Aims. The aim of this study was to compare the clinical effectiveness of Kirschner wire (K-wire) fixation with locking-plate fixation for patients with a dorsally displaced fracture of the distal radius in the five years after injury. Patients and Methods. We report the five-year follow-up of a multicentre, two-arm, parallel-group randomized controlled trial. A total of 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation were recruited from 18 trauma centres in the United Kingdom. Patients were excluded if the surface of the wrist joint was so badly displaced it required open reduction. In all, 448 patients were randomized to receive either K-wire fixation or locking-plate fixation. In the K-wire group, there were 179 female and 38 male patients with a mean age of 59.1 years (19 to 89). In the locking-plate group, there were 194 female and 37 male patients with a mean age of 58.3 years (20 to 89). The primary outcome measure was the patient-rated wrist evaluation (PRWE). Secondary outcomes were health-related quality of life using the EuroQol five-dimension three-level (EQ-5D-3L) assessment, and further surgery related to the index fracture. Results. At 12 months, 402/448 participants (90%) recruited into the main study provided PRWE scores. At year two, 294 participants (66%) provided scores; at year five, 198 participants (44%) provided scores. There was no clinically relevant difference in the PRWE at any point during the five-year follow-up; at five years, the PRWE score was 8.3 (12.5) in the wire group and 11.3 (15.6) in the plate group (95% confidence interval -6.99 to 0.99; p = 0.139). Nor was there a clinically relevant difference in health-related quality of life. Only three participants had further surgery in the five years after their injury (one in the wire group and two in the plate group). Conclusion. This follow-up study continues to show no evidence of a difference in wrist pain, wrist function, or quality of life for patients treated with wires versus locking plates in the five years following a dorsally displaced fracture of the distal radius. Cite this article: Bone Joint J 2019;101-B:978–983

The Paprosky acetabular bone defect classification system and related algorithms for acetabular reconstruction cannot properly guide cementless acetabular reconstruction in the presence of porous metal augments.

We aimed to introduce a rim, points, and column (RPC)-oriented cementless acetabular reconstruction algorithm and its clinical and radiographic outcomes.

A total of 123 patients (128 hips) were enrolled. A minimum 5-year radiographic follow-up was available for 96 (75.8%) hips. The mean clinical and radiographic follow-up durations were 6.8±0.9 (range: 5.2–9.2) and 6.3±1.9 (range: 5.0–9.2) years, respectively.

Harris hip score (HHS) improved significantly from 35.39±9.91 preoperatively to 85.98±12.81 postoperatively (P<0.001). Among the fixation modes, 42 (32.8%) hips were reconstructed with rim fixation, 42 (32.8%) with three-point fixation without point reconstruction, 40 (31.3%) with three-point fixation combined with point reconstruction, and 4 (3.1%) with three-point fixation combined with pelvic distraction. Complementary medial wall reconstruction was performed in 20 (15.6%) patients. All acetabular components were radiographically stable. Nine-year cumulative Kaplan–Meier survival rates for 123 patients with the endpoint defined as periprosthetic joint infection, any reoperation, and dissatisfaction were 96.91% (confidence interval [CI]: 86.26%, 99.34%), 97.66% (CI: 92.91%, 99.24%), and 96.06% (CI: 86.4%, 98.89%), respectively.

Cup stability in cementless acetabular reconstruction depends on rim or three-point fixation. The continuity of the anterior and posterior columns determines whether the points provide adequate stability to the cup. Medial wall reconstruction is an important complementary fixation method for rim or three-point fixation. The patients who underwent cementless acetabular reconstruction guided by the RPC decision-making algorithm demonstrated satisfactory mid-term clinical function, satisfaction levels, radiographic results, and complication rates.

Introduction and Aims: Third generation alumina ceramic-on-ceramic bearings are being increasingly used in hip replacement surgery as an alternative to polyethylene because of the unacceptably high wear of polyethylene bearings and associated osteolysis leading to failure of hip replacement. Follow-up time with these modern ceramic bearings is still short. Method: We report the minimum five-year follow-up of our first 300 hip replacements with these bearings in 283 patients, done between June 1997 and February 1999. Three hundred ceramic-on-ceramic Osteonics Securfit or Securfit Plus stems were used with the Osteonics Securfit cup in all cases – these are cement-free and hydroxyapatite coated. The bearings were third generation alumina ceramic femoral heads and cup inserts manufactured by CeramTec. The average age was 58 years and there were 52% females. Osteoarthritis was the diagnosis in 93% and inflammatory arthritis in four percent. We used 92% 32mm bearings and eight percent 28mm bearings. Results: Mean Harris hip score improved from 56 pre-operatively to 94 at five years. Complications included: three non-fatal and no fatal pulmonary emboli, one deep and four superficial infections. There were four revisions for periprosthetic femoral fracture, one for cup malposition and one for sciatic nerve palsy in a patient with proximal focal femoral deficiency. There were a further four re-operations for psoas tendonitis where the psoas tendon was released. There were no re-operations for bearing failure and none of the ceramic components failed catastrophically, although a small number of acetabular inserts chipped around the rim during insert and were discarded. Of particular interest is the fact that there was no osteolysis seen in any of these hips, either around the acetabulum or around the femur. The usual small lytic areas noted around the calcar and the trochanteric regions of the femur that are commonly seen with polyethylene bearings were completely absent in this group. Three of the hips squeak intermittently with vigorous activity. Conclusion: Third generation ceramic-on-ceramic bearings have only been available for seven or eight years. Early results using these new bearings are encouraging, in that osteolysis to date has not been seen in this series. No hip in this series has been revised for failure of these ceramic implants. It will be a further five to 10 years before we can be certain how these newer bearings will perform in the long term, but the five-year results are encouraging

Introduction

Autologous Matrix Induced Chondrogenesis (AMIC) for surgical treatment of osteochondral lesions of the talus (OCLT) has shown excellent clinical and radiological results at short term follow up two years after surgery. However, no mid-term follow up data is available.

Background

Recent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiological outcomes. It remains unknown whether these clinical and radiological outcomes are maintained in the medium to long-term. The aim of this study was to investigate the five-year clinical and radiological outcomes following third-generation MIS hallux valgus surgery.

Introduction

We report the functional outcome and survivorship of the Hintegra Total Ankle Replacement (TAR), in consecutive cases by multiple surgeons in a single UK institution. Between 2010–2014 the Hintegra TAR held 7.1% UK market share and surgeons should be aware of failure mechanisms.

Fractures of the neck of femur are common in the older adult with significant morbidity and mortality rates. This patient cohort is associated with frailty and multiple complex medical and social needs requiring a multidisciplinary team to provide optimal care. The aim of this study was to assess the outcomes at 5 years following implementation of a collaborative service between the Orthopaedic and Geriatric departments of Southland Hospital in 2012.

Retrospective data was collected for patients aged 65 years and older who were admitted with a fragility hip fracture. Data was collated for 2011 (pre-implementation) and 2017 (post-implementation). Demographics and ASA scores were recorded. We assessed 30-day and 1-year mortality, surgical data, length of stay and complications.

There were 74 patient admissions in 2011 and 107 in 2017. Mean age at surgery was 84.2 years in 2011 and 82.6 years in 2017 (p>0.05). Between the 2011 and 2017 groups there has been a non-significant reduction in length of stay on the orthopaedic ward (9.8 days vs 7.5 days, p=0.138) but a significant reduction in length of stay on the rehabilitation ward (19.9 vs 9 days, p<0.001). There was a significant decrease in frequency of patients with a complication (71.6% vs 57%, p=0.045) and a marginal reduction in number of complications (p=0.057). Through logistic regression controlling for age, sex and ASA score, there was a reduction in the odds of having a complication by 12% between 2011 and 2017 (p<0.001). There was no difference in mortality between the groups.

The orthogeriatric model of care at Southland Hospital appears to have reduced both the frequency of complications and length of stay on the rehabilitation ward 5 years after its implementation. This is the first study in New Zealand demonstrating medium-term post-implementation follow-up of what is currently a nationally accepted standard model of care.

Our objective was to examine revision rates and patient reported outcome scores (PROMS) for cemented and uncemented primary total knee joint replacement (TKJR) at six months, one year and five years post-operatively. Patients and Methods: This matched cohort study involved secondary analyses of data collected as part of a large prospective observational study monitoring outcomes following knee replacement in Christchurch, New Zealand. Cemented and uncemented TKJR participants (n = 1526) were matched on age (± 5 years), sex and body mass index (BMI). From this larger sample, PROMS data, Oxford Knee Score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), out to five years post-operatively were analysed for a matched subset of participants (n = 252).

The average age of participants was 67.9 years (SD 9.4, range 38-94). There were no differences between cemented and uncemented cohorts on the basis of age, sex, BMI or comorbidities, revision rates or PROMS outcomes. Cemented procedures had greater skin to skin times than uncemented procedures (p < 0.01). Unadjusted outcomes comparing risk for revision across the two participant cohorts did not significantly differ. Overall rates for revision were low (cemented 3.2% v uncemented 2.7%, p=0.70). Propensity adjusted associations between baseline characteristics (age, sex, BMI, comorbidity, baseline Oxford and baseline WOMAC scores) also revealed no differences in risk for revision at any post-operative timepoint.

In this large multi-surgeon matched cohort study there were no significant differences in functional outcomes or revision rates, when outcomes following modern cemented and uncemented TKJR were compared out to 5-year follow up. Based on our findings, uncemented TKJR is predictable irrespective of patient's age, BMI or gender

Introduction

Cementless TKA offers the potential for strong fixation through biologic fixation technology as compared to cemented TKA where fixation is achieved through mechanical integration of the cement. Few mid-term results are available for newer cementless TKA designs that have used additive manufacturing (3-D printing) for component design. The purpose of this study is to present minimum 5-year clinical outcomes and implant survivorship of a specific cementless TKA using a novel 3-D printed tibial baseplate.

Introduction

Osseointegration has been established as a promising approach for the reconstruction of amputated limbs, particularly for amputees suffering from traditional socket prosthesis (TSP). While Osseointegration was originally developed with a screw fixation design, several Osseointegration devices adopting a modern press-fit design have also been introduced. In this study, medium-term outcomes for patients with the two most common press-fit osseointegration implant used worldwide are analysed.

Abstract

Aims

This study aimed to investigate the relationship between changes in patellar height and clinical outcomes at a mean follow-up of 7.7 years (5 to 10) after fixed-bearing posterior-stabilized total knee arthroplasty (PS-TKA).

Aims

The primary aim of this independent prospective randomised trial was to compare serum metal ion levels for ceramic-on-metal (CoM) and metal-on-metal (MoM) bearing surfaces in total hip arthroplasty (THA). Our one-year results demonstrated elevation in metal ion levels above baseline with no significant difference between the CoM and MoM groups. This paper reviews the five-year data.

Introduction

Unicompartmental knee arthroplasty is in particular promoted for knee OA patients with high demands on function and activity. This study used wearable inertial sensors to objectively assess function during specific motion tasks and to monitor activities of daily living to verify if UKA permits better function or more activity in particular with demanding tasks.

INTRODUCTION

Lumbar total disc replacement (TDR) is an alternative treatment to avoid fusion related adverse events, specifically adjacent segment disease. New generation of elastomeric non-articulating devices have been developed to more effectively replicate the shock absorption and flexural stiffness of native disc. This study reports 5 years clinical and radiographic outcomes, range of motion and position of the center of rotation after a viscoelastic TDR.

Osteolysis is one of a major cause of failure that affect long term survival rate in THA. Hard-on-hard bearing surface were developed to reduce wear and osteolysis, such as ceramic-on-ceramic which is the lowest wear rate was introduced but it still has squeaking and ceramic fracture. Metal-on-metal bearing surface significantly reduce wear rate but it still release metal ion which affect local tissue reaction. Then ceramic-on-metal is another choice of bearing with combine the advantage of reduce wear rate, metal ion release, no stripe wear, no squeaking and no ceramic fracture. However after clinical use ALTRs may occur and disturb the longevity of THA.

During January 2009 to December 2009 we performed 98 THR with the same femoral stem and acetabular cup with difference bearing which were 87 cases of metal on cross-linked PE, 8 cases of ceramic on metal and 5 cases of metal on metal. Routinely postoperative care were done with clinical evaluation, plain x-rays and Harris hip score. After 5 years follow up there are clinical problems in ceramic on metal THA with decrease clinical score and progressive osteolysis in radiographic finding in 2 cases then we investigated to find the cause of this problem and revise the components. We preformed magnetic resonance imaging and collect blood sample for ESR, CRP and Cobalt and Chromium level. We revised 2 cases of ceramic on metal THA, during surgery we collected tissue for bacterial and AFB and histopathology. All retrieval components were studied for wear pattern. First patient have thigh pain and progressive osteolysis after year 4^th of follow up. She had normal ESR and CRP with high level of cobalt and chromium level. We revised both components and tissue histopathology showed metallosis with chronic inflammation. Another patient had failure due to ALTRs with mixed solid-cystic mass at trochanteric bursa but component is stable then only bearing surface were change. Wear pattern at femoral head was in weight bearing area with corresponding to apical center wear of metal liner.

Our study showed that only in group of ceramic-on-metal THA that have 5 years follow up have early reoperation due to osteolysis and tissue reaction. We routinely stop to use this bearing since 2010. But we have small number of cases in our study to conclude that is bearing are not suitable for clinical usage.

Background

Operative fixation of acute tendo-achilles ruptures remains controversial. Standard surgical exposure is associated with and increased risk of wound breakdown and infections. The mini-open technique was developed to minimise these risks and provide anatomical reduction/apposition of the tendon rupture.

Introduction

Most metal-on-metal hip resurfacing implants currently being used worldwide utilize bone ingrowth fixation on the acetabular side, but cement fixation remains the standard method of fixation on the femoral side. Our hypothesis is that bone ingrowth fixation of a fully porous-coated component is superior to cement fixation of the femoral hip resurfacing component.

Introduction

Up to 15 % of patients report anterior knee pain (AKP) after a total knee arthroplasty (TKA). The correlation of radiographic patellar measurements and post-operative AKP remains controversial. The purpose of this study was to determine whether any radiographic measurements can predict anterior knee pain after TKA.

Introduction

One of the main considerations in the revision TKR setting is deciding on the level of constraint to be utilized once the bone defects have been reconstructed. There is a fear that employing a maximally constrained insert could compromise long term results. We report on a consecutive series of full tibial and femoral component revisions all treated with a maximally conforming insert and followed for a minimum of 5 years.