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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 9 - 9
1 Feb 2016
Wilson L Altaf F Tyler P Sedra F
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Many operations have been recommended to treat Pars Interarticularis fractures that have separated and are persistently symptomatic, but little other than conservative treatment has been recommended for symptomatic incomplete fractures.

10 consecutive patients aged 15–28 [mean 21.7 years] were treated operatively between 2010–2014. All but one were either professional athletes [3 cricketers, 2 athletics, 1 soccer] or academy cricketers [3 patients]. 8 patients had unilateral fractures, and two had bilateral fractures at the same level. The duration of pre-operative pain and disability with exercise ranged from 4–24 months [mean 15.4 months].

The operation consists of a percutaneous compression screw inserted through a 1.5cm midline skin incision under fluoroscopic guidance: 6 cases were also checked with the O-arm intra-operatively. Post-operation the patients were mobilised with a simple corset and discharged the following day with a customised rehabilitation program.

All 12 fractures in 10 patients healed as demonstrated on post-operative CT scans at between 3–6 months. One patient had the screw revised at 24 hours for an asymptomatic breach, and one patient developed a halo around the fracture site without screw loosening, and had a successful revision operation to remove the screw and graft the pars from the screw channel. All patients achieved a full return to asymptomatic activity, within a timescale of 4–12 months post-surgery, depending on the sport.

Athletes that have persistent symptoms from incomplete pars interarticularis fractures should consider percutaneous fixation rather than undergoing prolonged or repeated periods of rest.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 15 - 15
1 Sep 2012
Holleyman R Gikas P Tyler P Coward P Carrington R Skinner J Briggs T Miles J
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Background

It is known that excessive varus alignment of the femoral stem in total hip replacement (THR) creates a sub-optimal biomechanical environment which is associated with increased rates of revision surgery and component wear. Little is known regarding the effect of femoral stem alignment on patient functional outcome.

Methods

A retrospective study of patients undergoing primary THR at the RNOH. Alignment of the femoral stem component in-situ was measured subjectively by a consultant musculoskeletal radiologist in both coronal and sagittal planes using post-operative anterior-posterior and lateral pelvic radiographs. Each THR was grouped into valgus, minor-valgus, neutral, minor-varus or varus coronal plane alignment and posterior, minor-posterior, neutral, minor-anterior or anterior sagittal plane alignment. Patient reported functional outcome was assessed by Oxford Hip Score (OHS) and WOMAC questionnaires after a minimum follow-up of 11 months. Maximum range of passive hip flexion, abduction, adduction, external and internal rotation were measured in clinic. A factorial linear regression model was used to analyse data.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVI | Pages 120 - 120
1 Aug 2012
Holleyman R Gikas P Tyler P Coward P Carrington R Skinner J Briggs T Miles J
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Background

The position of the hip-joint centre of rotation (HJC) within the pelvis is known to influence functional outcome of total hip replacement (THR). Superior, lateral and posterior relocations of the HJC from anatomical position have been shown to be associated with greater joint reaction forces and a higher incidence of aseptic loosening. In biomechanical models, the maximum force, moment-generating capacity and the range of motion of the major hip muscle groups have been shown to be sensitive to HJC displacement. This clinical study investigated the effect of HJC displacement and acetabular cup inclination angle on functional performance in patients undergoing primary THR.

Methods

Retrospective study of primary THR patients at the RNOH. HJC displacement from anatomical position in horizontal and vertical planes was measured relative to radiological landmarks using post-operative, calibrated, anterior-posterior pelvic radiographs. Acetabular cup inclination angle was measured relative to the inter-teardrop line. Maximum range of passive hip flexion, abduction, adduction, external and internal rotation were measured in clinic. Patient reported functional outcome was assessed by Oxford Hip Score (OHS) and WOMAC questionnaires. Data analysed using a linear regression model.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVI | Pages 111 - 111
1 Aug 2012
Holleyman R Gikas P Tyler P Coward P Carrington R Skinner J Briggs T Miles J
Full Access

It is known that excessive varus alignment of the femoral stem in total hip replacement (THR) creates a sub-optimal biomechanical environment which is associated with increased rates of revision surgery and component wear. Little is known regarding the effect of femoral stem alignment on patient functional outcome.

Methods

Retrospective study of primary THR patients at the RNOH. Alignment of the femoral stem component in-situ was measured subjectively by a consultant musculoskeletal radiologist in both coronal and sagittal planes using post-operative anterior-posterior and lateral pelvic radiographs. Each THR was grouped into valgus, minor-valgus, neutral, minor-varus or varus coronal plane alignment and posterior, minor-posterior, neutral, minor-anterior or anterior sagittal plane alignment. Patient reported functional outcome was assessed by Oxford Hip Score (OHS) and WOMAC questionnaires. Data analysed using a linear regression model.

Results

90 THRs were studied in 87 patients (55 Female). Mean age at THR=62 (22-86). Mean follow-up=17 months (11-39 months). Median OHS=16, WOMAC=8. Coronal plane alignment of the femoral stem was not associated with any change in OHS (p>0.05) or WOMAC score (p>0.05). Sagittal plane alignment of the femoral stem was not associated with any change in OHS (p>0.05) or WOMAC score (p>0.05).