Open reduction and internal fixation (ORIF) with trans-articular screws or dorsal plating is the standard surgical technique for displaced Lisfranc injuries. This aim of this study is to compare the clinical outcomes of percutaneous reduction and internal fixation (PRIF) of low energy Lisfranc injuries with a matched, control group of patients treated with ORIF. Over a seven-year period (2012–2019), 16 consecutive patients with a low energy Myerson B2-type injury were treated with PRIF. Patient demographics were recorded within a prospectively maintained database at the institution. This study sample was matched for age, sex and mechanism of injury to a control group of 16 patients with similar Myerson B2-type injuries treated with ORIF. Clinical outcome was compared using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Manchester Oxford Foot Questionnaire (MOXFQ). At a mean follow up of 43.0 months (95% CI 35.6 – 50.4), both the AOFAS and MOXFQ scores were significantly higher in the PRIF group compared to the control ORIF group (AOFAS 89.1vs 76.4, p=0.03; MOXFQ 10.0 vs 27.6, p=0.03). There were no immediate postoperative complications in either group. At final follow up, there was no radiological evidence of midfoot osteoarthritis in any patient in the PRIF group. Three patients in the ORIF group developed midfoot osteoarthritis, one of whom required midfoot fusion. PRIF is a technically simple, less invasive method of operative stabilisation of low energy Lisfranc injures which also appears to be associated with better mid-term clinical outcomes compared to ORIF.
The surgical treatment of unicompartmental knee osteoarthritis remains controversial. This study aims to compare the medium-term outcomes of age and gender matched patients treated with unicompartmental knee replacement (UKR) and total knee replacement (TKR). We retrospectively reviewed pain, function and total knee society scores (KSS) for every UKR and age and gender matched TKR in NHS Tayside, with up to 10 years prospective data from Tayside Arthroplasty Audit Group. KSS was compared at 1, 3 and 5 years. Medical complications and joint revision were identified. Kaplan-Meier with revision as end-point was used for implants survival analysis. 602 UKRs were implanted between 2001 and 2013. Preoperative KSS for pain and total scores were not significantly different between UKRs and TKRs whereas preoperative function score was significantly better for UKRs. Function scores remained significantly better in UKRs from preoperative until 3 years follow up. Further analysis revealed no statistically significant difference in the change of function scores in both groups over time. There was a trend for TKRs to perform better than UKRs in pain scores. Total KSS for both groups were not significantly different at any point of the 5-year study. Fewer medical complications were reported in the UKR group. Kaplan-Meier analysis showed a survival rate of 93.7% in UKRs and of 97% in TKRs (Log rank p-value = 0.012). The revision rate for UKR was twice as much as TKR. The theoretical advantages of UKR are not borne out by the findings in this study other than immediate postoperative complications.
Oxidized zirconium (OxZr) is used as a ceramic surface for femoral components in total knee arthroplasty (TKA). The aim of this study was to investigate its performance by examining retrieved femoral components and their corresponding PE inserts in matched comparison with conventional chrome/cobalt/molybdenum alloy (CrCoMo). 11 retrieved posterior stabilized (PS) TKA with an OxZr femoral component were included. From a cohort of 56 retrieved TKA with CrCoMo femoral components, pairs were matched according to duration of implantation, patient age, reason for revision, and BMI. The retrieved tibial polyethylene (PE) inserts were analyzed for wear using the Hood classification. Femoral components were optically viewed at 8–32x magnification and screened for scratching, pitting, delamination, and striation. Profilometry was performed to measure surface roughness of the OxZr components using a non-contact white light profiler.Introduction
Methods
The authors performed a short term prospective study of unicompartmental knee replacement (UKR) associated to patella-femoral arthroplasty (PFA) for the treatment of bicompartmental symptomatic knee arthritis. At the latest follow-up all the implants were matched to a similar computer assisted Total Knee Replacements (CAS-TKR) group implanted for the same indications. Hypothesis of the study was that this bicompartimental implants could achieve comparable outcomes to TKR with a more conservative surgery and a higher joint function. 19 cases of anteriomedial (12) or anterolateral (7) arthritis in 19 stable knees were prospectively involved in the study. All the knees underwent to a selective reconstruction using simultaneously both UKR and PFR using the same surgical technique. All bicompartmental implants were performed by the same surgeon. Surgical time, hospital staying and all intra and post operative complications were registered. At a minimum follow-up of 20 months, every single case was marched to a similar case where had been implanted a computer assisted cruciate retaining TKR. Criteria of matching were: sex, age, pre-operative range of motion and arthritis grade. In both the groups all the cases were assessed clinically using WOMAC, KKS and GIUM scores. All the knees were radiologically investigated using the same radiological protocol.Introduction
Materials and Methods
Total knee arthroplasty is an established and successful operation. In up to 10% of patients who undergo total knee arthroplasty continue to complain of pain [1]. Recently computerised tomography (CT) has been used to assess the rotational profile of both the tibial and femoral components in painful total knee arthroplasty. We reviewed 56 painful total knee replacements and compared these to 59 pain free total knee replacements. Datum gathered from case notes and radiographs using a prospective orthopaedic database to identify patients. The age, sex, preoperative Oxford score and BMI, postoperative Oxford score and treatments recorded. The CT information recorded was limb alignment, tibial component rotation, femoral component rotation and combined rotation.Introduction
Methods
Although tension band wiring fixation of patellar fracture has been the most widely used technique, the metal implants related complications including implant loosening, postoperative pain are very common and additional surgeries are often necessary. A totally metal free technique of transosseous suturing method could outperform the traditional fixation technique.Introduction
Hypothesis
To investigate health-related quality of life (HRQoL) of older adults (aged ≥ 60 years) after tibial plateau fracture (TPF) compared to preinjury and population matched values, and what aspects of treatment were most important to patients. We undertook a retrospective, case-control study of 67 patients at mean 3.5 years (SD 1.3; 1.3 to 6.1) after TPF (47 patients underwent fixation, and 20 nonoperative management). Patients completed EuroQol five-dimension three-level (EQ-5D-3L) questionnaire, Lower Limb Function Scale (LEFS), and Oxford Knee Scores (OKS) for current and recalled prefracture status. Propensity score matching for age, sex, and deprivation in a 1:5 ratio was performed using patient level data from the Health Survey for England to obtain a control group for HRQoL comparison. The primary outcome was the difference in actual (TPF cohort) and expected (matched control) EQ-5D-3L score after TPF.Aims
Methods
Prior cost-effectiveness analyses on osseointegrated prosthesis for transfemoral unilateral amputees have analyzed outcomes in non-USA countries using generic quality of life instruments, which may not be appropriate when evaluating disease-specific quality of life. These prior analyses have also focused only on patients who had failed a socket-based prosthesis. The aim of the current study is to use a disease-specific quality of life instrument, which can more accurately reflect a patient’s quality of life with this condition in order to evaluate cost-effectiveness, examining both treatment-naïve and socket refractory patients. Lifetime Markov models were developed evaluating active healthy middle-aged male amputees. Costs of the prostheses, associated complications, use/non-use, and annual costs of arthroplasty parts and service for both a socket and osseointegrated (OPRA) prosthesis were included. Effectiveness was evaluated using the questionnaire for persons with a transfemoral amputation (Q-TFA) until death. All costs and Q-TFA were discounted at 3% annually. Sensitivity analyses on those cost variables which affected a change in treatment (OPRA to socket, or socket to OPRA) were evaluated to determine threshold values. Incremental cost-effectiveness ratios (ICERs) were calculated.Aims
Methods
The primary aim of this study was to determine if delayed clavicular fixation results in a greater risk of operative complications and revision surgery. A retrospective case series was undertaken of all displaced clavicular fractures that underwent plate fixation over a ten-year period (2007 to 2017). Patient demographics, time to surgery, complications, and mode of failure were collected. Logistic regression was used to identify independent risk factors contributing towards operative complications. Receiver operating characteristic (ROC) curve analysis was used to determine if a potential ‘safe window’ exists from injury to delayed surgery. Propensity score matching was used to construct a case control study for comparison of risk.Aims
Patients and Methods
To evaluate the outcomes of cemented total hip arthroplasty (THA)
following a fracture of the acetabulum, with evaluation of risk
factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of
57 years (25 to 87) underwent cemented THA at a mean of 6.5 years
(0.1 to 25) following acetabular fracture. A total of 38 had undergone
surgical fixation and 11 had been treated non-operatively; 13 patients
died at a mean of 10.2 years after THA (0.6 to 19). Patients were
assessed pre-operatively, at one year and at final follow-up (mean
9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant
survivorship was assessed. An age and gender-matched cohort of THAs
performed for non-traumatic osteoarthritis (OA) or avascular necrosis
(AVN) (n = 98) were used to compare complications and patient-reported outcome
measures (PROMs).Aims
Patients and Methods
We evaluated the cost and consequences of proximal femoral fractures requiring further surgery because of complications. The data were collected prospectively in a standard manner from all patients with a proximal femoral fracture presenting to the trauma unit at the John Radcliffe Hospital over a five-year period. The total cost of treatment for each patient was calculated by separating it into its various components. The risk factors for the complications that arose, the location of their discharge and the mortality rates for these patients were compared to those of a matched control group. There were 2360 proximal femoral fractures in 2257 patients, of which 144 (6.1%) required further surgery. The mean cost of treatment in patients with complications was £18 709 (£2606.30 to £60.827.10), compared with £8610 (£918.54 to £45 601.30) for uncomplicated cases (p <
0.01), with a mean length of stay of 62.8 (44.5 to 79.3) and 32.7 (23.8 to 35.0) days, respectively. The probability of mortality after one month in these cases was significantly higher than in the control group, with a mean survival of 209 days, compared with 496 days for the controls. Patients with complications were statistically less likely to return to their own home (p <
0.01). Greater awareness and understanding are required to minimise the complications of proximal femoral fractures and consequently their cost.
