Surgical debridement for medial epicondylitis (ME) is indicated for patients with refractory ME. The clinical efficacy of simple debridement has not been studied sufficiently. Moreover, authors experienced surgical outcome of ME was not as good as lateral epicondylitis. In this regard, authors have combined the atelocollagen injection in the debridement surgery of ME. The purpose of study was to compare clinical outcomes between simple debridement and debridement combined with atelocollagen injection in the ME. Twenty-five patients with refractory ME and underwent surgical debridement were included in the study. Group A (n=13) was treated with isolated debridement surgery, and group B (n=12) was treated with debridement combined with 1.0 mL of type I atelocollagen. Pain and functional improvements were assessed using visual analogue scale, Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (DASH) scale respectively before surgery, at 3, 6 months after surgery and at the final follow-up. Demographic data did not show significant difference between two groups before surgical procedures. Both groups showed improvement in pain and functional score postoperatively. However, at the 3 months after surgery, group B showed significantly better improvement as compared to group A(VAS 3.1 / 2.0, MEPS 71/82 qDASH 29/23). At the 6 months after surgery and final follow-up, both groups did not show any difference. Surgical debridement combined with atelocollagen is effective treatment option in refractory ME and showed better short-term outcomes compared to isolated surgery

Introduction and Objective. Evidence in literature is contradicting regarding outcomes of total knee arthroplasty (TKA) in post-traumatic osteoarthritis (PTOA) and whether they are inferior to TKA in primary osteoarthritis (OA). The aim of this review was to find out if any difference exists in the results of TKA between the two indications. Materials and Methods. The electronic databases MEDLINE, EMBASE, The Cochrane Collaboration, and PubMed were searched and screened in duplicate for relevant studies. The selected studies were further subjected to quality assessment using the modified Coleman method. The primary outcome measure was patient reported outcome, and secondary outcome measures were infection, revision, stiffness, and patella tendon rupture. Results. A total of 18 studies involved 1129 patients with a mean age of 60.6 years (range 45.7–69) and follow up of 6.3 years. The time interval from index injury to TKA was 9.1 years. Knee Society Score (KSS) in PTOA reported in 12/18 studies showed functional improvement from 42.5 to 70 post-TKA exceeding minimally clinically important difference. In TKA for primary OA vs PTOA, deep peri-prosthetic joint infection (PJI) was reported in 1.9% vs 5.4% of patients, whilst revision of prosthesis at an average of 6 years post-operatively was performed in 2.6 vs 9.7% of patients. Conclusions. TKA is a successful treatment option for PTOA. However, the risk of significant complications like PJI and implant failure requiring revision is higher than primary OA cases. Patients should be counselled about those risks. Further well-designed comparative cohort-matched studies are needed to compare outcomes between the two populations

Introduction and Objective. An important subset of patients is dissatisfied after total joint arthroplasty (TJA) due to residual functional impairment. This study investigated the assessment of objectively measured step-up performance following TJA, to identify patients with poor functional improvement after surgery, and to predict residual functional impairment during early postoperative rehabilitation. Secondary, longitudinal changes of block step-up (BS) transfers were compared with functional changes of subjective patient reported outcome measures (PROMs) following TJA. Materials and Methods. Patients with end stage hip or knee osteoarthritis (n = 76, m/f = 44/32; mean age = 64.4 standard deviation 9.4 years) were measured preoperatively and 3 and 12 months postoperatively. PROMs were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscore. BS transfers were assessed by wearable-derived measures of time. In our cohort, subgroups were formed based on either 1) WOMAC function score or 2) BS performance, isolating the worst performing quartile (impaired) of each measure from the better performing others (non-impaired). Subgroup comparisons were performed with the Man-Whitney-U test and Wilcoxon Signed rank test resp. Responsiveness was calculated by the effect size, correlations with Pearson's correlation coefficient. A regression analysis was conducted to investigate predictors of poor functional outcome. Results. WOMAC function scores were strongly correlated to WOMAC pain scores (Pearson's r=0.67–0.84) and moderately correlated to BS performance (Pearson's r = 0.31–0.54). Prior to surgery, no significant differences for WOMAC function scores and BS performance were found between the impaired and non-impaired subgroups. One year after TJA, our cohort performed significantly better at WOMAC and BS with largest effect size for the non-impaired subgroups (0.62 and 0.43 resp.) At 12 months postop, 56% of patients allocated to the impaired subgroup defined by WOMAC, represented the impaired subgroup defined by BS. Allocation to the impaired subgroup at 3 months postop, raised the odds for belonging to the impaired subgroup at 12 months for WOMAC with an odds ratio=19.14 (67%) and for BS with an odds ratio=4.41 (42%). Conclusions. Assessment of BS performance following TJA reveals residual functional impairment that is not captured by pain-dominated PROMs. Its additional use may help to early identify those patients at risk for a poor outcome

Objectives. To explore the therapeutic potential of combining bone marrow-derived mesenchymal stem cells (BM-MSCs) and hydroxyapatite (HA) granules to treat nonunion of the long bone. Methods. Ten patients with an atrophic nonunion of a long bone fracture were selectively divided into two groups. Five subjects in the treatment group were treated with the combination of 15 million autologous BM-MSCs, 5g/cm. 3. (HA) granules and internal fixation. Control subjects were treated with iliac crest autograft, 5g/cm. 3. HA granules and internal fixation. The outcomes measured were post-operative pain (visual analogue scale), level of functionality (LEFS and DASH), and radiograph assessment. Results. Post-operative pain evaluation showed no significant differences between the two groups. The treatment group demonstrated faster initial radiographic and functional improvements. Statistically significant differences in functional scores were present during the first (p = 0.002), second (p = 0.005) and third (p = 0.01) month. Both groups achieved similar outcomes by the end of one-year follow-up. No immunologic or neoplastic side effects were reported. Conclusions. All cases of nonunion of a long bone presented in this study were successfully treated using autologous BM-MSCs. The combination of autologous BM-MSCs and HA granules is a safe method for treating nonunion. Patients treated with BM-MSCs had faster initial radiographic and functional improvements. By the end of 12 months, both groups had similar outcomes. Cite this article: H.D. Ismail, P. Phedy, E. Kholinne, Y. P. Djaja, Y. Kusnadi, M. Merlina, N. D. Yulisa. Mesenchymal stem cell implantation in atrophic nonunion of the long bones: A translational study. Bone Joint Res 2016;5:287–293. DOI: 10.1302/2046-3758.57.2000587

Surgical microfracture is considered a first line treatment for talar osteochondral defects. Pain reduction, functional improvement and patient satisfaction are described to be 61–86% in both primary and secondary osteochondral defects. However, limited research is available whether improvement of the surgical technique is possible. We do know that the current rigid awls and drills limit the access to all locations in human joints and increase the risk of heat necrosis of bone. Application of a flexible water jet instrument to drill the microfracture holes can improve the reachability of the defect without inducing thermal damage. The aim of this study is to determine whether water jet drilling is a safe alternative compared to conventional microfracture awls by studying potential side effects and perioperative complications, as well as the quality of cartilage repair tissue in a caprine model. 6 mm diameter talar chondral defects were created bilaterally in 6 goats (12 samples). One defect in each goat was treated with microfracture holes created with conventional awls. The contralateral defect was treated with holes created with 5 second water jet bursts at a pressure of 50 MPa. The pressure was generated with a custom-made setup using an air compressor connected to a 300 litre accumulator that powered an air driven high-pressure pump (P160 Resato, Roden, The Netherlands, . www.resato.com. ). Postoperative complications were recorded. After 24 weeks, analyses were performed using the ICRS macroscopic score and the modified O'Driscoll histological score. Wilcoxon ranked sum tests were used to assess significant differences between the two instrument groups using each goat as its own control (p ≤ 0.05). One postoperative complication was signs of a prolonged wound healing with swelling and reluctance to weight bearing starting two days after surgery on the water jet side. Antibiotics were administered which resolved the symptoms. The median total ICRS score for the tali treated with water jets was 9,5 (range: 6–12) and 9 (range 2–11) for Observer 1 and 2 respectively; and for the tali treated conventionally this was 9,5 (range 5–11) and 9 range (2–10). The median total Modified O'Driscoll score for the tali treated with water jets was 15 (range: 7–17) and 13 (range: 3–20) for Observer 1 and 2 respectively; and for the tali treated conventionally was 13 (range: 11–21) and 15 (range: 9–20). No differences were found in complication rate or repair tissue quality between the two techniques. The results suggest that water jet drilling can be a safe alternative for conventional microfracture treatment. Future research and development will include the design of an arthroscopic prototype of the water jet drill. The focus will be on stability in nozzle positioning and minimized sterile saline consumption to further the decrease the risk of soft tissue damage

Background. Focal resurfacing can treat localised articular damage of the knee not appropriate for arthroplasty or biological repair. Independent results on these implants are limited. We previously published early results showing significantly improved Knee Injury & Osteoarthritis Outcome Score (KOOS4) without complication or re-operation, demonstrating this system gives good analgesia and functional improvement in selected patients. We present long-term follow-up of these patients. Methods. We prospectively evaluated medium- to long-term results in patients with localised, full-thickness articular cartilage defects of the knee undergoing HemiCAP resurfacing. All procedures were performed by one consultant surgeon. Post-operative rehabilitation was standardised. Outcome measures were KOOS4 score, visual analogue score (VAS), Kellgren and Lawrence arthritis grade, and re-operation rates. Results. Six patients were evaluated with mean follow-up time of 74 months (range 61–96). Mean age was 44.8 years (range 33–51). One lateral and five medial compartments were resurfaced. Mean pre-operative KOOS4 was 39.1, mean 22-month follow-up KOOS4 improved significantly to 79.6, and mean latest follow-up KOOS4 remained good at 71.3. Mean VAS was 8.8 at latest follow-up. There was no loosening, migration or increase in osteoarthritis grade. One patient underwent revision to unicondylar knee replacement for pain after three years with comparable results at another centre (medial compartment, two year follow-up pre-revision KOOS4 84.6, latest follow-up post-revision KOOS4 73.6, VAS 6). Cause of pain was unclear (heel pain causing prolonged altered weight-bearing or failure of HemiCAP). Conclusion. Our results demonstrate that the use of the joint-preserving HemiCAP system provides good pain relief and functional improvement in both the short and longer-term. Few studies assess functional outcomes of focal resurfacing for localised full thickness articular cartilage defects. Our study assesses both the contemporaneous and time-dependent behaviour of focal resurfacing. We believe this is one of the longest follow-up series to date

Whilst home-based exercise rehabilitation plays a key role in determining patient outcomes following orthopaedic intervention (e.g. total knee replacement), it is very challenging for clinicians to objectively monitor patient progress, attribute functional improvement (or lack of) to adherence/non-adherence and ultimately prescribe personalised interventions. This research aimed to identify whether 4 knee rehabilitation exercises could be objectively distinguished from each other using lower body inertial measurement units (IMUs) and principle components analysis (PCA) in the hope to facilitate objective home monitoring of exercise rehabilitation. 5 healthy participants performed 4 repetitions of 4 exercises (knee flexion in sitting, knee extension, single leg step down and sit to stand) whilst wearing lower body IMU sensors (Xsens, Holland; sampling at 60 Hz). Anthropometric measurements and a static calibration were combined to create the biomechanical model, with 3D hip, knee and ankle angles computed using the Euler sequence ZXY. PCA was performed on time normalised (101 points) 3D joint angle data which reduced all joint angle waveforms into new uncorrelated PCs via an orthogonal transformation. Scatterplots of PC1 versus PC2 were used to visually inspect for clustering between the PC values for the 4 exercises. A one-way ANOVA was performed on the first 3 PC values for the 9 variables under analysis. Games-Howell post hoc tests identified variables that were significantly different between exercises. All exercises were clearly distinguishable using the PC scatterplot representing hip flexion-extension waveforms. ANOVA results revealed that PC1 for the knee flexion angle waveform was the only PC value statistically different across all exercises. Findings demonstrate clear potential to objectively distinguish between different knee rehabilitation exercises using IMU sensors and PCA. Flexion-extension angles at the hip and knee appear most suited for accurate separation, which will be further investigated on patient data and additional exercises

Summary Statement. Discovery system produced effective functional improvement in both primary and revision total elbow replacement. The incidence of major complications was in an acceptable range. Introduction. The search for the ideal elbow prosthesis continues as instability and loosening remain the prime reasons for total elbow replacement (TER) failure. The Discovery Elbow System (Biomet) is one of the latest generations of linked prosthesis and has been used in UK since 2003. We report outcome of TER using this system. Methods. A total of 100 TERs (75 primary, 25 revisions) were performed between 2003 and 2010. The main primary underlying pathologies for TER were advanced rheumatoid arthritis (N=58), osteoarthritis (N=35), acute fractures (N=7). There were 60 female and 40 male patients with an average age of 62 years. The outcome assessment included pain, patient satisfaction, Liverpool Elbow Score (LES), range of movement, and imaging during a mean follow-up period of 48.5 months. Major complications are also reported. Results. For the whole patient group (primary + revision), the LES was significantly (p<0.001) improved from 3.79+/−1.71 to 6.36+/−1.85There were significant improvements in elbow flexion from 100°+/−24 to 118°+17, supination from 38°+/−26 to 50°+/−25 and pronation from 48°+/−22 to 61°+/−21. Mean improvement in flexion-extension and pronation-supination arc was 20° and 25°, respectively. 64% of cases were completely pain-free and at the final follow-up (compared to 7% preoperatively). Only 6% of patients scored “Not Satisfied” at the final follow-up. LES improvement was significantly higher in the primary TER compared to revision TER (p<0.05). Imaging reviewed for 60 cases showed loosening in 4% of patients. Other main complications included deep infection (N=2), ulnar neuropathy (N=3), pre-prosthetic fracture (N=2), and prosthetic failure (N=1). Discussion. TER using the Discovery Elbow System is an effective arthroplasty in terms of functional improvement, pain relief and range of motion in both primary and revision patients. TER resulted in no/mild pain in 78% of cases. Patients undergoing Acclaim, Souter-Strathclyde, GSB III, and Coonrad-Morrey TER have been reported to have no/mild pain in 64%, 67%, 50–92% and 60–100% of cases, respectively. A 20° improvement in flexion-extension arc is comparable to that of Acclaim (23°), Souter-Strathclyde (15°), GSBIII (19–33°), and Coonrad-Morrey (17–26°) TER. An improvement of 25° in pronation-supination arc in our series is also comparable to that of 21–28° reported the Coonrad-Morrey and 27–33° for Discovery prostheses. An infection rate of 2% is lower than several other reports for GSB III TER (7–11%) and Coonrad-Morrey (6–8%). The incidence of persistent ulnar neuropathy (3%) was lower compared to GSBIII TER (11–14%), Coonrad-Morrey (12–26%), and Acclaim (8%)

Background. Assessment of functional outcome after total hip arthroplasty (THA) often involves subjective patient-reported outcome measures (PROMs) whereas analysis of gait allows more objective assessment. The aims of the study were to compare longitudinal changes of WOMAC function score and ambulatory gait analysis after THA, between patients with low and high self-reported levels of physical function. Methods. Patients undergoing primary THA (n=36; m/f=18/18; mean age=63.9; SD=9.8yrs; BMI=26.3 SD=3.5) were divided in a high and low function group, on their preoperative WOMAC function score. Patients were prospectively measured preoperatively and 3 and 12 months postoperatively. WOMAC function scores 0–100) were compared to inertial sensor based ambulatory gait analysis. Results. WOMAC function scores significantly improved in both low and high groups at 3 months postoperatively whereas gait parameters only improved in with a low pre-operative function. Between 3 and 12 months postoperatively, function scores had not significantly further improved whereas several gait parameters significantly improved in the low function group. WOMAC function scores parameters were only moderately correlated (Spearman's r = 0.33–0.51). Discussion. In routine longitudinal assessment of physical function following THA, ambulatory gait analysis can be supplementary to WOMAC. As gait significantly improved during the first 3 months and following 9 months after THA in patients with a low preoperative level of physical function only, assessment of more demanding tasks than gait may be more sensitive to capture functional improvement in patients with high preoperative function. Acknowledgements. This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (RP-PG-0407-10070). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The research team acknowledges the support of the NIHR, through the Comprehensive Clinical Research Network

The flat foot is a frequent deformity in children and results in various levels of functional alterations. A diagnosis based on foot morphology is not sufficient to define the therapeutic approach. In fact, the degree of severity of the deformity and the effects of treatments require careful functional assessment. In case of functional flatfoot, subtalar arthroereisis is the surgical treatment of choice. The aim of this study is to evaluate and compare the functional outcomes of two different bioabsorbable implants designed for subtalar arthroereisis in childhood severe flat foot by means of thorough gait analysis. Ten children (11.3 ± 1.6 yrs, 19.7 ± 2.8 BMI) were operated for flat foot correction [1,2] in both feet, one with the calcaneo-stop method, i.e. a screw implanted into the calcaneus, the other with an endoprosthesis implanted into the sinus-tarsi. Gait analysis was performed pre- and 24 month post-operatively using a 8-camera motion system (Vicon, UK) and a surface EMG system (Cometa, Italy) to detect muscular activation of the main lower limb muscles. A combination of established protocols, for lower limb [3] and multi-segment foot [4] kinematic analysis, was used to calculate joint rotations and moments during three level walking trials for each patient. At the foot, the tibio-talar, Chopart, Lisfranc, 1. st. metatarso-phalangeal joints were tracked in three-dimensions, together with the medial longitudinal arch. Significant differences in standard X-ray measurements were observed between pre- and post-op, but not between the two treatment groups. Analysis of the kinematic variables revealed functional improvements after surgery. In particular, a reduction of eversion between the shank and calcaneus (about 15° on average) and a reduction of inversion between metatarsus and calcaneus (about 18° on average) were detected between pre- and post-operatively after both treatments. Activation of the main plantar/dorsiflexor muscles was similar at both pre- and post-op assessments with both implants. The combined lower limb and multi-segment foot kinematic analyses were found adequate to provide accurate functional assessment of the feet and of the lower limbs. Both surgical treatments restored nearly normal kinematics of the foot and of the lower limb joints, associated also to a physiologic muscular activation

Spinal cord injury (SCI) is a devastating disorder for which the identification of exacerbating factors is urgently needed. Although age, blood pressure and infection are each considered to be prognostic factors in patients with SCI, exacerbating factors that are amenable to treatment remain to be elucidated. Microglial cells, the resident immune cell in the CNS, form the first line of defense after being stimulated by exposure to invading pathogens or tissue injury. Immediately after SCI, activated microglia enhance and propagate the subsequent inflammatory response by expressing cytokines, such as TNF-α, IL-6 and IL-1β. Recently, we demonstrated that the activation of microglia is associated with the neuropathological outcomes of SCI. Although the precise mechanisms of microglial activation remain elusive, several basic research studies have reported that hyperglycemia is involved in the activation of resident monocytic cells, including microglia. Because microglial activation is associated with secondary injury after SCI, we hypothesized that hyperglycemia may also influence the pathophysiology of SCI by altering microglial responses. The mice were anesthetized with pentobarbital (75 mg/kg i.p.) and were subjected to a contusion injury (70 kdyn) at the 10th thoracic level using an Infinite Horizons Impactor (Precision Systems Instrumentation). For flow cytometry, the samples were stained with the antibodiesand analyzed using a FACS Aria II flow cytometer and the FACSDiva software program (BD Biosciences). We retrospectively identified 528 SCI patients admitted to the Department of Orthopaedic Surgery at the Spinal Injuries Center (Fukuoka, Japan) between June 2005 and May 2011. The patients' data were obtained from their charts. We demonstrate that transient hyperglycemia during acute SCI is a detrimental factor that impairs functional improvement in mice and human patients after acute SCI. Under hyperglycemic conditions, both in vivo and in vitro, inflammation was enhanced through promotion of the nuclear translocation of the nuclear factor kB (NF-kB) transcription factor in microglial cells. During acute SCI, hyperglycemic mice exhibited progressive neural damage, with more severe motor deficits than those observed in normoglycemic mice. Consistent with the animal study findings, a Pearson χ2 analysis of data for 528 patients with SCI indicated that hyperglycemia on admission (glucose concentration ≥126 mg/dl) was a significant risk predictor of poor functional outcome. Moreover, a multiple linear regression analysis showed hyperglycemia at admission to be a powerful independent risk factor for a poor motor outcome, even after excluding patients with diabetes mellitus with chronic hyperglycemia (regression coefficient, −1.37; 95% confidence interval, −2.65 to −0.10; P < 0.05). Manipulating blood glucose during acute SCI in hyperglycemic mice rescued the exacerbation of pathophysiology and improved motor functional outcomes. Our findings suggest that hyperglycemia during acute SCI may be a useful prognostic factor with a negative impact on motor function, highlighting the importance of achieving tight glycemic control after central nervous system injury

Staged bilateral total knee arthroplasty is performed increasingly frequently but no data has been published comparing the specific outcome for the first knee replacement to that of the second. Pre-operative and post-operative Oxford Knee Scores (/ 48) were reviewed for each knee in a series of 91 patients undergoing staged bilateral total knee arthroplasty over a 5-year period. Pre-operative scores for the first total knee arthroplasty were significantly worse with a mean of 14.9 in comparison to 17.0 for the second knee (P=0.0083). While there was no significant difference between the mean post-operative scores for the first knee (37.4) and the second knee (36.6) (P=0.195), the mean improvement was significantly less for the second knee (22.6 points versus 19.6 points) (P=0.0045). Our results demonstrate that in patients undergoing staged bilateral knee arthroplasty, the second knee replacement is commonly performed at a lower threshold and functional improvement is less than for the first knee. This data will be important to inform the expectations of patients considering proceeding to bilateral knee arthroplasty after previously having undergone a primary total knee replacement

Repeat revision hip replacements can lead to severe bone loss necessitating salvage procedures such as proximal or total femoral replacement. We present medium term outcomes from our experience of the Limb Preservation System (LPS) in patients with failed revision hip arthroplasties. All patients undergoing proximal femoral or total femoral replacement from 2003–2007 at our unit were reviewed. Data was collected preoperatively and at annual assessment post procedure for a minimum of 5 years. This included clinical review, functional outcome scores (WOMAC, Oxford Hip Score, Harris Hip Score) and radiographic evaluation. A total of 17 patients underwent femoral replacement (13 proximal, 4 total) using the LPS during the study period. Within this cohort there were 13 males and 4 females with a mean age of 64 years (range 47–86). Median follow up was 7 years (range 5–9 years). Primary diagnoses were DDH (7), Primary OA (5), RA (2), proximal femoral fracture (2) and phocomelia (1). Five patients (29%) required further revision surgery for infection (2 patients) or recurrent dislocations (3 patients). No stems required revision due to aseptic loosening or stem failure at 5–9 years. Compared to preoperative assessment, there was significant improvement in median outcome scores at 5 years (WOMAC increased by 33 points, Oxford hip score by16 points and Harris hip score by 43 points). 82% of patients maintained functional independence at latest review. The Limb Preservation System offers a salvage procedure for failed revision total hip arthroplasty with significant symptom and functional improvement in most patients at medium term follow up

We undertook a retrospective cohort study to determine if body mass index (BMI) is an independent factor in determining patient outcome following total hip replacement (THR). Outcomes were determined using the Oxford Hip Score, a questionnaire designed to evaluate self-reported function and pain levels in people with hip pain. We looked at all THRs carried out on patients with a BMI of ≥30 over a 38 month period (220 operations) and compared these with 220 randomly selected THRs carried out on patients with a BMI of <30 within the same 38 month period. For each case we recorded patient BMI, P score and Oxford scores. We calculated the difference between pre-operative and one-year post-operative Oxford hip scores. We used Kendall's rank correlation to assess any potential correlation between BMI and functional change, and the Mann-Whitney U test to establish if functional change between the groups was statistically significant. Our study indicates that BMI is not an independent factor in determining relative subjective functional change following THR. Although it showed that patients with a BMI of ≥30 have worse function both before and after THR, there was no statistically significant difference between the two groups in terms of functional change. We therefore suggest that patients with a higher BMI be considered candidates for THR as they can expect the same degree of functional improvement. Given the trend for increasing numbers of obese patients in the population these findings could have a significant impact on the future of THR operations

Summary Statement. For RA patients undergoing TKR, the gain in function at 6 months following surgery is less than that experienced by OA patients; for THR, however, gains are similar in OA and RA patients. Introduction. Total joint replacement (TJR) is commonly used in rheumatoid arthritis (RA) patients and yet little information is available to quantify their functional gain following surgery and how it differs from what the osteoarthritis (OA) population experiences. Therefore, we examined 6-month functional outcomes of TJR in a population-based observational cohort of RA and OA patients who underwent total hip (THR) or knee (TKR) replacement. Methods. Patients undergoing primary TKR from 7/1/11 through 12/3/12 were identified from the FORCE-TJR national research consortium which enrolls patients from 111 surgeons across 27 states in the US. The registry gathers data from patients, surgeons and hospitals on patient demographics, underlying type of arthritis, operative joint severity based on the estimated Western Ontario and McMaster Universities Arthritis Index (WOMAC) using the Hip and Knee Disability and Osteoarthritis Outcome Scores, function based on the Short Form 36 Physical Component Score (PCS), and mental health using the SF-36 Mental Component Score (MCS). Descriptive statistics were performed. Results. There were 95 RA and 991 OA patients who underwent primary TKR, and 59 RA and 740 OA patients who underwent primary THR. Among TKR patients, RA patients are more likely to be women (68% vs. 61%), nonwhite (17% vs. 9%), unmarried (59% vs. 70%) with an annual income of ≤$45,000 (57% vs. 39%) as well as lower baseline emotional health (48 vs. 52) and functioning (31 vs 33). Among THR patients, RA patients are more likely to be nonwhite (18% vs. 8%), unmarried (66% vs. 69%) with an annual income of ≤$45,000 (54% vs. 34%) as well as lower baseline emotional health (46 vs. 51) and functioning (30 vs 32). RA patients undergoing TKR have less functional gain 6 months post-surgery (6.6 vs. 9.7; p=0.002) as compared to OA patients. In contrast, RA patients who undergo THR have similar functional gain (11.6 vs. 13.8; p=0.13) as compared to OA patients. Discussion/Conclusion. RA patients have less functional improvement as compared to those with OA when undergoing TKR but similar gains when undergoing THR

Articular cartilage implantation (ACI) and associated procedures (MACI = Matrix-assisted cartilage implantation) are now established treatments for osteochondral defects in the knee. The quality of repair in terms of histological appearance is frequently not known, whilst the correlation of histology results with functional outcomes remains undefined. Histological data of the quality of the repair tissue is sparse and a precise classification proved difficult. This was a single-centre, prospective study. Over 12 years (1998-2010) 406 patients that underwent articular cartilage implantation procedures at our institution (ACI = 170, MACI = 205) had biopsies taken at the 1-2 year interval, in order to assess whether these contained ‘hyaline-like’ cartilage, ‘mixed hyaline-like with fibrocartilage’, fibrocartilage or fibrous tissue alone. Histological sections of the biopsies were prepared and stained with haematoxylin, eosin and proteoglycan stains and viewed under polarised light. All biopsies were studied by a single histopathologist in a specialist, dedicated musculoskeletal laboratory. All patients were assessed by the Cincinnati, Bentley and Visual Analogue scores both pre-operatively and at the time of the review. The findings revealed that 56 patients healed with ‘hyaline-like’ cartilage (14.9%), 103 with ‘mixed’ (27.5%), 179 with fibrocartilage (47.7%) and 37 with fibrous tissue (9.9%). These findings showed that 42.4% of defects were filled with ‘hyaline-like’ or ‘mixed’ cartilage, with 70% of these achieving a ‘fair’ to ‘excellent’ functional outcome. This was also observed in the fibrocartilage group, where 72% achieved similar results. Predictably 89% of the patients that healed by fibrous tissue had a poor functional outcome. This study shows that 71% of patients whose osteochondral defects healed by either ‘hyaline-like’, ‘mixed’ or fibrocartilage experienced an improvement in the function. In contrast, only 11% of the patients whose defects filled with fibrous tissue, showed some functional improvement. Additionally, this data indicates the advantage of biopsies in assessing the overall results of cartilage implantation procedures

Objectives

The effects of disease progression and common tendinopathy treatments on the tissue characteristics of human rotator cuff tendons have not previously been evaluated in detail owing to a lack of suitable sampling techniques. This study evaluated the structural characteristics of torn human supraspinatus tendons across the full disease spectrum, and the short-term effects of subacromial corticosteroid injections (SCIs) and subacromial decompression (SAD) surgery on these structural characteristics.