Mental disorders in particular depression and anxiety have been reported to be prevalent among patients with spinal pathologies. Goal of the current study was to analyze the relationship of Zung pre- and post-op score to other PROs and length of stay. Secondary outcomes included revision surgery and post-operative infections. Data from the international multicenter prospective spine degenerative surgery data repository, DegenPRO v1.1 (AO Spine Knowledge Forum Degenerative) were utilized. Patients undergoing cervical or lumbar procedure were included. Patient's demographics, Charlson Comorbidity Index, surgical information, Zung score, NDI, pain related PROs and EQ-5D, and complications at surgery and at various post-op time periods. Except for hospital duration, data were analyzed, using multivariable mixed linear models. A robust linear regression model was used to assess the association between Zung score and hospital duration. All models were adjusted for gender and age. 42 patients had Zung score administered. Among those patients 22 (52%) were within normal range, 18 (43%) were mildly and 2 (5%) severely depressed. 62% of the patients had a lumbar pathology with fusion procedures being the most common. Median EQ-5D (3L) score at surgery was significantly higher (0.7, IQR: 0.4-0.7) for patients within normal range than for those with mild (0.4, IGR: 0.3-0.7) or severe depression (0.3, IQR: 0.3-0.3, p-value: 0.05). Compared to patients within normal Zung range, mixed models, indicated lower EQ-5D (3L) score values and higher values for neck and arm pain at surgery with both PROs and EQ-5D (3L) improving in patients with depression over the follow-up time. No association was found between Zung score and hospital length of stay. The initial analysis showed that 43% of the patients were mildly depressed and mainly male patients. Zung score was correlated with post-operative improvements in EQ-5D and arm and neck pain PROs

The optimal treatment strategy for post-traumatic long bone non-unions is subject of an ongoing discussion. At the Maastricht University Medical Center (MUMC+) the induced membrane technique is used to treat post-traumatic long bone non-unions. This technique uses a multimodal treatment algorithm involving bone marrow aspirate concentrate (BMAC), the reamer-irrigator-aspirator (RIA) and P-15 bioactive peptide (iFactor, Cerapedics). Bioactive glass (S53P4 BAG, Bonalive) is added when infection is suspected. This study aims to objectify the effect of this treatment algorithm on the health-related quality of life (HRQoL) of patients with post-traumatic long bone non-unions. We hypothesized that HRQoL would improve after treatment. From January 2020 to March 2023, consecutive patients who were referred to a multidisciplinary (trauma, orthopaedic and plastic surgery) non-union clinic at the MUMC+, The Netherlands, were evaluated using the Non-Union Scoring System (NUSS). The EQ-5D-5L questionnaire and the Lower Extremity Functional Scale (LEFS) were employed to obtain HRQoL outcomes both prior to and subsequent to surgery, with a follow-up at 6, 18 and 35 weeks. Seventy-six patients were assessed at baseline (T0), with a mean NUSS of 40 (± 13 SD). Thirty-eight patients had their first follow-up, six weeks after surgery (T1). Thirty-one patients had a second follow-up at 18 weeks (T2), and twenty patients had the third follow-up at 35 weeks (T3). The EQ-5D index mean at baseline was 0.480, followed by an index of 0.618 at T1, 0.636 at T2, and 0.702 at T3. A significant difference was found in the HRQoL score between T0 and T1, as well as T2 and T3 (p<0.001; p=0.011). The mean LEFS significantly increased from 26 before intervention to 34, 39, and 43 after treatment (p<0.001; p=0.033; p=0.016). This study demonstrated a significant improvement in the health-related quality of life of patients with post-traumatic long bone non-unions after the standardized treatment algorithm following the induced membrane technique

Introduction. We used patient reported outcome measures (PROMS) to evaluate qualitative and societal outcomes of trauma. Methods. We collected PROMs data between Sept 2013 and March 2015 for 92 patients with injury severity score (ISS) greater than 9. We enquired regarding return to work, income and socioeconomic status, dignity and satisfaction and the EQ-5D questionnaire. Results. Return to work. Of patients working at admission 15/58(26%) anticipated returning to work within 14 days of discharge. Work plans at discharge did not correlate with ISS scores overall (r=−0.05, ns), or when stratified by working group. Increased physicality of work showed a trend towards poorer return to work outcomes (not significant in Spearman's rank analysis: r= 0.14, p= 0.32). Income and socioeconomic status: No significant difference was demonstrated between the comparative incomes of patients with the best and worst return to work outcomes (ANOVA n=61, t=0.63, ns). Lowest quartile earners (n=19) were more likely to complete the open questions (79%) than higher income patients (62%). Dignity and satisfaction: Prominent positive themes were: care, staff, professionalism, and communication. Prominent negative themes were: food, ward response time, and communication. %). Patients ‘mostly’ or ‘always’ satisfied with their care did not have significantly different incomes (ANOVA, t=0.13, ns). EQ-5D: Self-rated health status correlated with perceived likelihood of return to work (r=0.25, p=0.0395). Correlation was demonstrated between EQ-5D scores and perceived dignity preservation (r=0.38, p=0.0004), and overall satisfaction (r=0.46, p< 0.0001). There was no correlation between EQ-5D and ISS score. Conclusion. EQ5D correlated with work plans, dignity, and satisfaction. Planned return to work did not correlate with ISS score or socioeconomic status. Unlike previous studies we demonstrated that lower socioeconomic groups have best engagement with PROMS. This study highlighted the value of qualitative PROMS analysis in leading patient-driven improvements in trauma care

Autologous micro-fragmented adipose tissue (MFAT) for the treatment of symptomatic knee osteoarthritis (OA) is gaining interest although there is still a lack of supportive data on safety and clinical efficacy. This study primarily aimed to identify patient- and pathology-related parameters to tighten patient selection criteria for future clinical MFAT application. Secondly, the overall (1) therapeutic response rate (TRR), (2) short-term clinical effect, (3) effect durability and (4) therapeutic safety was investigated at a minimal follow-up of 1 year. Sixty-four subjects (91 knees) with symptomatic knee OA (mild-severe on MRI) were enrolled in a prospective single-centre case series. Ethical approval was obtained from the local and academic ethical committee (#B300201733775). After liposuction, the adipose tissue was mechanically processed in a Lipogem® device which eventually produced 6–9cc MFAT. Subjects were clinically assessed by means of the KOOS, NRS, UCLA and EQ-5D at baseline and 1, 3, 6 and 12 months after injection. Adverse events were meticulously recorded. The TRR was defined according to the OMERACT-OARSI criteria. A baseline MRI was scored following the MOAKS system. Paired sample t-tests, independent t-test and Fischer's exact test were applied on appropriate variables. Multiple regression models were fit separately for patient-and pathology-specific factors. Significance level was set at α=0.05. The overall TRR was 66% at 3 months and 50% at 12 months after injection. Subgroup analysis revealed that specifically patients with no-mild bone marrow lesions (BML) had a TRR of 88% at 3 months and 75% at 12 months after MFAT injection. Therapy responders at these timepoints improved with 29.3±14.1 points and 30.8±15.3 points on KOOS pain, while non-responders deteriorated mildly. All clinical scores were significantly higher at follow-up compared to baseline (p<0.05). BMI (factor 0.17, p=0.002) and age (factor −0.48, p=0.048) were prognosticators for the TRR% at 1 month and for absolute KOOS pain improvement at 6 months, respectively. Posterior horn lesions (PHL) in the medial meniscus (p<0.001) and bone marrow lesions (p=0.003) were negative prognosticators for the TRR at respectively 6 and 12 months post-injection. An inflammatory reaction (pain, swelling or stiffness) to MFAT was reported in 79% knees and resolved spontaneously within 16.6±13.5 days after administration. The study showed a durable and satisfying TRR (up to 75% at 1 year in selected patients without BML) and clinical improvement after a single intra-articular injection with autologous MFAT. The availability of an index knee MRI is mandatory to select MFAT patients, preferably with no or mild BML and without PHL of the medial meniscus. High BMI and younger age are associated with better early outcomes. In comparison to other injection therapies such as cortisone, hyaluronic acid and PRP, MFAT appears very attractive with an effect durability of at least 1 year

Background. Hip resurfacing arthroplasty (HRA) and total hip arthroplasty (THA) are treatments of end-stage hip disease. Gait analysis studies comparing HRA and THA have demonstrated HRA results in a more normal gait than THA. The reasons may include the larger, more anatomic head diameter, the preservation of the femoral neck with restoration of the anatomical hip centre position and normal proprioception. This study investigated (1)whether femoral head size diameter affects gait; (2)whether gait still differs between THA and HRA patients even with comparable head diameters. Methods. We analysed the gait of 33 controls and 50 patients with unilateral hip replacement. Follow-up ranged from 9–68 months. In 27 hips a small femoral head size was used (≤ 36mm); in 23 hips a large head size (>36mm). The small size group consisted of 11 long femoral stem THA and 16 short-stem THA; the large group of 5 long-stem, 8 short-stem THA and 10 HRA patients. There were 14 females/19 males in the control group; 22 females/5 males in the small size group; 13 females/10 males in the large size group. Results. (1) We found a significant difference in step-length between small head sizes and controls (p<0.01) at speeds ranging from 4.0 to 5.5 km/h but no difference between the larger head size and the controls. There was no significant difference in maximum speed, weight acceptance, push-off, mid-stance, impulse and cadence between the groups. (2)Analysis between THA and HRA in the large head size group revealed a significant difference in maximum speed (p=0.021) between long-stem THA (6.338 km/h± 1.542) and HRA (7.756km/h± 0.7604) patients. At 5.5 km/h there was a significantly better weight acceptance (p=0.009) and mid-stance (p=0.041) of HRA compared to short-stems. Impulse was significantly higher for HRA compared to long-stem THA (p<0.05) at all speeds ranging 4 to 5.5 km/h. (3)Males (7.1972 km/h ± .9700) had significantly higher maximum speeds compared to females (6.6524km/h± 1.019) (p=0.017) and lower gait impulse (p<0.01) at speeds ranging from 4 to 5.5km/h. (4)There was no significant difference in Oxford Hip Score (OHS) and EQ-5D of patients in the small compared to large head size group. Conclusions. Gait analysis demonstrated a significant difference in step length between THA patients with head size ≤ 36mm and normal controls. There was no difference in step length between normal controls and THA patients with larger head sizes. Compared to larger head size THA, HRA still revealed higher maximum speeds and better weight acceptance. Males had significantly higher maximum speeds compared to females (controls and hip replacement patients). We could not demonstrate a correlation between better gait and Oxford scores or EQ-5D scores but these are known to have a ceiling effect. In a former study, better gait parameters such as longer step length and higher maximum speed have been associated with higher patient satisfaction

Background. Patient reported outcomes/experience measures have been a fundamental part of the NHS since 2009. Osteotomy procedures for hallux valgus produce varied outcomes due to their subjective nature. We used PROMS2.0, a semi-automated web-based system, which allows collection and analysis of outcome data, to assess what the patient reported outcome/experience measures for scarf+/− akin osteotomy for hallux valgus are at UHSM. Methods. Prospective PROMS data was collected from November 2012 to February 2015. Scores used to asses outcomes included EQ-5D VAS, EQ-5D Health Index, and MOxFQ, collected pre-operatively and post-operatively. Patient Personal Experience (PPE-15) was collected postoperatively. Results. 40 patients (35F/5M) (19LT +21RT) had undergone an osteotomy. Average age was 60.7 years (Range 29–88). No bilateral procedures. The pre-op average MOXFQ scores for pain, walking and social interaction were: 51.6 (range 5–100), 51.4 (range 0–96) and 48.8 (range 0–100) respectively. Post operatively these improved to 24.4 (range 0–100), 22.9 (range 0–86) and 23.1 (range 0–88). All statistically significant. EQ5D score showed an improvement; with pre-op index average of 0.70. Post-op index average was 0.80. 11 patients were under 54 years old, 15 between 55–64, and 14 over 65. The greatest improvement was in the over 65s for MOxFQ and in the under 55s in EQ5D. 27/35 women showed improvement in all three MOxFQ domains, in contrast to all men. EQ5D also showed similar results. 65 patients filled out a PPE questionnaire. The results show overall average satisfaction of 72.9%. Conclusion. The overall data suggests that scarf+/− akin osteotomy procedures for hallux valgus are a success. Data suggests that higher success rates are found in those over 65 and male patients. Level of Evidence. Prospective case series- Level 3

Background. Patient reported outcomes measures are a fundamental part of the NHS. Since 2009, they have been used to measure quality from the patient's perspective. PROMS2.0 is a semi-automated web based system, which allows collection and analysis of outcome data. This study looks at the factors, which can influence PROMS. These include looking at general trends which affect reported outcomes such as surgeon, age and gender. We also look to assess the reasons for non-uptake in the study. Methods. Data was collected from October 2012 to March 2015. Scores used to asses outcome measures included EQ-5D VAS, EQ-5D Health Index, and MOxFQ, collected pre-operatively and post-operatively. Results. 97/350 (27.8%) (69F+28M) patients consented and provided pre-op and post op scores. Average age was 57.2 years (Range-19–89). 69 Rt Vs 36 Lt. Surgeon A-51, B-31, C-8 procedures. MOxFQ- all three domains improved on average- Pain- 51.2 to 28.2. Walking/standing- 53.5 to 30.4 and Social interaction- 46.1 to 27.3. EQ5D scores also improved. VAS- 76.0 to 79.7, Index- 0.70 to 0.74. Patients over 70 showed the greatest improvement in MOxFQ, over 70s and under 50s did the same in EQ5D. Male patients reported better outcomes overall in both scores. All statistically significant. No significant patterns found between different surgeons. Left sided procedures did slightly better than right. Non-participation reasons- 20/30 lack of time, 7/30- reduced internet access, 3/30- non specified. Conclusions. Our results suggest improvement in PROMS. Better outcomes are linked to increased age, male sex, left sided procedures but not individual surgeons. Non-responding patients placed forgetfulness/time and lack of Internet access as reasons for non-participation Simplification and integration of PROMS will be key to increased participation. Level of evidence. Prospective case-series- Level 3

Background. Percutaneous vertebroplasty (PVP) is a well established procedure with respect to improved pain and function following vertebral compression fracture. Currently, there is no consensus on the optimal cement distribution within a treated vertebral body. The aim of this study was to determine the influence of two distinct patterns of cement distribution following PVP on patient reported outcome measures up to 1 year post procedure. Methods. A retrospective study was undertaken of 42 patients consecutively undergoing PVP of up to 3 levels by a sole operator. Immediate post-procedural CT scans were analysed with VOXAR MPR software to determine cement distribution in each treated vertebrae as one of two defined patterns -“anterolateral” or “diffuse”. Patients completed an EQ-5D questionnaire pre-procedure and at 1, 2, 6 and 12 months from the procedure. Results. A 97% follow up rate of questionnaire completion was achieved for 30 patients. There were 58 treated levels with PVP performed at all levels between T6 and L5. Twelve patients had an anterolateral fill pattern and 18 patients had a diffuse fill pattern. Statistically significant improvement occurred in in all EQ-5D domains except self care at almost all timepoints in the study group. In the anterolateral group, pain was significantly improved at 1 week, 2months, 6 months and 1 year compared with only at 1 year in the diffuse group. Conclusion. PVP leads to immediate and sustained improvement in quality of life. Lateral cement placement leads to greater pain relief in the short term compared with diffuse cement filling. Conflicts of Interest. None. Source of Funding. None. This abstract has not been previously published in whole or in part; nor has it been presented previously at a national meeting

Summary. Pyogenic spondylodiscitis is an uncommon but severe spinal infection. In majority of cases treatment is based on intravenous antibiotics and rigid brace immobilization. Posterior percutaneous spinal instrumentation is a safe alternative procedure in relieving pain, preventing deformity and neurological compromise. Introduction. Pyogenic spondylodiscitis (PS) is an uncommon but severe spinal infection. Patients affected by a non-complicated PS and treatment is based on intravenous antibiotics and rigid brace immobilization with a thoracolumbosacral orthosis (TLSO) suffices in most cases in relieving pain, preventing deformity and neurological compromise. Since January 2010 we started offering patients percutaneous posterior screw-rod instrumentation as alternative approach to TLSO immobilization. The aim of this study was to evaluate safety and effectiveness of posterior percutaneous spinal instrumentation for single level lower thoracic (T9-T12) or lumbar pyogenic spondylodiscitis. Materials and Methods. Retrospective cohort analysis on 27 patients diagnosed with PS who were offered to choose between 24/7 TLSO rigid bracing for 3 to 4 months and posterior percutaneous screw-rod instrumentation bridging the infection level followed by soft bracing for 4 weeks after surgery. All patients underwent antibiotic therapy. Fifteen patients chose conservative treatment, 12 patients chose surgical treatment. Patients were seen at 1, 3, 6, 9 months after diagnosis. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and complete blood count were measured at each follow-up visit. Segmental kyphosis was measured at diagnosis and at 9 months. VAS, SF-12, and EQ-5D questionnaires were recorded at each follow-up visit. Baseline groups’ demographic characteristics were assessed using independent sample t-tests for continuous variables and χ2 tests for frequency variables. Results. Complete healing was achieved in all patients, no difference was observed in healing time between the two groups (77.3±7.2 days vs 80.2±4.4). Instrumentation failure and screw loosening was not observed in any patient. In both group CRP and ESR decreased accordingly with response to antibiotic therapy. Surgically treated patients had significantly lower VAS scores at 1 month (3.05±0.57 in surgery group vs 5.20±1.21 in TLSO group) and 3 months (2.31±0.54 in surgery group vs 2.85±0.55 in TLSO group) post-diagnosis. Both groups had similar trends toward fast recovery in both mental (MCS) and physical components (PCS) of SF-12 questionnaire, surgically treated patients showed steeper and statistically significative improvement at 1 month (37.83±4.57 MCS in surgery group vs 24.52±3.03 MCS in TLSO group and 35.46±4.43 PCS in surgery group vs 27.07±4.45 PCS in TLSO group, p<0.001), 3 months (52.94±3.82 MCS in surgery group vs 39.45±4.92 MCS in TLSO group and 44.93±3.73 PCS in surgery group vs 35.33±6.44 PCS in TLSO group, p<0.001), and 6 months (54.93±3.56 MCS in surgery group vs 49.99±5.82 MCS in TLSO group) post-diagnosis, no statistically significant differences were detected at the other time points (9 months post-diagnosis). EQ-5D index was significantly higher in surgery patients at 1 month (0.764±0.043 in surgery group vs 0.458±0.197 in TLSO group) and 3 months (0.890±0.116 in surgery group vs 0.688±0.142 in TLSO group); no statistically significant changes were observed in segmental kyphosis between the two groups. Conclusion. Posterior percutaneous spinal instrumentation is a safe, feasible, and effective procedure in relieving pain, preventing deformity and neurological compromise. Surgical stabilization was associated with faster recovery, lower pain scores, and improved quality of life compared with TLSO conservative treatment at 1 and 3 months after diagnosis

Background. In the United Kingdom (UK), the fastest growing population demographic is the over 85 years of age, but despite this, outcomes achieved in the octogenarian population with a Unicompartmental Knee Replacement (UKR) are underrepresented in the literature. The Elective Orthopaedic Centre, Epsom, has an established patient reported outcome measures (PROMs) programme into which all patients are routinely enrolled. We aim to investigate the outcome of medial UKR using the oxford phase 3 implant in octogenarians. Methods. We retrospectively reviewed our database for patients aged 60–89 years, who underwent a medial unicompartmental Knee Replacement (UKR) using the oxford phase 3 implant, between June 2007-December 2012 (N=395). The patients were stratified into 3 groups based on age, 60–69 (N=188), 70–79(N=149), and 80–89(N=58). Oxford Knee Scores (OKS), Euro-quol (EQ-5D) scores, revision rates, and mortality were compared. Results. We found that the octogenarian group achieved considerable improvement at 1 year with a mean OKS of 39.2 (+/−7.193) and EQ-5D score of 0.791(+/−0.241). And this improvement remained significant at 2 years. There was no difference in functional outcome when the 3 groups were compared. Revision rates for the 3 groups from youngest to oldest were, 8.5%, 4.5%, and 6.9% respectively. Odds ratio and survival analysis showed no significant difference between the groups. Conclusion. In conclusion, we found that octogenarians over a 2 year period achieved similar functional outcome as their younger counterparts. Level of Evidence. IV

Background. PROMS and PREMS are a fundamental and essential part of the NHS. Chilectomy and fusion procedures for hallux rigidus produce varied outcomes due to their subjective nature. PROMS2.0, a semi-automated web-based system, which allows collection and analysis of outcome data, to compare what PROMS/PREMS for chilectomy/fusion for hallux rigidus are at UHSM including variance across osteoarthritis grades. Methods. Data was collected from March-2013 to December-2014. Scores used to assess outcomes included EQ-5D-VAS, EQ-5D Health-Index, and MOxFQ, collected pre-operatively and post-operatively. Patient-Personal-Experience (PPE-15) was collected postoperatively. Data was compared. Results. 10 patients (4F, 6M) (9R, 1L) had a 1st MTPJ chilectomy. Average age- 47.3 (range 34–70). 16 patients (12F, 4M) (9RT, 7LT) had a 1st-MTPJ fusion. Average age-60.3yrs (range19–83). Chilectomy pre-op average MOXFQ scores for pain, walking and social interaction: 33.5 (range 5–70), 27.6 (range 0–64) and 24.9 (range 0–75) respectively. Post operatively these improved to 25.0 (range 0–70), 24.3 (range 0–68) and 21.9 (range 0–50). EQ5D scores showed a regression; pre-op index average of 0.72 and post op 0.70. Pre-op VAS score average of 86.8 with post-op 80.4. Fusion pre-op average MOXFQ scores for pain, walking and social interaction: 50.7 (range 25–75), 49.1 (range 4–75) and 48.4 (range 25–75) respectively. Post-operatively improved to 9.7 (range 0–57), 16.1 (range 0–57) and 20.1 (range 0–50). EQ5D scores showed improvement; with pre-op index average of 0.68 and post-op 0.83. Pre-op VAS score average of 72.5 and post-op 83.6. Higher grades of OA responded better to fusion and lower grades better to chilectomy. 17 patients (10 fusion/7 chilectomy) filled PPE-questionnaires. Results show overall satisfactory experience for both sets of patients. Conclusion. Both procedures show improved outcomes. Fusions have greater improvements than chilectomy based on reported outcomes. Higher grades of OA do better with fusion. Level of Evidence. Prospective case series- Level 3

Weber A fractures are a sub-group of ankle fractures parallel or distal to the joint line, below the level of the syndesmosis. Most stable Weber A fractures are managed conservatively with no significant difference in outcome vs. surgical intervention. 1,2. In an effort to ensure staff time was being used as efficiently as possible, a consultant-led virtual fracture clinic (VFC) was introduced to manage Weber A fractures. Patients not requiring immediate surgery were reviewed remotely and, wherever possible, were ‘virtually discharged’ to a nurse-led telephone line. Those with diagnostic uncertainty, unusual features or delayed recovery received a face to face review from a nurse or surgeon. To examine how patients were allocated under this protocol, along with overall patient satisfaction and functional outcome. An audit of satisfaction and outcome was performed of all patients who presented with a Weber A fracture to the ED between October 2011 and October 2012. The minimum follow-up period was two years. A satisfaction and patient reported outcome (5-level-likert-scale, EQ-5D, MOXFQ) measure was conducted via telephone. 3,4. After exclusions, 79 patients were left, of which 63 were successfully contacted (80%). Of the 79 patients included, 33 (42%) required early face-to-face review while 46 (58%) were discharged with advice following discussion at the VFC. Of the 63 successfully contacted, receipt of the information leaflet was recalled by 61 (97%) and 54 (86%) were satisfied with the information they had received. There was no difference in patient satisfaction regarding recovery (p=0.079) or treatment information (p=0.236) provided between avulsion and transverse fractures or in functional outcome according to MOXFQ (p=0.626) or EQ-Vas (p=0.915) scores. Patient satisfaction can remain high without face-to-face consultations following injury. This was demonstrated by the high satisfaction with recovery (83%) and with information provided (86%) and is consistent with current published literature and similar to what would have been achieved with traditional fracture clinic review. 5. The new protocol reduces unnecessary hospital attendances for patients and reduces the burden of unnecessary review in orthopaedic departments. Only 15% of patients required review at a traditional fracture clinic and 27% at a nurse-led clinic, freeing resources for more complex cases

The CCI mobile bearing ankle implant used at our orthopedic department 2010–2013, was abandoned due to failures and findings of bone loss at revision. The aim of this study was to a) Determine our true revision rate, b) Investigate accuracy of measuring prevalence, size and location of periprosthetic bone cysts through X-ray and CT and c) Relate these findings to implant alignment and patient reported outcome measurements (PROMs). 51 primary surgeries were performed, prior to this study 8 had been revised. Out of 43 un-revised patients, 36 were enrolled and underwent evaluation with metal artefact reduction CT-scans and conventional X-ray. They filled out 3 PROMs; SEFAS, SF-12, EQ-5D. Cyst volume larger than 0.1 ml was measured using VITREA volume tools for CT-scans and calculation of spherical volume for X-rays; using AP- and lateral projections. Location of lesions was recorded, according to their position relative to the implant. Medial-/lateral- and anterior-/posterior tilt of the implant parts was measured using IMPAX built in measuring tools, applied to AP- and lateral X-ray projection. The relation between lesions location and alignment of components was analyzed by logistic regression. Bias and ICC estimation between CT and X-ray was analyzed by mixed effect model. Log transformation was used to fit the normal distribution assumption. PROMs association to osteolytic volume was analyzed by linear- and logistic regression. P-values of 0.05 were considered statistically significant. Finding large osteolytic lesions caused 4 additional patients to undergo revision and 7 are being monitored due to high risk of failure. Of the original 51 implants 14 have been revised. 8 cases because of osteolytic lesions and aseptic loosening (true revisions w. exchange of components or bone transplants), 3 periprosthetic fractures (2 non-traumatic fractures) and 3 cases of exostosis. The 3- and 5 year revision rate was 14% and 16% for true revisions and 17% and 27% overall. Cystic lesions were found in 81% of participants. Total cyst-volume was on average 13% larger on X-ray, however this difference was not significant (p = 0.55), with intraclass correlation being 0.66. Total cystic volume was not significantly related to PROM-scores (P 0.16–0.5). Location of cysts showed association with alignment of components (P 0.02–0.08). Mean tibia component anterior tilt was 89 degrees (SD 4). Mean medial tilt was 91 degrees (SD 3) for the tibial and 90 degrees (SD 4) for the talar component. The implant investigated performs below standard, compared to public registries. 1, 2. that report overall 5 year revision rates at 5 – 6.5%. We obtained larger measurements from X-rays than CT, unlike previous studies comparing these modalities. Cysts were common and large. Correlation between lesion location and alignment of implant, with valgus and anterior tilt of components causing more lesions in adjacent zones, may suggest a link between implant failure and alignment of components

Background and objectives. Local bone-related adverse events occur more frequently following metal-on metal hip resurfacing (MOMHR) versus convention total hip arthroplasty (THA). High local tissue levels of cobalt and chromium may contribute to impaired bone health, however the systemic effects on bone of exposure to elevated metal levels after MOMHR are unknown. Methods. In this cross-sectional study we compared whole body bone mineral density (WB-BMD) and biochemical markers of bone turnover in 31 healthy male subjects at a mean of 8 years after MOMHR versus 31 individually age and time since surgery matched male subjects after conventional THA. All subjects had well-functioning prostheses and were in good self-reported health as assessed by Oxford Hip Score and EQ-5D questionnaire. WB-BMD was measured by dual energy x-ray absorptiometry and adjusted for pre-morbid osteoporosis risk factors using the FRAX tool, and for the presence of the metal prostheses using identical exclusion regions. Bone turnover markers were measured on fasting morning serum or 24hr urine collection by electro-chemiluminescent assay. Cobalt and chromium were measured by ICP-MS. Results. The subject pairs were similar for all matching criteria (P>0.05, all comparisons). Cobalt and chromium were elevated in the MOMHR versus THA group (P<0.05, all comparisons). WB-BMD was 7% higher in the MOMHR versus THA subjects (1.05 versus 0.98 g/cm2, P= 0.002). Bone formation, measured by serum osteocalcin, was 17% lower in the MOMHR versus THA subjects (18.2 versus 21.1ng/mL, P= 0.02) and osteoclast number measured by TRAP 5b, was 23% lower (3.4 versus 3.9U/L, P= 0.008). Systemic levels of bone formation and resorption markers were inversely correlated with systemic cobalt, but not chromium levels (Spearman, P<0.05). Conclusion. Subjects 8 years after MOMHR versus THA have higher WB-BMD and lower bone turnover measured by some markers, and marker activity inversely correlate to systemic cobalt levels. These data suggest that this metal has a systemic suppressive effect on bone turnover. The difference in BMD may be due to a reduction in age-related bone loss since surgery, although the measured BMD might also be due, in part, to diffuse metal deposition within the skeleton

This protocol describes a pragmatic multicentre randomised controlled trial (RCT) to assess the clinical and cost effectiveness of arthroscopic and open surgery in the management of rotator cuff tears. This trial began in 2007 and was modified in 2010, with the removal of a non-operative arm due to high rates of early crossover to surgery.

Cite this article: Bone Joint Res 2014;3:155–60.