Arthroscopic surgery is a common intervention for osteoarthritis of the knee. However, the benefits from such an intervention are not clear. The purpose of the study was to perform a questionnaire survey of orthopaedic surgeons of Wales to analyse the practice of arthroscopy for osteoarthritic knee. Over a three-month period, a postal survey was conducted of all hospital orthopaedic consultants in Wales. Of a total of 62 questions sent we received a reply of 37. 31 surgeons perform arthroscopic lavage or debride-ment. 4 surgeons perform arthroscopic surgery for symptomatic meniscal tear only. There was no defined protocol regarding the management. Early OA was the commonest indication (18). Arthroscopic lavage (17) was equally popular to lavage and debridement (16). 6 respondents like to perform the surgery themselves while the majority would allow a middle grade surgeon to operate with or without supervision. 26 surgeons felt that the results of the procedure are unpredictable, but still continued to perform it. Only 6 surgeons felt a continued relevance of the procedure. Arthroscopic surgery is a commonly performed symptomatic treatment for arthritic knee. It bears a significant financial commitment. 266 arthroscopic knee surgery were performed annually in a district general hospital, of whom 115 were arthroscopic washout. Average cost of each operation is £1000. The physiological basis for arthroscopic washout is not clear. A majority of the Welsh surgeons have reservations about this procedure. In spite of evidence of limited usefulness, it is still performed widely.
Single Photon Emission Computed Tomography – Computed Tomography (SPECT-CT) combines metabolic information with an exact anatomical localization. We hypothesised that diagnostic infiltration with a local anaesthetic of a painful hindfoot or midfoot joint showing 99mTc-DPD-uptake in SPECT-CT, leads to a positive OA pain response.
Fractures of the distal radius occurring in young adults are treated increasingly by open surgical techniques, partly because of concern that failure to restore the alignment of the fracture accurately may cause
Given the growing prevalence of obesity around
the world and its association with osteoarthritis of the knee, orthopaedic
surgeons need to be familiar with the management of the obese patient
with degenerative knee pain. The precise mechanism by which obesity
leads to osteoarthritis remains unknown, but is likely to be due
to a combination of mechanical, humoral and genetic factors. Weight loss has clear medical benefits for the obese patient
and seems to be a logical way of relieving joint pain associated
with degenerative arthritis. There are a variety of ways in which
this may be done including diet and exercise, and treatment with
drugs and bariatric surgery. Whether substantial weight loss can
delay or even reverse the symptoms associated with osteoarthritis
remains to be seen. Surgery for osteoarthritis in the obese patient can be technically
more challenging and carries a risk of additional complications.
Substantial weight loss before undertaking total knee replacement
is advisable. More prospective studies that evaluate the effect
of significant weight loss on the evolution of symptomatic osteoarthritis
of the knee are needed so that orthopaedic surgeons can treat this
patient group appropriately.
Aims. Hyaline cartilage has a low capacity for regeneration. Untreated osteochondral lesions of the femoral head can lead to progressive and
Aims. Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design. Methods. Patients under the age of 70 years with
Aims. Recent studies have suggested that corticosteroid injections into the knee may harm the joint resulting in cartilage loss and possibly accelerating the progression of osteoarthritis (OA). The aim of this study was to assess whether patients with, or at risk of developing,
Aims. Total hip arthroplasty (THA) using the direct anterior approach (DAA) is undertaken with the patient in the supine position, creating an opportunity to replace both hips under one anaesthetic. Few studies have reported simultaneous bilateral DAA-THA. The aim of this study was to characterize a cohort of patients selected for this technique by a single, high-volume arthroplasty surgeon and to investigate their early postoperative clinical outcomes. Methods. Using an institutional database, we reviewed 643 patients who underwent bilateral DAA-THA by a single surgeon between 1 January 2010 and 31 December 2018. The demographic characteristics of the 256 patients (39.8%) who underwent simultaneous bilateral DAA-THA were compared with the 387 patients (60.2%) who underwent staged THA during the same period of time. We then reviewed the length of stay, rate of discharge home, 90-day complications, and readmissions for the simultaneous bilateral group. Results. Patients undergoing simultaneous bilateral DAA-THA had a 3.5% transfusion rate, a 1.8 day mean length of stay, a 98.1% rate of discharge home, and low rates of 90-day infection (0.39%), dislocation (0.39%), periprosthetic fracture (0.77%), venous thromboembolism (0%), haematoma (0.39%), further surgery (0.77%), and readmission (0.77%). These patients were significantly younger (mean 58.2 years vs 62.5 years; p < 0.001), more likely to be male (60.3% vs 46.5%; p < 0.001), and with a trend towards having a lower mean BMI (27.8 kg/m. 2. vs 28.4 kg/m. 2. ; p = 0.071) than patients who underwent staged bilateral DAA-THA. Conclusion. Patients selected for simultaneous bilateral DAA-THA in a single surgeon’s practice had a 3% rate of postoperative transfusion and a low rate of complications, readmissions, and discharge to a rehabilitation facility. Simultaneous bilateral DAA-THA appears to be a reasonable and safe form of treatment for patients with bilateral
Aims. Patients may present with concurrent
Purpose of the study: There is no satisfactory surgical solution for
Introduction. Simultaneous correction of knee varus malalignment with medial open wedge high tibial osteotomy (MOWHTO) combined with anterior cruciate ligament (ACL) surgery aims to address
Background. The optimal treatment for
Aims. The aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA). Patients and Methods. This prospective study included 110 patients with
The treatment of medial knee osteoarthritis (OA) in conjunction with anterior knee laxity is an issue of debate. Current treatment options include knee joint distraction, unicompartmental knee replacement (UKR) or high tibial osteotomy with anterior cruciate ligament (ACL) reconstruction or total knee replacement. Bone-conserving options are preferred for younger and active patients with intact lateral and patello-femoral compartment. However, still limited experience exists in the field of combining medial UKR and ACL reconstruction. The aim of this study is to retrospectively evaluate the results of combined fixed-bearing UKR and ACL reconstruction, specifically with regard to patient satisfaction, activity level, and postoperative functional outcomes. The hypothesis was that this represents a safe and viable procedure leading to improved stability and functional outcome in patients affected by isolated unicompartmental OA and concomitant ACL deficiency. Fourteen patients with ACL deficiency and concomitant medial compartment
The options for treatment of the young active patient with isolated
Introduction: The majority of patients with osteoarthritis of the knee suffer from femorotibial pain with a smaller proportion suffering predominantly patellofemoral symptoms. No clear consensus exists as to the need for patellar resurfacing when performing total knee replacement for patients with
Introduction: The majority of patients with osteoarthritis of the knee suffer from femorotibial pain with a smaller proportion suffering predominantly patello-femoral symptoms. No clear consensus exists as to the need for patellar resurfacing when performing total knee replacement for patients with
The lifetime prevalence of
Introduction. The prevalence of
Background. High tibial osteotomy is a common procedure to treat
We report a study of 112 patients with primary anteromedial osteoarthritis of the knee and their families. Sibling risk was determined using randomly selected single siblings. Spouses were used as controls. The presence of
The Oxford unicompartmental knee replacement gives good results in patients with
Patients with
This prospective study assessed the effect of social deprivation on the Oxford hip score at one year after total hip replacement. An analysis of 1312 patients undergoing 1359 primary total hip replacements for
The options for treatment of the young active patient with isolated
Despite widespread use, the benefit of knee arthroscopy for
We have undertaken a prospective clinical and radiological analysis of 124 shoulder arthroplasties (113 patients) carried out for osteoarthritis. The clinical results showed improvement in the absolute Constant score and the American Shoulder and Elbow Surgeons score of 22 and 43, respectively. Both were statistically significant (p <
0.001). There was no significant difference in the scores after hemiarthroplasty and total arthroplasty in those patients with an intact rotator cuff. When revision was used as the end-point for survival at ten years, survival of 86%, or 90% if glenoid components made of Hylamer sterilised in air were omitted, was obtained in primary osteoarthritis. The most common cause for revision in the hemiarthroplasty group was glenoid pain at a mean of 1.5 years; in the total arthroplasty group it was loosening of the glenoid at a mean of 4.5 years. Analysis of pre-operative factors showed that the risk of gross loosening of the glenoid increased threefold when there was evidence of erosion of the glenoid at operation. Shoulder arthroplasty should not be delayed once
Introduction and Method: For 16 years, now, we have been using custom made femoral stems (titanium stem, HA coated) based on preoperative patient CT scans in young patients presenting with
Purpose: We reviewed retrospectively 27 ankle arthrodesis procedures performed from 1990 to 2001 to assess the mid-term outcome. These patients had had on average 1.5 ankle interventions before the arthrodesis. Mean follow-up was seven years. Material and methods: The arthrodeses were performed for posttraumatic degeneration (n=21), sequelae of septic arthritis (n=3), poliomyelitis (n=2), and rheumatoid arthritis (n=1). Forty-four percent of the patients had osteoarthritis of the subtalar joint. The transfibular approach was used for 21 patients and an external fixation for five. One woman was treated with a 90 LC-DCP 4.5 plate. Results: Union was achieved in 13 weeks. There were three cases of wound necrosis (11%), two cases of superficial infection 7%) and one case each of axonotomesis of the posterior tibial nerve (3%) and malunion (3%) which required revision for insertion of a transplantar screw. Using the AOFAS system, the mean function score at last follow-up 88.4/92 compared with 42/92. Eighty-eight percent of the patients were satisfied. At last follow-up, 75% of patients had signs of active subtalar osteoarthritis. Three patients were symptomatic. Conclusion: Ankle arthrodesis is a good indication for
Aims of the study: The purpose of this paper was to evaluate the long term results of the open Bankart procedure for an anterior shoulder instability in heterogenic non selected patients. Material and Methods: Hundred and seventy seven patients were operated on at our instutution using open Bankart technique without using suture anchors, between 1993 and 2002. Hundred and sixty nine patients were evaluated. Average follow up was nine years and seven months (4–13 years). Average age at the time of operation was 27 (15 – 67). 89 % of shoulders had more than 3 dislocations, 60 % had more than 10 and 37 % more than 20 dislocations. American Shoulder and Elbow Society Scoring System and Constant Scoring System were used for assessment. Results: 155 patients (92 %) had Bankart lesion and 150 patients (89%) had Hill-Sachs lesion. Five patients (2.9%) had redislocation of the operated shoulder caused by new trauma, two of them underwent reoperation. 164 patients were satisfied and very satisfied with the results. None of patients needed a shoulder arthroplasty because of
Introduction: Diabetes mellitus type 2 (DM II) affects 18.2 million Americans and can cause several chronic and morbid complications. Furthermore, 90% of Americans have radiographic evidence of osteoarthritis by age 40. Diabetes may be an important risk factor for
Background. Dual compartment knee replacement has been introduced to allow sparing of the cruciate ligaments and lateral compartment and preserve some biomechanics of knee function. Aim. To study the early clinical and radiographic results of this new prosthesis. Method. Patients who underwent dual compartmental knee arthroplasty performed by 2 surgeons over a period of one year were studied prospectively. All subjects in the study had advanced
Background: No studies exist about the long-term correlation of patellofemoral osteoarthrosis to poor outcome after traditional realignment surgery for chronic patellofemoral instability. The objective of this study was to evaluate the recurrent instability and
We have investigated whether control of balance is improved during stance and gait and sit-to-stand tasks after unilateral total hip replacement undertaken for osteoarthritis of the hip. We examined 25 patients with a mean age of 67 years (. sd. 6.2) before and at four and 12 months after surgery and compared the findings with those of 50 healthy age-matched control subjects. For all tasks, balance was quantified using angular measurements of movement of the trunk. Before surgery, control of balance during gait and sit-to-stand tasks was abnormal in patients with severe osteoarthritis of the hip, while balance during stance was similar to that of the healthy control group. After total hip replacement, there was a progressive improvement at four and 12 months for most gait and sit-to-stand tasks and in the time needed to complete them. By 12 months, the values approached those of the control group. However, trunk pitch (forwards-backwards) and roll (side-to-side) velocities were less stable (greater than the control) when walking over barriers as was roll for the sit-to-stand task, indicative of a residual deficit of balance. Our data suggest that patients with
INTRODUCTION. A preoperative planning for accurately predicting the size and alignment of the prosthetic components may allow to perform a precise, efficient and reproducible total knee replacement. The planning can be carried out using as a support digital radiographic images or CT images with three-dimensional reconstruction. Aim of this prospective study is to evaluate and compare the accuracy of two different types of pre-operative planning, in determining the size of the femoral and tibial component in total knee arthroplasty performed with Patient Specific Instrument (PSI). The two compared techniques were: digital radiography and “CT-Based”. MATERIALS AND METHODS. A prospective study was conducted to compare the accuracy in predicting the size of the prosthetic components in total knee replacement in 71 patients diagnosed with primary and
Multiple reports suggest good outcome results following unicompartmental knee replacement (UKR). However, several authors report technically difficult revision surgery secondary to osseous defects. We reviewed clinical outcomes following revision total knee replacement for failed UKR and analysed the reasons for failure and the technical aspects of the revision surgery. Between 2003 and 2009, thirty three revisions from unicompartmental knee replacement to total knee replacement were performed in thirty two patients at a single centre. Demographics, indications for the primary and revision procedures, details of the revised prosthesis including augments and any technical difficulties or complications were noted. Patient assessment included range of motion and the functional status of the affected knee in the form of the Oxford knee score questionnaire. Statistical analysis was performed with the Student t test. All 33 revision knees were available for prospective clinical and radiological follow-up. The minimum duration of follow-up after revision surgery was 1 year (mean 3 years, range 1 – 7 years). The median interval between the original unicompartmental knee replacements to revision surgery was 19 months (range 2 – 159 months). The predominant cause of failure was aseptic loosening (50%). Other reasons included persistent pain (21%), dislocated meniscus (18%), mal-alignment (7%) and progression of
Introduction. The options for the treatment of the young active patient with unicompartmental
Introduction. The success of total hip replacement (THR) is closely linked to the positioning of the acetabular component. Malalignment increases rates of dislocation, impingement, acetabular migration, pelvic osteolysis, leg length discrepancy and polyethylene wear. Many surgeons orientate the cup to inherent anatomy of the acetabulum. Detailed understanding of the anatomy and orientation of the acetabulum in arthritic hips is therefore very important. The aim of this study was to describe the anteversion and inclination of the inherent acetabulum in arthritic hips and to identify the number that fall out with the ‘safe zone’ of acetabular position described by Lewinnek et al. (anteversion 15°±10°; inclination 40°±10°). Materials and Methods. A series of 65 hips all with
Introduction and aim: Early
The efficacy of intra-articular corticosteroids has led to their frequent use in the treatment of osteoarthritis (OA) of the knee. It is commonly believed that less soluble preparations given at higher doses provide longer lasting and more significant symptomatic relief. We performed a randomized controlled trial with corticosteroid preparations of different solubilities and dosages to test this longstanding but unproven belief. The pain subscale of the WOMAC was our primary outcome measurement. This study found no statistically significant difference between preparations or dosages. Regression analysis identified early onset of osteoarthritis as predictive of a positive treatment response. To determine if the solubility or dosage of an intra-articular corticosteroid preparation effects treatment outcome when used for the treatment of
Total knee arthroplasty (TKA) has produced excellent results, but many surgeons are hesitant to perform TKA in younger patients with isolated patellofemoral arthritis. In properly selected patients, patellofemoral arthroplasty (PFA) is an effective procedure with good long-term results. Contemporary PFA prostheses have eliminated many of the patellar maltracking problems associated with older designs, and short-term results, as described here, are encouraging. Long-term outcome and prospective trials comparing TKA to PFA are needed. Incidence. Isolated patellofemoral arthritis occurs in as many as 11% of men and 24% of women older than age 55 years with
Background: Distal third fractures account for 10 to 15% of all clavicle fractures. Traditional management of displaced lateral third fractures has been with internal fixation. Several authors have reported higher rates of non-union and poor outcome in conservatively managed fractures. However, long term follow up of non-operated distal third fractures has shown comparable functional outcomes to those managed with internal fixation. The purpose of this retrospective study was to analyse the clinical and radiographic results of nonoperative treatment of displaced lateral clavicle fractures. Methods: Eighty six patients with displaced lateral end clavicle fractures were treated primarily with a sling for comfort. The fractures were classified as Neer type IIa in fifty patients, type IIb in twenty nine and type III in seven. Physiotherapy was begun after the sling was removed at an average of two weeks after the injury. Patients were evaluated with regard to shoulder function and general health using a modification of the Constant score and SF-36 respectively. All patients had a repeat radiographic exam at follow up. The average duration of follow up was six years (range two to ten years). Results: Fourteen patients developed symptoms severe enough to warrant surgery at between seven and twenty four months post-injury. Eleven had radiographically confirmed non-union and three had
For many decades ankle fusion has been the only option for treatment of
Introduction: Total knee replacement (TKR) is an established and successful treatment option for
Purpose: To evaluate the safety and efficacy of hylan G-F 20 viscosupplementation in patients with
Aim: Inability to lose weight is often attributed to restriction of mobility due to painful arthritic joints. We hypothesise that removing the pain by total hip replacement or knee replacement will improve patients exercise tolerance thereby helping them lose weight. Method: A prospective study of obese patients (BMI >
30) undergoing consecutive primary total hip or knee replacement. BMI was measured pre operatively and 1 year post operatively. Patients with medical conditions or complications of surgery that would limit mobility were excluded. A questionnaire detailing pre and postoperative activity levels, walking distance/aids and diet was completed. Results: 37 patients were included in the study. All patients had
Objectives. Unicompartmental knee arthroplasty (UKA) is one surgical option for treating
The success of total hip replacement (THR) is closely linked to the positioning of the acetabular component. Malalignment increases rates of dislocation, impingement, acetabular migration, pelvic osteolysis, leg length discrepancy and polyethylene wear. Many surgeons orientate the cup in the same anteversion and inclination as the inherent anatomy of the acetabulum. The transverse acetabular ligament and acetabular rim can be used as a reference points for orientating the cup this way. Low rates of dislocation have been reported using this technique. Detailed understanding of the anatomy and orientation of the acetabulum in arthritic hips is therefore very important. The aim of this study was to describe the anteversion and inclination of the inherent acetabulum in arthritic hips and to identify the number that fall out with the ‘safe zone’ of acetabular position described by Lewinnek et al. (anteversion 15°±10°; inclination 40°±10°). A series of 65 hips, all with
Introduction. The new era of shoulder arthroplasty is moving away from long stemmed, cemented humeral components to cementless, stemless and metaphyseal fixed implants and to humeral resurfacing. The early clinical results and functional outcome of stemless shoulder arthroplasty is presented. Methods. A retrospective single-surgeon series of stemless shoulder prostheses implanted from 2011 to 2013 at our institution was evaluated. Perioperative complications, Theatre time and length of hospital stay (LOS) were recorded. Postoperative radiographic and clinical evaluation including measurement of joint mobility, the Oxford Shoulder Score (OSS), and Disabilities of the Arm, Shoulder and Hand (DASH) score by independent evaluators were made. Results. A total of 23 stemless shoulder arthroplasty were implanted in 22 patients. Mean age was 57.8 years. Mean follow up was 22 months (8–45). Symptomatic primary gleno-humeral osteoarthritis was the main indication for implantation (83%). None of the patients experienced periprosthetic fractures, glenoid notching, and implant loosening/migration. Mean OSS (44 ± 6.0) and mean DASH score (11 ± 6.5). Mean operative time was (88 ± 16.0 min) and mean length of hospital stay (1.1 ± 0.82 day). Active shoulder motion improved by (mean): 30° (95% CI 10–45) external rotation, 67° (95% CI 30- 100) forward elevation and 54° (95% CI 35- 90) Abduction. Conclusion. The implantation of stemless shoulder prosthesis in our institution offered good clinical results manifested by improved range of motion and favourable patient reported outcome measures. Although long term follow up is warranted, early results appear promising in young patients with