Ponseti method has become the most common and validated initial non-operative and/or minimally invasive treatment modality of idiopathic clubfoot regardless of the severity of the deformity worldwide. Despite hundreds of publications in the literature favoring Ponseti method, the data about
Aims. Multiple
Aim. Early fracture-related infections (FRIs) are a common entity in hospitals treating trauma patients. It is important to be aware of the consequences of FRI in order to be able to counsel patients about the expected course of their disease. Therefore, the aims of this study were to evaluate the recurrence rate, to establish the number of
Preoperative talar valgus deformity increases the technical difficulty of total ankle replacement (TAR) and is associated with an increased failure rate. Deformity of ≥15° has been reported to be a contraindication to arthroplasty. The goal of the present study was to determine whether the operative procedures and clinical outcomes of TAR for treatment of end-stage ankle arthritis were comparable for patients with preoperative talar valgus deformity of ≥15° as compared to those with <15°. We will describe the evolving surgical technique being utilized to tackle these challenging cases. Fifty ankles with preoperative coronal-plane tibiotalar valgus deformity of ≥15° “valgus” group) and 50 ankles with valgus deformity of <15° (“control” group) underwent TAR. The cohorts were similar with respect to demographics and components used. All TARs were performed by a single surgeon. The mean duration of clinical follow-up was 5.5 years (minimum two years). Preoperative and postoperative radiographic measurements of coronal-plane deformity, Ankle Osteoarthritis Scale (AOS) scores and Short Form (SF)-36 scores were prospectively recorded. All ancillary (intraoperative) and
Aims. Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°. Methods. A matched cohort of patients similar for demographics and components used but differing in preoperative coronal-plane tibiotalar valgus deformity ≥ 15° (valgus, n = 50; 52% male, mean age 65.8 years (SD 10.3), mean body mass index (BMI) 29.4 (SD 5.2)) or < 15° (control, n = 50; 58% male, mean age 65.6 years (SD 9.8), mean BMI 28.7 (SD 4.2)), underwent TAA by one surgeon. Preoperative and postoperative radiographs, Ankle Osteoarthritis Scale (AOS) pain and disability and 36-item Short Form Health Survey (SF-36) version 2 scores were collected prospectively. Ancillary
Sternoclavicular joint infections are uncommon but severe and complex condition usually in medically complex and compromised hosts. These infections are challenging to treat with risks of infection extending into the mediastinal structures and surgical drainage is often faced with problems of multiple unplanned returns to theatre, chronic non-healing wounds that turn into sinus and the risk of significant clinical escalation and death. Percutaneous aspirations or small incision drainage often provide inadequate drainage and failed control of infection, while open drainage and washout require multidisciplinary support, due to the close proximity of the mediastinal structures and the great vessels as well as failure to heal the wounds and creation of chronic wound or sinus. We present our series of 8 cases over 6 years where we used the plan of open debridement of the Sternoclavicular joint with medial end of clavicle excision to allow adequate drainage. The surgical incision was not closed primarily, and a suction vacuum dressing was applied until the infection was contained on clinical and laboratory parameters. After the infection was deemed contained, the surgical incision was closed by local muscle flap by transferring the medial upper sternal head of the Pectoralis Major muscle to fill in the sternoclavicular joint defect. This technique provided a consistent and reliable way to overcome the infection and have the wound definitively closed that required no
The aim of this study was to assess the impact of Covid-19 measures on the rate of surgical site infections (SSI) and subsequent readmissions in orthopaedic patients. Retrospective, observational study in a level 1 major trauma center comparing rates of SSI in orthopaedic patients who underwent surgery prior to the Covid-19 lockdown versus that of patients who underwent surgery during the lockdown period. A total of 1151 patients were identified using electronic clinical records over two different time periods; 3 months pre Covid-19 lockdown (n=680) and 3 months during the Covid-19 lockdown (n=470). Patients were followed up for 1 year following their initial procedure. Primary outcome was readmission for SSI. Secondary outcomes were treatment received and requirement for further surgeries. The most commonly performed procedures were arthroplasty and manipulation under anaesthesia with 119 in lockdown vs 101 non-lockdown (p=0.001). The readmission rate was higher in the lockdown group with 61 (13%) vs 44 (6.5%) in the non-lockdown group (p <0.001). However, the majority were due to other surgical complications such as dislocations. Interestingly, the SSI rates were very similar with 24 (5%) in lockdown vs 28 (4%) in non-lockdown (p=0.472). Twenty patients (4.2%) required a
Introduction/Purpose. A randomized clinical trial of first MTP joint hemiarthroplasty with a synthetic cartilage implant demonstrated equivalent pain, function and safety outcomes to first MTP joint arthrodesis at 2 years. Recognizing that many hemiarthroplasty and total toe implants have initially good results that deteriorate over time, the purpose of this study was to prospectively assess the safety and efficacy outcomes for the synthetic cartilage implant population and to determine if the excellent outcomes were maintained at >5 years. Methods. One hundred nineteen patients were evaluated at 5+ years; 23 could not be reached for follow-up, but implant status was available for 7 of these subjects. Patients completed a pain visual analogue scale (VAS) and Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) scores, preoperatively and at 2, 6, 12, 26, 52, 104 and 260 weeks postoperatively. Minimal clinically important differences are: ≥30% difference for pain VAS, 9 points for FAAM Sports, and 8 points for FAAM ADL. Great toe active dorsiflexion, weight-bearing radiographs,
Aim. The number of operatively treated clavicle fractures has increased over the past decades. Consequently, this has led to an increase in
Displaced femoral neck fractures can have devastating impacts on quality of life and patient function. Evidence for optimal surgical approach is far from definitive. The Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemi-Arthroplasty (HEALTH) trial aimed to evaluate unplanned
Introduction. Anterior cruciate ligament (ACL) injuries are one of the most common knee injuries amongst elite athletes and usually require an ACL reconstruction (ACLR) to enable return to sport. Secondary surgery can result in a longer rehabilitation period and often a. significant time away from sport which can have implications to the athlete including contract obligations and sponsorship. Advances in ACLR techniques and meniscal repair techniques as well as an awareness of meniscal root lesions, ramp lesions and lateral extraarticular procedures (LEAPs) during ACL surgery has improved outcomes. The purpose of this study was to evaluate the rates of secondary surgery following the introduction of a systematic arthroscopic evaluation of the knee, improved meniscal repair techniques and the addition of a concomitant LEAP This systematic approach was introduced after October 2012 (10/2012). Methods. Professional athletes who underwent primary ACLR with a minimum follow-up of 2 years were identified from the (blinded for review). Those who had undergone major concomitant procedures such as multi-ligament reconstruction or osteotomy were excluded. Analysis of the database and review of medical records identified athletes who had underwent
Various technical tips have been described on the placement of poller screws during intramedullary nailing however studies reporting outcomes are limited. Overall, there is no consistent conclusion about whether intramedullary nailing alone, or intramedullary nails augmented with poller screws is more advantageous. In a systematic review, we asked: (1) What is the proportion of non-unions with poller screw usage? (2) What is the proportion of malalignment, infection and
Paediatric bone sarcomas around the knee are often amenable to either endoprosthetic reconstruction or rotationplasty. Cosmesis and durability dramatically distinguish these two options, although patient-reported functional satisfaction has been similar among survivors. However, the impact on oncological and surgical outcomes for these approaches has not been directly compared. We retrospectively reviewed all wide resections for bone sarcoma of the distal femur or proximal tibia that were reconstructed either with an endoprosthesis or by rotationplasty at our institution between June 2004 and December 2014 with a minimum two year follow-up. Pertinent demographic information, surgical and oncological outcomes were reviewed. Survival analysis was performed using the Kaplan-Meier method with statistical significance set at p<0.05. Thirty eight patients with primary sarcomas around the knee underwent wide resection and either endoprosthetic reconstruction (n=19) or rotationplasty (n=19). Groups were comparable in terms of demographic parameters and systemic tumour burden at presentation. We found that selection of endoprosthetic reconstruction versus rotationplasty did not impact overall survival for the entire patient cohort but was significant in subgroup analysis. Two-year overall survival was 86.7% and 85.6% in the endoprosthesis and rotationplasty groups, respectively (p=0.33). When only patients with greater than 90% chemotherapy-induced necrosis were considered, overall survival was significantly better in the rotationplasty versus endoprosthesis groups (100% vs. 72.9% at two years, p=0.013). Similarly, while event-free survival was not affected by reconstruction method (60.2% vs. 73.3% at two years for endoprosthesis vs rotationplasty, p=0.27), there was a trend towards lower local recurrence in rotationplasty patients (p=0.07). When surgical outcomes were considered, a higher complication rate was seen in patients that received an endoprosthesis compared to those who underwent rotationplasty. Including all reasons for re-operation, 78.9% (n=15) of the endoprosthesis patients required a minimum of one additional surgery compared with only 26.3% (n=5) among rotationplasty patients (p=0.003). The most common reasons for re-operation in endoprosthesis patients were wound breakdown/infection (n=6), limb length discrepancy (n=6) and periprosthetic fracture (n=2). Excluding limb length equalisation procedures, the average time to re-operation in this patient population was 5.6 months (range 1 week to 23 months). Similarly, the most common reason for a
Segmental bone transport (SBT) using an external fixator is currently a standard treatment for large-diameter bone defects at the donor site with low morbidity. However, long-term application of the device is needed for bone healing. In addition, patients who received SBT treatment sometimes fail to show bone repair and union at the docking site, and require secondary surgery. The objective of this study was to investigate whether a single injection of recombinant human bone morphogenetic protein 2 (rhBMP-2)-loaded artificial collagen-like peptide gel (rhBMP-2/ACG) accelerates consolidation and bone union at the docking site in a mouse SBT model. Six-month-old C57BL/6J mice were reconstructed by SBT with external fixator that has transport unit, and a 2.0-mm bone defect was created in the right femur. Mice were divided randomly into four treatment groups with eight mice in each group, Group CONT (immobile control), Group 0.2mm/d, Group 1.0mm/d, and Group BMP-2. Mice in Group 0.2mm/d and 1.0mm/d, bone segment was moved 0.2 mm per day for 10 days and 1.0 mm per day for 2 days, respectively. Mice in Group BMP-2 received an injection of 2.0 μg of rhBMP-2 dissolved in ACG into the bone defect site immediately after the defect-creating surgery and the bone segment was moved 1.0 mm/day for 2 days. All animals were sacrificed at eight weeks after surgery. Consolidation at bone defect site and bone union at docking site were evaluated radiologically and histologically. At the bone defect site, seven of eight mice in Group 0.2mm/d and two of eight mice in Group 1.0mm/d showed bone union. In contrast, all mice in Group CONT showed non-union at the bone defect site. At the docking site, four of eight mice in Group 0.2 mm/d and three of eight mice in Group 1.0 mm/d showed non-union. Meanwhile, all mice in Group BMP-2 showed bone union at the bone defect and docking sites. Bone volume and bone mineral content were significantly higher in Group 0.2mm/d and Group BMP-2 than in Group CONT. HE staining of tissue from Group 0.2mm/d and Group BMP-2 showed large amounts of longitudinal trabecular bone and regenerative new bone at eight weeks after surgery at the bone defect site. Meanwhile, in Group CONT and Group 1.0mm/d, maturation of regenerative bone at the bone defect site was poor. Differences between groups were analyzed using one-way ANOVA and a subsequent Bonferroni's post-hoc comparisons test. P < 0.05 was considered significant. rhBMP-2/ACG combined with SBT may be effective for enhancing bone healing in large bone defects without the need for
Introduction. Arthroscopic ankle fusion is an effective treatment for end stage ankle arthritis. It reliably improves pain but at the expense of ankle motion. Development of adjacent degenerative joint disease in the foot is thought to be a consequence of ankle fusion due to altered biomechanics. However, it has been reported to be present on pre-operative radiographs in many patients. There is very little evidence reporting the long-term outcomes of patients undergoing arthroscopic ankle fusion and particularly those requiring
Introduction. Ankle fractures are common injuries presenting to trauma departments and ankle open reduction and internal fixation (ORIF) is one of the first procedures targeted in early orthopaedic training. Failure to address the fracture pattern with the appropriate surgical technique and hardware may lead to early failure resulting in revision procedures or premature degenerative change. Patients undergoing revision ORIF are known to be at much greater risk of complications, and many of these
Aims. To compare results of institutional preferences with regard to treatment of soft tissues in the setting of open tibial shaft fractures. Methods. We present a retrospective review of open tibial shaft fractures at two high-volume level 1 trauma centres with differing practices with regard to the acute management of soft tissues. Site 1 attempts acute primary closure, while site 2 prefers delayed closure/coverage. Comparisons include percentage of primary closure, number of surgical procedures until definitive closure, percentage requiring soft tissue coverage, and percentage of 90-day wound complication. Results. Overall, there were 219 patients at site 1 and 282 patients at site 2. Differences in rates of acute wound closure were seen (168 (78%) at site 1 vs 101 (36%) at site 2). A mean of 1.5 procedures for definitive closure was seen at site 1 compared to 3.4 at site 2. No differences were seen in complication, nonunion, or amputation rates. Similar results were seen in a sub-analysis of type III injuries. Conclusion. Comparing outcomes of open tibial shaft fractures at two institutions with different rates initial wound management, no differences were seen in 90-day wound complications, nonunion rates, or need for amputation. Attempted acute closure resulted in a lower number of planned
Introduction. Due to the opioid epidemic, our service developed a cultural change highlighted by decreasing discharge opioids after lower extremity arthroplasty. However, concern of potentially increasing refill requests exists. As such, the goal of this study was to analyze whether decreased discharge opioids led to increased postoperative opioid refills. Methods. We retrospectively reviewed 19,428 patients undergoing a primary hip or knee arthroplasty at a single institution from 2016–2019. Patients that underwent
Aims. The aim of this study was to determine the general postoperative opioid consumption and rate of appropriate disposal of excess opioid prescriptions in patients undergoing primary unilateral total knee arthroplasty (TKA). Patients and Methods. In total, 112 patients undergoing surgery with one of eight arthroplasty surgeons at a single specialty hospital were prospectively enrolled. Three patients were excluded for undergoing
Introduction and Aims: The management of diaphyseal tibial fractures remains controversial. This paper looks at the use of an innovative, unlocked, inflatable intra-medullary nail (Fixion, Disc-O-Tech). The study aim is to assess the performance of this nail relative to a traditional locked nail. Method: This study compares a prospectively recruited cohort of patients treated with the fixion nail to a consecutive series of patients treated with the Russel Taylor locked nail prior to the introduction of the new device. All the fractures were classified using the AO system. Operating time and the x-ray screening time were recorded, along with any peri or post-operative complications, and need for
Aim. We wonder what the results of two stage procedures were in terms of morbidity (amputation, dead) and infection recurrence. We also seek to identify risk factors for failure and see if the results of a second two stage surgery were not even worse. Material and Methods. We retrospectively reviewed 140 prosthetic joint infection (PJI) treated with a two stage procedure. Patient data has been reviewed to determine which factors would be predictive for failure. Results. From the 140 two stages, 98 patients were infection free at two years. Four died in the following year. 38 patients presented a recurrence within the two years: 2 died and 1 was amputated within one year. Nine were further treated with a second two stage procedure and 26 with debridement and implant retention procedures and antibiotics (DAIR). Six of these last received long terms suppressive antibiotics. In total 27 from the 38 were again diseases free at two years follow up. The dead and amputation rates are 4,3% and 0,8 % respectively. The rate of success after the first two stage was 80% and after a second two stage procedure 78%. The final rate of PJI cured is 89,3%. The only difference observed between success and failure after a first two stage procedure was related to microbiology. Polymicrobial infection was 28.6% of the PJI which will fail and only 14,1% in those whose treatment will succeed (p<0.05). Looking to the patients that underwent a second two stage surgery, recurrence involved monomicrobial pattern with a microorganism that has developed a resistance to quinolones. Conclusion. Mortality and amputation in PJI management should be mentioned to patients as significant potential complications. Infection control within a two stage procedure is not as high as reported, unless the final result is considered after
Purpose of the study. This study aims to evaluate the use of closed reduction of hips with developmental dysplasia of the hip (DDH) and medial open reduction of these hips as a subsection of closed reduced hips. Methods. The study was a retrospective analysis of treatment of 30 children with developmental dysplasia of the hip (DDH). These children were taken from a consecutive series of children treated over a period from June 2000 to 2011 with closed reduction by a single surgeon. The ages at the time of diagnosis were between 1 day and 13 months (mean 5.25 weeks). Included in this series are 7 patients treated with medial open reduction, all done with the Ludloff approach. Follow up of these patients was from 8 months to 12 years (mean 5 years). All patients needing
The April 2023 Children’s orthopaedics Roundup360 looks at: Can you treat type IIA supracondylar humerus fractures conservatively?; Bone bruising and anterior cruciate ligament injury in paediatrics; Participation and motor abilities after treatment with the Ponseti method; Does fellowship training help with paediatric supracondylar fractures?; Supracondylar elbow fracture management (Supra Man): a national trainee collaborative evaluation of practice; Magnetically controlled growing rods in early-onset scoliosis; Weightbearing restrictions and weight gain in children with Perthes’ disease?; Injuries and child abuse increase during the pandemic over 12,942 emergency admissions.
Purpose. Coronal plane malalignment at the level of the tibiotalar joint is not uncommon in advanced ankle joint arthritis. It has been stated that preoperative varus or valgus deformity beyond 15 degrees is a relative contraindication and deformity beyond 20 degrees is an absolute contraindication to ankle joint replacement. There is limited evidence in the current literature to support these figures. The current study is a prospective clinical and radiographic comparative study between patients who underwent total ankle arthroplasty with coronal plane varus tibiotalar deformities greater than 10 degrees and patients with neutral alignment, less than 10 degrees of deformity. Method. Thirty-six ankles with greater than 10 degrees of varus alignment were compared to thirty-six ankles which were matched for implant type, age, gender, and year of surgery. Patients completed preoperative and yearly postoperative functional outcome scores including the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores, the Ankle Osteoarthritis Scale (AOS) and the Short Form-36 Standard Version 2.0 Health Survey. Weightbearing preoperative and postoperative radiographs were obtained and reviewed by four examiners (AC, AQ, TD, TT) and measurements were taken of the degree of coronal plane deformity. Results. After a mean follow-up of 27 months (9–54), the varus ankles improved significantly on the AOFAS (P<0.0001), AOS-Pain Score (P<0.0001), AOS-Disability Score (P<0.0001), and SF-36 Physical Component Score (P<0.0001). There was no improvement in SF-36-Mental Component Score. (P=0.722). There was no statistically significant differences between the two groups when comparing AOFAS (P=0.155), AOS-Pain Score (P=0.854), AOSDisability Score (P=0.593), SF-36-Physical Component Score (P=0.433), SF-36 Mental Component Score (P=0.633). Sixteen of Thirty-Six ankles in the varus group needed a
The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population. We performed a post hoc exploratory analysis of a fitter cohort of patients from the HEALTH trial. Participants were aged over 50 years and had sustained a low-energy displaced femoral neck fracture (FNF). The fittest participant cohort was defined as participants aged 70 years or younger, classified as American Society of Anesthesiologists grade I or II, independent walkers prior to fracture, and living at home prior to fracture. Multilevel models were used to estimate the effect of THA versus HA on functional outcomes. In addition, a sensitivity analysis of the definition of the fittest participant cohort was performed.Aims
Methods
Clinical management of open fractures is challenging and frequently requires complex reconstruction procedures. The Gustilo-Anderson classification lacks uniform interpretation, has poor interobserver reliability, and fails to account for injuries to musculotendinous units and bone. The Ganga Hospital Open Injury Severity Score (GHOISS) was designed to address these concerns. The major aim of this review was to ascertain the evidence available on accuracy of the GHOISS in predicting successful limb salvage in patients with mangled limbs. We searched electronic data bases including PubMed, CENTRAL, EMBASE, CINAHL, Scopus, and Web of Science to identify studies that employed the GHOISS risk tool in managing complex limb injuries published from April 2006, when the score was introduced, until April 2021. Primary outcome was the measured sensitivity and specificity of the GHOISS risk tool for predicting amputation at a specified threshold score. Secondary outcomes included length of stay, need for plastic surgery, deep infection rate, time to fracture union, and functional outcome measures. Diagnostic test accuracy meta-analysis was performed using a random effects bivariate binomial model.Aims
Methods
The primary aim of this study was to report the radiological outcomes of patients with a dorsally displaced distal radius fracture who were randomized to a moulded cast or surgical fixation with wires following manipulation and closed reduction of their fracture. The secondary aim was to correlate radiological outcomes with patient-reported outcome measures (PROMs) in the year following injury. Participants were recruited as part of DRAFFT2, a UK multicentre clinical trial. Participants were aged 16 years or over with a dorsally displaced distal radius fracture, and were eligible for the trial if they needed a manipulation of their fracture, as recommended by their treating surgeon. Participants were randomly allocated on a 1:1 ratio to moulded cast or Kirschner wires after manipulation of the fracture in the operating theatre. Standard posteroanterior and lateral radiographs were performed in the radiology department of participating centres at the time of the patient’s initial assessment in the emergency department and six weeks postoperatively. Intraoperative fluoroscopic images taken at the time of fracture reduction were also assessed.Aims
Methods
The April 2024 Foot & Ankle Roundup360 looks at: Safety of arthroscopy combined with radial extracorporeal shockwave therapy for osteochondritis of the talus; Bipolar allograft transplantation of the ankle; Identifying risk factors for osteonecrosis after talar fracture; Balancing act: immediate versus delayed weightbearing in ankle fracture recovery; Levelling the field: proximal supination osteotomy’s efficacy in severe and super-severe hallux valgus; Restoring balance: how adjusting the tibiotalar joint line influences movement after ankle surgery.
The purpose of this study was to assess the success rate and functional outcomes of bone grafting for periprosthetic bone cysts following total ankle arthroplasty (TAA). Additionally, we evaluated the rate of graft incorporation and identified associated predisposing factors using CT scan. We reviewed a total of 37 ankles (34 patients) that had undergone bone grafting for periprosthetic bone cysts. A CT scan was performed one year after bone grafting to check the status of graft incorporation. For accurate analysis of cyst volumes and their postoperative changes, 3D-reconstructed CT scan processed with 3D software was used. For functional outcomes, variables such as the Ankle Osteoarthritis Scale score and the visual analogue scale for pain were measured.Aims
Methods
The Vantage Total Ankle System is a fourth-generation low-profile fixed-bearing implant that has been available since 2016. We aimed to describe our early experience with this implant. This is a single-centre retrospective review of patients who underwent primary total ankle arthroplasty (TAA) with a Vantage implant between November 2017 and February 2020, with a minimum of two years’ follow-up. Four surgeons contributed patients. The primary outcome was reoperation and revision rate of the Vantage implant at two years. Secondary outcomes included radiological alignment, peri-implant complications, and pre- and postoperative patient-reported outcomes.Aims
Methods
There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA). We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening, complications, and revision surgery with or without implant removal.Aims
Methods
The open Latarjet procedure is a widely used treatment for recurrent anterior instability of the shoulder. Although satisfactory outcomes are reported, factors which influence a patient’s experience are poorly quantified. The aim of this study was to evaluate the effect of a range of demographic factors and measures of the severity of instability on patient-reported outcome measures in patients who underwent an open Latarjet procedure at a minimum follow-up of two years. A total of 350 patients with anterior instability of the shoulder who underwent an open Latarjet procedure between 2005 and 2018 were reviewed prospectively, with the collection of demographic and psychosocial data, preoperative CT, and complications during follow-up of two years. The primary outcome measure was the Western Ontario Shoulder Instability Index (WOSI), assessed preoperatively, at two years postoperatively, and at mid-term follow-up at a mean of 50.6 months (SD 24.8) postoperatively. The secondary outcome measure was the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. The influence of the demographic details of the patients, measurements of the severity of instability, and the complications of surgery were assessed in a multivariate analysis.Aims
Methods
Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed.Aims
Methods
Introduction:. Two fixed bearing options exist for tibial resurfacing when performing unicompartmental knee arthroplasty (UKA). Inlay components are polyethylene-only implants inserted into a carved pocket on the tibial surface, relying upon the subchondral bone to support the implant. Onlay components have a metal base plate and are placed on top of a flat tibial cut, supported by a rim of cortical bone. To our knowledge, there is no published report that compares the clinical outcomes of these two implants using a robotically controlled surgical technique. We performed a retrospective review of a single surgeon's experience with Inlay versus Onlay components, using a robotic-guided protocol. Methods:. All surgeries were performed using the same planning software and robotic guidance for execution of the surgical plan (Mako Surgical, Fort Lauderdale, FL). The senior surgeon's prospective database was reviewed to identify patients with 1) medial-sided UKA and 2) at least two years of clinical follow up. Eighty-six patients met these inclusion/exclusion criteria: 41 Inlays and 45 Onlays. Five patients underwent a secondary or revision procedure during the follow up period and were considered separately. Our primary outcome was the WOMAC score, subcategorized by the Pain, Stiffness, and Function sub-scores. The secondary outcome was need for secondary surgery. Continuous variables were analyzed using the two-tailed Student's t-test; categorical variables were analyzed using Fisher's exact test. Results:. Average follow up was 2.7 years and 2.3 years in the Inlay and Onlay groups, respectively. The post-op WOMAC Pain score was 3.1 for Inlays and 1.6 for Onlays (p = 0.03). The post-op Stiffness score was 1.8 for Inlays and 1.4 for Onlays (p = 0.19). The post-op Function score was 10.3 for Inlays and 6.7 for Onlays (p = 0.12). We identified a subgroup of 51 patients (23 Inlay, 28 Onlay) for whom there was both pre- and post-op WOMAC data available. There were no differences in the pre-op Pain, Stiffness, or Function scores between groups. In this subgroup, the Pain score improved from 8.3 to 4.0 for Inlays, versus an improvement from 9.2 to 1.7 for Onlays (p = 0.01). The Stiffness score improved from 3.9 to 2.2 for Inlays, versus an improvement from 4.3 to 1.5 for Onlays (p = 0.08). The Function score improved from 27.5 to 12.5 for Inlays, versus an improvement from 32.1 to 7.3 for Onlays (p = 0.03). When all 86 patients in the study were considered, 4/41 Inlays (9.8%) underwent a
The aim of this study was to investigate the rate of revision for distal femoral arthroplasty (DFA) performed as a primary procedure for native knee fractures using data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR). Data from the AOANJRR were obtained for DFA performed as primary procedures for native knee fractures from 1 September 1999 to 31 December 2020. Pathological fractures and revision for failed internal fixation were excluded. The five prostheses identified were the Global Modular Arthroplasty System, the Modular Arthroplasty System, the Modular Universal Tumour And Revision System, the Orthopaedic Salvage System, and the Segmental System. Patient demographic data (age, sex, and American Society of Anesthesiologists grade) were obtained, where available. Kaplan-Meier estimates of survival were used to determine the rate of revision, and the reasons for revision and mortality data were examined.Aims
Methods
The scapula is a rare site for a primary bone tumour. Only a small number of series have studied patient outcomes after treatment. Previous studies have shown a high rate of recurrence, with functional outcomes determined by the preservation of the glenohumeral joint and deltoid. The purpose of the current study was to report the outcome of patients who had undergone tumour resection that included the scapula. We reviewed 61 patients (37 male, 24 female; mean age 42 years (SD 19)) who had undergone resection of the scapula. The most common resection was type 2 (n = 34) according to the Tikhoff-Linberg classification, or type S1A (n = 35) on the Enneking classification.Aims
Methods
Modern microsurgery has allowed severed digits to be salvaged by replantation. A retrospective case review was undertaken of all patients undergoing digital replantation at Middlemore Hospital between February 2004 and February 2009. 48 digits from 28 patients underwent digital replantation during this period. The aim of the analysis was to determine what factors were predictive for survival of the replants. Secondary outcomes of interest included subjective functional recovery, pain and further procedures. Digital replantation over the review period was subject to a 75% survival rate. Smoking and male gender were identified as significant negative prognostic factors (p=0.02). 69% of patients reported post operative stiffness, chronic pain or cold intolerance. The majority of replanted digits underwent
Aims. To evaluate the effect of a single early high-dose vitamin D
supplement on fracture union in patients with hypovitaminosis D
and a long bone fracture. Patients and Methods. Between July 2011 and August 2013, 113 adults with a long bone
fracture were enrolled in a prospective randomised double-blind
placebo-controlled trial. Their serum vitamin D levels were measured
and a total of 100 patients were found to be vitamin D deficient
(<
20 ng/ml) or insufficient (<
30 ng/mL). These were then
randomised to receive a single dose of vitamin D. 3. orally
(100 000 IU) within two weeks of injury (treatment group, n = 50)
or a placebo (control group, n = 50). We recorded patient demographics,
fracture location and treatment, vitamin D level, time to fracture
union and complications, including vitamin D toxicity. Outcomes included union, nonunion or complication requiring an
early, unplanned
Background. The management of the patella during primary total knee arthroplasty (TKA) is controversial. Despite the majority of patients reporting excellent outcomes following TKA, a common complaint is anterior knee pain. Resurfacing of the patella at the time of initial surgery has been proposed as a means of preventing anterior knee pain, however current evidence, including four recent meta-analyses, has failed to show clear superiority of patellar resurfacing. Therefore, the purpose of this study was to estimate the cost-effectiveness of patellar resurfacing compared to non-resurfacing in TKA. Methods. We conducted a cost-effectiveness analysis using a decision analytic model to represent a hypothetical patient cohort undergoing primary TKA. Each patient will receive a TKA either with the Patella Resurfaced or Not Resurfaced. Following surgery, patients can transition to one of three chronic health states: 1) Well Post-operative, 2) Patellofemoral Pain (PFP), or 3) Serious Adverse Event (AE), which we have defined as any event requiring Revision TKA, including: loosening/lysis, infection, instability, or fracture (Figure 1). We obtained revision rates following TKA for both resurfaced and unresurfaced cohorts using data from the 2014 Australian Registry. This data was chosen due to similarities between Australian and North American practice patterns and patient demographics, as well as the availability of longer term follow up data, up to 14 years postoperative. Our effectiveness outcome for the model was the quality-adjusted life year (QALY). We used utility scores obtained from the literature to calculate QALYs for each health state. Direct procedure costs were obtained from our institution's case costing department, and the billing fees for each procedure. We estimated cost-effectiveness from a Canadian publicly funded health care system perspective. All costs and quality of life outcomes were discounted at a rate of 5%. All costs are presented in 2015 Canadian dollars. Results. Our cost-effectiveness analysis suggests that TKA with patella resurfacing is a dominant procedure. Patients who receive primary TKA with non-resurfaced patella had higher associated costs over the first 14 years postoperative ($16,182 vs $15,720), and slightly lower quality of life (5.37 QALYs vs 6.01 QALYs). The revision rate for patellar resurfacing was 1.3%. If the rate of
Introduction. Over the past few decades, opioid abuse has become a major threat to public health. In 2013 alone, enough opioid prescriptions were written in the United States for every American adult to have their own bottle of pills. Since then, opioid prescribing rates and opioid related deaths have continued to grow, with over 46 people dying on average each day from prescription opioid overdoses in 2016. Orthopaedic surgeons are among the top 5 specialties in the number of opioid prescriptions written. For many common surgeries, such as total knee arthroplasty (TKA), post-discharge prescriptions are based on prescriber habits and opinion. There exists limited data-driven protocols to guide post-operative opioid prescribing practices. The purpose of this prospective study was to determine the average postoperative opioid consumption in patients undergoing primary TKA using a novel mobile text messaging platform. We hypothesized that majority of patients undergoing TKA do not properly dispose of left over pills after surgery. Methods. 95 patients undergoing primary unilateral TKA with one of nine arthroplasty surgeons at a single orthopaedic specialty hospital were prospectively enrolled. Daily pain levels and opioid consumption, and quantity and disposal patterns for left over medications were collected for six weeks following surgery using a novel mobile phone text messaging system. This system automatically queried patients twice a day, storing responses on a secure third-party host that investigators monitored and used to generate data reports in real-time. Results. Of the 95 patients enrolled, 1 was excluded for undergoing a
Introduction. Studies have compared outcomes of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis, but there is a paucity of data on the influence of patient factors on outcomes. We evaluated data from a prospective, RCT of MTPJ1 implant hemiarthroplasty (Cartiva) and arthrodesis to determine the association between patient factors and clinical outcomes. Methods. Patients ≥18 years with Coughlin hallux rigidus grade 2, 3, or 4 were treated with implant MTPJ1 hemiarthroplasty or arthrodesis. Pain VAS, Foot and Ankle Ability Measure (FAAM) Sports and ADL, and SF-36 PF scores were obtained preoperatively, and at 2, 6, 12, 24, 52 and 104 weeks postoperatively. Final outcomes, MTPJ1 active peak dorsiflexion,
Introduction. Hoffa fractures are rare, intra-articular fractures of the femoral condyle in the coronal plane and involving the weight-bearing surface of the distal femur. Surgical fixation is warranted to achieve stability, early mobilisation and satisfactory knee function. We describe a unique type of Hoffa fracture in the coronal plane with sagittal split and intra-articular comminution. There is scant evidence in current literature with regards to surgical approaches, techniques and implants. We report of our case with a review of the literature. Case report. A 40 year old male motorcyclist was involved in a high speed road traffic collision. X-rays confirmed displaced unicondylar fracture of the lateral femoral condyle. CT showed sagittal split of the Hoffa fragment and intra-articular comminution. MRI showed partial rupture of the anterior cruciate ligament. The patient underwent definitive surgical treatment via a midline skin incision and lateral parapatellar approach using cannulated screws, headless compression screws and anti-glide plate. Weightbearing was commenced at 8 weeks. Arthroscopy and adhesiolysis was performed at 12 weeks to improve range of motion. The patient was discharged at one year with a pain-free, functional knee. Discussion. Hoffa fractures are high-energy fractures, often seen in young male motorcyclists with flexed and slightly abducted knee. Most papers recommend surgical fixation, however there is no widely accepted surgical method or rehabilitation regime. Varying surgical approaches, screw direction, choice of implants, and post-operative care have been described. Surgical approach depends on the configuration of the fracture. The medial/lateral parapatellar approach is commonly used as it does not compromise future arthroplasty, but it does not allow access to fix posterior comminution. Arthroscopic-assistance may be used with good outcomes and less tissue dissection. AP screws are widely reported in the literature, most likely due to easier access to the fracture site. PA screws may provide better stability, but access is more difficult. Fixation often involves passing screws through the articular surface, therefore the area damaged should be kept to a minimum by using the smallest possible screw; headless compression screws leave a smaller footprint in the articular cartilage. Locking plate augmentation generally gives good outcomes. Conclusion. Hoffa fractures are rare and difficult to treat. Surgical treatment is the best choice for optimum post-operative knee function. There is no consensus on choice of surgical approaches, techniques and implants, as these are dependent on fracture configuration. In this particular case we emphasise the importance of using an anti-glide plate to address the sagittal component. Despite the need for a
Open reduction and plate fixation (ORPF) for displaced proximal humerus fractures can achieve reliably good long-term outcomes. However, a minority of patients have persistent pain and stiffness after surgery and may benefit from open arthrolysis, subacromial decompression, and removal of metalwork (ADROM). The long-term results of ADROM remain unknown; we aimed to assess outcomes of patients undergoing this procedure for stiffness following ORPF, and assess predictors of poor outcome. Between 1998 and 2018, 424 consecutive patients were treated with primary ORPF for proximal humerus fracture. ADROM was offered to symptomatic patients with a healed fracture at six months postoperatively. Patients were followed up retrospectively with demographic data, fracture characteristics, and complications recorded. Active range of motion (aROM), Oxford Shoulder Score (OSS), and EuroQol five-dimension three-level questionnaire (EQ-5D-3L) were recorded preoperatively and postoperatively.Aims
Methods
Background: Total hip arthroplasty (THR) is a commonly performed procedure to treat displaced fractures of the femoral neck, either as a primary procedure, or as a
Simultaneous bilateral total knee arthroplasty (TKA) has been used due to its financial advantages, overall resource usage, and convenience for the patient. The training model where a trainee performs the first TKA, followed by the trainer surgeon performing the second TKA, is a unique model to our institution. This study aims to analyze the functional and clinical outcomes of bilateral simultaneous TKA when performed by a trainee or a supervising surgeon, and also to assess these outcomes based on which side was done by the trainee or by the surgeon. This was a retrospective cohort study of all simultaneous bilateral TKAs performed by a single surgeon in an academic institution between May 2003 and November 2017. Exclusion criteria were the use of partial knee arthroplasty procedures, staged bilateral procedures, and procedures not performed by the senior author on one side and the trainee on another. Primary clinical outcomes of interest included revision and re-revision. Primary functional outcomes included the Oxford Knee Score (OKS) and patient satisfaction scores.Aims
Methods
The volume of spinal procedures have increased over the last two decades (220% in lumbar region). A simultaneous increase in re-operation rates (up to 20%) has been reported. Our aim was to compare with literature the reoperation rates and complications for various spinal procedures from a peripheral unit and to provide this information to the patients. This was a retrospective study of all patients who underwent spinal surgery during the period 1995 to 2005 by one surgeon. Using ICDM-9 codes and private notes patients were identified and medical records were used to gather relevant data. The following information was extracted-demographics, diagnosis, ASA criteria, primary procedure, any complication/s,
Background. Total ankle arthroplasty is an accepted alternative to arthrodesis of the ankle. However, complication and failure rates remain high compared to knee and hip arthroplasty. Long-term results of the Scandinavian Total Ankle Replacement (STAR) are limited, with variable complication and failure rates observed. This prospective study presents the long-term survivorship and the postoperative complications of the STAR prosthesis. Additionally, clinical outcomes and radiographic appearance were evaluated. Methods. Between May 1999 and June 2008, 134 primary total ankle arthroplasties were performed using the STAR prosthesis in 124 patients. The survivorship, postoperative complications and reoperations were recorded, with a minimum follow-up period of 7.5 years. Clinical results were assessed using the Foot Function Index (FFI) and the Kofoed score. The presence of component migration, cysts and radiolucency surrounding the prosthesis components, heterotopic ossifications and progression of osteoarthritis in adjacent joints were determined. Results. The cumulative survival was 78% after a 10-year follow-up period (Figure 1). An ankle arthrodesis was performed in the 20 ankles that failed. Fourteen polyethylene insert fractures occurred. Other complications occurred in 29 ankles, requiring