcomes of Chevron and Scarf with Akin osteotomy in the treatment of hallux valgus.
The mean post-operative intermetatarsal angles (IMA) were: Chevron mean 8.050, standard deviation 2.560, standard error 0.57. Scarf with Akin mean 7.220, standard deviation 2.56, standard error 0.57. The difference in postoperative IMA between the two groups did not achieve statistical significance. The mean change in IMA for each was: Chevron mean increment 4.90 Standard deviation 2.290, standard error 0.51. Scarf with Akin mean increment 6.680, standard deviation 4.130, and standard error 0.88. The difference in alteration of IMA between the two groups did not achieve statistical significance.
Of the 6075 patients enrolled in EU-CORE registry, 206 patients had orthopaedic device-related infections. Significant underlying diseases were reported in 71% patients, most frequently cardiovascular disease (38%). The common sites of infection were knee (40%) and hip (33%). Among the 170 patients with available culture results, 135 (79%) were positive. Coagulase-negative staphylococci (CoNS, 44%) and Staphylococcus aureus (43%, of those 47% were methicillin resistant) were the most commonly isolated pathogens. Daptomycin was used empirically in 48% patients and as second-line therapy in 67% patients. During daptomycin therapy, 67% patients had undergone surgery (debridement, 61%; removal of foreign device, 39%; incision and drainage, 9%). Over half of the inpatients (54%) received concomitant antibiotics. Daptomycin was most frequently prescribed at a dose of 6 mg/kg/day (48%), with a median duration of therapy of 16 (range, 1–176) days. The overall clinical success rate was 85%, and was similar whether daptomycin was administered as first- or second-line therapy. The success rates achieved for infections caused by S. aureus and CoNS were 86% and 83%, respectively. Among the 79 patients who entered the long-term follow-up, 85% had a sustained response. Adverse events (AEs) and serious AEs possibly related to daptomycin were reported in 4.4% and 1.9% patients, respectively. Results from this real-world clinical experience showed that daptomycin is an effective and well-tolerated treatment option for orthopaedic device-related infections with a high success rate up to 2 years of follow-up.
We classified septic revision surgeries following total knee according to a classification published by Mc Pherson. Eradication rate of one stage versus two stage exchange was compared.
Regarding Mc Pherson’s systemic grades classification the eradication rate for two stage exchanges was 85,7% in group A+B and 60%% in group C. One stage procedures achieved 0% eradication rate in group B and 60% in group C. Regarding Mc Pherson’s local extremity grade classification eradication rates within two stage revisions were 84% in group 2 and 75% in group 3. One stage revision achieved 40% and 0%.
Our aim was to determine the prevalence of shoulder symptoms in patients with type I compared to type 2 diabetes mellitus and evaluate the clinical presentation of patients diagnosed with adhesive capsulitis. This was a retrospective case-note review of 164 diabetic patients treated for shoulder symptoms from 1996 to 2007. Diabeta 3 for relevant Diabetic data. We used ANOVA, Tukey HSD, Chi-Square and Fisher’s Exact tests. The incidence of treated shoulder patients in diabetic population: 1.04%. 86 males; 78 females. Average age 58 years (22 – 83). DM Type I 34% (46/136); Type II 66% (90/136). Mean duration of DM at presentation: 10 years (1–33). Mean HbA1c at presentation 8.3%. Retinopathy 16% (19/90); Neuropathy 12% (12/88). The diagnoses were: Impingement 101 (62%); Adhesive Capsulitis 35 (21%); Cuff tear 17 (10%); Arthritis 11 (7%). Mean recorded pre-treatment ROM: Impingement (flexion 117°, abduction 103°, ER 36°); Adhesive Capsulitis (flexion 90°, abduction 75°, ER 12°); Cuff tear (flexion 109°, abduction 95°, ER 45°); Arthritis (flexion 67°, abduction 93°, ER 18°). Adhesive Capsulitis was significantly related to: HbA1c (9.9%); p<
0.001, Type I DM; p<
0.003, Duration of DM (average 17.5 yrs); p<
0.03. An interesting statistically significant (p<
0.003) correlation was found between Type 2 DM and Impingement Syndrome. Treatments included: Injection (53), MUA (49), Arthroscopy (99), Open Surgery (56). 82% patients satisfactorily discharged (mild/no pain and improved ROM: flexion >
150°, abduction >
150° and ER >
50°) after an average 3.4 months. Three referred to pain clinic, sixteen patients didn’t attend their follow-up appointment and seven died. Eleven relapsed (eight adhesive capsulitis). Persistent symptoms were more common in Diabetic patients with adhesive capsulitis, which was found to be significantly related to Type I DM, its duration and control (HbA1c levels). Type II Diabetics are more likely to be affected with impingement syndrome. Close liaison with the Diabetology Department is essential for effective treatment of Diabetic Shoulder pathology.
The development of local recurrence after multimodal treatment of osteosarcoma is associated with a very poor prognosis. The importance of clear surgical margins has been demonstrated in multiple studies, however up to date there are no studies defining which margin width is safe from an oncological perspective. The purpose of this
We report our experience in 42 patients, using corticocancellous bone grafts and lag screw fixation for un-united scaphoid fractures. Using a grading system, we analysed the suitability of the method for three types of nonunion. We recommend the operation for the treatment of scaphoid nonunion, except where there is avascular necrosis of the proximal pole.
Aims. Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis. It allows correction of scoliosis through growth modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemiepiphysiodesis concept. The other modality is anterior scoliosis correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected. Methods. We conducted a
Aims. The aim of this study was to determine the impact of hospital-level service characteristics on hip fracture outcomes and quality of care processes measures. Methods. This was a
To evaluate functional and oncological outcomes following sacral resection A retrospective review was conducted of 97 sacral tumours referred to tertiary referral spinal or oncology unit between 2004 and 2009.Objective
Methods
To evaluate functional and oncological outcomes following resection of primary malignant bone tumours. Primary malignant tumours of the sacrum are rare, arising from bony or neural elements, or bone marrow in haematological malignancies. Management of these lesions is dictated by anatomical considerations and the behaviour of tumours. The three key issues which arise are the adequacy of tumour resection, mechanical stabilisation and the need for colostomy. A retrospective review of the surgical management of primary malignant sacral tumours from 2004 - 2009. The study included 46 patients (34 males, 12 females) with an average age of 49 (range 7 – 82). Median duration of symptoms before presentation was 26 months. 10 patients had inoperable tumours at presentation. 6 patients had chemotherapy. 2 patients opted for palliative radiotherapy. 1 patient was unfit for surgery. 25 patients (54%) underwent surgical resection. 8 underwent instrumented stabilisations with fibula strut graft vs. 17 uninstrumented. Colostomy was performed in 10 patients (40%). Mean follow post-operatively was 19.0 months. Wound healing problems were present in 5/25 (20%). There was no difference in infection rates between definitive surgery with and without colostomy. Mechanical failure of stabilisation was noted in 75%. There was one peri-operative death. Local recurrence occurred in 12%(3/25) of operated patients although follow-up period was noted to be short. Mechanical stabilisation for extensive lesions in the sacrum are particularly challenging in tumour surgery. Despite radiological failure in 7/8 instrumented stabilisations, patients were relatively asymptomatic and only 1/8 required revision stabilisation surgery. Ethics approval: None: Audit Interest Statement: None
Time at the surgical ‘coal-face’ has been reduced by introduction of the European Working Time Directive (EWTD) significantly impacting training opportunity. Our null hypothesis was that duration of surgery is significantly longer if a trainee were performing the operation despite supervision or level of trainee experience. Cemented hip hemiarthroplasty was chosen as our index procedure as complexity is largely comparable between cases. 461 patients were identified on the hospital trauma database. Data were augmented by information regarding level of surgeon, assistant and time of surgery from the hospital theatre database. There was no significant difference in registrar and consultant operative times, mean time 69 and 72 minutes respectively. SHOs were significantly slower (mean 80 minutes, p=0.0006). Junior (ST5 or less) registrars were significantly slower (mean 81minutes, p=0.0002) whereas senior registrars were not. Supervision level had no effect on duration of senior registrar operations but when junior registrars were consultant supervised they were not significantly slower (mean 75 minutes, p=0.09). Supervised operating therefore reduces time variability and should be promoted within a climate of training. Increase in mean operative time in registrars and SHOs is insignificant within a day's operating and is unlikely to lead to cancellations of cases.
Aims. The new COVID-19 variant was reported by the authorities of the UK to the World Health Organization (WHO) on 14 December 2020. We aim to describe the clinical characteristics and nosocomial infection rates in major trauma and orthopaedic patients comparing the first and second wave of COVID-19 infection. Methods. A
To determine the outcome of Clavicle Hook Plate fixation in terms of level of function achieved, healing of the fracture and the need for removal of the hook plate. Review of patient records and radiographs of all the fractured clavicles and acromioclavicular dislocations that were surgically treated with a Clavicle Hook Plate. The study population was identified using the operating theatre data. A total of 24 patients (19 lateral third-Neer type II-fractures and 5 type III acromioclavicular dislocations) were treated from January 1998 to December 2003. Eighteen of the 24 plates (75%) had been removed at the time of the study. In 72% restriction of the range of movement and pain due to plate impingement were the main causes for removal of the plate. Two of the plates (11%) were removed due to ‘mechanical failure’; the plate being levered off the bone or eroding the acromion. Mechanical failure of the plate was significantly associated with an older age group (P=0.01). At the time of discharge from the clinic 57% had more than 50% of their shoulder movements, while 55.5% had minimal or no pain. We suggest that Clavicle Hook Plates should be routinely removed as they cause impingement symptoms and they be used with caution (if at all) in the older age group given the tendency for the plate to lever off the bone.
Pathogens, whenever possible, were identified from blood, bone, tissue or exudate samples and antibiotic susceptibility was tested using the disk method. Demographic details, type of infection, presence of prosthetic material, duration of treatment, concomitant and subsequent antimicrobial agents, serum creatinine, adverse events, outcome at the end of treatment, and length of follow-up were noted from patient records. Results: Eighty-eight patients (67.7%) were male and 42 (32.3%) female. Their ages ranged from 15 to 89 years, with a median of 50 years. The most common infections were chronic osteomyelitis with or without foreign material [96 cases (73.9%)], with a median duration of 15 months (range 1–180 months): 30 with osteosynthetic material and 22 with prosthetic implants (15 patients who had received total hip replacements and 7 patients with total knee replacements). There were 44 diagnoses of chronic osteitis not associated with foreign material or prosthetic implants. Twenty-three were septic arthritis (17.6%), 11 (8.5%) spondylitis. In 81 cases the pathogens identified from samples of blood, bone or exudate were staphylococci (61 of Staphylococcus aureus, 20 of Staphylococcus epidermidis). In 11 cases were isolated Gram-negative bacteria, such as Pseudomonas aeruginosa (6), Proteus mirabilis (3), Enterobacter cloacae (2). Where more than one species was isolated (1 case) a combination of a Enterococcus faecalis and Pseudomonas aeruginosa (a case of spondylitis) was identified. The causative pathogen was not identified in 37 cases (28.5%). Teicoplanin was administered i.v. at a dosage of 10 mg/kg/day once a day, alone or in combination therapy with other antibiotics. Patients received teicoplanin i.v. alone in 5 cases and with 1–3 concurrent antibiotics (ceftriaxon in most cases) for a mean time of 4.5 months (R 2–12). The final assessment was that cure or improvement (clinical success) was achieved in 102 patients (78.5%); in 3 cases (2.3%) was recorded a clinical failure for persistence of infection signs but bacteriological eradication was achieved in all cases. During the follow-up, which varied from 1 to 48 months (median 8 months) twenty-one patients (16.1%) relapsed. Nine were patients with prosthetic implants. The other recurrences were recorded in cases of chronic osteomyelitis with foreign material. Four patients (3.1%) with prosthetic joint infection were given chronic suppression therapy. Eight patients showed adverse reactions, but discontinuation of teicoplanin treatment was not necessary. Conclusions: Teicoplanin has been shown to be effective as monotherapy or combination therapy for bone and joint infections.
Standard therapy for soft-tissue sarcomas remains complete resection, irresectable tumours or tumours after resection with gross residual disease are a special challenge. For primary radiotherapy with median 60 Gy local control rates of 30–45% have been reported. We analysed retrospectively 11 cases of radiochemotherapy with single-agent Ifosfamide in patients with macroscopic soft-tissue sarcomas. The patients were treated in irresectable high risk situations: T2-tumours (100%), G3 (73%), localisation at the trunk (82%). Radiation therapy was performed with median 60 Gy (50 to 72.6 Gy) in 1.8–2.0 Gy single fraction dose, once daily, five times a week. During the first and fifth week the concommittant chemotherapy with 1.0/1.5 gr/m2/d Ifosfamide on five days was added. Two patients received trimodal therapy with additional hyperthermia. The therapy was completed in 73% of the patients. Average local control time was 91 months, median disease-free-survival/overall-survival was 8/26 months. Five-year rates for local control/disease free survival/overall survival were 70%/34%/34%. Long-term tumor control could be achieved in three patients. The median disease free survival is dependant on the histological tumor grading (21 vs 8 months for G2 vs G3 tumors, no statistical significance due to small patient numbers). The limited prognosis is mainly caused by systemic treatment failure. Concomitant radiochemotherapy with Ifosfamide in patients with macroscopic soft-tissue-sarcomas yields a good local control rate of 70% compared to previously published 30% in definitive radiotherapy with similar radiation doses. Additional simultaneous chemotherapy should be considered for irresectable soft tissue sarcomas or tumors after resection with gross residual disease, if the applicable radiation dose is limited due to close vicinity of organs at risk. A decrease of systemic failure with additional chemotherapy might be speculated.
Invasive tests such as urodynamic tests, anorectal manometry and post ejaculatory urine sample would precisely determine its incidence. As a first step we, along with Urogynaecologist devised and validated a questionnaire to determine the urogenital function post operatively.
In males we had 3 cases of retrograde ejaculation which affected the sexual function (based on IIEF score), and were reported to be resolving slowly. There was no incidence of any urinary or bowel dysfunction postoperatively.
A combined posterior-anterior approach is usually proposed for the fixation of highly unstable spinal lesions. A monocortical anterior fixation seems to become more and more popular. In the period from 1993 to 1998, 43 patients with minimally anterior and middle column destruction of thoracolumbar spine were anteriorly instrumented. There were 23 tumors, 11 specific infections, 5 posttraumatic conditions with failed posterior instrumentation, 4 acute fractures. Anterior instrumentation (45Nm rod-screw rotation rigidity) were used in all cases. A four screws principle with two non connected rods were bicortically applied to correct the deformity and to fix the corpectomy gap. No postoperative bracing was necessary. There was one pseudarthrosis 2yrs post op. due to poor anterior fusion in a posttraumatic case. In one case instrumentation failure occurred due to widespreading of the prostatic tumor. The study revealed no complications due to bicortical screw fixation in thora-columbar region. It is suggested that combined anterior and posterior procedure is only exceptionally necessary.
Material and method: Among a series of 485 hips with LPCd, 148 (30.5%) with massive involvement were identified. Ninety-six (64.9%)severe forms were analyzed at the end of growth. Magnetic resonance imaging, scintigraphy and arteriography were used to better assess the femoral head and identify hips at risk. These hips were treated surgically: Salter osteotomy (SA), triple pelvis osteotomy (TO), or varus osteotomy (VA). Three groups of infants were identified according to age at diagnosis of LPCd: less than 6 years, 6–9 years, more than 9 years. Outcome was considered good (Stulberg 1 and 2, Mose good), fair (Stulberg 3, Mose fair), or poor (Stulberg 4 and 5, Mose poor).
There is a high risk of the development of avascular
necrosis of the femoral head and nonunion after the treatment of
displaced subcapital fractures of the femoral neck in patients aged
<
50 years. We retrospectively analysed the results following
fixation with two cannulated compression screws and a vascularised
iliac bone graft. We treated 18 women and 16 men with a mean age
of 38.5 years (20 to 50) whose treatment included the use of an
iliac bone graft based on the ascending branch of lateral femoral
circumflex artery. There were 20 Garden grade III and 14 grade IV
fractures. Clinical and radiological outcomes were evaluated. The
mean follow-up was 5.4 years (2 to 10). In 30 hips (88%) union was
achieved at a mean of 4.4 months (4 to 6). Nonunion occurred in
four hips (12%) and these patients had a mean age of 46.5 years
(42 to 50) and underwent revision to a hip replacement six months
after operation. The time to union was dependent on age with younger
patients achieving earlier union (p <
0.001). According to the
Harris hip score which was available for 27 of the 30 hips with
satisfactory union, excellent results were obtained in 15 (score ≥ 90
points), fair in ten (score 80 to 90 points), and poor in two hips
(≤ 80 points). One patient aged 48 years developed avascular necrosis
of femoral head six years after operation and underwent total hip
replacement. The management of displaced subcapital fractures of the femoral
neck, in patients aged <
50 years, with two cannulated compression
screws and an iliac bone graft based on the ascending branch of
lateral femoral circumflex artery, gives satisfactory results with
a low rate of complication including avascular necrosis and nonunion. Cite this article:
Synovial sarcoma (SS) is a malignant soft tissue sarcoma with a poor prognosis because of late local recurrence and distant metastases. To our knowledge, no studies have minimum follow-up of 10 years that evaluate long-term outcomes for survivors. Data on 62 patients who had been treated for SS from 1968 to 1999 were studied retrospectively in a multicenter study. The following parameters were examined for their potential prognostic value: age at diagnosis, sex, tumour site and size, histology, histological grade, fusion type (SYT-SSX1 vs. SYT-SSX2), and surgical margin status. Mean follow-up of living patients was 17.2 years, and of dead patients 7.7 years.Aim
Method
Poor results increase in older patients. After Orthopaedic treatment 60% of hips in children with LPC Disease appearing before the age of 6 find again its sphericity (Stulberg 1 or 2). About 30 % of hips in children with LCP Disease appearing between 6 and 9 years of age became “normal” (Stulberg 1 or 2) at the end of growth/Only 1 hip out of 10, in the oldest group of children (over 9 years), became spherical at the end of growth. Surgery increases the percentage of good results in all groups of patients.
25 (12.4%) patients who had dural tear had worse results.
The principles of evidence-based medicine (EBM) are the foundation of modern medical practice. Surgeons are familiar with the commonly used statistical techniques to test hypotheses, summarize findings, and provide answers within a specified range of probability. Based on this knowledge, they are able to critically evaluate research before deciding whether or not to adopt the findings into practice. Recently, there has been an increased use of artificial intelligence (AI) to analyze information and derive findings in orthopaedic research. These techniques use a set of statistical tools that are increasingly complex and may be unfamiliar to the orthopaedic surgeon. It is unclear if this shift towards less familiar techniques is widely accepted in the orthopaedic community. This study aimed to provide an exploration of understanding and acceptance of AI use in research among orthopaedic surgeons. Semi-structured in-depth interviews were carried out on a sample of 12 orthopaedic surgeons. Inductive thematic analysis was used to identify key themes.Aims
Methods
Over the last 10 years atypical femoral fractures (AFFs) have become recognised as a complication of standard-dose bisphosphonate use. In 2014 the American Society for Bone and Mineral Research published updated diagnostic criteria for AFF. We undertook a 5-year