The aim of this study is to determine the predictors of overall survival (OS) and predictive factors of poor prognosis of conventional high-grade osteosarcoma of the limbs in a single-centre in South Africa. We performed a retrospective cross-sectional analysis to identify the prognostic factors that predict the OS of patients with histologically confirmed high-grade conventional osteosarcoma of the limbs over ten years. We employed the Cox proportional regression model and the Kaplan-Meier method for statistical analysis.Aims
Methods
Perthes' disease (PD) is a relatively rare syndrome of idiopathic osteonecrosis of the proximal femoral epiphysis. Treatment for Perthes' disease is controversial due to the many options available, with no clear superiority of one treatment over another. Despite having few evidence-based approaches, many patients with Perthes' disease are managed surgically. Positive outcome reporting, defined as reporting a study variable producing statistically significant positive (beneficial) results, is a phenomenon that can be considered a proxy for the strength of science. This study aims to conduct a systematic literature review with the hypothesis that positive outcome reporting is frequent in studies on the treatment of Perthes' disease. We conducted a systematic review of all available abstracts associated with manuscripts in English or with English translation between January 2000 and December 2021, dealing with the treatment of Perthes' disease. Data collection included various study characteristics, surgical versus non-surgical management, treatment modality, mean follow-up time, analysis methods, and clinical recommendations.Aims
Methods
The paediatric trigger thumb is a distinct clinical entity with unique anatomical abnormalities. The aim of this study was to present the long-term outcomes of A1 pulley release in idiopathic paediatric trigger thumbs based on established patient-reported outcome measures. This study was a cross-sectional, questionnaire-based study conducted at a tertiary care orthopaedic centre. All cases of idiopathic paediatric trigger thumbs which underwent A1 pulley release between 2004 and 2011 and had a minimum follow-up period of ten years were included in the study. The abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH) was administered as an online survey, and ipsi- and contralateral thumb motion was assessed.Aims
Methods
The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion. The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two-year MRI follow-up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two-year MRI was used as the primary outcome, defined as a dural sac cross-sectional area ≤ 75 mm2 at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis).Aims
Methods
Two-stage exchange revision total hip arthroplasty (THA) performed in case of periprosthetic joint infection (PJI) has been considered for many years as being the gold standard for the treatment of chronic infection. However, over the past decade, there have been concerns about its safety and its effectiveness. The purposes of our study were to investigate our practice, collecting the overall spacer complications, and then to analyze their risk factors. We retrospectively included 125 patients with chronic hip PJI who underwent a staged THA revision performed between January 2013 and December 2019. All spacer complications were systematically collected, and risk factors were analyzed. Statistical evaluations were performed using the Student's Aims
Methods
The primary aim of this study was to determine the rates of return to work (RTW) and sport (RTS) following a humeral shaft fracture. The secondary aim was to identify factors independently associated with failure to RTW or RTS. From 2008 to 2017, all patients with a humeral diaphyseal fracture were retrospectively identified. Patient demographics and injury characteristics were recorded. Details of pre-injury employment, sporting participation, and levels of return post-injury were obtained via postal questionnaire. The University of California, Los Angeles (UCLA) Activity Scale was used to quantify physical activity among active patients. Regression was used to determine factors independently associated with failure to RTW or RTS.Aims
Methods
The outcome following the development of neurological complications after corrective surgery for scoliosis varies from full recovery to a permanent deficit. This study aimed to assess the prognosis and recovery of major neurological deficits in these patients, and to determine the risk factors for non-recovery, at a minimum follow-up of two years. A major neurological deficit was identified in 65 of 8,870 patients who underwent corrective surgery for scoliosis, including eight with complete paraplegia and 57 with incomplete paraplegia. There were 23 male and 42 female patients. Their mean age was 25.0 years (SD 16.3). The aetiology of the scoliosis was idiopathic (n = 6), congenital (n = 23), neuromuscular (n = 11), neurofibromatosis type 1 (n = 6), and others (n = 19). Neurological function was determined by the American Spinal Injury Association (ASIA) impairment scale at a mean follow-up of 45.4 months (SD 17.2). the patients were divided into those with recovery and those with no recovery according to the ASIA scale during follow-up.Aims
Methods
The aim of this study was to assess whether it is possible to predict the mortality, and the extent and time of neurological recovery from the time of the onset of symptoms and MRI grade, in patients with the cerebral fat embolism syndrome (CFES). This has not previously been investigated. The study included 34 patients who were diagnosed with CFES following trauma between 2012 and 2018. The clinical diagnosis was confirmed and the severity graded by MRI. We investigated the rate of mortality, the time and extent of neurological recovery, the time between the injury and the onset of symptoms, the clinical severity of the condition, and the MRI grade. All patients were male with a mean age of 29.7 years (18 to 70). The mean follow-up was 4.15 years (2 to 8), with neurological recovery being assessed by the Glasgow Outcome Scale and the Mini-Mental State Examination.Aims
Methods
Introduction. A key outcome measured by national joint registries are revision events. This informs best practice and identifies poor-performing surgical devices. Although registry data often record reasons for revision arthroplasty, interpretation is limited by lack of standardised definitions of revision reasons and objective assessment of radiologic and laboratory parameters. Our study aim was to compare reasons for unicompartmental knee arthroplasty (UKA) revision reported to the New Zealand Joint Registry (NZJR) with reasons identified by independent clinical review. Methods. A total of 2,272 patients undergoing primary medial and lateral UKA at four large tertiary hospitals between 2000 and 2017 were included. A total of 158 patients underwent subsequent revision with mean follow-up of 8 years. A systematic review of clinical findings, radiographs and operative data was performed to identify revision cases and to determine the reasons for revision using a standardised protocol. These were compared to reasons reported to the NZJR using Chi-squared and
Aim. Prosthetic joint infection (PJI) is a devastating and costly complication of total joint arthroplasty (TJA). Use of extended oral antibiotic prophylaxis (EOAP) has become increasingly popular in the United States following a highly publicized study (Inabathula et al) from a single center demonstrating a significant protective effect (81% reduction) against PJI in ‘high-risk’ patients. However, these results have not been reproduced elsewhere and EOAP use directly conflicts with current antibiotic stewardship efforts. In order to study the role of EOAP in PJI prevention, consensus is needed for what defines ‘high-risk’ patients. The revision TJA (rTJA) population is an appropriate group to study due to having a higher incidence of PJI. The purpose of the current study was to rigorously determine which preoperative conditions described by Inabathula et al. (referred to as Inabathula criteria (IBC)) confer a higher rate of PJI in patients undergoing aseptic rTJA. Method. 2,256 patients that underwent aseptic rTJA at a single high-volume institution between 2016–2022 were retrospectively reviewed. Patient demographics and comorbidities were recorded to determine if they had 1 or more ‘IBC’, a long list of preoperative conditions including autoimmune diseases, active smoking, body mass index (BMI)>35, diabetes mellitus, and chronic kidney disease (CKD). Reoperation for PJI at 90-days and 1-year was recorded. Chi-squared or
The management of periprosthetic distal femur fractures is an issue of increasing importance for orthopaedic surgeons. Because of the expanding indications for total knee arthroplasty (TKA) and an aging population with increasingly active lifestyles there has been a corresponding increase in the prevalence of these injuries. The management of these fractures is often complex because of issues with obtaining fixation around implants and dealing with osteopenic bone or compromised bone stock. In addition, these injuries frequently occur in frail, elderly patients, and the early restoration of function and ambulation is critical in these patients. There remains substantial controversy with respect to the optimal treatment of periprosthetic distal femur fractures, with some advocating for Locked Plating (LP), others Retrograde Intramedullary Nailing (RIMN) and finally those who advocate for Distal Femoral Replacement (DFR). The literature comparing these treatments, has been infrequent, and commonly restricted to single-center studies. The purpose of this study was to retrospectively evaluate a large series of operatively treated periprosthetic distal femur fractures from multiple centers and compare treatment strategies. Patients who were treated operatively for a periprosthetic distal femur fracture at 8 centers across North America between 2003 and 2018 were retrospectively identified. Baseline characteristics, surgical details and post-operative clinical outcomes were collected from patients meeting inclusion criteria. Inclusion criteria were patients aged 18 and older, any displaced operatively treated periprosthetic femur fracture and documented 1 year follow-up. Patients with other major lower extremity trauma or ipsilateral total hip replacement were excluded. Patients were divided into 3 groups depending on the type of fixation received: Locked Plating, Retrograde Intramedullary Nailing and Distal Femoral Replacement. Documented clinical follow-up was reviewed at 2 weeks, 3 months, 6 months and 1 year following surgery. Outcome and covariate measures were assessed using basic descriptive statistics. Categorical variables, including the rate of re-operation, were compared across the three treatment groups using
Retrospectively to analyse factors contributing to the development of hyperextension deformity after distal surgical lengthening of hamstrings in cerebral palsy. In the cohort of 51 diparetic patients (98 operated knees ) surgically treated for fixed flexion deformity at least five yers before this study was contemplated, the range of of hyperextension of the knee was measured. According to surgical technique two subgroups were differentiated:. A./ Simple cutting of gracilis and semitendinosus, followed by fractional lengthening of semimembranosus and biceps femoris. B./ Proximal stumps of gracilis and semitendinosus after its transverse division were anchored to fractionally lengthened semimembranosus. Assessment involved: Measurement of hyperextension of the knee in lying and standing position and by walking using video-documentation. Values of Bleck popliteal angle before and after operation were estimated. This cohort did not involve any case with residual fixed plantar flexion of the foot. Both surgical subgroups were compared for occurence of hyperextension deformity >
5° in lying, standing positions and by walking. Testing by
Perioperative glucocorticoids have been used as a successful non-opioid analgesic adjunct for various orthopaedic procedures. Here we describe an ongoing randomized control trial assessing the efficacy of a post-operative methylprednisolone taper course on immediate post-operative pain and function following surgical distal radius fixation. We hypothesize that a post-operative methylprednisolone taper course following distal radius fracture fixation will lead to improved patient pain and function. This study is a randomized control trial (NCT03661645) of a group of patients treated surgically for distal radius fractures. Patients were randomly assigned at the time of surgery to receive intraoperative dexamethasone only or intraoperative dexamethasone followed by a 6-day oral methylprednisolone (Medrol) taper course. All patients received the same standardized perioperative pain management protocol. A pain journal was used to record visual analog pain scores (VAS-pain), VAS-nausea, and number of opioid tablets consumed during the first 7 post-operative days (POD). Patients were seen at 2-weeks, 6-weeks, and 12-weeks post-operatively for clinical evaluation and collection of patient reported outcomes (Disabilities of the Arm, Shoulder and Hand Score [qDASH]). Differences in categorical variables were assessed with χ2 or
Autologous micro-fragmented adipose tissue (MFAT) for the treatment of symptomatic knee osteoarthritis (OA) is gaining interest although there is still a lack of supportive data on safety and clinical efficacy. This study primarily aimed to identify patient- and pathology-related parameters to tighten patient selection criteria for future clinical MFAT application. Secondly, the overall (1) therapeutic response rate (TRR), (2) short-term clinical effect, (3) effect durability and (4) therapeutic safety was investigated at a minimal follow-up of 1 year. Sixty-four subjects (91 knees) with symptomatic knee OA (mild-severe on MRI) were enrolled in a prospective single-centre case series. Ethical approval was obtained from the local and academic ethical committee (#B300201733775). After liposuction, the adipose tissue was mechanically processed in a Lipogem® device which eventually produced 6–9cc MFAT. Subjects were clinically assessed by means of the KOOS, NRS, UCLA and EQ-5D at baseline and 1, 3, 6 and 12 months after injection. Adverse events were meticulously recorded. The TRR was defined according to the OMERACT-OARSI criteria. A baseline MRI was scored following the MOAKS system. Paired sample t-tests, independent t-test and
Olecranon Osteotomy is a common approach used in the management of intraarticular distal humerus fractures. Significant complication rates have been associated with this procedure, including non-union rates of 0–13% and implant removal rates between 12–86%. This study is a multicentre retrospective study involving the largest cohort of olecranon osteotomies in the literature, examining implant fixation types, removal rates and associated complications. Patients were identified between 2007 and 2017 (minimum one year follow-up) via Canadian Classification of Health Interventions (CCI) coding and ICD9/10 codes by our health region's data information service. CCI intervention codes were used to identify patients who underwent surgery for their fracture with an olecranon osteotomy. Reasons for implant removal were identified from a chart review. Our primary outcome was implant removal rates. Categorical data was assessed using Chi square test and
Introduction. Soft tissue releases are often required to correct deformity and achieve gap balance in total knee arthroplasty (TKA). However, the process of releasing soft tissues can be subjective and highly variable and is often perceived as an ‘art’ in TKA surgery. Releasing soft tissues also increases the risk of iatrogenic injury and may be detrimental to the mechanically sensitive afferent nerve fibers which participate in the regulation of knee joint stability. Measured resection TKA approaches typically rely on making bone cuts based off of generic alignment strategies and then releasing soft tissue afterwards to balance gaps. Conversely, gap-balancing techniques allow for pre-emptive adjustment of bone resections to achieve knee balance thereby potentially reducing the amount of ligament releases required. No study to our knowledge has compared the rates of soft tissue release in these two techniques, however. The objective of this study was, therefore, to compare the rates of soft tissue releases required to achieve a balanced knee in tibial-first gap-balancing versus femur-first measured-resection techniques in robotic assisted TKA, and to compare with release rates reported in the literature for conventional, measured resection TKA [1]. Methods. The number and type of soft tissue releases were documented and reviewed in 615 robotic-assisted gap-balancing and 76 robotic-assisted measured-resection TKAs as part of a multicenter study. In the robotic-assisted gap balancing group, a robotic tensioner was inserted into the knee after the tibial resection and the soft tissue envelope was characterized throughout flexion under computer-controlled tension (fig-1). Femoral bone resections were then planned using predictive ligament balance gap profiles throughout the range of motion (fig-2), and executed with a miniature robotic cutting-guide. Soft tissue releases were stratified as a function of the coronal deformity relative to the mechanical axis (varus knees: >1° varus; valgus knees: >1°). Rates of releases were compared between the two groups and to the literature data using the
Background. Prior research has shown that depression negatively impacts outcomes after total hip arthroplasty (THA); however, arthroplasty patients may also have depressive symptoms without an established diagnosis. The purpose of this study was to determine whether the Patient Health Questionnaire-2 (PHQ-2), a two-question depression screener, correlates with joint-specific symptom improvement after primary THA. Methods. This was a prospective cohort study. Patients completed the PHQ-2 and the Hip Disability and Osteoarthritis Outcome Score - Joint Replacement (HOOS-JR) prior to THA, with follow-up at 6 weeks and 6 months. An a priori power analysis determined a sample size of 31 would detect an effect size of 0.5 with a power of 0.80. We used previously established minimum clinically important difference (MCID) values for HOOS-JR. Continuous variables were analyzed with t-tests or Mann-Whitney tests while categorical variables were analyzed with Chi square or
Introduction. The obesity epidemic is a growing problem and must be considered with the projected increased demand for total hip arthroplasty (THA). Previous studies have reported increased complication rates after THA in the obese population, which has led to hesitation in offering surgery to this population. Moreover, some insurers are denying coverage for morbidly obese patients. While many consider obesity a “modifiable” risk factor, very few patients with advanced osteoarthritis have successfully lost substantial weight. The experience of centers that utilize systematic preoperative risk stratification tools and standardized postoperative total joint pathways may be underrepresented in prior studies. The aim of this study is to describe one surgeon's experience performing THA in morbidly and super-obese patient populations using an institutional preoperative Risk Stratification Tool (RST) and total joints pathway. Methods. We conducted a retrospective review of patients undergoing primary THA between May 2014 and December 2017 performed by a single surgeon at a tertiary care referral center. All patients were assessed preoperatively using an institutional RST and had a minimum of 90-day postoperative follow up. Patients were stratified by body mass index (BMI, kg/m. 2. ): non-obese (BMI < 30), obese (30–34), severely obese (35–39), morbidly obese (40–44), and super-obese (≥ 45). Primary outcomes were inpatient and 90-day complications. Continuous and binary parameters were analyzed by Kruskal-Wallis and
Introduction: The problem of ingrowing toenails is worldwide, affecting all age groups. The exact incidence in children is difficult to measure. The aim of this study was to review the different surgical modalities for ingrown toenails in the paediatric age group in a hospital setting. Methods: We reviewed case series of 66 children aged between 9 months and 16 yrs. In total there were 89 affected toes operated upon between 1995 and 2001. The patients were followed up for up to 18 months. All procedures were carried out under general anaesthetic. The treatment methods practised were:. Nail avulsion with or without nail matrix ablation using phenol. Wedge excision of the nail with or without nail matrix ablation using phenol or thermal ablation. RESULTS: We performed statistical analysis using
Introduction. Orthopaedic trauma surgery is characterised by repetitive, forceful tasks that are physically demanding, thus theoretically increasing the risk of musculoskeletal injuries in these surgeons. The aim of this study is to assess prevalence, characteristics and impact of musculoskeletal disorders among orthopaedic trauma surgeons. Methods. A modified version of the physical discomfort survey was sent to surgeon members of the Orthopaedics Trauma Association (OTA) via e-mail. For data analysis, one-way ANOVA and
Bowel management following joint replacement is often neglected leading lot of patient distress, with the advent of the enhanced orthopedic rehabilitation program, there is a need of a guideline to ensure prompt and quick recovery of bowel habits before discharge. Our aim was to identify the incidence of constipation in joint replacement patients, to evaluate the current practice of bowel management and formulate a protocol for management of constipation to improve the practice. We conducted a prospective study of 50 patients who underwent joint replacement procedures at our institute between September and October 2015. Following initial audit, we formulated a protocol for bowel management, and performed a re-audit by collecting a prospective data of 50 patients. The statistical analysis was done and calculating the mean and standard deviation for continuous variable and
Background. Orthopedic trauma patients can have significant pain management requirements. Patient satisfaction has been associated with pain control and narcotic use in previous studies. Due to the multifactorial nature of pain, various injury patterns, and differences in pain tolerances the relationship between patient factors and narcotic requirements are poorly understood. The purpose of this study is to compare patient demographics for trauma patients requiring high doses of narcotics for pain control versus those with more minimal requirements. Methods. Our study sample included 300 consecutive trauma activations who presented to our emergency department during the 2015 calendar year. Opioids given to the patients during their hospital stay were converted to oral morphine equivalents using ratios available from the current literature. Patients were placed into two groups including those who were in the top 10% for average daily inpatient oral morphine equivalents and the other group was composed of the remaining patients. In addition to morphine equivalents, patient age, gender, injury severity score, length of stay, number of readmissions and urine toxicology results were also recorded. Injury severity score (ISS), morphine equivalents, and patient age were evaluated with the Shapiro-Wilk test of normality. Comparisons were performed with the Mann-Whitney U test. Between group comparisons for positive urine toxicology screen and gender were performed with Chi square and
Aim. The induced membrane technique (IMT) or Masquelet technique is a two-step surgical procedure used to treat bony defects (traumatic or resulting from tumoral resections) and pseudo arthroses, even caused by infections. The relatively small case series reported, sometimes with variants to the original technique, make it difficult to assess the real value of the technique. Aim of this study was then to undertake a systematic review of the literature with a particular focus on bone union, infection eradication and complication rates. Method. A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Individual Patient Data (PRISMA-IPD) guidelines. PubMed and other medical databases were searched using “Masquelet technique” and “induced membrane technique” keywords. English, French or Italian written articles were included if dealing with IMT employed to long bones in adults and reporting at least 5 cases with a 12 months minimum follow-up. Clinical and bone defect features, aetiology, surgical data, complications, re-interventions, union and infection eradication rates were recorded into a database.
Non-large head Metal-on-metal (MoM) hip replacements were seen as a solution to concerns about implant wear in younger patients. Mid-term loosening of once well-fixed hydroxyapatite (HA) coated femoral stems was recently observed in select MoM patients upon revision surgery. Accordingly, an implant retrieval study was undertaken to examine the incidence of aseptic loosening of in HA-coated femoral stems with MoM, ceramic on ceramic (CoC) and metal on polyethylene (MoP) bearing couples. A single-centre implant retrieval lab reviewed 44 hydroxyapatite (HA)-coated titanium wedge taper stems of the same design retrieved over a period of 9 years. Ten were MoM articulations, 23 MoP and 11 CoC. Head sizes ranged from 28 to 40 with only four 40mm heads, all of which were MoM. Reason for revision, duration of implantation, femoral head size, patient age and body mass index was recorded for each retrieval. Goldberg corrosion scores were determined for the taper surfaces of each retrieval, with ‘0’ indicating no corrosion and ‘3’ indicating severe corrosion. Logistic regression analysis, Wilcoxan Rank Sum and
Infection is among the first reasons for failure of orthopedic implants. Various antibacterial coatings for implanted biomaterials are under study, but only few technologies are currently available in the clinical setting. Previous studies showed the in vitro and in vivo efficacy and safety of a fast resorbable (<96 h) hyaluronic and polylactic acid based hydrogel, loaded with antibiotic or antibiofilm agents (DAC®, Novagenit Srl, Mezzolombardo, TN). Aim of this study is to report the results of the largest clinical trial in trauma and orthopedic patients. In this prospective, controlled, study, a total of 184 patients (86 treated with internal osteosinthesis for closed fractures and 98 undergoing cementless total hip or knee joint prosthesis) were randomly assigned in three European orthopaedic centers to receive antibiotic-loaded DAC coating or to a control group, without coating. Pre- and post-operative assessment of laboratory tests, wound healing (ASEPSIS score), clinical score (SF-12 score) and x-rays were performed at fixed time intervals. Statistical analysis was performed with
Introduction:. Distal humerus fractures as well as elbow fracture dislocation are often accompanied by soft tissue damage that warrants early fixation with an external fixator. The distal humerus is a hazardous area for placement of an external fixator due to the close proximity of the radial nerve to the humerus in this area. No known safe zone has been identified on the lateral border of the humerus to avoid radial nerve damage. The aim of this study was to record the incidence of radial nerve damage by placing two 4 mm pins into the humerus and to note the relation of the nerve to the pins. Methods:. Two 4 mm pins used to fix an external fixator were drilled into the lateral border of the humerus at points 100 mm and 70 mm proximal to the lateral epicondyle of both arms of 39 cadavers. The 30 mm interval between the pins is the interval between the pins in a pinblock of a commonly-used external fixator. The arms were dissected by medical students and the incidence of radial nerve damage was recorded. Statistical analysis was done using a
Background. The optimal strategy for postoperative deep venous thrombosis (DVT) prophylaxis remains among the most controversial topics in hip and knee arthroplasty. Warfarin, the most commonly used chemical anticoagulant, initially causes transient hypercoagulability; however the optimal timing of treatment with respect to surgery remains unclear. Our purpose was to evaluate the effects of pre- versus postoperative initiation of warfarin therapy with a primary endpoint of perioperative change in hemoglobin (pre- minus post-operative level), with secondary endpoints of postoperative International Normalized Ratio (INR), drain output, and bleeding/thrombotic events. Methods. A quasi-experimental study design was employed, under which patients were assigned to begin taking warfarin the night prior to surgery or the night following surgery based on day of the week seen in clinic. An a priori power analysis was conducted in order to ensure appropriate enrollment to detect a 0.5 g/dL difference in perioperative change in hemoglobin between groups, given an alpha level of 0.05 and beta of 0.80. Based on the results, the study included all primary, elective total hip and knee arthroplasties performed by a single surgeon over a 12 month period. Fifteen patients were excluded (7 chronic anticoagulation, 3 hip fractures, 2 medical contraindications, 3 simultaneous procedures), leaving 165 cases (108 hips, 57 knees) available for study. Of these, 73 received warfarin preoperatively (49 hips, 24 knees) and 92 postoperatively (59 hips, 33 knees). Warfarin was dosed according to a standard nomogram in both groups. INR (on postoperative days 1 and 2), perioperative decrease in hemoglobin (difference between level preoperatively and on postoperative days 1 and 2), and drain outputs were compared between groups using a student t test. Adverse events (transfusions, hematomas, epidural complications, and pulmonary embolus) were compared using two-tailed
Surgeons often target the Lewinnek zone (40°±10° of inclination; 15°±10° of anteversion) for acetabular orientation during total hip arthroplasty (THA). However, matching native anteversion (20°-25°) may achieve optimal stability. The purpose of this study was to (1) determine incidence of early dislocation with increased target acetabular anteversion, and (2) report the accuracy of imageless navigation for achieving target acetabular position in a large, single-surgeon cohort. A posterolateral approach with soft tissue repair was performed in the 553 THA meeting the inclusion criteria. The same imageless navigation system was used for acetabular component placement in all THA. Target acetabular orientation was 40° ± 10° of inclination and 25° ± 10° of anteversion. Computer software was used to measure acetabular positioning on 6-week postoperative anteroposterior pelvic radiographs. Incidence of dislocation within 6 months of surgery was determined. Repeated measures multiple regression using the Generalised Estimating Equations approach was used to identify baseline patient characteristics (age, gender, BMI, primary diagnosis, and laterality) associated with component positioning outside of the targeted ranges for inclination and anteversion.
Obesity is a risk factor for acetabular malposition when total hip arthroplasty (THA) is performed with manual orientation techniques. However, conflicting evidence exists regarding the usefulness of computer-assisted surgery for performing THA in obese patients. The purpose of this study was to compare the precision and accuracy of imageless navigation for acetabular component placement in obese versus non-obese patients. After institutional review board approval, 459 THA performed for primary hip osteoarthritis were reviewed retrospectively. The same imageless navigation system was used for acetabular component placement in all THA. During surgery the supine anterior pelvic plane was referenced superficially. THA was performed via posterolateral approach in the lateral position. A hemispherical acetabular component was used, with target inclination of 40° and target anteversion of 25°. Computer software was used to determine acetabular orientation on postoperative anteroposterior pelvic radiographs. Obese patients (BMI ≥ 30 kg/m2) were compared to non-obese patients. A 5° difference in mean orientation angles was considered clinically significant. Orientation error (accuracy) was defined as the absolute difference between the target orientation and the measured orientation. Student's t test was used to compare means. Hartley's test compared variances of the mean differences (precision).
The purpose of this study was to evaluate the results of subcutaneous ulnar nerve transposition in the treatment of Cubital Tunnel Syndrome (CTS) and the influence of prognostic factores such as preoperative McGowan stage, age and duration of symptoms. 36 patients (17 men and 19 women) with CTS who underwent subcutaneous ulnar nerve transposition between 2006 and 2009 were evaluated postoperatively, an average follow-up of 28 months. Sensory and motor recovery was evaluated clinically. The postoperative outcome was based on modified Bishop score, subjective assessment of function and on the degree of patient satisfaction. The dominant side was involved in 61% cases and the mean age was 51.2 years. There were 9 (25%) McGowan stage I, 18 (50%) stage II and 9 stage III patients. We used the Mann-Whitney and Kruskal-Wallis test to compare continuous variables and chi-square and
Background. Dislocation is one of the commonest complications of total hip arthroplasty (THA) with incidence of between 0.3 and 10% in primary, and from 15 % to 30% of revision cases. Despite this, little is known of the outcome of treatment strategies for dislocation. In this study, we evaluated clinical results in patient undergoing revision THA for recurrent dislocation. Materials and Methods. Twenty-four hips underwent revision THA for recurrent instability between 1998 and 2011 at our institution. Nine patients were male, and 15 were female. At the time of revision, the average age was 69.9 years (range, 45–83 years). Average follow-up was 29.8 months (range, 6–72 months). We recorded the number of times of dislocation, the direction of dislocation, the factor of dislocation and the operative strategy employed for each case. Demographic data and surgical treatment used were analyzed to determine risk factors for failure. We performed Mann-Whitney rank sum test, Student's t-test and
Introduction and purpose: The aim of this study is to determine the risk profile of a repeat hip fracture based on the patients’ intrinsic characteristics, their associated risk factors and concomitant pathological conditions, with the aim of carrying out preliminary work that might allow subsequent studies to quantify these risk factors. Materials and methods: Case study and multi-center control: 1576 cases of hip fracture were collected of which 138 (8.76%) were repeat-fractures of the hip (the latter was the test group and the control group comprised the remaining 1574 cases [91.24%]). Variables were analyzed that could represent the risk profile of the patients and their predisposition to an osteoporotic fracture, their modifiable or non-modifiable risk factors and concomitant pathological conditions. Qualitative variables were analyzed using chi square; any necessary adjustments were made by means of
Purpose:. While the use of press-fit humeral components has been accepted in total shoulder arthroplasty, few studies focus on the outcomes after uncemented reverse total shoulder arthroplasty. The purpose of this study is to compare the radiographic and functional results of uncemented and cemented humeral fixation in reverse total shoulder arthroplasty. Materials/Methods:. A retrospective review was performed identifying all patients that underwent reverse total shoulder arthroplasty (RTSA) between May 2007 and December 2010. Medical records and a prospective research database were reviewed for demographic, operative, and clinical information. Inclusion criteria were a primary reverse total shoulder arthroplasty from one manufacturer with a grit-blasted humeral metaphyseal stem and minimum follow-up of 2 years. Exclusion criteria included shoulder arthroplasty for fractures, fracture sequelae, or inflammatory arthropathy. Antibiotics were not routinely added to the cement. The radiographic and functional outcomes were compared between the uncemented and cemented groups. Statistical analysis was performed using the
Purpose. The correction obtained in the coronal plane knee deformity using guided growth was assessed in children with sick physes (Height<1SD of the normal children) to define the limits of this technique in sick physis. Methods. We retrospectively assessed deformity correction following guided growth using 8 plates in children with coronal plane deformity and metabolically abnormal physis- renal rickets in 6 and bone dysplasias (multiple epiphyseal dyspasia, spondyloepiphyseal dysplasia, metaphyseal dysplasia, mesomelic dysplasia, chondrodysplasia punctata) in 10 children aged 2 to 14 years. Lateral distal femoral angle(LDFA) and medial proximal tibia(MPTA) angles were serially assessed after eight plate application as a day care procedure. We noted correction achieved rate of correction, complications and additional surgical procedures.
Purpose: Some patients with Cerebral Palsy who had a de-rotation osteotomy performed for correction of excessive anteversion had persistence of internal foot progression even after the surgery. The aim of this study was to see if there is any relationship between significant abductor weakness [less than Grade III: MRC] and persistence of internal foot progression. Methods: We included all ambulatory patients with cerebral palsy who had had a de-rotation osteotomy between the periods of 2000 – 2005, who had also had a pre and post operative gait analysis, assessment of anteversion, muscle charting and hip range of movements. There were 12 patients [17 hips, 5 bilateral] 5 male 7 female with an average age of 13. Seven were diplegic, two hemiplegic and three had asymmetric diplegia. Data was assessed using SPSS 13.0. As the data was found to be normally distributed the
Purpose: Some patients with Cerebral Palsy who had a de-rotation osteotomy performed for correction of excessive anteversion had persistence of internal foot progression even after the surgery. The aim of this study was to see if there is any relationship between significant abductor weakness [less than Grade III: MRC] and persistence of internal foot progression. Methods: We included all ambulatory patients with cerebral palsy who had had a de-rotation osteotomy between the periods of 2000 – 2005, who had also had a pre and post operative gait analysis, assessment of ante-version, muscle charting and hip range of movements. There were 12 patients [17 hips, 5 bilateral] 5 male 7 female with an average age of 13. Seven were diplegic, two hemiplegic and three had asymmetric diplegia. Data was assessed using SPSS 13.0. As the data was found to be normally distributed the
Chondrosarcoma is treated with respect by oncology surgeons, given that it is relatively resistant to chemotherapy and radiotherapy. The aim was to study the outcomes of surgery for chondrosarcoma and determine the role of initial surgical margins and local recurrence on outcome. Electronic patient records were retrieved on all patients seen with chondrosarcoma of bone with a minimum of two years follow up. A total of 532 patients were seen with Chondrosarcoma between 1970 and 2006. Patients were excluded if they had initial treatment in another unit (20 patients), a subdiagnosis of dedifferentiated chondrosarcoma (due to very poor prognosis, 43 patients), metastases at presentation (30 patients), if they presented with disseminated metastases prior to local recurrence (12 patients) or were not offered surgery, leaving 402 patients in the study group. The mean age was 48 years old (range 6–89 years) with the most commonly sites of presentation being in the pelvis in 132 patients (29%), proximal femur in 81 patients (18%), distal femur in 40 patients (9%) and proximal humerus in 40 patients (9%). Grade at presentation was grade 1 in 44%, grade 2 in 44% and grade 3 in 12%. Surgical margins were radical in 3%, wide in 44%, marginal in 29%, planned incisional in 13% and unplanned incisional in 11%. Local recurrence occurred in 87 patients (22%). Local recurrence rates were significantly different for surgical margins on
Purpose. To determine whether radiographically demonstrated femoral neck irregularities (pistolgrip-deformity, focal prominences or lytic defects) are associated with positive clinical impingement tests. Methods. The 1989 Bergen birth cohort (n=4004) was invited to a population-based follow-up including clinical examination and two pelvic radiographs. 2081 (52%) were enrolled. Associations between clinical and radiographic findings were examined using chi-squared or
Purpose: The aim of the study was to establish normal reference standards for the appearance of the femoral head ossification center according to age, sex and gestational age. Material and Methods: Sonographic examination of the hip was performed in 1800 healthy Indian and Israeli infants (900 each) aged 2 to 24 weeks. There was an equal number of males and females. A single physician performed all examinations in each country. For each infant, we recorded sex, date of birth, gestational age at birth (weeks), date of ultrasound examination, age at examination (weeks), and presence or absence of the femoral head ossification center on sonographic examination. All data were collected in a Microsoft Excell file and submitted for independent statistical analysis using paired
The aim of the present study was to compare the amount of blood loss between Gamma nail and DHS operative procedures in treating fractures N.O.F. Material and Method: thirty patients 81 years of age (average), suffering from N.O.F. fracture were divided in two groups, depending on sex, age, weight and type of fracture, in such way that for every patient operated using one procedure there was a similar one treated with the other one (pairing). The admission and discharge Ht, the blood unites needed for the whole patients hospitalization time were compared. Statistically T-test, Pearson chi square –
Operative treatment of flexion-distraction fractures of the thoraco-lumbar spine in children and adolescents may be the preferred approach to the management of this fracture. In this retrospective review of thoraco-lumbar flexion-distraction spine fractures at a paediatric level One trauma center we compared outcomes (fusion and loss of reduction) of operatively and non-operatively managed patients. Twenty cases of thoraco-lumbar and lumbar region flexion-distraction fractures were identified. Patients were grouped by non-operative versus operative and three Cobb angles were recorded from radiographs of each patient: one taken at the time of fracture, one at initiation of treatment, and the last at final follow-up. Union rate and changes in angular deformity was analysed using Chi square analysis and
There is little in the literature reporting on the incidence of heterotopic ossification (HO) after hip resurfacing arthroplasty. HO has long been recognized as a complication of THA, with a reported incidence that ranges between 5 – 90 %. We investigated the incidence of HO in a group of hip resurfacing patients, and compared this against the incidence of HO in a comparable group of patients managed with a conventional THA. We retrospectively reviewed patients who had a hip resurfacing procedure from January 2004 to December 2007 carried out by a single surgeon. To act as our comparative group, we selected a closely matched group of patients in terms of age and sex who underwent a THA over the same time period, under the same surgeon. 47 cases of resurfacing, 23 were female and 24 male. The 47 cases of the selected THA group consisted of 24 females and 23 males. Therefore the two groups were of a similar sex make up. Within the resurfacing group of patients, the ages ranged from 31 to 68 years, with the mean being 55.4 years, and the median being 56.5 years. The THA group possessed an age range of from 31 to 68 years, with the mean being 55.4 years, and the median being 56.5 years. The resurfacing group of patients had 5 cases showing HO, giving an overall rate of 10.6 percent. 3 were of the grade I variety, while 2 were grade II. The THA group had 6 cases showing HO, giving an overall rate of 12.8 percent. 5 of these were of the grade I variety, while 1 was of the grade III variety. We used a two tailed
In primary total knee arthroplasty (TKA) performed under ischemia the antibiotic prophylaxis is administered 15’ before inflating the tourniquet. The infection rate in TKA is higher than in hip arthroplasty. We hypothesise that ischemia could impair the efficacy of the antibiotic. The objective of our study was to compare the effectiveness of two schedules of antibiotic administration. We conducted a randomised and a double blind study. Patients were assigned to receive placebo 15’ before inflating tourniquet and cefuroxim 1.5 g 10’ before releasing the tourniquet (experimental arm) or cefuroxim 1.5 g 15’ before inflating tourniquet and placebo 15’ before releasing tourniquet (standard arm). In both arms cefuroxime 1.5 g was administered 6 hours after finishing surgery. The variables gathered were: age, sex, indication for TKA, co-morbidity, ASA score, duration of the operation, number of blood transfusions, days of hospitalisation and number of surgical site infections after 3 months of surgery. Categorical variables were compared using the χ. 2. test or the
Aim: To assess the infection rate following Lower Limb Arthroplasty using single dose gentamicin antibiotic prophylaxis compared to a traditional three doses of cephalosporin. Material and Methods: All patients undergoing Total Hip and Knee joint replacements over 6 months (October 2007 to March 2008) at 3 participating hospitals were prospectively followed up to assess perioperative infection rates. Joint replacements were defined as having infection by the UK Health Protection Agency Surgical Site Surveillance criteria. All patients received single dose antibiotic prophylaxis using intravenous Gentamicin 4.5mg/kg body weight adjusted for body mass index. This group of patients were compared with previous data collected over a 6 month period (Jan to Mar 2007 and Oct to Dec 2005) from the same hospitals for infection rates in Lower Limb Arthroplasty using 3 doses of Cefuroxime 750mg as antibiotic prophylaxis. Results: 408 patients underwent Total Hip Replacements (THR) and 458 patients underwent Total Knee Replacements (TKR) during the study period. This was compared with 414 patients who underwent THR and 421 patients who underwent TKR during a 6 month period over 2 years. Surgical site infection was detected in 9 THRs (2.2%) and 2 TKRs (0.44%) in the study group as compared to infection in 13 THRs (3.1%) and 12 TKRs (2.9%) in the control group. Using the
Aims: The aim of this prospective study is to compare the results regarding non-union and AVN of two different methods of treatment after displaced femoral neck fractures in young and middle age population. Methods: Between 1980–1998 we treated 91 patients with displaced femoral neck fractures. In 56 patients (Group A) we performed open reduction, dynamic screw fixation and gluteus minimus muscle pedicle bone graft from greater trochanter inserted through a tunnel prepared parallel to screw. 38 patients had fracture Type Garden III and 18 Garden IV. In 35 patients (Group B) after closed reduction the fracture was fixed with three parallel canullated screws. 24 had fracture Type Garden III and 11 Type IV. All patients were operated within 24 hours. After reduction, Garden Index of 1600±100/1800±100 was acceptable. Follow up varied between 3 to 12 years.
Introduction: Increasing numbers of patients are being treated outside traditional NHS hospitals as part of GSup (General supplemental funding) projects and other initiatives to reduce waiting lists. Concerns regarding these arrangements include case mix at NHS hospitals, quality of clinical care and patient satisfaction. Null Hypothesis: There is no difference between overall patient satisfaction following treatment within the NHS, as part of GSup or as an independent private patient. Methods: Patients undergoing total hip arthroplasty by a single consultant were contacted 6 to 18 months postop. 3 groups were formed; those treated in the local NHS hospital, patients treated as part of GSup and private patients independently financed. A previously validated patient satisfaction questionnaire was completed by each patient. This investigates satisfaction with admission, environment, healthcare professionals, treatment, leaving hospital and overall care.
Aims: To determine whether lumbar spinal injection in conjunction with general anaesthesia decreases peri-operative blood loss and thereby transfusion rates as compared to general anaesthesia alone in patients undergoing primary hip arthroplasty. Methods: This is an observational study of 47 consecutive patients who underwent unilateral primary total hip arthroplasty. These were all performed by the same surgeon using the same approach, prosthesis and postoperative care. Group I consisted of 28 patients who had combined lumbar spinal and general anaesthesia performed by the same anaesthetist. Group II consisted of 19 patients who had general anaesthesia alone. Analysis was made of intra-operative blood pressure, post-operative haemoglobin levels using Mann-Whitney test and of transfusion rates using
Purpose: Do children from different gender or racial groups receive different analgesic doses for the same acute pain condition? We previously reported on intra-thecal morphine for preemptive analgesia in children undergoing posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI) for idiopathic scoliosis (IS). We determined the optimal dose range to maximize analgesia while minimizing adverse effects. The purpose is to ensure this adopted protocol is equally effective across gender and racial groups. Method: We studied 407 intrathecal morphine patients. Those given a moderate dose of 9–19 mcg/kg (n=293) had the most effective and safe postoperative pain relief. This group consisted of 246 female and 47 male patients. There were 224 Caucasian (CA) and 63 African-American (AA) patients. Other ethnicities were excluded. Factors analyzed included postoperative Wong-Baker visual analog pain scores (VAS), time to first opioid rescue dose, total morphine dose over the first 48 hours, and postoperative complications. Results: For female and male gender, mean VAS pain scores in post-anesthesia care unit (PACU) were 0.48 and 0.56, mean times to first opioid rescue dose were 999.1 and 1003.3 minutes, and total morphine over the first 48 hours were 1.5mg/kg in both groups, respectively. Respiratory depression and PICU admission occurred in 2 (4.2.%) and 4 (1.6%) patients, respectively. For CA and AA patients, mean VAS pain scores in PACU were 0.48 and 0.46, mean times to first opioid rescue dose were 991.7 and 1031.9 minutes, and total morphine over the first 48 hours were 1.5mg/kg and 1.3mg/kg, respectively. Respiratory depression occurred in 5 (2.2.%) and 2 (3.2%) patients and PICU admission occurred in 4 (1.8.%) and 4 (6.3%) patients, respectively. StudentÂ’s t-test and
Patients with bilateral femur shaft fractures are known to have a higher rate of complications when compared with those who have unilateral fractures. Many contributing factors have been considered responsible, however due to the heterogeneity of the studied populations solid conclusions cannot be substantiated. Patients included in our study were separated according to the presence of a unilateral (group USF) (n=146) versus bilateral femur shaft fracture (group BSF) (n=19)Endpoints of the study included the incidence of systemic (SIRS, Sepsis, Acute Lung Injuries) complications. The perioperative assessment included documentation of clinical and laboratory data assessing blood loss, coagulopathy, wound infection, and pneumonia. Local (wound infection, compartment syndrome etc.) and systemic complications (ALI, MOF, Sepsis) were documented. Statistical analyses were conducted to examine the relation between the occurrence of unilateral versus bilateral femoral fractures and variables indexing patient demographic characteristics and other indicators of initial injury severity. Independent sample t-tests were used to examine treatment group differences for variables that approximated a Gaussian distribution. For non-normal indicators of injury severity Mann-Whitney tests were performed. Pearson chi-square tests were performed for binary indicators of injury severity, except when expected cell counts did not exceed 5 participants. When this occurred, the
