Arthroscopic hip procedures have increased dramatically over the last decade as equipment and techniques have improved. Patients who require hip arthroscopy for femoroacetabular impingement on occasion require surgery on the
The aim of this study was to determine Anterior Cruciate Ligament (ACL) graft and
Introduction. Legg-Calvé-Perthes disease (LCPD) often results in femoral head deformity and leg length discrepancy (LLD). Objective of this study was to analyse femoral morphology in LCPD patients at skeletal maturity to assess where the LLD originates, and evaluate the effect of
There is increasing evidence that patients with ACL reconstruction using ipsilateral graft harvest are at greater risk of rupture (12.5%) on their
Aims. Medial unicompartmental knee arthroplasty (UKA) is undertaken in patients with a passively correctable varus deformity. Our hypothesis was that restoration of natural soft tissue tension would result in a comparable lower limb alignment with the
Background:. Little validation has been done to compare the principle of using the
Laterality and bilaterality have been reported as prognostic variables in DDH outcomes. However, there is little clarity across the literature on the reporting of laterality in developmental dysplasia of the hip (DDH) due to the variability in severity of the condition. It is widely accepted that the left hip is most frequently affected; however, the true incidence of unilateral left, unilateral right and bilateral cases can be hard to quantify and compare across studies. The purpose of this study was to examine laterality accounting for graded severity in a multicentre, international prospective observational study of infants with hip dysplasia in order to demonstrate the complexity of this issue. A multicentre, prospective database of infants diagnosed with DDH between the ages of 0 and 18 months was analysed from 2010 to April 2015. Patients less than six months were enrolled in the study if at least one hip was frankly dislocated. Patients between 6 and 18 months were enrolled if they had any form of hip dysplasia. Each hip was classified as reduced, dysplastic, dislocatable/subluxable, dislocated reducible or dislocated irreducible. Baseline diagnosis was used to classify patients into a graded laterality category accounting for hip status within the DDH spectrum. A total of 496 patients were included in the analysis; 328 were <6 months old at diagnosis and 168 were between 6 and 18 months old. Of these patients, 421 had at least one frankly dislocated hip. Unilateral left hip dislocations were most common, with 223 patients, followed by unilateral right and bilateral dislocations with 106 and 92 respectively. Stratifying these patients based on status of the
Shoulder arthroplasty, both primary (TSA) and reverse (RTSA), are common interventions for arthritis and cuff tear arthropathy. The effect of shoulder arthroplasty on shoulder motion is of particular interest in assessing the effectiveness of the procedure and the development and biomechanical testing of implants. A comparison of the arthroplasty shoulder to that of the non-operated
Slipped upper femoral epiphysis (SUFE) is an uncommon condition with potentially severe complications including avascular necrosis (AVN) and chondrolysis. Children with a ‘slip’ are at a significantly higher risk of a
Purpose. Radial head implant over-lengthening, a common cause of capitellar wear and clinical failure, is difficult to diagnose using radiographs of the injured elbow. The purpose of this study was to determine if a novel measurement technique based on
Background:. The literature is unclear about the optimal rotation of the femoral component during TKR. Measured resection techniques rely on the use of bony landmarks, while the balanced gap technique relies on soft tissue tensioning to guide the surgeon in rotating the femoral component. All these techniques still result in a wide range of component rotation. We compared the functional flexion axis (FFA) of 20 replaced knees to that of the
To identify the incidence of sequential slip of the unaffected hips in patients presenting with unilateral SCFE managed with prophylactic fixation or observation. A retrospective review of all unilateral SCFE treated during 1998 to 2012 was undertaken. The study compares the incidence of sequential slip of the initially unaffected hip in patients managed with prophylactic fixation or observation. The study also reports the incidence avascular necrosis, chondrolysis, and metal-work related problem in this group of patients. All patients included in this current work have at least 12 months of follow-up from the index slip. A total of 44 cases had prophylactic fixation of the unaffected hip (mean age 12.6 years,) and 36 patients managed with regular observation (mean age 13.4 years). Sequential slip of the unaffected hip was noted in a total of 10 patients (28 %) managed with regular observation and only in 1 patient (2%) managed with prophylactic fixation. A Fishers exact test showed significantly high incidence of sequential slip in unaffected hips when managed by regular observation (p-value-0.002). There is no evidence of avascular necrosis or chondrolysis in the unaffected hip in both groups, 3 patients had metalwork related problem and one had superficial wound infection in prophylactic fixation group. Simultaneous prophylactic fixation of the unaffected hips significantly reduces the incidence of sequential slip. This is a relatively safe procedure and should be advocated in all cases of unilateral SCFE to avoid potential complications and preserve function of the unaffected hip.
Previous fluoroscopic studies compared total knee arthroplasty (TKA) kinematics to normal knees. It was our hypothesis that comparing TKA directly to its non-replaced controlateral knee may provide more realistic kinematics information. Using fluoroscopic analysis, we aimed to compare knee flexion angles, femoral roll-back, patellar tracking and internal and external rotation of the tibia. 15 patients (12 women and 3 men) with a mean age of 71.8 years (SD=7.4) operated by the same surgeon were included in this fluoroscopic study. For each patient at a minimum one year after mobile-bearing TKA, kinematics of the TKA was compared to the controlateral knee during three standardized activities: weight-bearing deep-knee bend, stair climbing and walking. A history of trauma, pain, instability or infection on the non-replaced knee was an exclusion criteria. A CT-scan of the non-replaced knee was performed for each patient to obtain a 3-D model of the knee. The Knee Osteoarthitis Outcome Score (KOOS) was also recorded.Introduction
Material and methods
The bone-patellar tendon-bone (BTB) autograft has a lower rate of graft failure but a higher rate of
Reconstruction of the anterior cruciate ligament (ACL) allows to restore stability of the knee, in order to facilitate the return to activity (RTA). Although it is understood that the tendon autograft undergoes a ligamentous transformation postoperatively, knowledge about longitudinal microstructural differences in tissue integrity between types of tendon autografts (ie, hamstring vs. patella) remains limited. Diffusion tensor imaging (DTI) has emerged as an objective biomarker to characterize the ligamentization process of the tendon autograft following surgical reconstruction. One major limitation to its use is the need for a pre-injury baseline MRI to compare recovery of the graft, and inform RTA. Here, we explore the relationship for DTI biomarkers (fractional anisotropy, FA) between knees bilaterally, in healthy participants, with the hypothesis that agreement within a patient's knees may support the use of the
Aims. Despite numerous studies on periprosthetic joint infections (PJI), there are no robust data on the risk factors and timing of metachronous infections. This study was performed to answer the following questions: 1) Is there any difference of manifestation time of metachronous PJIs between different localizations of multiple artificial joints? 2) Can we identify any specific risk factor for metachronous PJIs for different localizations of multiple artificial joints?. Methods. Between January 2010 and December 2018, 661 patients with more than one prosthetic joint at the time of PJI surgical treatment were recruited. Seventy-one developed metachronous PJI after a mean time interval of 101.4 months (range 37.5 to 161.5 months). The remaining patients were chosen as control group. The diagnosis of the PJI, including the metachronous PJI, was made according to the Muscoloskeletal Infection Society (MSIS) criteria. The metachronous infections were divided in group 1: metachronous infections in the same extremity (e.g. right hip and right knee); group 2: metachronous infections of the other extremity (e.g. right knee and left hip); group 3: metachronous infections of the lower extremity and upper extremity (e.g. right knee and left shoulder). Results. We identified 32 PJI cases in group 1, 38 in group 2 and 1 in group 3. Diabetes mellitus was found higher in the metachronous infections (p<0.05). Rate of same side infection was significantly higher compared to
A primary goal of revision Total Knee Arthroplasty (rTKA) is restoration of the Joint Line (JL) and Posterior Condylar Offsets (PCO). The presence of a native
Abstract. Background. Reconstruction following resection of sarcomas of the upper extremity with methods described in the prevalent literature may not be possible in few selected cases. We describe Surgical Phocomelia or Phoco-reduction as a method of limb salvage in such cases of extensive sarcomas of the upper limb with its functional and oncological outcomes. Methods. Evaluation of functional and oncological outcomes was performed for 11 patients who underwent surgical phocomelia or phocoreduction for extensive sarcomas of the upper limb between 2010 and 2019. Results. Mean follow-up period in the study was27.8 months. Five patients required a segmental resection including the entire humerus while 6 patients underwent segmental resection around the elbow with a mean resection length of 21.5 cm. Mean MSTS 93 score was 22 depicting a good functional outcome. Mean hand grip strength on the operated side was 62% of the
3D printing techniques have attracted a lot of curiosity in various surgical specialties and the applications of the 3D technology have been explored in many ways including fracture models for education, customized jigs, custom implants, prosthetics etc. Often the 3D printing technology remains underutilized in potential areas due to costs and technological expertise being the perceived barriers. We have applied 3D printing technology for acetabular fracture surgeries with in-house, surgeon made models of mirrored
Abstract. Background. Although tantalum is a well recognised implant material used for revision arthroplasty, little is known regarding the use of the same in primary total hip arthroplasty. Methods. A literature search was performed to find all relevant clinical studies until March 2020, which then underwent a further selection criteria. The inclusion criteria was set as follows: Reporting on human patients undergoing primary total hip arthroplasty; Direct comparison between tantalum acetabular cups with conventional acetabular cups. for use in primary total hip arthroplasty; Radiological evaluation (cup migration, osteointegration); Clinical (functional scores, need for subsequent revision, patient-reported outcomes; Post-operative complications; Reporting findings in the English Language. After a thorough search a total of six studies were included in the review. The primary outcome. measures were clinical outcomes, implant migration, change in bone mineral density and rate of revision and infection. Results. Tantalum was found superior to titanium with regards to fewer radiolucencies, survivorship, osteointegration, decreased osteolysis and mechanical loosening. No significant difference in radioisometric analysis, bone mineral density or Harris Hip Score was found. Revision and infection rates were found to be significantly lower in tantalum group at 10 years from pooled data of national joint registry. Conclusion. The use of tantalum can be reserved for cases of high risk of failure or mechanical loosening, where failure of a