There remains much debate regarding the optimal method for surgical management of patients with long
Introduction. Assessment of the humeral
Some activities of daily living require that the
Introduction and Objective. There remains much debate regarding the optimal method for surgical management of patients with long
Recently in traumatology various methods of impregnation biodegradable implants and allografts with antibiotics are widely used. Among them the soaking, shaking and ionophores are common used. We aimed to choose the optimal method of impregnation with the antibiotic of the
Neck of femur fracture (NOF#) is the commonest reason for admission to an orthopaedic ward with 70-75,000 cases each year in the UK1. The femoral head is often sent to pathology if there is clinical suspicion of a malignant cause. There is limited evidence in the literature to support the efficacy of this2. The purpose of this project was to study the incidence of femoral head pathology analysis in NOF # patients with a background of malignancy and evaluate the impact this investigation has on guiding future management. Retrospective analysis of all neck of femur fractures admitted to the Queen Elizabeth University Hospital between 01/01/2021 and 31/12/2021. The electronic notes were accessed and for patients with past medical history of malignancy, it was confirmed whether femoral head or bone reamings were sent to pathology, resultant findings and the impact on subsequent management. In 2021, 784 patients were admitted to the QEUH with a NOF#. Of these, 770 (98.2%) underwent operative management, 138 (17.3%) of whom had a past medical history (PMH) of malignancy. Intra-operative pathology was sent from 19 (13.7%) of these 138 patients. No malignant cells were found in 13 (69%) samples, and in 6 (31%), the known active malignancy was confirmed. In all cases where samples were sent for pathology, none caused any change in management. In this retrospective study, pathological investigations in NOF# patients with a PMH of malignancy had no impact on further management. The authors would not advocate for sending pathology results in this cohort group.
Femoral head collapse due to avascular necrosis (AVN) is a relatively rare occurrence following intertrochanteric fractures; however, with over thirty-thousand intertrochanteric fractures per year in England and Wales alone, and an incidence of up to 1.16%, it is still significant. Often patients are treated with a hip fixation device, such as a sliding hip screw or X-Bolt. This study aimed to investigate the influence of three factors on the likelihood of
We have reviewed 70 patients with bilateral simultaneous total hip arthroplasties to determine the rate of failure and to compare polyethylene wear and osteolysis between an implant with a cobalt-chrome head and Hylamer liner with that of a zirconia
The poor outcome of large
There is continued concern over complication rates (20–30% of cases) in locked proximal humeral plating. The most common sequelae of this is screw penetration of the humeral
We undertook a study on eight arms from fresh cadavers to define the clinical usefulness of the lesser sigmoid notch as a landmark when reconstructing the length of the neck of the radius in replacement of the
This study compared the effect of a computer-assisted and a traditional surgical technique on the kinematics of the glenohumeral joint during passive abduction after hemiarthroplasty of the shoulder for the treatment of fractures. We used seven pairs of fresh-frozen cadaver shoulders to create simulated four-part fractures of the proximal humerus, which were then reconstructed with hemiarthroplasty and reattachment of the tuberosities. The specimens were randomised, so that one from each pair was repaired using the computer-assisted technique, whereas a traditional hemiarthroplasty without navigation was performed in the contralateral shoulder. Kinematic data were obtained using an electromagnetic tracking device. The traditional technique resulted in posterior and inferior translation of the humeral
Material loss at the head-stem taper junction may contribute to the high early failure rates of stemmed large
In vitro the introduction of microseparation and edge loading to hip simulator gait cycle has replicated clinically relevant wear rates and wear mechanisms in ceramic-on-ceramic bearings. [1]. , and elevated the wear rates of MoM surface replacements (SR) to levels similar to those observed in retrievals. [2]. The aim was to assess the wear of two different sized MoM total hip replacement bearings under steep cup inclination angles and adverse microseparation and edge loading conditions. Two tests were performed on the Leeds II hip joint simulator using two different size bearings (28mm and 36mm). Cups were mounted to provide inclination angles of 45 degrees (n=3) and 65 degrees (n=3). The first three million cycles were under standard gait conditions. Microseparation and edge loading conditions as described by Nevelos et al. [1]. were introduced to the gait cycle for the subsequent three million cycles. The lubricant was 25% new born calf serum. The mean wear rates and 95% confidence limits were determined and statistical analysis was performed using One Way ANOVA. Under standard gait conditions, when the cup inclination angle increased from 45 degrees to 65 degrees, the wear of size 28mm bearing significantly (p=0.004) increased by 2.7-fold, however, the larger bearings did not show any increase in wear (p=0.9). The introduction of microseparation conditions resulted in a significant (p=0.0001) increase in wear rates for both bearing sizes under both cup inclination angle conditions. Under microseparation conditions, the increase in cup inclination angle had no influence on the wear rate for both bearing sizes (Figure 1). With larger bearings, head-rim contact occurs at a steeper cup inclination angle providing an advantage over smaller bearings. The introduction of edge loading and microseparation conditions resulted in a significant increase in wear rates for both bearing sizes. The wear rates obtained in this study under combined increased cup inclination angle and microseparation were half of those obtained when SR MoM bearings were tested under similar adverse conditions. [2]. This study shows the importance of prosthesis design and accurate surgical positioning of the
It has been speculated that high wear at the head-stem taper may contribute to the high failure rates reported for stemmed large
The metal on metal implants was introduced without the proper stepwise introduction. The ASR resurfacing hip arthroplasty (RHA) withdrawn due to high clinical failure rates and the large diameter
The reintroduction of hip resurfacing has raised the possibility of whether it could offer a better outcome in sporting and work activity after surgery compared to total hip replacement. Questionnaires were analysed from 125 total hip replacement (THR) and 108 hip resurfacing (HR) patients regarding participation in sport in the year after their surgery and returning to work they were employed at prior to their surgery. The two groups had similar average age (61 vs 60) and pre-operative Oxford hip scores (41 vs 38). Seventy-one of one-hundred and twenty-five THR patients compared to 76/108 HR patients participated in sporting activity in the year after their surgery. When including only patients that played sport before their surgery 54/75 THR and 66/83 HR patients returned to same sporting activity level after their surgery. Of the patients that worked before surgery 35/44 THR patients compared to 70/74 HR patients returned work to after their surgery. There is significant difference quantity of patients participating in sporting activity after HR and THR (fishers exact test, p value=0.04). However there is no significant difference in quantity of patients returning to sporting activity after HR or THR including only patients that played sport before their surgery (fishers exact test, p value=0.35). There is a significant difference in the quantity of patients returning to work activity after HR and THR (fishers exact test, p value= 0.02). HR has a better outcome in patients participating in sport after surgery compared to THR however there is no benefit for patients that are active pre-operatively. More patients return to work after HR than THR.
Osteoporosis (OP) results in a reduction in the mechanical competence of the bone tissue of the sufferers. In skeletal sites such as the proximal femur and the vertebrae, OP manifests itself in low trauma fragility fractures which are debilitating for the patient. The relationships between the compressive strength of cancellous tissue and its apparent density are well established in studies of the past. Recently the authors have presented a method able to assess the fracture toughness properties of cancellous bone (1), a challenging cellular material which can exhibit large elasto-plastic deformations. The in-vitro measurement of fracture toughness alongside the customary compressive strength can provide a comprehensive assessment of the mechanical capacity of cancellous bone, which will reflect closer its ability to resist crack initiation. The aims of the present study were: (1) to examine whether the observed fracture toughness deterioration can also be detected by non-invasive quantitative ultrasound (QUS); and (2) to provide rational evidence for the well proven ability of QUS to predict directly ‘risk of fracture’. 20 femoral heads were obtained from donors undergoing emergency surgery for a fractured neck of femur. QUS investigations of the calcaneus, proximal phalanx and distal radius were undertaken within 72 hours of surgery. 128 fracture toughness samples and 20 compression cores were manufactured and tested. Two clinical QUS systems were used to obtain in-vivo scan data and then directly compared those to the density, porosity and the fracture mechanics of tissue extracted from the same individuals. The results demonstrated not only that there was a significant link between in-vivo determined QUS values for the calcaneus and finger to the density of the density of the femoral head; but that there was also a significant link between the QUS results from the calcaneus and the fracture toughness of the cancellous bone from the femoral head. These results point towards a systemic effect of osteoporosis which affects similarly different parts of the skeleton and supports the use of clinical QUS systems as a diagnostic tool for the prediction of fracture risk.
To create a comprehensive, user-friendly, database that facilitates selection of optimized animal models for fracture research. Preclinical testing using research animal models can expedite effective and safe interventions for clinical fracture patients but ethical considerations (e.g., adherence to 3R humane principles) and failure to meet critical review (e.g., clinical translation, reproducibility) currently complicate the model selection process. English language publications (1980-2021) were derived from PubMed® using the search-term ‘bone 4602 papers were derived from 677 journals from 177 publishers. Number of annual publications progressively increased from 18 (1980), peaking in 2015 (250) before substantially declining in 2020 (121) and 2021 (51). Descriptors (low to high) included 15 species (frog [1]–rat [1586]), 24 bones (phalanx [1]–femur [1646]), 134 research foci (bioprinting [4]–fracture healing [3533]), and 37 fracture models (avulsion [4]–diaphyseal [2113]). Percent of total publications scoring 1 or more stars for reproducibility, clinical translation and animal welfare ranged from: 1.0–5.8% (1 star), 5.9–30.6% (2 star), 21.3–42.8% (3 star), 19.2–44.4% (4 stars), and 1.3–26.7% (5 stars). FRAMD provides a dedicated resource that enhances selection of animal models that pertain to researchers’ fracture focus while being clinically relevant, reproducible and humane. FRAMD will help improve scientific data, reduce unnecessary use of animals, heighten workplace efficiency, and reduce cost by avoiding ill-suited or outdated models. FRAMD may particularly benefit grant writers and organizations seeking ‘best-practice’ assurance (e.g., funding agencies, academic research societies, CROs).
Abstract. Objectives. Total hip replacement (THR) is one of the most successful and cost-effective interventions in orthopaedic surgery. Dislocation is a debilitating complication of THR and managing an unstable THR constitutes a significant clinical challenge. Stability in THR is multifactorial and is influenced by surgical, patient and implant related factors. It is established that larger diameter femoral heads have a wider impingement-free range of movement and an increase in jump distance, both of which are relevant in reducing the risk of dislocation. However, they can generate higher frictional torque which has led to concerns related to increased wear and loosening. Furthermore, the potential for taper corrosion or trunnionosis is also a potential concern with larger femoral heads, particularly those made from cobalt-chrome. These concerns have meant there is hesitancy among surgeons to use larger sized