SARS-CoV-2 emerged in Wuhan, China in December 2019 causing pneumonia and resulting in a pandemic, commonly known as COVID-19. This pandemic led to significant changes to our daily lives due to restrictions, such as social distancing, quarantining, stay at home orders and closure of restaurants and shops among other things. The psychological effects of this uncertainty as well as of these changes to our lives have been shown to be significant. This study is a prospective study investigating the mental effects of the pandemic on hand and wrist patients seen in our clinic during this pandemic. A prospective database on wrist pain was used to identify patients seen in our hand clinic from January 1, 2018 to December 10, 2021. All participants had been diagnosed with either radial sided wrist pain or ulnar side wrist pain. The Center for Epidemiological Studies Depression (CES-D) Scale was used to assess the mental health of our participants before and during this pandemic. An independent samples t-test was used to compare the scores of the 2 groups. A total of 437 CES-D questionnaires were collected during this period. 118 of them belonging to the pandemic group and 319 to the pre-pandemic group. A difference (p < 0 .05) in the CES-D score was observed between the pre-pandemic and during pandemic groups. The mean score for the pre-pandemic group was found to be 9.23 (8.94) and 12.81 (11.45) for the pandemic group. However, despite the increase in score, it didn't exceed the cut off score of 16 or greater used to assess depression. Our results indicate that there was a slight increase in score for depression in hand and wrist patients, but not above the cut off level of 16 to be of a significant risk for depression. Other global studies have shown an increase in depression in the general public. Our mild results might be attributed to the fact that British Columbia did not implement severe restrictions compared to other countries or regions, i.e no stay at home orders. Additionally, our study population was skewed and included more middle age and older patients compared to younger ones and age might be a factor in keeping the score down

Purpose of Study and Background. Degenerative cervical myelopathy resulting in cord compromise is a progressive condition that results in significant quality of life limitations. Surgical treatment options available are anterior and/or posterior decompression of the affected levels. Patients are counselled pre-operatively that the aim of surgical intervention is to help prevent deterioration of neurology. Anecdotal evidence suggested improvements in both EMS and PROMs in this cohort of patients. A 2-year prospective study tested this hypothesis. Methodology and Results. 67 patients undergoing anterior cervical surgery were followed up to two years. Myelopathic features, radiological cord compression, myelomalacia change and levels of surgery were recorded. Pre/post intervention myelopathy scores/grades, and PROM's were recorded. Paired t-test was performed when comparing pre/post intervention scores and Annova test when comparing results across levels. Our prospective study identified statistically significant improvements in European myelopathy scores and grade and patient reported clinical outcomes in the said population. Conclusions. DCSM patients undergoing anterior surgery demonstrated statistically significant improvement in PROMs and EMS scores and grades. This has been demonstrated irrespective of number of surgical levels. Conflicts of Interest: None. Sources of Funding: None. Previously presented as a poster at Cervical Spine Research Society, Paris 2020-Virtual Meeting

Aims. Patients with midcarpal instability are difficult to manage. It is a rare condition, and few studies have reported the outcomes of surgical treatment. No prospective or retrospective study has reported the results of arthroscopic palmar capsuloligamentous suturing. Our aim was to report the results of a prospective study of arthroscopic suture of this ligament complex in patients with midcarpal instability. Methods. This prospective single-centre study was undertaken between March 2012 and May 2022. The primary outcome was to evaluate the functional outcomes of arthroscopic palmar midcarpal suture. The study included 12 patients, eight male and four female, with a mean age of 27.5 years (19 to 42). They were reviewed at three months, six months, and one year postoperatively. Results. There was a significant improvement in flexion, extension, grip strength, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire score, and pain, in all patients. After telephone contact with all patients in March 2023, at a mean follow-up of 3.85 years (2.2 to 6.25), no patient had a persistent or recurrent clunk. Conclusion. Arthroscopic suture of the midcarpal capsuloligamentous complex represents a minimally invasive, easy, and reproducible technique for the management of patients with midcarpal instbility, with a clear improvement in function outcomes and no complications. Cite this article: Bone Joint J 2024;106-B(3):262–267

Adverse spinopelvic characteristics (ASC) have been associated with increased dislocation risk following primary total hip arthroplasty (THA). A stiff lumbar spine, a large posterior standing tilt when standing and severe sagittal spinal deformity have been identified as key risk factors for instability. It has been reported that the rate of dislocation in patients with such ASC may be increased and some authors have recommended the use of dual mobility bearings or robotics to reduce instability to within acceptable rates (<2%). The aims of the prospective study were to 1: Describe the true incidence of ASC in patients presenting for a THA 2. Assess whether such characteristics are associated with greater symptoms pre-THA due to the concomitant dual pathology of hip and spine and 3. Describe the early term dislocation rate with the use of ≤36mm bearings. This is an IRB-approved, two-center, multi-surgeon, prospective, consecutive, cohort study of 220 patients undergoing THA through anterolateral- (n=103; 46.8%), direct anterior- (n=104; 27.3%) or posterior- approaches (n=13; 5.9%). The mean age was 63.8±12.0 years (range: 27.7-89.0 years) and the mean BMI 28.0±5.0 kg/m. 2. (range: 19.4-44.4 kg/m. 2. ). There were 44 males (47.8%) and 48 females (52.2%). The mean follow-up was 1.6±0.5 years. Overall, 54% of femoral heads was 32 mm, and 46% was 36mm. All participants underwent lateral spinopelvic radiographs in the standing and deep-flexed seated positions were taken to determine lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA) and pelvic incidence (PI) in both positions. Spinal stiffness was defined as lumbar flexion <20° when transitioning between the standing and deep-seated position; adverse standing PT was defined as >19° and adverse sagittal lumbar balance was defined as mismatch between standing PI and LL >10°. Pre-operative patient reported outcomes was measured using the Oxford Hip Score (OHS) and EuroQol Five-Dimension questionnaire (EQ-5D). Dislocation rates were prospectively recorded. Non-parametric tests were used, significance was set at p<0.05. The prevalence of PI-LL mismatch was 22.1% (43/195) and 30.4% had increased standing PT (59/194). The prevalence of lumbar stiffness was 3.5% (5/142) and these patients had all three adverse spinopelvic characteristics (5/142; 3.5%). There was no significant difference in the pre-operative OHS between patients with (20.7±7.6) and patients without adverse spinopelvic characteristics (21.6±8.7; p=0.721), nor was there for pre-operative EQ5D (0.651±0.081 vs. 0.563±0.190; p=0.295). Two patients sustained a dislocation (0.9%): One in the lateral (no ASC) and one in the posterior approaches, who also exhibited ASC pre-operatively. Sagittal lumbar imbalance, increased standing spinal tilt and spinal stiffness are not uncommon among patients undergoing THA. The presence of such characteristics is not associated with inferior pre-operative PROMs. However, when all characteristics are present, the risk of instability is increased. Patients with ASC treated with posterior approach THA may benefit from the use of advanced technology due to a high risk of dislocation. The use of such technology with the anterior or lateral approach to improve instability is to date unjustified as the rate of instability is low even amongst patients with ASCs

Pathologies such as Scapho-Lunate Advanced Collapse (SLAC), Scaphoid Non-union Advanced Collapse (SNAC) and Kienbock's disease can lead to arthritis in the wrist. Depending on the articular surfaces that are involved, motion preserving surgical procedures can be performed. Proximal Row Carpectomy (PRC) and Four Corner Fusion (4CF) are tried and tested surgical options. However, prospective studies comparing the two methods looking at sufficient sample sizes are limited in the literature. The purpose of this study was to prospectively compare the early results of PRC vs 4CF performed in a single centre. Patients with wrist arthritis were prospectively enrolled (2015 to 2021) in a single centre in Vancouver, Canada. Thirty-six patients and a total of 39 wrists underwent either a PRC (n=18) or 4CF (n=21) according to pre-operative clinical, radiographical, and intra-operative assessment. Patient-Rated Wrist Evaluation (PRWE) scores were obtained preoperatively, as well as at six months and one year post operatively. Secondary outcomes were range of motion (ROM) of the wrist, grip strength, reoperation and complication rates. Statistical significance was set at p=0.05. Respectively for PRC and 4CF, the average PRWE scores at baseline were 61.64 (SD=19.62) and 63.67 (SD=20.85). There was significant improvement at the six-month mark to 38.81 (SD=22.95) (p=0.031) and 41.33 (SD=26.61) (p=0.007), then further improvement at the 12month mark to 33.11 (SD=23.42) (p=0.007) and 36.29 (SD=27.25) (p=0.002). There was no statistical difference between the two groups at any time point. Regarding ROM, statistical difference was seen in pronation for the PRC group at the 6month mark from an average of 72.18 deg to 61.56 deg and in flexion at the 12 month mark from 47.89 deg to 33.50 deg. All other parameters did not show statistically significant difference post operatively. For ROM of the 4CF group, only flexion at the 12month mark showed statistically significant change from an average of 48.81 deg to 38.03 deg. There was no statistical difference in pre-operative ROM between the two groups. One patient in the 4CF group required a revision for delayed union, and three patients ended up with ulnar sided wrist pain. Patients undergoing PRC and 4CF showed significant improvement in post operative PRWE scores, this reflects existing literature. For 4CF care must be taken to minimise ulnar sided wrist pain by relatively shortening the unar sided carpal column mass. ROM analysis showed that patients lost some wrist flexion ROM post-operatively at the 12month mark with both PRC and 4CF. However, other ROM parameters were unchanged

Aims. The aims were to assess whether preoperative joint-specific function (JSF) and health-related quality of life (HRQoL) were associated with level of clinical frailty in patients waiting for a primary total hip arthroplasty (THA) or knee arthroplasty (KA). Methods. Patients waiting for a THA (n = 100) or KA (n = 100) for more than six months were prospectively recruited from the study centre. Overall,162 patients responded to the questionnaire (81 THA; 81 KA). Patient demographics, Oxford score, EuroQol five-dimension (EQ-5D) score, EuroQol visual analogue score (EQ-VAS), Rockwood Clinical Frailty Score (CFS), and time spent on the waiting list were collected. Results. There was a significant correlation between CFS and the Oxford score (THA r = −0.838; p < 0.001, KA r = −0.867; p < 0.001), EQ-5D index (THA r = −0.663, p =< 0.001; KA r = −0.681; p =< 0.001), and EQ-VAS (THA r = −0.414; p < 0.001, KA r = −0.386; p < 0.001). Confounding variables (demographics and waiting time) where adjusted for using multiple regression analysis. For each 8.5 (THA, 95% CI 7.1 to 10.0; p < 0.001) and 9.9 (KA, 95% CI 8.4 to 11.4; p < 0.001) point change in the Oxford score, there was an associated change in level of the CFS. For each 0.16 (THA, 95% CI 0.10 to 0.22; p < 0.001) and 0.20 (KA, 95% CI 0.12 to 0.27; p < 0.001) utility change in EQ-5D, there was an associated change in level of the CFS. EQ-VAS (THA, B = −11.5; p < 0.001, KA B = −7.9; p = 0.005) was also associated with CFS. Conclusion. JSF and HRQoL in patients awaiting THA or KA for more than six months, were independently associated with level of clinical frailty. With further prospective studies, clinical frailty may prove to be a useful metric to assist in the prioritization of arthroplasty waiting lists. Cite this article: Bone Jt Open 2023;4(4):241–249

Objectives. Total hip arthroplasty (THA) is one of the most successful surgical procedures; several bearing technologies have been used, however none of these is optimal. Metal on polycarbonate-urethane (PCU) is a new bearing technology with several potential advantages: PCU is a hydrophilic soft pliable implant quite similar in elasticity to human cartilage, offers biostability, high resistance to hydrolysis, oxidation, and calcification, no biodegradation, low wear rate and high corrosion resistance and can be coupled with large metal heads (Tribofit Hip System, THS). The aim of this prospective study was to report the survivorship and the clinical and radiographic outcomes and the metal ions dosage of a group of patients operated with metal on PCU arthroplasty featuring large metal diameter heads, at 5 years from surgery. Study Design & Methods. 68 consecutive patients treated with the THS were included. The patients have been contacted by phone call and invited to return to our centre for clinical (Oxford Hip Score, OHS, and Harris Hip Score, HHS), radiographic exam and metal ion levels evaluation. All the patients were operated with uncemented stems. Results. The survival rate is 100% and no major complications were seen. The average preoperative OHS was 17 (6–34), at follow-up it was 44 (40–48). The average preoperative HHS was 48 (12–76), at follow-up it was 93 (84–100). On the x rays taken at follow-up, no signs of periprosthetic bone rarefaction and/or osteolysis were seen. No signs of PCU liner wear were visible. At follow up mean Co serum level was 0.52 ng/mL (<0.1–2.5, sd 0.5), mean Cr level was 0.27 ng/mL (0.1–2.2, sd 0.2). In this prospective study at a mean follow up of 5 years, all implants were well functioning, with no radiological signs of loosening and normal serum levels of cobalt and chrome. Although large diameter metal heads and metal sleeve were used no trunnionosis occurred. Conclusions. We believe that these positive outcomes are due the positive biomechanical characteristics of PCU. These results need to be confirmed at a longer follow up and in a more active younger patient population

Aim. Cutibacterium acnes (C. acnes) is the most cultured organism implicated in periprosthetic shoulder infections. Nevertheless, the clinical significance of its persistence on the skin surface and in the deep layers during shoulder arthroplasty surgery remains still unknown. The purpose of this study was to know if the C. acnes isolate present in deep tissues at the end of a primary shoulder arthroplasty could be responsible for shoulder arthroplasty infection. Method. Prospective study including 156 patients undergoing primary shoulder arthroplasty. In all the patients included 5 to 12 tissue samples were obtained and were specifically cultured to detect C. acnes presence. DNA was extracted from the C. acnes colonies selected with the QIAsymphony DSP Virus/Pathogen Midi Kit (Qiagen, Hilden, Germany). Libraries were prepared using Nextera XT kit (Illumina) and sequenced in an Illumina MiSeq sequencer. Sequencing files were pre-processed using The Microbial Genome Atlas pipeline. Samples that failed on QC analysis were discarded for further analysis. Isolate nucleotide distances were calculated using Genome-based distance matrix calculator from the enveomics collection. Comparative genomic analysis was performed between intra- and inter-patients’ isolates. Data analysis was performed using R 3.6.3. Results. For twenty-seven out of 156 patients (17.31%), C. acnes was present at the end of the primary surgery. Two of these patients (both male) developed a C. acnes periprosthetic shoulder infection after 6 and 4 months from the primary surgery. DNA from the C. acnes responsible for the periprosthetic infection was further analysed by whole genome sequencing (WGS). Average Nucleotide Identity (ANI) value was assessed, measuring the nucleotide-level genomic similarity between genome pairs. We found a clear ANI clustering in two major groups which corresponded, mainly, to the associated phylotype (97%–98% ANI). Moreover, when analysing both isolates that developed a periprosthetic shoulder infection, we found that all the revision-surgery isolates clustered nearer to their corresponding primary-surgery isolates (99.4% of similarity) than to the other independent bacterial isolates, supporting the causal relationship between the initial and the delayed infection. Conclusions. C. acnes present at the end of the primary surgery can be the cause of early- or delayed-periprosthetic joint infections in shoulder arthroplasty, revealing the potential route of infection. Therefore, efforts must be made in terms of antibiotic prophylaxis and skin preparation to limit infections of total shoulder arthroplasties

This study was proposed to evaluate the efficacy of fibrin clot augmentation in meniscal tear using inside-out meniscal repair.

A total of 35 patients with meniscus tears were operated on with inside-out meniscus repair and fibrin clot augmentation. Patients were evaluated preoperatively and postoperatively with clinical criteria, Lysholm knee scoring system, and MRI.

Out of the total 35 cases, 5 cases were lost to follow up. Clinical improvement was observed in 29 out of 30 patients (96.6%). The mean Lysholm score improved significantly from 67.63 ± 6.55 points preoperatively to 92.0 ± 2.9 points postoperatively (P < 0.05) in 2 years follow-up. Follow-up MRI in all patients revealed complete healing except in 1 case where the patient presented with recurrence of symptoms such as pain and locking which resolved with partial meniscectomy. Paraesthesia in the anterior part of the knee was observed in 2 cases. (6.6%).

We conclude that fibrin clot augmentation is a good cost-effective modality of treatment for repairable meniscus tears to preserve the meniscus and decrease the point contact pressure on the condyles which may prevent the early occurrence of osteoarthritis.

A ceramic-on-ceramic hip resurfacing implant (cHRA) was developed and introduced in an MHRA-approved clinical investigation to provide a non metallic alternative hip resurfacing product. This study aimed to examine function and physical activity levels of patients with a cHRA implant using subjective and objective measures both before and 12 months following surgery in comparison with age and gender matched healthy controls.

Eighty-two unilateral cHRA patients consented to this study as part of a larger prospective, non-randomised, clinical investigation. In addition to their patient reported outcome measures (PROMs), self- reported measures of physical activity levels and gait analysis were undertaken both pre- operatively (1.5 weeks) and post operatively (52 weeks). This data was then compared to data from a group of 43 age gender and BMI matched group of healthy controls. Kinetics and kinematics were recorded using an instrumented treadmill and 3D Motion Capture. Statistical parametric mapping was used for analysis.

cHRA improved the median Harris Hip Score from 63 to 100, Oxford Hip score from 27 to 48 and the MET from 5.7 to 10.3. cHRA improved top walking speed (5.75km vs 7.27km/hr), achieved a more symmetrical ground reaction force profile, (Symmetry Index value: 10.6% vs 0.9%) and increased hip range of motion (ROM) (31.7° vs 45.9°). Postoperative data was not statistically distinguishable from the healthy controls in any domain.

This gait study sought to document the function of a novel ceramic hip resurfacing, using those features of gait commonly used to describe the shortcomings of hip arthroplasty. These features were captured before and 12 months following surgery. Preoperatively the gait patterns were typical for OA patients, while at 1 year postoperatively, this selected group of patients had gait patterns that were hard to distinguish from healthy controls despite an extended posterior approach. Applications for regulatory approval have been submitted.

Abstract

Background

Charcot neuroarthropathy is a destructive disease characterized by progressive bony fragmentation as a result of the isolated or accumulative trauma in patients with decreased sensation that manifests as dislocation, periarticular fractures and instability. Although amputation can be a reasonable cost economic solution, many patients are willing to avoid that if possible. We explored here one of the salvage procedures.

Background/Purpose. Patient-specific design (PSD) total knee arthroplasty (TKA) implants are marketed to restore neutral mechanical axis alignment (MAA) and provide better anatomic fit compared to standard off-the-shelf (OTS) TKA designs. The purpose of this study was to compare the Knee-Society scores, radiographic outcomes, and complications of PSD and OTS implants. Methods. IRB approved prospective study comparing PSD and OTS by a single surgeon. Implant design change in PSD occurred during the study leading to PSD-1 and PSD-2 subgroups. Demographic, radiographic data including MAA, coronal-tibial angle (CTA), femoro-tibial angle (FTA), tibial-slope (TS) and patella-tilt (PT), and complications were analyzed. Minimum follow-up was 2 year or until revision, and patients completed Knee-Society scores preoperatively, and postoperatively at 3-, 6-, 12-, 24 weeks and final follow up. Results. 136 patients (154 knees), average age (62.7 ± 8.4 years) and follow up (3.1 ± 1.5 years). PSD-1 (77 knees), PSD-2 (36 knees), and OTS (41 knees). PSD-2 had significantly higher early Knee-Society function scores compared to PSD-1 and OTS up to 6 months. All groups had excellent knee society scores after 6 months. PSD-2 had significantly shorter hospital stay (p<0.001), and less hemoglobin drop (p = 0.031) compared to PSD-1 and OTS. No significant difference in MAA (p=0.349) or final ROM (p=0.629). There was approximately 1 degree difference between the groups in the CTA, FTA, TS and PT. Failures requiring revision were 24% (18/75) PSD-1, 0% PSD-2, and 3% (1/35) OTS. Most common modes-of- failure were tibial subsidence (56%) and polyethylene locking mechanism failure (22%) in PSD-1. Conclusion. PSD-2 had better early Knee-Society function scores, shorter hospital stay, lower hemoglobin drop, and no failures compared to PSD-1 and OTS. There was an unexpected high failure rate in the early patient-specific design TKA that was not seen after the manufacturer changed the design

The prevalence of gluteal tendinopathy (GT) associated with osteoarthritis of the hip is difficult to determine as it is frequently undiagnosed or misdiagnosed as trochanteric bursitis. Its relationship to total hip arthroplasty (THA) outcomes is currently unknown. The aim of this study was to determine the incidence of GT at the time of hip arthroplasty and examine the relationship between GT and patient reported outcomes (PROMS) before and after THA.

Patients undergoing THA for primary osteoarthritis between August 2017 and August 2020 were recruited. Tendinopathy was assessed and graded at time of surgery. PROMS included the Oxford Hip Score (OHS), HOOS JR, EQ-5D, and were collected preoperatively and at one year after THA. Satisfaction with surgery was also assessed at 1 year.

797 patients met eligibility criteria and were graded as Grade 1: normal tendons (n =496, 62%), Grade 2: gluteal tendinopathy but no tear (n=222, 28%), Grade 3: partial/full thickness tears or bare trochanter (n=79, 10%). Patients with abnormal gluteal tendons were older (p=0.001), had a higher mean BMI (p=0.01), and were predominately female (p=0.001). Patients with higher grade tendinopathy had statistically significant inferior PROMS at one year, OHS score (44.1 v 42.9 v 41.3, p 0.001) HOOS JR (89.3 V 86.3 V 85.6 p 0.005). Increasing gluteal tendon grade was associated with a greater incidence of problems with mobility (p=0.001), usual activities (p=0.001) and pain (p=0.021) on EQ5D. There was a 3 times relative risk of overall dissatisfaction with THA in the presence of gluteal tears.

This study demonstrated that gluteal tendinopathy was commonly observed and associated with inferior 1-year PROMS in patients undergoing THA for OA. Increasing degree of tendinopathy was a negative prognostic factor for worse functional outcomes and patient satisfaction.

The iASSIST system is a portable, accelerometer base with electronic navigation used for total knee arthroplasty (TKA) which guides the surgeon to align and validate bone resection during the surgical procedure. The purpose of this study was to compare the radiological outcome between accelerometer base iASSIST system and the conventional system. Method. A prospective study between two group of 36 patients (50 TKA) of primary osteoarthritis of the knee who underwent TKA using iASSIST ™ or conventional method (25 TKA in each group) from January 2018 to December 2019. A single surgeon performs all operations with the same instrumentation and same surgical approach. Pre-operative and postoperative management protocol are same for both groups. All patients had standardized scanogram (full leg radiogram) performed post operatively to determine mechanical axis of lower limb, femoral and tibial component alignment. Result. There was no significant difference between the 2 groups for Age, Gender, Body mass index, Laterality and Preoperative mechanical axis(p>0.05). There was no difference in proportion of outliers for mechanical axis (p=0.91), Coronal femoral component alignment angle (p=0.08), Coronal tibial component alignment angle (p=1.0). The mean duration of surgery, postoperative drop in Hb, number of blood transfusion didn't show significant difference between 2 groups (p>0.05). Conclusion. Our study concludes that despite being a useful guidance tool during TKA, iASSIST does not show any difference in limb alignment (mechanical axis), Tibial and femoral component alignment when compared with the conventional method

Purpose

To explore the relationship in terms of time scale between pre-operative expectations and postoperative outcomes and satisfaction after Hallux valgus surgery.

The optimum indications for debridement, antibiotics and implant retention (DAIR) are unclear. Previous studies have demonstrated higher success rate of DAIR within one year of the primary arthroplasty. This study aimed to compare the success rate of DAIR vs revision in “early” and “late” infections to provide guidance for clinical decision making.

The Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort prospectively recorded PJIs between July 2014 and December 2017 in 27 hospitals. This study included PIANO patients with first time PJIs occurring after primary TKA. Treatment success was defined as the patient being alive, free from further revision and without clinical or microbiological evidence of reinfection at two years follow-up.

“Early” and “late” infections were analyzed separately. Univariate analysis compared demographic and disease specific factors between the DAIR and Revision groups. Multivariate binary logistic regression identified whether treatment strategy and other risk factors were associated with treatment success in “early” and “late” infections.

In 117 “early” (<1 year) infections, treatment success rate was 56% in the DAIR group and 54% in the revision group (p=0.878). No independent risk factors were associated with treatment outcome on multivariate analysis.

In 134 “late” (>1 year) infections, treatment success rate was 34.4% in the DAIR group and 60.5% in the revision group (OR 3.07 p=0.006). On multivariate analysis, revision was associated with 2.47x higher odds of success (p=0.041) when compared to DAIR, patients with at least one significant co-morbidity (OR 2.27, p=0.045) or with Staphylococcus aureus PJIs (OR 2.5, p=0.042) had higher odds of failure.

In “late” PJIs occurring >1 year following primary TKA, treatment strategy with revision rather than DAIR was associated with greater success. Patients with significant comorbidities and Staphylococcus aureus PJIs were at higher risk of failure regardless of treatment strategy.

Chronic low back pain (CLBP) is the most common cause of disability worldwide, and lumbar spine fusion (LSF) is often chosen to treat pain caused by advanced degenerative disease when clinical treatment failed certain cases, the post-surgical outcomes are not what was expected. Several studies highlight how important are. In psychological variables during the postoperative spine surgery period. The aim of this study is to assess the role of preoperative depression on postoperative clinical outcomes. We included patients who underwent LSF since December 2021. Preoperative depression was assessed administering Beck Depression Inventory questionnaire (BDI). And pain and disability were evaluated at 1, 3, and 6 months, administering respectively Visual Analogic Scale (VAS) and Oswestry Disability Index (ODI). As statistical analysis Mann-Whitney test was performed. We included 46 patients, 20 female (43,5%) and 26 male (56,5%) with an average age of 64,2. The population was divided in two groups, fixing the BDI cut-off point at 10. Patients with BDI < 10 points (N=28) had normal mental health status, instead patients with BDI > 10 points (N=16) had depressive disorders. At 3 months patients with healthy mental status reported statistically significant reduction of pain (U = 372,5, p = .006) and improvement of disability but without statistical significancy (U = 318, p = 0,137). At 6 months patients without psychological disease reported statistically significant reduction of pain (U = 342, p = 0,039) and disability (U = 372,5, p = 0,006).

This study demonstrates the correlation between pre-existing depressive state and poorer clinical outcomes after spine surgery. These results are consistent with the literature. Therefore, during the surgical decision making it is crucial to take psychological variables into account in order to predict the results after surgery and inform patients on the potential influence of mental status.

In patients admitted to hospital with a hip fracture, urinary issues are common. Despite guidelines that recommend avoiding foley catheter usage when possible, it remains a common part of perioperative care. To date, there is no prospective data on the safety and satisfaction associated with catheter use in such cohort. The aim of this study was to evaluate the satisfaction of patients when using a foley catheter while they await surgery for their fractured hip and the safety associated with catheter use.

In our prospectively collected database, 587 patients were admitted to our tertiary care center over a 1 year period. Most patients (328) were catheterized within the first 24h of admission, primarily inserted in ED. Of these patients, 119 patients (61 catheterized and 58 noncatheterized) completed a questionnaire about their perioperative management with foley catheter usage administered on day 1 of admission. This was used to determine satisfaction of catheter use (if catheterized) and pain levels (associated with catheterized or associated with transferring/voiding if not catheterized). Adverse effects related with catheter use included urinary tract infection (UTI) and post-operative urinary retention (POUR).

Ninety-five percent of patients found the catheter to be convenient. Only 5% of patients reported any pain with catheter use. On the contrary, 47.5% of non-catheterized patients found it difficult to move to the bathroom and 30.4% found it difficult to urinate. Catheterized patients had significative less pain than uncatheterized patients (0.62/10 vs 2.45/10 respectively, p < 0 .001). The use of nerve block reduced pain levels amongst catheterized patients but was not associated with reduced pain levels or satisfaction amongst non-catheterized patients. The use of catheter was not associated with increased risk of UTI(17.5% in the catheterized vs 13.3% in the non-catheterized, p = 0.541) or POUR (6.8% in the catheterized vs 11.1% in the non-catheterized, p = 0.406).

This study illustrates the benefits and safety associated with the use of urinary catheters in the pre-operative period amongst hip fractures. The use of catheters was associated with reduced pain and satisfaction without increasing post-operative UTI or POUR. These findings suggest that pre-operative catheter use is associated with less pain and more satisfaction for patients awaiting hip surgery and whom other measures, such as nerve blocks, are unlikely to reduce the discomfort associated with the mobility required to void. A prospective randomized control study could lead to a more evidence based approach for perioperative foley catheter usage in hip fracture patients.

Aim. A key of success in the treatment of prosthetic joint infection (PJI) is the proper diagnosis. There is a lack of diagnostic tools able to diagnose a PJI with high accuracy. Alpha-defensin has been proposed as possible solution but the available literature is still limited. This prospective study was carried out in order to determine (1) what is the sensitivity, the specificity, the positive and the negative predictive value of the Alpha-defensin immunoassay test in diagnosing PJI; (2) which clinical features may be responsible for false positive and false negative results?. Method. Preoperative aspiration was performed in patients presenting with a painful hip/knee arthroplasty. Metallosis, other inflammatory comorbidities and previous/concomitant antibiotic therapy were not considered as exclusion criteria. Patients with inadequate amount of synovial fluid for culture were excluded. At time of revision synovial fluid samples were taken in the OR in order to perform Alpha-defensin assay. During surgical debridement tissue samples for cultures were obtained. Prospectively, 156 patients (65 knees and 91 hips) were included. A diagnosis of PJI was confirmed in 29 patients. Results. The sensitivity of the Alpha-defensin immunoassay was 97% (95% CI, 92% – 99%), the specificity was 97% (95% CI, 92% – 99%), the positive predictive value was 88% (95% CI, 81% – 92%) and the negative predictive value was 99% (95% CI, 96% – 99%). Among four false positive patients two had a metallosis and one had a polyethylene wear. The false negative case presented with a draining sinus, and intraoperative cultures were also negative. Conclusions. Alpha-defensin assay may have a significant role in PJI diagnosis. Negative tests may exclude the diagnosis of PJI. Positive tests are very much likely to confirm PJI, but other conditions (metallosis, poly wear) should be excluded

Aims. Diagnosis of cauda equina syndrome (CES) remains difficult; clinical assessment has low accuracy in reliably predicting MRI compression of the cauda equina (CE). This prospective study tests the usefulness of ultrasound bladder scans as an adjunct for diagnosing CES. Methods. A total of 260 patients with suspected CES were referred to a tertiary spinal unit over a 16-month period. All were assessed by Board-eligible spinal surgeons and had transabdominal ultrasound bladder scans for pre- and post-voiding residual (PVR) volume measurements before lumbosacral MRI. Results. The study confirms the low predictive value of ‘red flag’ symptoms and signs. Of note ‘bilateral sciatica’ had a sensitivity of 32.4%, and a positive predictive value (PPV) of only 17.2%, and negative predictive value (NPV) 88.3%. Use of a PVR volume of ≥ 200 ml was a demonstrably more accurate test for predicting cauda equina compression on subsequent MRI (p < 0.001). The PVR sensitivity was 94.1%, specificity 66.8%, PPV 29.9% and NPV 98.7%. The PVR allowed risk-stratification with 13% patients deemed ‘low-risk’ of CES. They had non-urgent MRI scans. None of the latter scans showed any cauda equina compression (p < 0.006) or individuals developed subsequent CES in the intervening period. There were considerable cost-savings associated with the above strategy. Conclusion. This is the largest reported prospective evaluation of suspected CES. Use of the PVR volume ≥ 200 ml was considerably more accurate in predicting CES. It is a useful adjunct to conventional clinical assessment and allows risk-stratification in managing suspected CES. If adopted widely it is less likely incomplete CES would be missed. Cite this article: Bone Joint J 2020;102-B(6):677–682

Australian Football (AF) is a popular sport in Australia, with females now representing one-third of participants. Despite this, the injury profiles of females versus males in largely unknown. The current study investigated fractures, dislocations and tendon ruptures in females versus males presenting to emergency departments (ED) with an AF injury.

All patients, regardless of age, presenting to one of 10 EDs in Victoria, Australia, with an AF injury were included. Data were prospectively collected over a 10-month period, coinciding with a complete AF season. Data were extracted from patient medical records regarding injury-type, body-part injured and treatments required. Female and male data were compared with chi-squared tests.

Of the 1635 patients presenting with an AF injury, 595 (36.0%) had a fracture, dislocation or tendon rupture, of whom 85 (14.3%) were female and the average age was 20.5 years (SD 8.0). Fractures accounted for most injuries (n=478, 80.3% of patients had a fracture), followed by dislocations (n=118, 19.8%) and tendon ruptures (n=14, 2.4%). Upper limb fractures were more common than lower limb fractures (71.1% v 11.5% of fractures). Females were more likely to fracture their hands or fingers than males (45.7% v 34.3%). Males were more likely to fracture ribs (5.4% v 0%). Most fractures (91.2%) were managed in the ED, with the remainder being admitted for surgery (GAMP/ORIF). Males were more likely to be admitted for surgery than females (11.2% v 5.9%). Regarding dislocations (n=118), females were more likely to dislocate the patella (36.8% v 8.1% of dislocations). Only males sustained a tendon rupture (n=14): finger extensor or flexor (57.1%), achilles tendon (28.6%) and patella tendon (14.3%).

Orthopaedic AF injuries are common presentations to EDs in Victoria, though few require specialist orthopaedic intervention. Injury profiles differed between genders suggesting that gender specific injury prevention and management might be required.

Aims

Previous studies have suggested that selenium as a trace element is involved in bone health, but findings related to the specific effect of selenium on bone health remain inconclusive. Thus, we performed a meta-analysis by including all the relevant studies to elucidate the association between selenium status (dietary intake or serum selenium) and bone health indicators (bone mineral density (BMD), osteoporosis (OP), or fracture).

High energy pelvic injury poses a challenging setting for the treating surgeon. Often multiple injuries are associated, which makes the measurement of short- and long-term functional outcomes a difficult task. The purpose of this study was to determine the incidence of pelvic dysfunction and late impacts of high energy pelvic ring fractures on pelvic floor function in women, with respect to urinary, sexual and musculoskeletal function. This was compared to a similar cohort of women with lower limb fractures without pelvis involvement. The data in our study was prospectively gathered between 2010 and 2013 on 229 adult females who sustained injury between 1998 and 2012. Besides demographic and operative variables, the scores of three validated health assessment tools were tabulated: King's Health Questionnaire (KHQ), Female Sexual Function Index (FSFI) and the Short Musculoskeletal Functional Assessment (SMFA). A multivariate regression analysis was done to compare groups. The incidence of sexual dysfunction was 80.8% in the pelvis and 59.4% in the lower extremity group. A Wilcoxon rank sum test showed a significant difference in KHQ-score (p<0.01) with the pelvis group being worse. When adjusting for age, follow-up and Injury Severity Score this difference was not significant (p=0.28), as was for FSFI and SMFA score. The mean FSFI scores of both groups met the criteria for female sexual dysfunction (<26). Patients with a Tile C fracture have better FSFI scores (16.98) compared to Tile B fractures (10.12; p=0.02). Logistic regression predicting FSFI larger than 26.5 showed that older age and pelvic fractures have a higher likelihood having a form of sexual dysfunction. Sexual dysfunction after lower extremity trauma is found in patients regardless of pelvic ring involvement. Urinary function is more impaired after pelvic injuries, but more data is needed to confirm this. Older age and pelvic fracture are predictors for sexual dysfunction in women. This study is important as it could help counsel patients on the likelihood of sexual dysfunction, something that is probably under-reported and recognized during our patient follow up

Aims

The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O).

INTRODUCTION. Despite clear clinical advantages Unicompartimetal Knee Replacement (UKR) still remain a high demanding and less forgiving surgical procedure. Different Authors in literature pointed out how in coronal tibial malalignment beyond 3° as well as tibial slope beyond 7° increase the rate of aseptic failure. Likewise, overcorrection in the coronal plain is a well recognised cause of failure because of an overweighting on the controlateral compartment. Furthermore it has been shown how in UKR surgery even using short narrow intramedullary guide this can cause errors in both coronal planes. Computer assisted surgery has been proposed to improve implant positioning in joint replacement surgery with no need of intramedullary guide. Likewise more recently Patient Specific Instrumentation (PSI) has been suggested as a new technology capable of new advantages such as shorter surgical times and lower blood losses maintaining at least the same accuracy. Aim of this prospective study is to present comparing 2 groups of UKRs using either a computer assisted technique or a CT based PSI. MATERIALS AND METHODS. Since January 2010 54 patients undergoing UKR because of medial compartment arthritis were prospectively enrolled in the study. Before surgery patients were alternatively assigned to either computer-assisted alignment (group A) or PSI group (group B). In the group A (27 knees) the implant (Sigma, Depuy Orthopaedics Inc, Warsaw, Indiana, USA) was positioned using a CT-free computer assisted alignment system specifically created for UKR surgery (OrthoKey, Delaware, USA USA). In group B (27knees) the implant (GMK uni, Medacta, Castel San Pietro, Switzerland) was performed using a CT-Based PSI technology (MyKnee, Medacta, Castel San Pietro, Switzerland). In both the groups all the implants were cemented and using always a fixed metal backed tibial component. The duration of surgery and all the complications according to Kim classification were documented in all cases. Six months after surgery each patient had long-leg standing anterior-posterior radiographs and lateral radiographs of the knee. The radiographs were assessed to determine the Frontal Femoral Component angle (FFC), the Frontal Tibial Component angle (FTC), the Hip-Knee-Ankle angle (HKA) and the sagittal orientation (slope) of both tibial and femoral component. The number and percentage of outliners for each parameter was determined. In addition the percentage of patients from each group with all 5 parameters within the desired range was calculated. Furthermore at the latest follow-up the 2 groups were clinically assessed using KSS and Functional score. RESULTS. At the last assessments there were no differences in the clinical outcome. The mean surgical time was longer in the navigated group of a mean of 5.9 minutes without any statistical differences in complications. The mechanical axis, tibial slope the FTC angle were significantly better aligned in the navigated group. A statistically significant higher number of outliners was seen in the PSI group. The number of implants with all 5 radiological parameters aligned within the desired range was statistically higher in the navigated group. All the implants in the navigated group were correctly aligned in all the planned parameters. DISCUSSION. To our knowledge this is the first prospective study in literature assessing navigation compared to PSI technique in UKR surgery. Despite a slight not significant longer surgical time in the navigated group, at a short follow-up the results could not demonstrate any clinical diffences between the 2 technologies However according to their results the Authors indicate navigation as more helpful in UKR surgery compared to PSI technology in terms of accuracy

Purpose: To assess the safety and efficacy of using mini-incisions (? 10 cm) in the implantation of total hip prostheses. Materials and methods: A prospective study was carried out to compare a cohort of 25 total hip prostheses implanted using a posterior approach through mini-incisions (mean length 9.4 cm, range: 8–10) with another 25-patient cohort where the incisions were of standard length. Patients in both groups had a similar gender distribution, similar ages (± 3 years), weight (± 3 kg) and height (± 3 cm). The type of implant used was also similar. Statistical analysis used: Chi-square, Mann-Whitney U test and Student’s t test. Results: After 6 months, no significant differences were observed in the body mass index, femoral cortical index, intraoperative or postoperative complications, cup diameter, stem size, cup inclination, stem alignment, quality of femoral cementation, metaphyseal and isthmic filling of the stem, leg length discrepancy, number of blood units transfused, hemoglobin and hematocrite levels 6 hours post-op, in the decline of these levels from those of the preop period or in the Harris Hip Score values. The mini-incision group showed higher haemoglobin and hematocrite levels after 48 hours and a lower reduction of these values from preop to 48 hours after surgery and a lower suction drain. Fewer patients of these patients needed a transfusion, they were the first to sit and start walking and they had significantly shorter hospital stays. Mean follow-up was 20 months. Conclusions: Total hip prostheses can be implanted through mini-incisions in a safe and reproducible way and lead to a better, faster recovery without additional complications, with the same degree of precision and similar clinical results

Summary. There is little consensus regarding the regime for treatment of tuberculosis of spine, although WHO has laid down guidelines couple of years back classifying spinal tuberculosis in Category 1. This study proves the efficacy of WHO regime in spinal tuberculosis by clinico-radiological evaluation. Introduction. The medical fraternity is divided over the duration of chemotherapy in cases spinal tuberculosis. WHO clearly recommend spinal tuberculosis under Category I, but not accepted by most clinicians. Patient and Methods. In this prospective study during the period between August 2005 and July 2012, a total of 76 cases were diagnosed and evaluated clinico-radiologically to test the efficacy of WHO protocol (2HRZE+4HR) in our hospital with a mean follow up of 50 months (30 – 80 months). Results. Spinal tuberculosis was seen in 56% of all osteoarticular tuberculosis. Maximum population was between 11–50 years, females were involved more than males (66%), and regional distribution was different in males (Lumbar) and females (Thoracic). Skip and multifocal lesions were seen in 13% (6 cases), more common in immune compromised cases. Pain was the most common symptom (95%) followed by constitutional symptoms. Radiographic changes were nonspecific, appear late and suggestive of tuberculosis in 53%case, MRI is very useful in diagnosing in 95% cases especially when X ray is contributory. ESR is useful tool for follow up of patients, elevated in 94%cases. Results were evaluated on clinical, hematological and radiological basis. Of the total 64cases (after dropouts, lost in follow up, mortality), 50 patients (78%) received treatment for 6 months and14 cases for more than 6months (P value<0.001). No MDR cases were present. In 50 patients fall in ESR at the end of 2 months was found to be statistically significant (P value<0.05) and hence were given a treatment for 6 months, the fall at the end of 6 months was highly significant (P value<0.001). In rest of the 14 cases the duration of treatment was given for more than 6 months as the trend of fall of ESR was not significant. MRI changes were assessed in the form of osteitis, osteitis with discitis, abscess formation and granulation tissue on initiation of treatment, completion of treatment and 6 months after completion of treatment. Conclusion and Discussion. The experience shows that spinal tuberculosis is common in a tertiary health care centre in India with diagnosis possible by combination of clinical evaluation and radiological evaluation. Statistical significance was found in clinical symptoms, ESR trends and MRI evaluation in cases receiving 6 months of chemotherapy. With this study, WHO short course chemotherapy was found to be effective in spinal tuberculosis, with no relapse over a period of 6 years

Abstract

Objective

To evaluate early mobilization with the ‘STRONG regime’ is safe after lateral ankle ligament repair with suture tape augmentation.

Purpose of the study: Ankle sprains constitute a serious public health problem with nearly 6000 consultations daily in France. The prognosis is generally good if a precise clinical diagnosis can be established and appropriate treatment undertaken. The purpose of this study was to ascertain the pertinence of the initial physical examination which determines the treatment by correlating it with the results of a high-resolution ultrasound examination. Material and methods: This prospective study included 23 patients, mean age 30.7 years, who were followed regularly for three months. A total of 154 ultrasound explorations were performed. The initial treatment for these patients who consulted a hospital emergency room for ankle trauma was established on the basis of the Ottawa criteria. The ankles were examined by a senior physician and an ultrasonographic exploration was performed 3.9 days on average after the first consultation in the emergency room. Standard protocols were used for the physical examination and for the ultrasonography. Results: The initial results confirmed a lesion of the lateral collateral ligament in 91% of cases with an initial tear of the anterior talofibular ligament in half of the cases and a injury to the calcaneofibular ligament in one out of five cases. One quarter of the patients had an isolated lesion. One out of ten presented a lesion of the syndesmosis and one out of three lesions of the fibular tendons. The standard ankle examination performed by the senior physician established correct diagnosis of the precise lesion in 80% of the cases. Discussion: Lesions of the mid food and of the syndesmosis are diagnosed clinically, ultrasonography is not contributive. The stage of the initial lesion was compared with the stage at three months: in 7 out of 10 cases, the anterior talofibular and the calcaneofibular ligaments had healed correctly. Physical examination is essential but ultrasonography provides certain complementary information at a time when the physical examination can be hindered by the pain and potentially the lesser experience of emergency room examinators. Conclusion: In light of the evidence provided by this study, it can be confirmed that the initial diagnosis of ankle sprain established in an emergency room setting can be corrected by a physical examination performed by an experienced clinician. At the present time, it is not possible to demonstrate the specific contribution of ultrasonography for the management of ankle sprains. This would require a prospective study over a longer period and should be designed to demonstrate the relationship between injury of the fibular tendons and ankle stability

Many procedures have been described for the operative treatment of tennis elbow (lateral epicondylitis). Arthroscopic tennis elbow release is a relatively recent development. The aim of this study was to review our early results of arthroscopic tennis elbow release. This was a prospective study of 29 consecutive patients (30 elbows) with tennis elbow refractory to conservative management, who underwent arthroscopic tennis elbow release performed by one surgeon. At surgery, arthroscopic assessment of the elbow joint was performed followed by capsulectomy and debridement of the Extensor Carpi Radialis Brevis (ECRB) tendon origin using the proximal lateral, anteromedial and anterolateral portals. Associated intra-articular pathology was noted. The ECRB lesions were classified according to their gross morphology and resected with a shaver but the insertion site was not decorticated. Patients were assessed preoperatively, at 2 weeks and at 3 months using the DASH score. 29 patients with tennis elbow were treated with arthroscopic release of the ECRB origin on the lateral epicondyle. Of the 30 elbows undergoing surgery, 22 were noted to have a Nirschl type I lesion (intact capsule), 7 had a type II lesion (linear capsular tear) and 1 had a type 3 lesion (capsular rent). Degenerative articular changes were noted in 18 elbows. Arthroscopic debridement was undertaken if appropriate. Three elbows had eccentric radial heads. Radial plicae which were impinging on the radial head were present in three patients. Mean follow up is 9 months (1–23). 1 patient was lost to follow up. There was a significant improvement in DASH scores (p< 0.05) at 2 weeks post operatively. This improvement became more significant at 3 months post operatively. This is a worst case scenario analysis using a paired t test. 6 patients failed to improve, 1 partially improved and 1 was revised and improved. There were no surgical complications; however, one patient has post operative stiffness which required an arthroscopic release. The early results of this study would suggest arthroscopic tennis elbow release is an effective treatment for tennis elbow, which in addition also allows assessment of the elbow joint and the potential to address associated intra-articular pathology if required. This minimally invasive technique has been demonstrated to be safe and affords early post operative rehabilitation and return to normal activities

A prospective study of 33 civilian parachutists with 41 injuries is presented. Because the training for civilians is less rigorous than that for military parachutists, the hospital admission rate for severe injuries was high (81.8%). Most injuries occurred during landing and the ankle was most frequently involved. The types and possible mechanisms of injury are discussed, as well as recommendations for modifying the civilian training programme

Ingrowing of the nail of the hallux has been ascribed to an abnormality of the shape of the nail; our prospective study was planned to test this association. Twenty-three consecutive patients and 23 age-matched controls were assessed by caliper measurement and standard photographs, before a first operation for ingrowing toenail. We found no differences in shape between the toenails of the patients and those of the controls, both groups showing great variation. Our results suggest that the ingrowth is not commonly associated with an abnormal shape of the nail

Background. Exebacase, an antistaphylococcal lysin in Phase 3 of development as a treatment for S. aureus bacteremia/right-sided endocarditis has demonstrated antibiofilm activity in vitro and has previously been used as salvage therapy in four patients with relapsing multidrug-resistant (MDR) S. epidermidis knee prosthetic joint infection (PJI) using a procedure called LysinDAIR (administration of the lysin during the performance of an arthroscopic DAIR). Materials/methods. We performed a single center, exploratory, open-label prospective study using the LysinDAIR procedure in patients with chronic (inoculation >3 months prior to treatment) coagulase-negative staphylococci (CNS) PJI of the knee with two different clinical presentations and treatment paradigms. Cohort A: first episode of CNS knee PJI, for whom the LysinDAIR was followed by clindamycin + levofloxacin planned to be prescribed for three months and then stopped; and Cohort B: relapsing episodes of MDR CNS knee PJI for whom the LysinDAIR was followed by primary antimicrobial therapy for three months, followed by suppressive antimicrobial therapy (SAT). Exebacae susceptibility testing was performed before treatment for each patient. In agreement with the French Health authority, exebacase (2 to 3.5 total mg in 30–50 ml (∼0.067 – 0.075 mg/m) was administered directly into the joint during arthroscopy. Results. Eight patients were treated. Exebacase administration was well tolerated by all patients and no serious adverse drug reactions to exebacase were reported. In cohort A (n=4), patients had susceptible S. epidermidis PJI, a painful joint effusion without fistula and without loosening, and received three months of levofloxacin + clindamycin (one patient received an alternative regimen following antibiotic adverse events) and then antibiotics were stopped. During a follow-up of 14, 19, 26 and 36 months, no relapse, no recurrence of the joint effusion and no loosening occurred. In cohort B (n=4), patients had MDR CNS, clinical signs of septic arthritis with a joint effusion without fistula and without loosening and received daptomycin + linezolid or doxycycline. One patient died from COVID-19 at week 4. SAT (tedizolide, n=2; doxycycline, n=1) was then prescribed to other patients. One experienced an infection relapse involving S. caprae under tedizolid therapy at six months. The two other patients continue to do well under SAT 8 and 12 months after the LysinDAIR procedure. Conclusions. The LysinDAIR procedure is a minimally invasive procedure, which has been shown to be easy-to-perform, safe, and has the potential for use as initial treatment or salvage therapy in patients with CNS chronic knee PJI

Between September 2004 and December 2005 we carried out a prospective study of all cases of sepsis of the hip in childhood at a South African regional hospital with a large local population, and which also took referrals from nine rural hospitals. The clinical, radiological, ultrasound and bacteriological features were assessed. All the hips were drained by arthrotomy and the diagnosis was confirmed microbiologically and histologically. Hips with tuberculosis were excluded. The children were reviewed in a dedicated clinic at a mean follow-up of 8.1 months (3 to 18). There were 40 hips with sepsis in 38 patients. Two patients were lost to follow-up. Nine (24%) had multi-focal sepsis. Overall, 13 hips (34%) had a full and uncomplicated clinical and radiological recovery and 25 (66%) had complications. All patients treated by arthrotomy and appropriate antibiotics within five days of the onset of symptoms had an uncomplicated recovery. Initial misdiagnosis was associated with a delay to arthrotomy. However, ‘deprivation’, consultation with a traditional healer, maternal educational attainment and distance to a primary health-care facility were not associated with delay to arthrotomy. The early correct diagnosis of this condition, common in the developing world, remains a significant factor in improving the clinical outcome

As blood transfusion is associated with various risks, a prospective study was carried out to see if it was possible to predict patients more likely to require transfusion following TKR. Data was collected prospectively on 1532 patients undergoing primary TKR between 1998 and 2006. This was collected at a preadmission clinic and various demographics were measured including haemoglobin, BMI, and a knee score. All patients had a tourniquet and the same approach. All received a LMWH until discharge. Patients with a post op haemoglobin less than 8.5 g/dl were transfused as were those less than 10 g/dl who were symptomatic as per unit protocol. Each of the predictive factors was tested for significance using t-tests and chi-squared tests as appropriate. Multiple logistic regression was used to test for the independent predictive of factors after adjusting for one another. Results show transfusion is more likely if the patient was older, female, short light or thin. Also those undergoing a lateral release or a bilateral procedure, having a low pre-op haemoglobin or a large post-op drop were more likely to be transfused. There was also a 2 fold difference between surgeons. After regression analysis 4 important factors were identified. These were a bilateral procedure, low pre-op haemoglobin, a low BMI or having a post-op drop greater than 3g/dl. Following this all patients with pre-op haemoglobin less than 11g/dl are postponed and investigated and treated as required. For those with the above predictive factors, measures can be taken to try and reduce the rate of transfusion such as pre-donation, cell salvage or tran-sexamic acid

Patient reported outcomes and satisfaction scores following excision of interdigital Morton's neuroma have been recently established. However, little is known regarding what patient factors affect these outcomes. This is the first and largest prospective study to determine which patient factors influence surgical outcome following Morton's neuroma excision. Over a seven-year period, 99 consecutive patients (112 feet) undergoing surgical excision of Morton's neuroma were prospectively studied. 78 patients were female with a mean age at operation of 56 years. Patient recorded outcomes and satisfaction were measured using the Manchester-Oxford Foot Questionnaire (MOXFQ), Short Form-12 (SF12) and a supplementary patient satisfaction survey three months pre and six months post-operatively. Patient demographics were recorded in addition to co-morbidities, deprivation, associated neuroma excision and other forefoot surgery. Obesity, deprivation and revision surgery proved to statistically worsen MOXFQ outcomes post-operatively (p=0.005, p=0.002 and p=0.004 respectively). Deprivation significantly worsened the mental component of the SF12 (p=0.043) and depression the physical component (p=0.026). No difference in outcome was identified for age, sex, time from diagnosis to surgery, multiple neuroma excision and other forefoot surgeries. 23.5percnt; of deprived patients were dissatisfied with their surgery compared to 7percnt; of the remaining cohort. Patient reported outcomes following resection of symptomatic Morton's neuroma are shown to be less favourable in those patients who display characteristics of obesity, depression, deprivation and in those who undertake revision neuroma resection. Surgery can be safely delayed, as time to surgery from diagnosis bears no impact on clinical outcome

Aim. We aimed to assess the efficacy of conservative management of proximal phalanx fractures in a plaster slab. Methods. 23 consecutive patients with proximal phalanx fractures were included in this prospective study. The fractures were reduced and the position was held with a dorsal slab for three weeks. They were followed up an average of 7 weeks (range 2 to 45) after the injury. Radiographic confirmation of adequate reduction was carried out each week until union. After removal of the plaster, range of motion of the finger and radiological evidence of union, non-union or malunion was documented. Results. In united fractures, an average angulation of 4° (apex volar) was measured (range 0 to 45°). In one case (45°) this was not acceptable. All other cases measured less than 15° of angulation. On the AP radiograph the angulation was on average 2° (range 0 to 8°). On average 1.3 mm of shortening (range 0 to 5mm) were measured. In one case delayed union with rotational deformity of 20° was evident. After removal of the slab mild stiffness was noted in one case at the metacarpophalangeal joint and in two cases at the proximal interphalangeal joint. Conclusion. Most proximal phalanx fractures can be managed conservatively with acceptable results. NO DISCLOSURES

The incidence of wound complications after a hip or a knee replacement is well established, but there is no such data about foot/ankle surgery. Without this data it is difficult to compare performance between different care-providers. It is also difficult to benchmark services that could potentially be provided by a wide range of care providers (chiropodists, podiatrists, podiatric surgeons, general orthopaedic surgeons with a small foot/ankle practice, etc). Our aim was to establish the incidence of wound complications after foot/ankle surgery and provide a baseline for future comparison. Our study was done in two parts. First part was to conduct an opinion-survey of BOFAS members with a substantial foot/ankle practice, on wound complications from foot/ankle surgery in their own practice. Second part was to conduct a prospective study on the incidence of wound complications from our own foot/ankle practice. The study was registered as an audit and did not require ethical approval. All wound complications (skin necrosis, wound dehiscence, superficial and deep infections) were recorded prospectively. Record of such data was obtained by an independent observer, and from multiple sources, to avoid under-reporting. 60 % of the responders to our survey had a predominant foot/ankle practice (exclusive or at least 75 % of their practice was foot/ankle surgery) and were included for further analysis of their responses. A large majority of these responders (64%) reported a rate of 2–5 % for superficial infection, and a significant majority (86 %) reported a deep infection rate of less than 2 %. Results from our own practice showed an incidence of superficial infection of 2.8 % and deep infection of 1.5 %. With increasing focus on clinical outcome measures as an indicator of quality, it is imperative to publish data on wound complications/ infection after foot/ankle surgery, and in the absence of such data, our two-armed study (survey-opinion and prospective audit) provides a useful benchmark for future comparisons

Developmental dysplasia of the hip (DDH) is defined as abnormal, pathological relations between the elements of the hip joint, resulting from disorders of its development. Since 1984, periacetabular bernese osteotomy (PAO) has been a method of treating DDH. The aim of this study was to evaluate the results of the PAO in persistent deformity from childhood and primary late dysplasia in adolescents and adults.

Patients were divided into four groups: A - adolescent patients not operated of DDH in childhood, B – adolescent patient after a surgical treatment of DDH in childhood, C - adults with hip dysplasia not previously operated, D - control group. Radiological evaluation of standard AP view of hip joints was performed before and after the surgery and included parameters: Wiberg angle (CEA), femoral head cover (FHC), medialization, distalisation, the ilio-ischial angle.

Improvement in radiological parameters and statistical significance were achieved in all measurements in all patients. The greatest improvement was achieved in: CEA − 19˚ in Group B, Medialization − 3mm in Group C, Distalization − 6mm in Group B, FHC − 17% in Group B, Ilio-ischial angle − 5˚ in Group B.

The greatest correction of radiological parameters was obtained in children operated in childhood. Surgical treatment of DDH in childhood worsens the operating conditions in adolescents and adults due to scars, adhesions and altered bone anatomy but leaves the need for less deformity correction. The surgical treatment of DDH in childhood has a beneficial effect on the final outcome of the treatment of patients undergoing PAO surgery in adolescents and young adults.

Our aim in this prospective study was to determine the best diagnostic method for discriminating between patients with and without osteochondral lesions of the talus, with special relevance to the value of MRI compared with the new technique of multidetector helical CT. We compared the diagnostic value of history, physical examination and standard radiography, a 4 cm heel-rise view, helical CT, MRI, and diagnostic arthroscopy for simultaneous detection or exclusion of osteochondral lesions of the talus. A consecutive series of 103 patients (104 ankles) with chronic ankle pain was included in this study. Of these, 29 with 35 osteochondral lesions were identified. Twenty-seven lesions were located in the talus. Our findings showed that helical CT, MRI and diagnostic arthroscopy were significantly better than history, physical examination and standard radiography for detecting or excluding an osteochondral lesion. Also, MRI and diagnostic arthroscopy performed better than a mortise view with a 4 cm heel-rise. We did not find a statistically significant difference between helical CT and MRI. Diagnostic arthroscopy did not perform better than helical CT and MRI for detecting or excluding an osteochondral lesion

Accepted treatment for acute septic arthritis in children involves drainage of the pus and systematic antibiotics. Review of published studies show that there is a tendency for paediatricians and physicians to drain pus by aspiration and for surgeons to drain the pus by arthrotomy and surgical lavage. There is however no published prospective study comparing the two methods of drainage. 201 consecutive children under 13 (134 boys and 67 girls) presenting to our hospital with acute septic arthritis were entered into a prospective study and randomised to either aspiration of the joint with a 14g needle or arthrotomy and lavage. Both groups had systematic antibiotics for six weeks. All patients were followed up with clinical examination and x-rays at 2, 6, 12, 24 and 52 weeks. There were 102 patients in the aspiration group and 99 in the lavage group. Both groups were similar in respect to mean age (2 yrs 5m and 2 yrs 10m respectively) and both groups had had symptoms for a mean of 6. 5 days. The commonest joint involved in both groups was the knee, followed by the shoulder, and the commonest organism involved was salmonella, followed by staphylococcus aureus. Aspiration failed in 9/102 patients who then underwent arthrotomy. Aspirated cases were discharged at a mean of 7. 9 days compared to 9. 8 days in the lavage group. There is no published method of measuring clinical improvement in septic arthritis so we devised the Blantyre septic joint score (BSJS) which measures pain, swelling, range of motion and function. Using the BSJS we found significant difference in scores between the aspirated and the lavage groups at any stage of follow up. We could not demonstrate any difference in clinical outcome between aspiration and arthrotomy with lavage in the treatment of septic arthritis

Introduction: This prospective study is designed to evaluate PCL reconstruction using the arthroscopic ‘double bundle technique’ in a consecutive series of patients with multiple ligament instability. Methods: 12 consecutive patients who underwent arthroscopic posterior cruciate ligament reconstruction at Warrington Hospital for a combined ligament injury with PCL tear between 2001 and 2004 were included in the study. The indication for surgery was functional disability of the knee due to pain and instability. All were male patients with an average age 33 years (range 18 to 44). Average time from injury to surgery was 31.5 months (range 1 day to 96 months). The evaluation parameters included functional assessment, clinical examination, and functional score. All data was collected prospectively. The average period of follow up was 23months (range 9 to 50 months). Results: Using the IKDC subjective assessment 63% of the patients had normal/near normal knee function (range 16 to 94). On Lysholm scoring 71% reported good or excellent results. On objective examination 83% had abolition of reverse pivot with 91% showing no evidence of PLC instability. Conclusions: Arthroscopic double bundle PCL reconstruction in this study produced a satisfactory clinical outcome in terms of return to function objective assessment and symptom improvement. The technique has improved results in terms of outcome than previous reports in the literature would suggest

Femoral shaft fractures are fairly common injuries in paediatric age group. The treatment protocols are clear in patients of age less than 4 years and greater than 6 years. The real dilemma lies in the age group of 4–6 years. The aim of this study is to find whether a conservative line should be followed, or a more aggressive surgical intervention can provide significantly better results in these injuries.

This study was conducted in a tertiary care hospital in Bhubaneswar, India from January 2020 to March 2021. A total of 40 patients with femur shaft fractures were included and randomly divided in two treatment groups. Group A were treated with a TENS nail while group B were treated with skin traction followed by spica cast. They were regularly followed up with clinical and radiological examination to look out for signs of healing and any complications. TENS was removed at 4–9 months’ time in all Group A patients.

Group A patients had a statistically significant less hospital stay, immobilisation period, time to full weight bearing and radiological union. Rotational malunions were significantly lower in Group A (p-value 0.0379) while there was no statistically significant difference in angular malunion in coronal and sagittal plane at final follow up. Complications unique to group A were skin necrosis and infection.

We conclude that TENS is better modality for treatment of shaft of femur fractures in patients of 4–6 years age as they significantly reduce the hospital stay, immobilization period and rotational malalignment.

We report a prospective study of the factors associated with acute urinary retention after total hip replacement in 103 consecutive male patients. Eleven patients (10.7%) developed retention after operation. Of the factors investigated before operation three had predictive value: inability to pass urine into a bottle whilst lying in bed, urinary peak-flow rates indicative of obstruction, and a history of previous bladder outflow problems. This study suggests that patients showing one or more of these factors should be assessed and if necessary treated by a urologist before arthroplasty, so as to avoid the need for catheterisation, and the consequent risk of deep infection

Shortening of patellar tendon after total knee arthroplasty (TKA) was previously reported by several studies. Its etiology still remains controversial. Patellar tendon shortening, a direct cause of patella baja, has a dramatic negative impact in terms of clinical outcomes after TKA. Main objective of this study is to assess the feasibility of utilizing a different technique with Ultrasound that is easy to use, cost-effective and able to eliminate the problem of differential magnification occurring in other techniques which count on standard x-rays and to establish the correlation between clinical outcomes and changes in patellar tendon length and thickness after TKA.

The study was designed as prospective cohort and, after a minimum of 4-year-follow up period, 47 knees of 24 patients who had undergone primary TKA without patellar resurfacing were included in the study. All patients were scored with Kujala and HSS scores and all patellar tendons were evaluated with USG regarding their length and thickness. We used conventional grey-scale ultrasound imaging (US) to determine any changes in patellar tendon morphology. All cases were evaluated by the same radiologist. The patellar tendon was examined with the knee in 30° flexion. The flexion angle helped to stretch the extensor mechanism and avoid anisotropy (concavity) of the patellar tendon. The transducer was placed along the long axis of the tendon. The patellar tendon was initially examined in the longitudinal plane in order to measure the total length. Then, total length was divided into three parts and sagittal thickness was calculated at the proximal, median, and distal thirds of the patellar tendon. Both the length and thickness of the tendon were measured before surgery and at the 4th year of follow-up.

Of the 47 knees that were included in our study, the mean pre-operative and postoperative length of the patellar tendon was 40.78±6.15 mm and 35.93±4.52 mm. Our results suggested significant shortening of the patellar tendon after primary TKA surgery (p<0.05). Intergroup analysis suggested that reduced sagittal thickness in the proximal third of the tendon was more strongly correlated with an increase in functional outcomes (p<0.05). Our results suggested no significant difference in clinical outcome scores between patients with increased or decreased length of the patellar tendon after TKA (p>0.05).

We suggest that determining morphologic changes in sagittal thickness as well as length is important in explaining some of the ambiguous causes of anterior knee pain and impaired clinical outcomes after TKA. More accurate documentation of morphologic changes in the patellar tendon after TKA will certainly help to develop new techniques by surgeons or avoid some existing routines that may harm the tendon. USG is a feasible method for evaluating patellar tendon morphology after TKA but more future studies are needed.

Background. Femoroacetabular impingement (FAI) may be a predisposing factor in progression of osteoarthritis. The use of hip arthroscopy is in its infancy with very few studies currently reported. Early reports show favourable results for treatment of young patients with FAI. This prospective study over a larger age spectrum represents a significant addition to this expanding field of minimally invasive surgery. Methods. Over a twenty-two month period all patients undergoing interventional hip arthroscopy were recorded on a prospective database. Patient demographics, diagnosis, operative intervention and complications were noted. Patients were scored pre-operatively and postoperatively at 6 months and 1 year using the McCarthy score. Results. 94 patients met the criteria for inclusion in this study. Median age was 39 (15–66) years with 57.4% female, 16 patients were over the age of 50 years. At operation, 50 patients had a labral tear, 70 had cam impingement and 62 had chondral damage, with 21 of these deemed severe (grade 3 or 4). For all patients a mean increase in the McCarthy score of 14.6 (p=<0.0001) was seen at 6 months and 19.1 (p=0.0002) at 1 year postoperatively. For those over 50 years, at 6 months an increase of 11.9 (p=0.08) was seen, improving to 33.8 (p=<0.0001) at 1 year. Eight patients underwent THR, of these, 2 were over 50 years of age. All of this group of patients had chondral damage (50% judged as severe at arthroscopy). At 6 months postoperatively these patients had severe pain and their mean score worsened by −16.3 (p=0.2). Few complications were seen, 7 patients had tight access (5 males), 3 of which received chondral scuffing and 1 had the procedure abandoned, 1 patient had groin labral bruising and 2 patients had transient parasthesia. Conclusions. Patients see a gradual and significant improvement post hip arthroscopy, with symptoms continuing to improve until 1 year. This is a well-tolerated procedure with a low complication rate and the opportunity for treatment of a range of hip pathology. Patients over the age of 50 gain a significant improvement from this procedure. Two groups of patients who gain no improvement are those with inflammatory arthropathy and those with dysplastic acetabulae

We describe the clinical results of a technique of direct pars repair stabilised with a construct that consists of a pair of pedicle screws connected with a modular link that passes beneath the spinous process. Tightening the link to the screws compresses the bone grafted pars defect providing rigid intrasegmental fixation. 20 patients aged between 9 and 21 years were included in this prospective study. Each of the patients had high activity levels and suffered from significant back pain without radicular symptoms or signs. Patients had either no or grade I spondylolisthesis. Definitive pseudoarthrosis and fracture were confirmed via computerize tomography (CT). Magnetic resonance imaging was performed in every patient to assess the adjacent disc spaces which demonstrated normal signal intensity. A midline incision was used for surgery. The pars interarticularis defect was exposed and filled with autologous iliac crest bone graft prior to screw insertion. After screw insertion, a link was contoured to fit, and placed just caudal to the spinous process, deep to the interspinous ligament of the affected level, and attached to each pedicle screw. There was early mobilization post-operatively without a brace. The average inpatient stay was 3 days. Post-operative complications included 1 superficial wound haematoma and two superficial wound infections which responded to antibiotic treatment. Follow-up was at 6 weeks, 6 months and at 18 months, and 24 months. Clinical assessments for all patients was via the Oswestry disability index (ODI) and visual analogue scores (VAS). At the latest follow-up, 18 out of the 20 patients showed a significant (p<0.05) improvement in their ODI and VAS scores. The mean post-operative ODI score was 8%. All patients had radiographs and CT scans which showed fusion rates of 80% in those patients followed up for a minimum of 24 months. This new technique for direct pars repair demonstrates high fusion rates in addition provides the possible benefits of maintaining adjacent level motion. Clinically this group had good-to excellent functional outcomes as indicated by visual analogue scales and the Oswestry Disability Index in 18 out of 20 patients studied with a minimum follow-up of 2 years

Current knowledge regarding outcomes following surgical treatment of Morton's neuroma remains incomplete. This is the first prospective study to report the pre- and post-operative patient reported outcomes and satisfaction scores following excision of interdigital Morton's neuroma. Over a seven year period, 99 consecutive patients (112 feet) undergoing surgical excision of Morton's neuroma were prospectively studied. 78 patients were female with a mean age at operation of 56 years. Patient recorded outcomes and satisfaction were measured using the Manchester-Oxford Foot Questionnaire (MOXFQ), Short Form-12 (SF12) and a supplementary patient satisfaction survey three months pre and six months post-operatively. Statistically significant differences were found between the mean pre- and post-operative MOXFQ and physical component of the SF-12 (p< 0.05). No difference in outcome was identified in patients in whom multiple neuromas were operated compared to single site surgery. However, revision surgery proved to statistically worsen MOXFQ outcomes post-operatively p< 0.004. Overall satisfaction was reported as excellent (49%) or good (29%) by the majority of patients but 10% were dissatisfied with poor (8%) or very poor (2%) results expressed. Only 64% were pain free at the time of follow-up and 8% of patients MOXFQ scores worsened. These findings illustrate that overall, patient reported outcomes following resection of symptomatic Morton's neuroma are acceptable but may not be as favourable as earlier studies suggest. Caution should be taken when considering revision surgery which has shown to be a poor prognostic indicator. Contrary to current knowledge, multiple site surgery can be safely undertaken