Robotic TKA allows for quantifiable precision performing bone resections for implant realignment within acceptable final component and limb alignments. One of the early steps in this robotic technique is after initial exposure and removal of medial and lateral osteophytes, a “pose-capture” is performed with varus and valgus stress applied to the knee in near full extension and 90° of flexion to assess gaps. Component alignment adjustments can be made on the preoperative plan to balance the gaps. At this point in the procedure any posterior osteophytes will still be present, which could after removal change the flexion and extension gaps by 1–3mm. This must be taken into consideration, or changes in component alignment could result in over-correction of gaps can occur. The purpose of this study was to identify what effect the posterior osteophyte's size and location and their removal had on gap measurements between pose-capture and after bone cuts are made and gaps assessed during implant trialing.Introduction
Objective
Background.
The study describes the topography, morphology and growth of osteophytes in forty femoral heads removed from patients presenting with advanced osteoarthritis of the hip. In addition to standard histological techniques, radiography of serial bone slices and in vivo bone labelling with tetracycline and . 32. P were used. The pattern of major osteophyte formation appeared to be influenced by the direction, degree and rate of displacement of the femoral head in relation to the acetabulum; four principal patterns of growth were noted.
INTRODUCTION. In total hip arthroplasty, preoperative planning is almost indispensable. Moreover, 3-dimensional preoperative planning became popular recently. Anteversion management is one of the most important factors in preoperative planning to prevent dislocation and to obtain better function. In arthritic hip patients osteophytes are often seen on both femoral head and acetabulum. Especially on femoral head, osteophytes are often seen at posterior side and its surface creates smooth round contour that assumes new joint surface. (Fig. 1). We can imagine new femoral head center tracing that new joint surface. OBJECTIVES. In the present study, the posterior osteophytes are compared in osteoarthritic patients and other patients. MATERIALS & METHODS. Anteversion and new anteversion which was reduced by osteophyte formation were assessed in 28 hip CAT scans, (22 arthritic hips, 6 avascular necrotic hips). RESULTS. Only in arthritic patients, osteophytes on posterior side were observed. The anteversion was 33.7+/− 13.0 degree in arthritic patients, which was reduce to 29.7+/−13.1 degree. The mean difference was 4.0+/−4.7 degree reduction. In AVN patients the mean anteversion was 21.4 +/− 9.40 in AVN patients. No reduction was observed in AVN patients. DISCUSSION.
Purpose. The effects of Acetabular Rim
Sagittal plane imbalance (SPI), or asymmetry between extension and flexion gaps, is an important issue in total knee arthroplasty (TKA). The purpose of this study was to compare SPI between kinematic alignment (KA), mechanical alignment (MA), and functional alignment (FA) strategies. In 137 robotic-assisted TKAs, extension and flexion stressed gap laxities and bone resections were measured. The primary outcome was the proportion and magnitude of medial and lateral SPI (gap differential > 2.0 mm) for KA, MA, and FA. Secondary outcomes were the proportion of knees with severe (> 4.0 mm) SPI, and resection thicknesses for each technique, with KA as reference.Aims
Methods
While osteophytes are a hallmark feature of knee osteoarthritis (OA), there is limited information regarding their location. In particular, it is unknown whether osteophytes develop in patient-specific locations or if there are consistent osteophyte locations among OA knees. This lack of data mainly stems from the fact that osteophytes have been mostly assessed with scores quantifying their size or severity but not their location. Given the important role that bone could play in OA development and the option it offers for OA treatment, there is a need to better understand the osteophyte locations. This study aimed to develop a method to compare osteophyte locations among knees and determine the overlapping ratio. CT arthrogram of 11 medial-compartment OA tibias (Kellgren-Lawrence grade ≥ 3) were segmented to locate the osteophytes and a bone matching technique was used to report the osteophyte locations of the 11 knees on a single reference tibia. This newly proposed method was highly reproducible (intra-operator ICC = 0.89). When used to compare the 11 tibias, it showed that more than 60% of the overall subosteophytal area, defined as the reference bone area covered by at least one osteophyte from one knee, was common to less than two tibias. Moreover, less than 20% of the overall subosteophytal area was common to five or more tibias. The results of this study suggest that osteophyte locations are specific to each knee. Future work should determine the relationships with mechanical loading, as this could explain the high inter-patient variability.
We present to you a match-controlled study assessing co-existing arthroscopic findings during hip arthroscopy in patients with an intraoperative diagnosis of a central acetabular osteophyte (CAO). We feel that this manuscript is both pertinent and timely. Recent literature has described the entity of central acetabular impingement, in which an osteophyte of the cotyloid fossa impinges against the superomedial femoral head and fovea. The technique for central acetabular decompression has also been described to treat this entity. The primary purpose of this study was to report the prevalence of femoral head articular damage in a matched cohort of patients with and without central acetabular osteophyte (CAO) that was identified during hip arthroscopy. A secondary purpose was to identify the rates of co-existing intraarticular pathology in both patient groups. Intraoperative data was collected prospectively on all patients undergoing hip arthroscopy at our institution between February 2008 to March 2015,. The inclusion criteria for this study were the presence of a CAO identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement (FAI). Exclusion criteria were revision surgeries, Tönnis grade 1 and higher, and previous hip conditions such as Legg-Calves-Perthes disease, avascular necrosis, and prior surgical intervention. The matched cohort control group was selected based on gender, age within 5 years, body mass index (BMI), and workers' compensation claim, on a 1:3 ratio to patients who underwent hip arthroscopy for a labral tear and/or FAI and did not have a CAO. The CAO group consisted of 126 patients, which were matched to 378 patients in the control group. The grades of femoral and acetabular chondral damage were significantly different between the two groups (p<0.01). This study showed that patients with CAO had a significantly higher prevalence of femoral and acetabular chondral damage, size of articular defects on both surfaces and the prevalence of LT tears compared to matched controls.
Newer prosthetic total knee arthroplasty (TKA) designs as well as unicondylar TKAs spare the anterior cruciate ligament (ACL). Although success of these procedures requires near normal ACL function, little has been written about the arthritic ACL. This study was designed to evaluate the relationship between cross sections of the intercondylar notch and the macroscopic condition of ACL degeneration. Thirty osteoarthritic patients who underwent TKA as a result of severe osteoarthritis were randomly selected. Occupation rate of the osteophytes to the notch width were measured at the anterior 1/3, middle 1/3, and posterior 1/3 notche images obtained from preoperative tunnel view. Macroscopic conditions of the ACL and PCL were classified into four types of Normal, Frayed, Partial rupture, and Absent. The macroscopic ACL conditions were Normal: 9 cases, Frayed: 9 cases, Partial rupture: 9 cases, and Absent: 3 cases. The macroscopic PCL conditions were Normal: 24 cases, Frayed: 3 cases, Partial rupture: 3 cases, and Absent: 0 case. Occupation rate of the osteophytes to the notch correlated to the preoperative femorotibial angle (p<
0.05). In terms of ACL, the occupation rate of the osteophytes to the notch were 22.9%, 28.8%, 46.0%, and 81.8% in Normal, Frayed, partial ruptured, and Absent, respectively. The patients with more than 40% occupation rate showed either partial rupture or absent of the ACL during the surgery. We conclude that occupation rate of the osteophytes to the notch is a good predictor of evaluating the ACL degeneration in osteoarthritic knee.
The influence of Posterior Cruciate Ligament (PCL) removal and re-establishment of the posterior condylar recess on flexion and extension gaps width during posterior-stabilized Total Knee Arthroplasty (TKA) is still controversial. It has been reported that PCL resection lead to a selective increase of the flexion space of 3–4 mm, creating a potential for instability in flexion. Our hypothesis was that these surgical steps will equally increase both gaps. Measurements of the flexion and extension gaps heights were obtained during different surgical phases in 50 consecutive primary posterior-stabilised TKAs using a tensor device and a calibrated torque wrench. There was a slight symmetrical increase in both gaps after PCL release. In extension the width of the gap increased on average 1.3 mm and 1.0 mm in the medial and lateral compartment respectively. The same pattern was observed in flexion, averaging 1.3 mm medially and 1.3 mm laterally. Another increase of the two gaps was observed after the posterior condylar osteophytes were removed and the posterior recess was re-established. The gaps in extension increased, with respect to the baseline value, on average 1.8 mm medially and 1.8 mm laterally, while in flexion the increase averaged 2.0 mm and 2.2 respectively on the medial and lateral side. Again there were no statistical differences between flexion and extension gaps. No independent differences between the flexion and extension gaps were found in any considered surgical phase. PCL removal and re-establishment of posterior condylar recess does not seem to require any additional consideration in gap balancing during posterior-stabilized TKA.
Objectives.
It has been well documented in the arthroplasty literature that lumbar degenerative disc disease (DDD) contributes to abnormal spinopelvic motion. However, the relationship between the severity or pattern of hip osteoarthritis (OA) as measured on an anteroposterior (AP) pelvic view and spinopelvic biomechanics has not been well investigated. Therefore, the aim of the study is to examine the association between the severity and pattern of hip OA and spinopelvic motion. A retrospective chart review was conducted to identify patients undergoing primary total hip arthroplasty (THA). Plain AP pelvic radiographs were reviewed to document the morphological characteristic of osteoarthritic hips. Lateral spine-pelvis-hip sitting and standing plain radiographs were used to measure sacral slope (SS) and pelvic femoral angle (PFA) in each position. Lumbar disc spaces were measured to determine the presence of DDD. The difference between sitting and standing SS and PFA were calculated to quantify spinopelvic motion (ΔSS) and hip motion (ΔPFA), respectively. Univariate analysis and Pearson correlation were used to identify morphological hip characteristics associated with changes in spinopelvic motion.Aims
Methods
The objective of our study is to evaluate the accuracy of an X-ray based image segmentation system for patient specific instrument (PSI) design or any other surgical application that requires 3D modeling of the knee. The process requires two bilateral short film X-ray images of knee and a standing long film image of the leg including the hip and ankle. The short film images are acquired with an X-ray positioner device that is embedded with fiducial markers to correct for setup variation in source and cassette position. An automated image segmentation algorithm, based on a statistical model that couples knee bone shape and radiographic appearance, calculates 3D surface models of the knee from the bi-lateral short films (Imorphics, Manchester UK) (Figure 1). Surface silhouettes are used to inspect and refine the automatically generated segmentation; the femur and tibia mechanical axes are then calculated using automatically generated surface model landmarks combined with user-defined markups of the hip and ankle center from the standing long film (Figure 2). The accuracy of the 2D/3D segmentation system was evaluated using simulated X-ray imagery generated from one-hundred osteoarthritic, lower limb CT image samples using the Insight Toolkit (Kitware, Inc.). Random, normally distributed variations in source and cassette positions were included in the dataset. Surface accuracy was measured using root-mean-square (RMS) point-to-surface (P2S) distance calculations with respect to paired benchmark CT segmentations. Landmark accuracy was calculated by measuring angular differences between the 2D/3D generated femur and tibia mechanical tibia with respect to paired CT-generated landmark data. The paired RMS sample mean and standard deviation of femur P2S errors on the distal quarter of the femur after auto-segmentation was 1.08±0.20mm. The RMS sample mean and standard deviation of tibia P2S errors on the proximal quarter of the tibia after auto-segmentation was 1.16±0.25mm. The paired sample mean and standard deviation of the femur and tibia mechanical axis accuracy with respect to benchmark CT data landmarks were 0.02±0.42[deg] and −0.33±0.56[deg], respectively. Per surface-vertex sample RMS P2S errors are illustrated in Figure 3. Visual inspection of RMS results found the automatically segmented femur to be very accurate in the shaft, distal condyles, and posterior condyles, which are important for PSI guide fit and accurate planning. Similarly, the automatically segmented tibia was very accurate in the shaft and plateaus, which are also important for PSI guide fit.
Stiffness after a TKA might be said to be present when reasonable functions of daily living cannot be performed or can only be performed with difficulty or pain. This will certainly be true if flexion is less than 75 degrees and/or there is a 15-degree lack of full extension. The purpose of this presentation is to discuss the causes of a stiff TKA, consider the aspects of surgical technique that are associated with the occurrence of stiffness, present post-surgical management that impacts on the development of stiffness and summarise the results of the surgical treatment of a stiff TKA. Pre-operative stiffness is strongly correlated with post-operative limitation of motion. Therefore, pre-surgical measures to optimise motion should be carried out. These include appropriate physical therapy, adequate pain management and a discussion with the patient of the issues likely to affect post-operative range of motion. It is particularly important to discuss with the patient appropriate expectations with regard to the likely range of motion that will be achieved following TKA surgery. There are a number of steps that can be taken during the performance of a TKA that have an impact on range of motion.
We report the technique and results of a new method of debridement arthroplasty for advanced primary osteoarthritis of the elbow. Triceps and the periosteum of the olecranon are reflected towards the ulnar side and the joint is opened by dividing the radial collateral ligament.
Tissue engineering is a rapidly expanding field of research. Bone and cartilage engineering are being undertaken in an attempt to treat osteoarthritis and repair bone defects. In spite of extensive research little successful clinical application of this work has been seen. There are however many advances in the field that one day may have therapeutic interest. One particular area of interest is the potential for using osteophyte tissue in repairing osteoarthritic defects.
We assessed the long-term outcome of open debridement for the treatment of anterior impingement of the ankle in 27 patients. By using preoperative radiographs to group patients according to both the McDermott and the van Dijk scoring system, we assessed the accuracy of these classifications in predicting outcome. The Ogilvie-Harris scoring system, a visual analogue scale of patient satisfaction, the time to return to full activities, and the ability to return to sports determined the clinical outcome. Follow-up radiographs were used to assess the recurrence of osteophytes. We also assessed the incidence of talar osteochondral lesions at surgery. At a mean follow-up of 7.3 years, 23 of 25 patients (92%) without joint-space narrowing had a good or excellent result. Improvement in the Ogilvie-Harris score was seen in all patients. In athletes, 19 of 24 (79%) were able to return to sports at the same level. Two patients with preoperative joint-space narrowing had a poor result.
The aims of this study were: 1) to describe extended restricted kinematic alignment (E-rKA), a novel alignment strategy during robotic-assisted total knee arthroplasty (RA-TKA); 2) to compare residual medial compartment tightness following virtual surgical planning during RA-TKA using mechanical alignment (MA) and E-rKA, in the same set of osteoarthritic varus knees; 3) to assess the requirement of soft-tissue releases during RA-TKA using E-rKA; and 4) to compare the accuracy of surgical plan execution between knees managed with adjustments in component positioning alone, and those which require additional soft-tissue releases. Patients who underwent RA-TKA between January and December 2022 for primary varus osteoarthritis were included. Safe boundaries for E-rKA were defined. Residual medial compartment tightness was compared following virtual surgical planning using E-rKA and MA, in the same set of knees. Soft-tissue releases were documented. Errors in postoperative alignment in relation to planned alignment were compared between patients who did (group A) and did not (group B) require soft-tissue releases.Aims
Methods
This systematic review aimed to summarize the full range of complications reported following ankle arthroscopy and the frequency at which they occur. A computer-based search was performed in PubMed, Embase, Emcare, and ISI Web of Science. Two-stage title/abstract and full-text screening was performed independently by two reviewers. English-language original research studies reporting perioperative complications in a cohort of at least ten patients undergoing ankle arthroscopy were included. Complications were pooled across included studies in order to derive an overall complication rate. Quality assessment was performed using the Oxford Centre for Evidence-Based Medicine levels of evidence classification.Aims
Methods
Bone Tissue Engineering Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia.
The purpose of this study was to present our experience with femoral neck fractures that occurred after metal-on-metal hybrid surface arthroplasty and to assess their causation. Materials and Methods: A series of 600 metal-on-metal surface arthroplasties was performed from late 1996 to early 2003 by the primary author. Failures during this period were assessed radiographically and with implant retrieval analysis to determine the cause of failure. There were five femoral neck fractures in this series (0.83%). In addition, a review of the femoral neck fracture cases identified from the Conserve+ Multi-Center IDE was performed (19 femoral neck fractures in 1203 cases, 1.6%). Results: Lead Author Series: Four of the five fractures occurred at the component–neck junction in the first five months after surgery (average three months). All were associated with a traumatic episode but they also had structural and or technical risk factors, which weakened the constructs. The most important technical deficiency was failure to cover all of the reamed bone with the component in three of the five. One fracture was associated with histological changes consistent with osteonecrosis of the head in a case of overpenetration of cement in very soft bone. Multi-Center IDE: Additional risk factors were identified among which impingement of the neck with the acetabular component, notching of the lateral femoral neck cortex, and leaving the femoral component proud (not completely seated). Conclusion: It is important to avoid or at least minimize notching the femoral neck by performing the cylindrical reaming at the recommended angle of 140° and to stop reaming before the reamer touches the lateral cortex.
Osteoarthritis (OA) is a highly prevalent degenerative joint disorder characterized by joint pain and physical disability. Aberrant subchondral bone induces pathological changes and is a major source of pain in OA. In the subchondral bone, which is highly innervated, nerves have dual roles in pain sensation and bone homeostasis regulation. The interaction between peripheral nerves and target cells in the subchondral bone, and the interplay between the sensory and sympathetic nervous systems, allow peripheral nerves to regulate subchondral bone homeostasis. Alterations in peripheral innervation and local transmitters are closely related to changes in nociception and subchondral bone homeostasis, and affect the progression of OA. Recent literature has substantially expanded our understanding of the physiological and pathological distribution and function of specific subtypes of neurones in bone. This review summarizes the types and distribution of nerves detected in the tibial subchondral bone, their cellular and molecular interactions with bone cells that regulate subchondral bone homeostasis, and their role in OA pain. A comprehensive understanding and further investigation of the functions of peripheral innervation in the subchondral bone will help to develop novel therapeutic approaches to effectively prevent OA, and alleviate OA pain. Cite this article:
Introduction: A subjective observation suggests that a significant percentage of patients offered a TKR could benefit from a relatively more conservative, less invasive unicompartmental knee arthroplasty. We set out to challenge this hypothesis. Materials &
Methods: 1147 TKRs were performed between 2002 and 2005 at Ravenscourt Park Hospital. 50 consecutive knee x-rays of patients who underwent a TKR were reviewed by three independent observers. Medial and lateral articular cartilage height, varus angulation, and femero-tibial anteroposterior and mediolateral translation were measured on antero-posterior and lateral weight bearing radiographs. Skyline views were analysed for patellofemoral disease. The most appropriate procedure according to local radiological criteria was recorded for all three observers. Unicompartmental arthroplasty was considered when the following criteria was met 1) anteromedial disease with preservation of posterior slope, 2) preservation of the tibial spines, 3) no anteroposte-rior or mediolateral translation, 4) normal tibiofemoral alignment and 5) preservation of patellofemoral joint.
No predictive model has been published to forecast operating time for total knee arthroplasty (TKA). The aims of this study were to design and validate a predictive model to estimate operating time for robotic-assisted TKA based on demographic data, and evaluate the added predictive power of CT scan-based predictors and their impact on the accuracy of the predictive model. A retrospective study was conducted on 1,061 TKAs performed from January 2016 to December 2019 with an image-based robotic-assisted system. Demographic data included age, sex, height, and weight. The femoral and tibial mechanical axis and the osteophyte volume were calculated from CT scans. These inputs were used to develop a predictive model aimed to predict operating time based on demographic data only, and demographic and 3D patient anatomy data.Aims
Methods
The purposes of this study were to determine whether it is necessary to obtain MRI of the knee prior to high tibial osteotomy (HTO) and to evaluate usefulness of MRI regarding its contributions on accurate diagnosing and changing possible indications for surgical intervention in patients on way to HTO. Preoperative MRI of affected knee of 39 patients (23 female, 16 male) who had indication of HTO due to varus gonarthrosis were evaluated based on expected findings, possible findings and unexpected findings. The structural changes in bone (at femoral condyles, tibial platoes and patellae), meniscal abnormalities, ligamentous changes, the joint space width, osteophytes, subcondral cysts, baker cyst and joint effusion were evaluated. As expected, the most common and severe findings were observed at medial compartment in te majority of patients. For medial femoral condyl (MFC), subchondral sclerosis was seen in 22 patients (56.4%), osteonecrosis was seen in 9 patients (23.1%), bone marrow edema was seen in 4 patients (10.3%). Although there were less severe lesions, similar results were observed in the medial tibial plato (MTP) (51.3%, 17.9% and 7.7%, respectively). In the lateral compartments, the severity of lesions were higher than expected. A higher occurence rate of subchondral sclerosis (48.7%) was observed in patellae.
INTRODUCTION: The reverse DELTA III shoulder prosthesis can successfully relieve pain and restore function in cuff tear arthropathy. The most frequently reported complication is inferior scapular notching. The purpose of this study was to evaluate the clinical relevance of notching and to determine the anatomic and radiographic parameters that predispose to its occurrence. STUDY PROTOCOL: Seventy-seven consecutive shoulders of 76 patients of an average age of 71 years with an irreparable rotator cuff deficiency were treated with a reverse DELTA III shoulder arthroplasty and followed clinically and radiographically under fluoroscopic control for a minimum of 24 months (mean: 44, range: 24 to 96). The effect of glenoid cranial caudal component positioning and of the prosthesis–scapular neck angle on the development of inferior scapular notching and clinical outcome was assessed. RESULTS: All shoulders which developed notching did so in the first fourteen months. Forty-four percent of the shoulders had inferior scapular notching, 30% had posterior notching and anterior notching (8%) was rare.
Introduction. Anteromedial osteoarthritis of the knee (anteromedial gonarthrosis-AMG) is a common form of knee arthritis. In a clinical setting, knee arthritis has always been assessed by plain radiography in conjunction with pain and function assessments. Whilst this is useful for surgical decision making in bone on bone arthritis, plain radiography gives no insight to the earlier stages of disease. In a recent study 82% of patients with painful arthritis had only partial thickness joint space loss on plain radiography. These patients are managed with various surgical treatments; injection, arthroscopy, osteotomy and arthroplasty with varying results. We believe these varying results are in part due to these patients being at different stages of disease, which will respond differently to different treatments. However radiography cannot delineate these stages. We describe the Magnetic Resonance Imaging (MRI) findings of this partial thickness AMG as a way of understanding these earlier stages of the disease. Method. 46 subjects with symptomatic partial thickness AMG underwent MRI assessment with dedicated 3 Tesla sequences. All joint compartments were scored for both partial and full thickness cartilage lesions, osteophytes and bone marrow lesions (BML). Both menisci were assessed for extrusion and tear. Anterior cruciate ligament (ACL) integrity was also assessed.
Internal rotation contracture/tightness presents a functional problem for the patient and a technical challenge for the surgeon performing total shoulder arthroplasty most commonly occurring in cases of osteoarthritis. Internal rotation contractures result from a number of physiologic and biomechanical conditions.
Osteoarthritis (OA) is the most prevalent systemic musculoskeletal disorder, characterized by articular cartilage degeneration and subchondral bone (SCB) sclerosis. Here, we sought to examine the contribution of accelerated growth to OA development using a murine model of excessive longitudinal growth. Suppressor of cytokine signalling 2 (SOCS2) is a negative regulator of growth hormone (GH) signalling, thus mice deficient in SOCS2 ( We examined vulnerability of Aims
Methods
Purpose: Removal of intra-articular foreign bodies (FB) constitues a major indication for elbow arthroscopy. The purpose of our study was to evalute our experience with arthroscopic treatment of elbow osteochondromatosis. Material and methods: Between September 1988 and June 2001 we performed elbow arthroscopy in 25 active patients (15 manual workers, 8 athletes including 2 high-level) who presented intra-articular FB osteochon-dromatosis of the elbow. Male gender predominated (n=22). Mean age at intervention was 42 years (17–68). The right (n=21) and dominant (n=24) side predominated. The mean clinical course before arthroscopy was two years. Seven patients had had upper limb trauma (five with elbow injury) a mean 60 months (6–144) before arthroscopy. Clinical assessment before arthroscopy and at last follow-up (mean follow-up 60 months, 8–138) included pain score (visual analogue scale), the notion of blocking and joint effusion and joint motion, as well as index of functional impairment during occupational and recreational activities and a subjective satisfaction index. Standard x-rays and arthroscan were obtained before arthroscopy to identify and evaluate intra-articular foreign bodies. Cartilage damage and presence of synovial anomalies were evaluated on the preoperative scan and during the intervention. Arthros-copy was performed according to the same procedure in all cases: lateral decubitus, arm cuff, anterior expoloration (anteromedial and anterolateral access). Standard x-rays were also obtained after arthroscopy and at last follow-up. Results: FB were found and extracted in all cases. Cartilage injury was associated in 14 cases. Synovectomy was performed systematically in case of synovitis, a macroscopic synovial anomaly, or to extract a FB trapped in the synovial (n=18).
To report early (two-year) postoperative findings from a randomized controlled trial (RCT) investigating disease-specific quality of life (QOL), clinical, patient-reported, and radiological outcomes in patients undergoing a total shoulder arthroplasty (TSA) with a second-generation uncemented trabecular metal (TM) glenoid versus a cemented polyethylene glenoid (POLY) component. Five fellowship-trained surgeons from three centres participated. Patients aged between 18 and 79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Patients were randomized intraoperatively to either a TM or POLY glenoid component. Study intervals were: baseline, six weeks, six-, 12-, and 24 months postoperatively. The primary outcome was the Western Ontario Osteoarthritis Shoulder QOL score. Radiological images were reviewed for metal debris. Mixed effects repeated measures analysis of variance for within and between group comparisons were performed.Aims
Methods
Although knee osteoarthritis (OA) is diagnosed and monitored radiologically, actual full-thickness cartilage loss (FTCL) has rarely been correlated with radiological classification. This study aims to analyze which classification system correlates best with FTCL and to assess their reliability. A prospective study of 300 consecutive patients undergoing unilateral total knee arthroplasty (TKA) for OA (mean age 69 years (44 to 91; standard deviation (SD) 9.5), 178 (59%) female). Two blinded examiners independently graded preoperative radiographs using five common systems: Kellgren-Lawrence (KL); International Knee Documentation Committee (IKDC); Fairbank; Brandt; and Ahlbäck. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Intraoperatively, anterior cruciate ligament (ACL) status and the presence of FTCL in 16 regions of interest were recorded. Radiological classification and FTCL were correlated using the Spearman correlation coefficient.Aims
Methods
Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°. A matched cohort of patients similar for demographics and components used but differing in preoperative coronal-plane tibiotalar valgus deformity ≥ 15° (valgus, n = 50; 52% male, mean age 65.8 years (SD 10.3), mean body mass index (BMI) 29.4 (SD 5.2)) or < 15° (control, n = 50; 58% male, mean age 65.6 years (SD 9.8), mean BMI 28.7 (SD 4.2)), underwent TAA by one surgeon. Preoperative and postoperative radiographs, Ankle Osteoarthritis Scale (AOS) pain and disability and 36-item Short Form Health Survey (SF-36) version 2 scores were collected prospectively. Ancillary procedures, secondary procedures, and complications were recorded.Aims
Methods
The aim of this study was to systematically review the literature for evidence of the effect of a high-fat diet (HFD) on the onset or progression of osteoarthritis (OA) in mice. A literature search was performed in PubMed, Embase, Web of Science, and Scopus to find all studies on mice investigating the effects of HFD or Western-type diet on OA when compared with a control diet (CD). The primary outcome was the determination of cartilage loss and alteration. Secondary outcomes regarding local and systemic levels of proteins involved in inflammatory processes or cartilage metabolism were also examined when reported.Aims
Methods
As our understanding of hip function and disease improves, it is evident that the acetabular fossa has received little attention, despite it comprising over half of the acetabulum’s surface area and showing the first signs of degeneration. The fossa’s function is expected to be more than augmenting static stability with the ligamentum teres and being a templating landmark in arthroplasty. Indeed, the fossa, which is almost mature at 16 weeks of intrauterine development, plays a key role in hip development, enabling its nutrition through vascularization and synovial fluid, as well as the influx of chondrogenic stem/progenitor cells that build articular cartilage. The pulvinar, a fibrofatty tissue in the fossa, has the same developmental origin as the synovium and articular cartilage and is a biologically active area. Its unique anatomy allows for homogeneous distribution of the axial loads into the joint. It is composed of intra-articular adipose tissue (IAAT), which has adipocytes, fibroblasts, leucocytes, and abundant mast cells, which participate in the inflammatory cascade after an insult to the joint. Hence, the fossa and pulvinar should be considered in decision-making and surgical outcomes in hip preservation surgery, not only for their size, shape, and extent, but also for their biological capacity as a source of cytokines, immune cells, and chondrogenic stem cells. Cite this article:
Osteoarthritis (OA) is a disabling joint disorder and mechanical loading is an important pathogenesis. This study aims to investigate the benefits of less mechanical loading created by intermittent tail suspension for knee OA. A post-traumatic OA model was established in 20 rats (12 weeks old, male). Ten rats were treated with less mechanical loading through intermittent tail suspension, while another ten rats were treated with normal mechanical loading. Cartilage damage was determined by gross appearance, Safranin O/Fast Green staining, and immunohistochemistry examinations. Subchondral bone changes were analyzed by micro-CT and tartrate-resistant acid phosphatase (TRAP) staining, and serum inflammatory cytokines were evaluated by enzyme-linked immunosorbent assay (ELISA).Aims
Methods
The primary aim of the study was to compare the knee-specific functional outcome of robotic unicompartmental knee arthroplasty (rUKA) with manual total knee arthroplasty (mTKA) for the management of isolated medial compartment osteoarthritis. Secondary aims were to compare length of hospital stay, general health improvement, and satisfaction between rUKA and mTKA. A powered (1:3 ratio) cohort study was performed. A total of 30 patients undergoing rUKA were propensity score matched to 90 patients undergoing mTKA for isolated medial compartment arthritis. Patients were matched for age, sex, body mass index (BMI), and preoperative function. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were collected preoperatively and six months postoperatively. The Forgotten Joint Score (FJS) and patient satisfaction were collected six months postoperatively. Length of hospital stay was also recorded.Aims
Methods
The objectives of this study were: 1) to examine osteophyte formation, subchondral bone advance, and bone marrow lesions (BMLs) in osteoarthritis (OA)-prone Hartley guinea pigs; and 2) to assess the disease-modifying activity of an orally administered phosphocitrate ‘analogue’, Carolinas Molecule-01 (CM-01). Young Hartley guinea pigs were divided into two groups. The first group (n = 12) had drinking water and the second group (n = 9) had drinking water containing CM-01. Three guinea pigs in each group were euthanized at age six, 12, and 18 months, respectively. Three guinea pigs in the first group were euthanized aged three months as baseline control. Radiological, histological, and immunochemical examinations were performed to assess cartilage degeneration, osteophyte formation, subchondral bone advance, BMLs, and the levels of matrix metalloproteinse-13 (MMP13) protein expression in the knee joints of hind limbs.Objectives
Methods
It has been hypothesized that patellofemoral pain, a common knee condition in adolescents and young adults, may be a precursor of degenerative joint changes and may ultimately lead to patellofemoral osteoarthritis. Since both conditions share several mechanical disease characteristics, such as altered contact area between the femur and patella and increased joint stress, we investigated whether these conditions share similar and different shape characteristics of the patella compared with normal controls. This cross-sectional study compared three different study populations: 32 patellofemoral pain subjects (mean age, 32 years (22 to 45); 72% female); 56 isolated radiological patellofemoral osteoarthritis subjects (mean age, 54 years (44 to 58); 89% female); and 80 healthy control subjects (mean age, 52 years (44 to 58); 74% female). Measurements included questionnaires, and lateral and skyline radiographs of the knee. Two separate 30-point 2D statistical shape models of the patella were created from the lateral and skyline radiographs. A general linear model was used to test for differences in standardized shape modes (a specific shape variant of the patella) between patellofemoral osteoarthritis, patellofemoral pain, and controls, using Bonferroni correction and adjustment for body mass index and gender.Objectives
Methods
Patient-specific glenoid guides (PSGs) claim an improvement in
accuracy and reproducibility of the positioning of components in
total shoulder arthroplasty (TSA). The results have not yet been
confirmed in a prospective clinical trial. Our aim was to assess
whether the use of PSGs in patients with osteoarthritis of the shoulder
would allow accurate and reliable implantation of the glenoid component. A total of 17 patients (three men and 14 women) with a mean age
of 71 years (53 to 81) awaiting TSA were enrolled in the study.
Pre- and post-operative version and inclination of the glenoid were
measured on CT scans, using 3D planning automatic software. During
surgery, a congruent 3D-printed PSG was applied onto the glenoid
surface, thus determining the entry point and orientation of the
central guide wire used for reaming the glenoid and the introduction
of the component. Manual segmentation was performed on post-operative
CT scans to compare the planned and the actual position of the entry
point (mm) and orientation of the component (°).Aims
Patients and Methods
This study aimed to examine the effects of SRT1720, a potent SIRT1 activator, on osteoarthritis (OA) progression using an experimental OA model. Osteoarthritis was surgically induced by destabilization of the medial meniscus in eight-week-old C57BL/6 male mice. SRT1720 was administered intraperitoneally twice a week after surgery. Osteoarthritis progression was evaluated histologically using the Osteoarthritis Research Society International (OARSI) score at four, eight, 12 and 16 weeks. The expression of SIRT1, matrix metalloproteinase 13 (MMP-13), a disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMTS-5), cleaved caspase-3, PARP p85, and acetylated nuclear factor (NF)-κB p65 in cartilage was examined by immunohistochemistry. Synovitis was also evaluated histologically. Primary mouse epiphyseal chondrocytes were treated with SRT1720 in the presence or absence of interleukin 1 beta (IL-1β), and gene expression changes were examined by real-time polymerase chain reaction (PCR).Objectives
Methods
The aim of this study was to compare the post-operative radiographic
and clinical outcomes between kinematically and mechanically aligned
total knee arthroplasties (TKAs). A total of 60 TKAs (30 kinematically and 30 mechanically aligned)
were performed in 60 patients with varus osteoarthritis of the knee
using a navigation system. The angles of orientation of the joint
line in relation to the floor, the conventional and true mechanical
axis (tMA) (the line from the centre of the hip to the lowest point
of the calcaneus) were compared, one year post-operatively, on single-leg
and double-leg standing long leg radiographs between the groups.
The range of movement and 2011 Knee Society Scores were also compared
between the groups at that time.Aims
Patients and Methods
Arthroscopy of the native hip is an established diagnostic and therapeutic procedure. Its application in the symptomatic replaced hip is still being explored. We describe the use of arthroscopy of the hip in 24 symptomatic patients following total hip replacement, resurfacing arthroplasty of the hip and partial resurfacing (study group), and compared it with arthroscopy of the native hip in 24 patients (control group). A diagnosis was made or confirmed at arthroscopy in 23 of the study group and a therapeutic arthroscopic intervention resulted in relief of symptoms in ten of these. In a further seven patients it led to revision hip replacement. In contrast, arthroscopy in the control group was diagnostic in all 24 patients and the resulting arthroscopic therapeutic intervention provided symptomatic relief in 21. The mean operative time in the study group (59.7 minutes (35 to 93)) was less than in the control group (71 minutes (40 to 100), p = 0.04) but the arthroscopic approach was more difficult in the arthroplasty group. We suggest that arthroscopy has a role in the management of patients with a symptomatic arthroplasty when other investigations have failed to provide a diagnosis.
We evaluated clinical and radiographic outcomes of total shoulder
arthroplasty (TSA) using the second-generation Trabecular Metal
(TM) Glenoid component. The first generation component was withdrawn
in 2005 after a series of failures were reported. Between 2009 and
2012, 40 consecutive patients with unilateral TSA using the second-generation
component were enrolled in this clinical study. The mean age of
the patients was 63.8 years (40 to 75) and the mean follow-up was
38 months (24 to 42). Patients were evaluated using the Constant score (CS), the American
Shoulder and Elbow Surgeons (ASES) score and routine radiographs.Aims
Methods
Deformity of the proximal femur in fibrous dysplasia
leads to deviation of the mechanical axis of the hip, which may lead
to the development of secondary osteoarthritis (OA). This study
investigated the prevalence and predisposing factors for the development
of OA in patients with fibrous dysplasia of the proximal femur.
We reviewed the records of 209 patients from our institutional database
with fibrous dysplasia of the proximal femur, investigating possible predisposing
factors including patient demographics, the extent of the coxa vara
deformity, the presence of peri-articular disease, and the overall
burden of skeletal disease. Of the 209 patients, 24 (12%) had radiological
evidence of OA in the ipsilateral hip. The prevalence was significantly
higher in patients with polyostotic fibrous dysplasia compared with
those with monostotic disease (p <
0.001). In a subgroup analysis of
patients with polyostotic disease, the extent of deformity (quantified
using the neck–shaft angle), and the presence of peri-articular
disease (whether in the head of the femur or the acetabulum) were
significant predictors of osteoarthritis (neck–shaft angle likelihood
ratio (LR) = 0.847 per 1° increase, p = 0.004; presence of lesion
in the head of the femur LR = 9.947, p = 0.027; presence of lesion
in the acetabulum LR = 11.231, p = 0.014). Our data suggest that patients with polyostotic fibrous dysplasia
have a high risk of developing secondary OA of the hips. This risk
is higher in patients with peri-articular disease, and those with
a more severe deformity of proximal femur. Cite this article:
In Japan, osteoarthritis (OA) of the hip secondary
to acetabular dysplasia is very common, and there are few data concerning
the pathogeneses and incidence of femoroacetabular impingement (FAI).
We have attempted to clarify the radiological prevalence of painful
FAI in a cohort of Japanese patients and to investigate the radiological findings.
We identified 176 symptomatic patients (202 hips) with Tönnis grade
0 or 1 osteoarthritis, whom we prospectively studied between August
2011 and July 2012. There were 61 men (65 hips) and 115 women (137
hips) with a mean age of 51.8 years (11 to 83). Radiological analyses
included the α-angle, centre–edge angle, cross-over sign, pistol
grip deformity and femoral head neck ratio. Of the 202 hips, 79
(39.1%) had acetabular dysplasia, while 80 hips (39.6%) had no known
aetiology. We found evidence of FAI in 60 hips (29.7%). Radiological
FAI findings associated with cam deformity were the most common.
There was a significant relationship between the pistol grip deformity
and both the α-angle (p <
0.001) and femoral head–neck ratio
(p = 0.024). Radiological evidence of symptomatic FAI was not uncommon
in these Japanese patients. Cite this article: