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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 57 - 57
1 Sep 2012
Agrawal Y Davies H Blundell C Davies M
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Introduction. Growing evidence in the literature suggests better clinical and functional outcomes and lower re-rupture rates with repair compared to non-operative treatment of ruptured Achilles tendon. There are however, concerns of wound infection, nerve injury and scar tenderness with the standard open and percutaneous techniques of repair. We aim to evaluate clinical and functional outcomes and complications in patients treated with minimally invasive Achillon device. Materials and Methods. Prospectively collected clinical data was reviewed of all consecutive patients who underwent repair of the ruptured Achilles tendon using the Achillon device. Patients were contacted using a postal questionnaire for assessment of their functional status using the validated Achilles Tendon Total Rupture Score (ATRS) and compared with their uninjured side. The outcomes were compared to the published results. Results. We present patient demographics; and clinical and functional outcomes of 140 consecutive patients who underwent repair of ruptured Achilles tendon using the minimally invasive technique between June 2007 to August 2010. Our complication rate was of two-three percent each of proximal DVT, scar sensitivity, superficial wound infection and no re-rupture after a minimum of 6 months. There was no case of nerve injury leading to permanent neurological deficit. Discussion. This study demonstrates good clinical and functional outcomes from using the Achillon device in repair of ruptured Achilles tendon with a low complication rate comparable to other published series. We recommend Achillon device as a safe minimally invasive technique for repair of the ruptured Achilles tendon


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 74 - 74
1 Sep 2012
Akula M Chatterton B Gopal S Tsiridis E Stott P Hatrick C Reeves W
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We report our retrospective multicentre experience of managing periprosthetic knee fractures using locking plates, cemented nails and distal femoral prosthesis. The Aim of this study is to analyze the practicality of management of these injuries using modern methods of fixation or salvation. 62 patients presented to 3 centres between 2003 and 2010. After implementation of inclusion criteria, clinical, radiological and functional outcomes were evaluated in 54 patients, with a minimum follow-up of 6 months. 34 patients were treated with locking plates (10 males, 24 female; mean age 76), 16 with cemented/locking nails (4 males, 12 females; mean age 84.5), and 4 with distal femoral replacement prosthesis (2 males, 2 females; mean age 79). Locking plates which were used with a minimally invasive pattern produced the best outcomes in our study. A statistical significance of p value of less than 0.01 was found in union time between patients operated on with an open technique (6.69±2.69 months) and those operated on with a minimally invasive technique (3.6±0.91 months). Nailing with augmented cement is a useful technique in patients who are not suitable for challenging surgery & rehabilitation programmes. There was a significant difference in mean time to functional weight bearing (p< 0.01) between the plate group (4.79±2.6 months) and the nail group (2.63±0.5 months). Post-operative range of motion was also better for nails (106.36±14.33. O. flexion) compared to plates (93.24±26.8. O. ), a result that approached significance (p=0.065). We recommend minimal invasive plating in uncompromised physiological conditions, as an ideal method of fracture fixation in view of statistically significant union rates. Cemented nailing is recommended in patients where early rehabilitation is essential. Distal Femoral prosthesis replacement is a useful salvage method


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 13 - 13
24 Nov 2023
Sliepen J Hoekstra H Onsea J Bessems L Depypere M Herteleer M Sermon A Nijs S Vranckx J Metsemakers W
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Aim. The number of operatively treated clavicle fractures has increased over the past decades. Consequently, this has led to an increase in secondary procedures required to treat complications such as fracture-related infection (FRI). The primary objective of this study was to assess the clinical and functional outcome of patients treated for FRI of the clavicle. The secondary objectives were to evaluate the healthcare costs and propose a standardized protocol for the surgical management of this complication. Method. All patients with a clavicle fracture who underwent open reduction and internal fixation (ORIF) between 1 January 2015 and 1 March 2022 were retrospectively evaluated. This study included patients with an FRI who were diagnosed and treated according to the recommendations of a multidisciplinary team at the University Hospitals Leuven, Belgium. Results. We evaluated 626 patients with 630 clavicle fractures who underwent ORIF. In total, 28 patients were diagnosed with an FRI. Of these, eight (29%) underwent definitive implant removal, five (18%) underwent debridement, antimicrobial treatment and implant retention, and fourteen patients (50%) had their implant exchanged in either a single-stage procedure, a two-stage procedure or after multiple revisions. One patient (3.6%) underwent resection of the clavicle. Twelve patients (43%) underwent autologous bone grafting (tricortical iliac crest bone graft (n=6), free vascularized fibular graft (n=5), cancellous bone graft (n=1)) to reconstruct the bone defect. The median follow-up was 32.3 (P. 25. -P. 75. : 23.9–51.1) months. Two patients (7.1%) experienced a recurrence of infection. The functional outcome was satisfactory, with 26 out of 28 patients (93%) having full range of motion. The median healthcare cost was € 11.506 (P. 25. -P. 75. : € 7.953–23.798) per patient. Conclusion. FRI is a serious complication that can occur after the surgical treatment of clavicle fractures. Overall, the outcome of patients treated for FRI of the clavicle is good, when management of this complication is performed by using a multidisciplinary team approach. The median healthcare costs of these patients are up to 3.5 times higher compared to non-infected operatively treated clavicle fractures. Expert opinion considers factors such as the size of the bone defect, the condition of the soft tissue, and patient demand to guide surgical decision making


Increasing expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions require precise knowledge of technical details such as minimum intra-femoral tunnel graft lengths. A common belief of having ≥20mm of grafts within the femoral tunnel is backed mostly by hearsay rather than scientific proof. We examined clinico-radiological outcomes in patients with intra-femoral tunnel graft lengths <20 and ≥20mm. Primary outcomes were knee scores at 1-year. Secondarily, graft revascularization was compared using magnetic resonance imaging (MRI). We hypothesized that outcomes would be independent of intra-femoral tunnel graft lengths. This prospective, single-surgeon, cohort study was conducted at a tertiary care teaching centre between 2015–2018 after obtaining ethical clearances and consents. Eligible arthroscopic ACL reconstruction patients were sequentially divided into 2 groups based on the intra-femoral tunnel graft lengths (A: < 20 mm, n = 27; and B: ≥ 20 mm, n = 25). Exclusions were made for those > 45 years of age, with chondral and/or multi-ligamentous injuries and with systemic pathologies. All patients were postoperatively examined and scored (Lysholm and modified Cincinnati scores) at 3, 6 and 12 months. Graft vascularity was assessed by signal-to-noise quotient ratio (SNQR) using MRI. Statistical significance was set at p<0.05. Age and sex-matched patients of both groups were followed to 1 year (1 dropout in each). Mean femoral and tibial tunnel diameters (P =0.225 and 0.595) were comparable. Groups A (<20mm) and B (≥20mm) had 27 and 25 patients respectively. At 3 months, 2 group A patients and 1 group B patient had grade 1 Lachman (increased at 12 months to 4 and 3 patients respectively). Pivot shift was negative in all patients. Lysholm scores at 3 and 6 months were comparable (P3= 0.195 and P6= 0.133). At 1 year both groups showed comparable Cincinnati scores. Mean ROM was satisfactory (≥130 degrees) in all but 2 patients of each group (125–130 degrees). MRI scans at 3 months and 1 year observed anatomical tunnels in all without any complications. Femoral tunnel signals in both groups showed a fall from 3–12 months indicating onset of maturation of graft at femoral tunnel. Our hypothesis, clinical and radiological outcomes would be independent of intra-tunnel graft lengths on the femoral aspect, did therefore prove correct. Intra-femoral tunnel graft lengths of <20 mm did not compromise early clinical and functional outcomes of ACL reconstructions. There seems to be no minimum length of graft within the tunnel below which suboptimal results should be expected


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_12 | Pages 31 - 31
1 Dec 2022
Sheridan G Clesham K Greidanus NV Masri B Garbuz D Duncan CP Howard L
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To date, the literature has not yet revealed superiority of Minimally Invasive (MI) approaches over conventional techniques. We performed a systematic review to determine whether minimally invasive approaches are superior to conventional approaches in total hip arthroplasty for (1) clinical and (2) functional outcomes. We performed a meta-analysis of level 1 evidence to determine whether (3) minimally invasive approaches are superior to conventional approaches for clinical outcomes. All studies comparing MI approaches to conventional approaches were eligible for analysis. The PRISMA guidelines were adhered to throughout this study. Registries were searched using the following MeSH terms: ‘minimally invasive’, ‘muscle-sparing’, ‘THA’, ‘THR’, ‘hip arthroplasty’ and ‘hip replacement’. Locations searched included PubMed, the Cochrane Library, ClinicalTrials.gov, the EU clinical trials register and the International Clinical Trials Registry Platform (World Health Organisation). Twenty studies were identified. There were 1,282 MI THAs and 1,351 conventional THAs performed. (1). There was no difference between MI and conventional approaches for all clinical outcomes of relevance including all-cause revision (p=0.959), aseptic revision (p=0.894), instability (p=0.894), infection (p=0.669) and periprosthetic fracture (p=0.940). (2). There was also no difference in functional outcome at early or intermediate follow-up between the two groups (p=0.38). (3). In level I studies exclusively, random-effects meta-analysis demonstrated no difference in the rate of aseptic revision (p=0.461) between both groups. Intermuscular MI approaches are equivalent to conventional THA approaches when considering all-cause revision, aseptic revision, infection, dislocation, fracture rates and functional outcomes. Meta-analysis of level 1 evidence supports this claim


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_8 | Pages 121 - 121
1 May 2016
Kosse N Heesterbeek P Schimmel J Van Hellemondt G Wymenga A Defoort K
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Background. To improve implant positioning in total knee arthroplasty (TKA) patient-specific instrumentation (PSI) has been introduced as alternative for conventional instrumentation (CI). Though the PSI technique offers interesting opportunities in TKA, there is no consensus about the effectiveness of PSI in comparison with CI and results concerning soft-tissue balancing remain unclear. Therefore, the primary aim of the present study was to investigate the varus-valgus laxity in extension and flexion in patients receiving a TKA using PSI compared with CI. Additionally, radiological, clinical and functional outcomes were assessed. Methods. In this prospective randomization controlled trial, 42 patients with osteoarthritis received a Genesis II PS (Smith & Nephew, Memphis, Tennessee), with either PSI (Visionaire, Smith & Nephew) or CI (Smith & Nephew). Patients visited the hospital preoperative and postoperative after 6 weeks, 3 and 12 months. One-year postoperative varus-valgus laxity was measured in extension and flexion on stress radiographs. Additional assessments included: the hip-knee-ankle angle on long-leg radiographs, femoral and tibia component rotation on CT-scans, radiolucency, the Knee Society Score (KSS), VAS pain, VAS Satisfaction, Knee injury and Osteoarthritis Outcome score (KOOS), Patella score (Kujala), the University of California Los Angeles activity score (UCLA), the anterior-posterior laxity in 20° and 90° knee flexion, adverse events and complications. The outcome measures were compared using independent t-tests, non-parametric alternatives and repeated measurements, with a significance level of p<0.05. Results. In four cases intra-operative modifications were needed, since the PSI did not fit correctly on the tibia and/or femur. No significant differences were found between the two groups for varus-valgus laxity in both extension and flexion (figure 1), as well as for the other radiological outcomes. Both groups improved significantly on clinical and functional outcomes over time. No significant differences were found between the groups one year postoperatively. Finally, the PSI group received a thinner insert than the CI group (p=0.04). Conclusion. In conclusion, PSI in TKA does not result in better varus-valgus laxity, and clinical and functional outcomes compared with CI, one year postoperative. Since the PSI group received a thinner insert, the pre-operative surgery plan developed for he PSI probably provides more conservative bone cuts compared with CI. The thinner insert might be beneficial in the long-term; however, further research is needed to gain more insight in the long-term results of PSI


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_13 | Pages 19 - 19
1 Nov 2019
Vijayan S Kulkarni MS Shetty S Naik AM Rao SK
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Anterior cruciate ligament (ACL) injuries are one of the most common ligament injury occurring in young and active individuals. Reconstruction of the torn ligament is the current standard of care. Of the many factors which determine the surgical outcome, fixation of the graft in the bony tunnels has significant role. This study compared the clinical and functional outcome in patients who underwent ACL reconstruction by standard anteromedial portal technique with single bundle hamstring graft anchored in the femoral tunnel using rigidfix and cortical button with adjustable loops. The tibial fixation and rehabilitation protocol were same in both groups. 107 patients underwent ACL reconstruction over a two-year period (87 males, 20 females, 44 after motor vehicle accident, 34 after sports injuries, 79 isolated ACL tear, 21 associated medial meniscus tear, 16 lateral meniscus tear and 11 both menisci). Rigid fix group had 47 patients and adjustable loop 60 patients. Clinical evaluation at end of one year showed better stability in rigid fix group regarding Lachman, anterior drawer, pivot shift tests, KT 1000 arthrometer side to side difference and hop limb symmetry index. However, the differences were not statistically significant. Functional evaluation using IKDC 2000 subjective score and Lysholm score showed better results in rigidfix group than variable loop, but was not statistically significant. However, lower scores were noted in patients with concomitant meniscal injury than in isolated acl tear patients and this was statistically significant in both groups. Rigidfix seems to give better graft fixation on femoral side than variable loop, but by the end of one year the functional outcome is comparable in isolated acl reconstructions


The Bone & Joint Journal
Vol. 106-B, Issue 9 | Pages 1016 - 1020
9 Jul 2024
Trompeter AJ Costa ML

Aims

Weightbearing instructions after musculoskeletal injury or orthopaedic surgery are a key aspect of the rehabilitation pathway and prescription. The terminology used to describe the weightbearing status of the patient is variable; many different terms are used, and there is recognition and evidence that the lack of standardized terminology contributes to confusion in practice.

Methods

A consensus exercise was conducted involving all the major stakeholders in the patient journey for those with musculoskeletal injury. The consensus exercise primary aim was to seek agreement on a standardized set of terminology for weightbearing instructions.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 152 - 152
1 May 2016
Zhu M Chen J Chong H Yew A Foo L Chia S Lo N Yeo S
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Objective. Patient-specific instrumentation (PSI) is a novel technique in total knee arthroplasty (TKA) which potentially permits more accurate alignment of the components; however, there is no consensus in literature regarding the accuracy and reliability of PSI as many studies have shown controversial and inconsistent results of various PSI systems. A 24-month follow-up study was carried out to compare perioperative clinical outcomes, radiological limb alignment and component positioning, as well as functional outcomes following TKA between PSI and conventional instrumentation (CI). Methods. During September 2011 and August 2012, 90 consecutive patients were scheduled to undergo unilateral TKA with either PSI or CI. TruMatch® Personalised Solutions was used in this study, and a senior surgeon performed all operations. Patients were clinically assessed before, 6-month and 24-month after surgery. Results. There were 42 patients who underwent TKA with PSI and 48 patients with CI, with no preoperative demographic and clinical difference. There was significant improvement in maximal extension for both groups at both of the two follow-ups, compared to baseline. While the CI group maintained similar maximal flexion angle, PSI group had significant decrease in maximal flexion angle, at both follow-ups. Overall, there was no significant improvement in the range of motion for both groups over the 24-month period after surgery. At 6 and 24 months postoperatively, there were similarly significant improvements in the mean scores of Oxford Knee Score, Knee Society Score, and Physical Component Sscore of the SF-36 Health Survey for both groups. At 24 months postoperatively, no significant differences were detected between PSI and CI groups in all clinical and functional outcomes. Radiographic results showed that the lower limb mechanical alignment and coronal component positioning were satisfactory and similar between the two groups. There were no differences in operating time, haemoglobin loss, transfusion rate and length of hospitalisation between PSI and CI, perioperatively. Conclusion. In conclusion, CT-based PSI showed comparable clinical and functional outcomes at 24 months after TKA compared with CI. There were no significant differences between the two types of instruments in achieving alignment restoration, component positioning, and perioperative clinical outcomes in terms of operating time and blood loss


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_4 | Pages 27 - 27
1 Apr 2019
Shah N Vaishnav M Patel M Wankhade U
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Objective. To evaluate the clinical and functional outcomes obtained by combination of high-flexion Freedom® Total Knee System (TKS) and mini-subvastus approach in total knee replacement patients. Method. This is a retrospective, observational, real world study conducted at Mumbai in India from 2011 to 2016. All patients who were above the age of 18 and operated for total knee replacement (TKR) with mini-subvastus approach using Freedom (Maxx Medical) by the senior author were included. The Implant survivorship was the survey endpoint; primary endpoint was range of motion (ROM); and secondary endpoints were AKSS (American Knee Society Score) and WOMAC (Western Ontario and McMaster Universities Osteoarthritis) scores collected pre- and post-operatively. Results. 184 patients with 242 knees (126 unilateral and 58 bilateral) were operated with high-flexion TKS. Average age of patients was 70 ± 6.2 years. The mean ROM increased from 99.4°±10.44° (50°-120°) preoperatively to 116.78°±8.18° (88°–140°) postoperatively (p<0.001). Clinical and functional AKSS scores improved from 60.83±5.12 to 91.16±2.19 (p<0.001) and 65.35±3.52 to 99.13±4.61 (p<0.001) respectively. There average WOMAC pain scores improved from 12.12±1.72 to 0.066±0.37 (<0.0001). Moreover, post-operative WOMAC stiffness and function scores depicted significant improvement from 4.43±0.97 to 0.03±0.26 (p<0.0001) and 0.03±0.26 to 0.18±1.21 (p<0.0001) respectively at a mean follow-up of 3.71 ± 0.98 years. Implant survivorship was 100%. Conclusion. High-flexion Freedom® TKS demonstrated a satisfactory clinical and functional improvements including high flexion when operated by the mini-subvastus approach at a mean FU of 4 years


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XL | Pages 163 - 163
1 Sep 2012
Schimmel J Wyemnga A Defoort K Van Hellemondt G
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Introduction. An important factor in the functional results after total knee arthroplasty (TKA) is the achieved maximal flexion. To date, a TKA still provides dissimilar flexion capabilities compared to the healthy knee, which could be due to the mismatch between the normal knee geometry and the implant geometry. The implant design of the Journey (Smith&Nephew) aims to replicate the normal knee function. According to the manufacturer of the Journey system, it intends to replicate PCL and ACL function, accommodates deep flexion, induces normal tibiofemoral axial rotation and provides proper patellar tracking throughout the entire range of flexion (‘guided motion’). The objective of this study is to investigate the maximal knee flexion one year after surgery of the Journey and its predecessor the Genesis II (Smith&Nephew). In addition, clinical and functional outcomes will be evaluated. Methods. A total of 124 patients presenting with noninflammatory osteoarthritis received the Journey or the Genesis II prosthesis, by randomization. The primary outcome was defined as the maximum flexion angle on a lateral X-ray performed with the patient lying on a bench and using manual force on bending the knee. Secondary outcomes were: active flexion (lying and standing), Knee Society System score (KSS), Patella Scoring System (PSS), number of adverse events (AE) and satisfaction. The changes in KSS and PSS between the pre-operative situation and 1 year after surgery were calculated as: δKSS = KSS. 1 year. – KSS. pre-op. , and δPSS = PSS. 1 year. – PSS. pre-op. Two-sided t-tests and non-parametric alternatives were performed in order to test for differences between the Journey and the Genesis II group. Results. The demographic and flexion characteristics were comparable between the two groups at baseline. No significant differences could be observed in maximal flexion on X-ray as well as the active flexion between both groups at 1 year (Figure). Median maximal flexion on X-ray was 127° (range 83°-150°) in the Journey group and 125° (range 81°-145°) in the Genesis II group. The active flexion was lower (p<0.001) than the flexion on X-ray (both lying and standing, median 120°). The δKSS and δPSS scores improved significantly more for the Genesis II (p=0.018 and p=0.005, respectively). In the Journey group 40 AEs in 27 patients were reported, including 14 manipulations under anaesthesia (MUA), 10 patients with persistent pain, 3 insert exchanges, and 2 total system revisions. In the Genesis group, 13 AEs were observed in 12 patients, including 6 MUAs, 3 patients with persistent pain, and 1 insert exchange. Patients were equally satisfied in both groups. Discussion. An increased maximal flexion of the Journey prosthesis could not be shown. In both groups patients did not use the maximum of their flexion ability. Less improvement in clinical and functional outcomes and a higher number of adverse events were observed in the Journey group. The achieved kinematics of this current Journey implant design show an increased lateral roll-back as compared to the native knee which probably causes the functional problems. In conclusion, this new design does not result in the desired increased flexion and better clinical and functional outcome


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_4 | Pages 101 - 101
1 Apr 2019
Haidar F Tarabichi S Osman A Elkabbani M Mohamed T
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Introduction. Early complication post total knee replacement reported to be higher in obese patient in general. Also the outcome of cruciate retaining and PS knee has been fully discussed before and there was no major difference in the outcomes for all the patients overall regardless of their weight. However, the purpose of this paper is to find out if the CR knee has superiority over PS knee in terms of clinical and functional outcomes and if early complication postTKR such as fracture and instability is more common in PS implant than in CR knee. This is a retrospective study comparing two groups of obese patients. The first using PS implant and the other using CR implant. These two groups were matched for age, body mass and severity of deformity. Materials & Methods. At our institution we have been using Persona implant which has the option of using PS insert or a CR. The decision to proceed with CR or PS mainly depends on the availability of the implant and also the ability to well balance the knee in patients. In most patients we try to proceed with CR implant. However, the flow of implant sometime sometimes limit us from using CR or the imbalance in the ligament force us to process with PS implant. We have reviewed a chart of over 200 patients in each group of obese patient they were done within the last three years. All cases had a minimum follow up of 6 months. Those groups were matched for body mass, age and severity of deformity. After matching the groups we documented Knee Society Score (KSS), Knee Society Function Score (KSFS), blood loss, post – operative pain and complications. All surgeries were performed by the same surgeon. Results. Our study showed that the clinical scores (KSS) in both groups were very close while significant differences were observed in functional scores (KSFS) for the CR knee. We had 8 cases of per-prosthetic fracture in the PS group and one in the CR implant. We had 4 revisions in the PS group for instability and MCL insufficiency and non in the CR implant. Infection, wound complication, blood loss, and patient satisfaction were same in both groups. Discussion. This study suggests a significant difference in functional outcomes, especially walking, stair climbing and the use of walking aids, between CR and PS that favors CR implant which may be related to the CR knee retaining proprioception and ligaments tension with balance. In addition, PS knee have more varus-valgus and mid-flexion laxity than CR knee throughout the range of motion which appear clearly in obese patient. On the other hand, the study clearly shows that the decrease incidence of peri-prosthetic fracture in the CR implant which could be easily explained by the fact that a good cortical bone is resected in order to make room for the PS spine. Also, the fact that resecting the posterior cruciate ligament might cause more stress on the implant versus the CR. Instability also were more common in the PS group. We believe this has to do with the fact that the PCL serve as a secondary constraint to the MCL. The presence of the PCL help maintain the stability in case of incidental injury to the MCL during surgery which was reported to be higher in obese patients. Conclusion. There is clear advantage of improving the outcomes or knee scores and decreasing the early postoperative complications in obese patient using CR knee and we strongly recommend using CR implant in obese patients in order to restore functionality faster and reduce the incidence of peri-prosthetic fracture and the revision for instability


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 362 - 362
1 Mar 2013
Yaffe M Patel A Luo M Chan P Cayo M Stulberg SD
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Introduction. Patient specific instruments (PSI) and computer-assisted surgery (CAS) are innovative technologies that offer the potential to improve the accuracy and reproducibility with which a total knee arthroplasty (TKA) is performed. It has not been established whether clinical, functional, or radiographic outcomes between PSI, CAS, and manual TKA differ in the hands of an experienced TKA surgeon. The purpose of this study was to evaluate clinical, functional and radiographic outcomes between TKA performed with PSI, CAS, and manual instruments at short-term follow-up. Our hypothesis was that at early follow-up, we would be unable to elucidate any significant differences between the groups using the most commonly utilized outcomes measures. Methods. 40 PSI, 38 CAS, and 40 manual TKA were performed by a single surgeon. The groups were similar in regards to age, sex, and preoperative diagnosis. The Knee Society Scoring System was used to evaluate patient clinical and functional outcome scores preoperatively and at 1 and 6 months postoperatively. Long-standing AP radiographs were obtained pre and postoperative to evaluate mechanical axis alignment. Results. PSI, CAS, and manual TKA produced similar interval improvements in clinical and functional outcomes at both 1 and 6-months postoperative. Knee Society Knee scores were on average 88.5, 72.5, and 69.3 for PSI, CAS, and manual TKA at 1 month and 99.4, 83.4, and 84.6 at 6 months postoperative. Knee Society Function scores were on average 65.9, 49.3, and 48.4 for PSI, CAS, and manual TKA at 1 month and 86.3, 66.2, and 61.2 at 6 months postoperative. Although PSI tended to have higher absolute Knee and Function scores at 1 and 6 months postoperative, the interval change from preoperative to postoperative between each group was similar. Postoperative mechanical axis alignment was not significantly different between PSI, CAS, and manual TKA (1.0â�°, 2.0â�°, and −0.2â�°, respectively). Discussion. This study suggests that in the hands of an experienced arthroplasty surgeon, PSI, CAS and manual TKA produce similar interval improvements in clinical, functional, and radiographic outcomes at short-term follow-up. These results may reflect the ability of an arthroplasty-trained academic surgeon to perform a TKA accurately with multiple technologies. These findings may also represent the lack of sensitivity and inability of commonly utilized evaluation tools, like plain radiographs and the Knee Society Scoring System, to adequately differentiate small differences in outcomes and limb alignment, if differences do indeed exist. Long-term follow-up will help establish whether these TKA technologies continue to demonstrate equivalent clinical and functional interval improvements


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLI | Pages 39 - 39
1 Sep 2012
Moopanar T Sorial R
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In an effort to improve alignment in total knee arthroplasty (TKA), more recent prosthetic devices adapt computerised sculpting technologies based on preoperative MRIs to individualize surgical treatment. This is achieved by creating patient-specific surgical positioning guides for prosthetic alignment. Our study reports on the early clinical and functional outcomes and CT measured alignment of patients undergoing surgery with the Signature patient specific knee system. We have reviewed the first one hundred patients selected to have a TKA using the patient specific knee system by a single surgeon over the last two years. Clinical and functional outcomes were assessed using the Western Ontario and McMaster Universities (WOMAC) index, the American Knee Society Scores (AKSS) and range of flexion at 6months. All data was analysed using a two tailed paired students t-test with statistical significance accepted at p<0.05. Post-operative CT scans were analysed to report on overall mechanical axial limb alignment, axial prosthetic tibial alignment, posterior tibial slope and femoral component rotation from the epicondylar axis. Preoperative versus postoperative WOMAC scores for patients were 80.4 ± 2.2 and 45.2 ± 2.1 respectively. This was statistically significant at p=1.3×10–14. The AKSS pre- and postoperatively were 85.1 ± 4.6 and 151.9 ± 4.6 respectively with statistical significance reached at p = 1.3×10–13. Specifically, the pre- vs postoperative knee scores were 33.6 ± 2.8 and 75.1 ± 2.6 (p=3.9×10–12) while the function scores were 51.5 ± 2.8 and 75.8 ± 4 (p=3.4×10–7) respectively. Range of flexion preoperatively was 110.8 ± 2.8 while postoperatively was 122.1 ± 2.6 (p=0.0003). Postoperative CT scans revealed that the tibial axial alignment was 90.5 ± 7.7 degrees while the posterior tibial slope was 5.5 ± 0.3 degrees on average. In terms of femoral rotation, the epicondyllar axis was found to be 0.56 ± 0.1 degrees externally rotated with respect to Whiteside's line. The mechanical axis was 0.84 ± 0.1 on average. With all these measured parameters the number of outliers outside the accepted +/−3 degree range are small. Our data demonstrates that the early results for knee replacements performed using the Signature patient specific jigs are very satisfactory delivering good clinical outcomes and an improved level of prosthetic alignment when compared to published data for standard instrumented knees


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_5 | Pages 23 - 23
1 Mar 2017
Mirghasemi S Maltenfort M Tabatabaee R Rasouli M Rashidinia S Parvizi J
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Introduction. Reported data on impact of obesity on outcome of total joint arthroplasty (TJA) is mixed. The purpose of this systematic review was to evaluate the impact of obesity on surgical procedure and postoperative outcomes after total hip and knee arthroplasty. Methods. Pubmed and Scopus databases were searched from 2000 to 2013 for English-language studies that compared the outcomes of total hip or knee arthroplasty between different body mass index (BMI) groups. Data from these studies were pooled and analyzed. Results. Twenty-six studies for each type of procedure fulfilled the criteria. Lower BMI was associated with lower risk of superficial (OR=2.16, P<0.001) and deep infections (OR=3.65, P<0.001), hip dislocation (OR=1.56, P<0.001), hip revision (OR=1.21, P=0.02), blood transfusion (OR=0.47, P<0.05), operative time (P<0.01), and short form physical score (P<0.001) in hip arthroplasty. In knee arthroplasty, lower BMI was also associated with lower risk of superficial (OR=1.44, P<0.001) and deep infections (OR=3.81, P<0.001), as well as better short form mental score (P<0.001), Knee Society score (P<0.001) and Knee Society function scores (P<0.001). Other outcome measures were not significantly different between obese and non-obese groups. Conclusion. Obesity is associated with an increased risk of postoperative complications and worse clinical and functional outcomes following TJA


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_6 | Pages 65 - 65
1 Mar 2017
Vasarhelyi E Petis S Lanting B Howard J
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Introduction. Total hip arthroplasty (THA) is the most effective treatment modality for severe arthritis of the hip. Patients report excellent clinical and functional outcomes following THA, including subjective improvement in gait mechanics. However, few studies in the literature have outlined the impact of THA, as well as surgical approach, on gait kinetics and kinematics. Purpose. The purpose of this study was to determine the impact of surgical approach for THA on quantitative gait analysis. Methods. Thirty patients undergoing THA for primary osteoarthritis of the hip were assigned to one of three surgical approaches (10 anterior, 10 posterior, and 10 lateral). A single surgeon performed each individual approach. Each patient received standardized implants at the time of surgery (cementless stem and acetabular component, cobalt chrome femoral head, highly cross-linked liner). Patients underwent 3D gait analysis pre-operatively, and at 6- and 12-weeks following the procedure. At each time point, temporal gait parameters, kinetics, and kinematics were compared. Statistical analysis was performed using one-way analysis of variance. Results. All three groups were similar with respect to age (p=0.27), body mass index (p=0.16), and the Charlson Comorbidity Index (p=0.66). Temporal parameters including step length, stride length, gait velocity, and percent stance and swing phase were similar between the groups at all time points. The lateral cohort had higher pelvic tilt during stance on the affected leg than the anterior cohort at 6-weeks (p=0.033). Affected leg ipsilateral trunk lean during stance was higher in the lateral group at 6-weeks (p=0.006) and 12-weeks (p=0.037) compared to the other cohorts. The anterior and posterior groups demonstrated an increased external rotation moment at 6-weeks (p=0.001) and 12-weeks (p=0.005) compared to the lateral group. Discussion. Although temporal parameters were similar across all groups, some differences in gait kinematics and kinetics exist following THA using different surgical approaches. However, the clinical relevance based on the small magnitude of the differences remains in question


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_20 | Pages 100 - 100
1 Nov 2016
Petis S Vasarhelyi E Lanting B Jones I Birmingham T Howard J
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Total hip arthroplasty (THA) is the most effective treatment modality for severe arthritis of the hip. Patients report excellent clinical and functional outcomes following THA, including subjective improvement in gait mechanics. However, few studies in the literature have outlined the impact of surgical approach on gait kinetics and kinematics. The purpose of this study was to determine the impact of surgical approach for THA on quantitative gait analysis. Thirty patients undergoing THA for primary osteoarthritis of the hip were assigned to one of three surgical approaches (10 anterior, 10 posterior, and 10 lateral). A single surgeon performed each individual approach. Each patient received standardised implants at the time of surgery (cementless stem and acetabular component, cobalt chrome femoral head, highly cross-linked liner). Patients underwent 3D gait analysis pre-operatively, and at 6- and 12-weeks following the procedure. At each time point, temporal gait parameters, kinetics, and kinematics were compared. Statistical analysis was performed using one-way analysis of variance. All three groups were similar with respect to age (p=0.27), body mass index (p=0.16), and the Charlson Comorbidity Index (p=0.66). Temporal parameters including step length, stride length, gait velocity, and percent stance and swing phase were similar between the groups at all time points. The lateral cohort had higher pelvic tilt during stance on the affected leg than the anterior cohort at 6-weeks (p=0.033). Affected leg ipsilateral trunk lean during stance was higher in the lateral group at 6-weeks (p=0.006) and 12-weeks (p=0.037) compared to the other cohorts. The anterior and posterior groups demonstrated an increased external rotation moment at 6-weeks (p=0.001) and 12-weeks (p=0.005) compared to the lateral group. Although temporal parameters were similar across all groups, some differences in gait kinematics and kinetics exist following THA using different surgical approaches. However, the clinical relevance based on the small magnitude of the differences remains in question


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_6 | Pages 14 - 14
1 Mar 2017
Speranza A Alonzo R De Santis S Frontini S D'arrigo C Ferretti A
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Femoral neck fractures are the second cause of hospitalization in elderly patients. Nowadays it is still not clear whether surgical treatment may provide better clinical outcome than conservative treatment in patients affected by mental disorders, such as senile dementia. The aim of this study was to retrospectively assess mortality and clinical and functional outcome after hemi arthroplasty operation following intracapsular neck fractures in patients with senile dementia. Between 2008 and 2014, 819 patients were treated at our Orthopaedic Institute for neck fracture of the femur (mean age: 83.8 years old). Eighty-four of these showed clear signs of cognitive impairment at time of admission in the Emergency Department. Mental state of patients was assessed in all cases, as routine, at the Emergency Room with the Short Portable Mental Status Questionnaire (Sh-MMT) and the Mini Mental State Examination (MMSE). Patients were divided in two groups depending whether they were surgically treated with hemiarthroplasty (Group B, 46 patients; 35 females, 11 males; mean age: 88.5 y.o.) or conservatively treated (Group C, 38 patients; 28 females, 10 males; mean age: 79.5 y.o.). These two groups were compared with a matched case-control group of patients surgically treated with no mental disorders (Group A, 40 patients; 34 females, 6 males; mean age: 81.5 y.o.). Incidence of mortality, systemic or local complications and functional clinical outcomes were evaluated with the ADL score and the Barthel index. Mortality rate was 35% (14 patients) for Group A, 50% (21 patients) for Group B and 95% (22 patients) for Group C. Paired t-test, with significance rate set at 0.05, showed significant higher mortality rate in Group A compared to both Group B (p:0.02) and Group C (p:0.001), and also between Group B and Group C (p:0.01). Three orthopaedic complications were found in Group B (two cases of infection and one dislocation of the prosthesis) while none in Group A (p<0.001). There have been 14 overall general complication in Group A (33%), 16 in group B (38%) and 15 in Group C (65%), with significant higher rate in Group B vs. Group A (p:0.02) and in group C vs. Group B (p: 0.001). Activity daily living scale and Barthel Index results showed higher results in Group B than Group C both in terms of recovery of walking ability and daily living (hairdressing, wearing clothes, eating). For any figures or tables, please contact authors directly (see Info & Metrics tab above).


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_3 | Pages 105 - 105
1 Feb 2017
Bhowmik-Stoker M Martinez N Bluemke V Elmallah R Mont M Dunbar M
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Background. Total knee arthroplasty (TKA) is a routine, cost-effective treatment for end-stage arthritis. While the evidence for good-to-excellent patient-reported outcomes and objective clinical data is present, approximately 20% of patients continue to be dissatisfied with results of their surgery. Dissatisfaction is strongly correlated with unmet patient expectations, and these patients may experience a higher cost of care due to recurring office and emergency visits. Therefore, this survey asked a large group of United States (U.S) and international surgeons to prioritize areas of opportunity in primary TKA. Specifically, we compared surgeon responses regarding: 1) the top 5 areas needing improvement; which were stratified by: 2) surgeons' years of experience; and 3) surgical case volume. Methods. A total of 418 orthopaedic surgeons were surveyed. Two hundred U.S. surgeons and 218 international surgeons participated from 7 different countries including: The United Kingdom (40), France (40), Germany (43), Italy (40), Spain (38), and Australia (17). To participate, surgeons had to be board certified, in practice for 2 years, spend 60% of their time in clinical practice, and perform a minimum of 25 joint arthroplasties per year. Surgeons were asked to choose the top 5 areas of improvement for TKA from a list of 17 attributes including clinical and functional outcomes, procedural workflow and economic variables. Surgeons were able to specify additional options if needed. Results were stratified by annual case volume (25 to 50; 51 to 100; greater than 100 cases) and years of experience (1 to 10; 11 to 20; greater than 20). Single-tail proportion tests were used to compare results between cohorts, where an alpha of 0.05 was set as significant. Results. The most frequently identified opportunity in both groups was functional outcomes, selected by 63% of U.S. surgeons (p=0.001) compared to 71% of international surgeons (p=0.002). In the U.S. cohort, this was followed by cost (47%), which was not identified in the top 5 choices for international surgeons. Cost was followed by implant survivorship (45%), patient satisfaction (42%), and accuracy/precision (39%). In the international cohort, implant survivorship (57%), dynamic joint balancing (40%), accuracy/precision (39%), and patient satisfaction rates (35%) were noted. When stratified by years of experience and case volume, the top area for improvement remained functional outcomes for U.S. and International groups. Conclusion. The responses in the international survey demonstrate that functional outcomes, implant survivorship and costs had greater perceived potential for improvement, compared to the specific targeting of post-operative patient satisfaction. Functional outcomes remained a top area for improvement, regardless of years of experience or case volume. As a result, enhancing functional outcomes and implant survivorship may ultimately address patient satisfaction, by more consistently meeting patient expectations. These results serve as baseline data to help guide future improvements in knee arthroplasty


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_4 | Pages 87 - 87
1 Feb 2017
Kuropatkin G Osin D
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Managing severe acetabular bone defects during primary and revision total hip arthroplasty is a challenging problem. Standard treatment options for this cases is using of acetabular reconstruction type-Burch-Schneider rings. Unfortunately, the possibility of osseointegration of these implants with surrounding bone has always remained a contentious issue. The emergence in recent years of new designs of trabecular titanium, representing a symbiosis of acetabular reconstructive plates and modular cup helped to solve this problem on a completely new level. The aim of this prospective study is to evaluate the short and mid-term clinical and radiographic outcomes of different types of acetabular revision cups - old and new design. From 2006 to 2015, we performed 48 acetabular reconstruction with reconstruction rings CONTUR Smith and Nephew(group 1) and 34 operations with Delta TT Lima Revision system (group 2). The mean age of patients was 59.2 years (range 30–79). Indications for operations included fractures in acetabular region (10 pat – 12,2 %), acetabular nonunions with bone defects (14 pat – 17,1%), aseptic loosening with multiple dislocation of the primary implants in 38 cases (46,3%) and second stage of infection treatment in 20 cases (24.4%). Clinical and functional outcomes were evaluated by Harris Hip Score (HHS). Bone density in Charnley's zones was measured by dual-energy x-ray absorptiometry. With CONTUR reconstruction rings were used 3 different types of bearing surface articulation (22 metal/polyethylene, 10 ceramic/polyethylene, and 16 oxinium/polyethylenel). With Delta TT Revision system were used metal/poly couples in 22 cases, ceramic/poly in 6 cases, and ceramic/ceramic couple in 4 cases. In two patients with high risk of dislocations were used double mobility system. In all operations with CONTUR rings was used bone impaction grafting to fill cavitary defects (Paprosky 2B-3A), with Delta TT Revision system in 14 cases (41,2%) additionally TT augments were used. In group 1 were 3 dislocations (6,3 %), 2 deep infections (4,2 %) and 4 aceptic loosenings with secondary instability of implants (8,3 %). In group 2 Trabecular Titanium showed a high capacity of osseointegration, providing good results in short-term follow-up. We registered only 2 dislocations (5,8 %) and 1 aceptic loosening (2,9 %). The mean HHS increased from 39.7 (range 23–62) preoperatively to 86.5 (range 68–98) at the last follow-up examination. The implanted cups were radiographically stable at the last follow-up visit (1 and 2 years) without radiolucent lines or periprosthetic osteolysis. Conclusions. Delta Revision TT is a good solution for acetabular reconstruction even when there are cavitary and segmental bone defects. Modularity of this system make it possible to correct inlay position, center of hip rotation and minimising the risk of dislocation