Background. Many patients undergo frame removal in the outpatient setting and nitrous oxide is frequently used, but has varying effects. The aim of the study was to ascertain whether
MOXIMED KineSpring® Knee Implant System is an Orthopaedic device designed for younger or highly active patients with osteoarthritis. The device is placed under the skin, is attached to the tibia and femur, and contains springs which help limit some of the forces that are transmitted through the knee during activities such as walking or running and thereby relieve pain that may be experienced by patients with early arthritis of the knee. The aim of this study is to determine the long term safety and efficacy of the KineSpring knee implant system. This is a prospective case series involving two centres in Glasgow. 29 patients (mean age of 45.1 years and range 18-65 years) were recruited into the study between 2011 and 2016. The Primary outcome measure was Oxford knee score (OKS) at 2, 5 and 10 years post-operatively. Secondary outcome measures include device related complications and survival, patient reported functional outcome measures, patient satisfaction,
Patient decision aids have previously demonstrated an improvement in the quality of the informed consent process. This study assessed the effectiveness of detailed written patient information, compared to standard verbal consent, in improving postoperative recall in adult orthopaedic trauma patients. This randomized controlled feasibility trial was conducted at two teaching hospitals within the South Eastern Sydney Local Health District. Adult patients (age ≥ 18 years) pending orthopaedic trauma surgery between March 2021 and September 2021 were recruited and randomized to detailed or standard methods of informed consent using a random sequence concealed in sealed, opaque envelopes. The detailed group received procedure-specific written information in addition to the standard verbal consent. The primary outcome was total recall, using a seven-point interview-administered recall questionnaire at 72 hours postoperatively. Points were awarded if the participant correctly recalled details of potential complications (maximum three points), implants used (maximum three points), and postoperative instructions (maximum one point). Secondary outcomes included the anxiety subscale of the Hospital and Anxiety Depression Scale (HADS-A) and visual analogue scale (VAS) for pain collected at 24 hours preoperatively and 72 hours postoperatively. Additionally, the Patient Satisfaction Questionnaire Short Form (PSQ-18) measured satisfaction at 72 hours postoperatively.Aims
Methods
Total Hip Arthroplasty (THA) is one of the most successful and cost-effective treatments available for painful hip arthritis. Unfortunately, dislocation following primary THA is one of the most common complications, occurring in approximately 0.50–10percnt; cases. However, there is little literature that investigates the effects that dislocation has on the patient's overall function and satisfaction. We reviewed 229 THA patients that had sustained dislocation from a prospective database, consisting 156 single dislocations and 73 with two or more. Patient outcomes were compared with a matched control group of 196 patients without dislocation in the same follow-up period. Harris Hip Score (HHS) and patient satisfaction were recorded pre-operatively and at one, five and ten years post-operatively. Mann-Whitney test compared HHS between control and dislocation groups, Chi-Square test compared patient satisfaction and implant survival. Total HHS and functional component were significantly lower in the dislocation group at one, five and ten years (p<0.05). HHS Pain component revealed a significant difference but only at one and three years (p<0.05). Patient satisfaction only showed a significant difference at one-year review. Dislocation rates were significantly higher in females. Implant survivorship was significantly lower in the dislocation group at 15-years. Hip-function and implant survival is significantly reduced following prosthesis dislocation, however patient satisfaction and
Background. Chronic acquired radial head dislocations pose a complex problem in terms of surgical decision making, especially if surgery has already previously failed. There are several underlying causes that should be investigated, including previous trauma resulting in a missed Monteggia fracture. Aim. To review the clinical and radiological outcomes for children up to 18 years of age, with a radial head dislocation treated with circular frame surgery. Method. A retrospective study was designed to identify patients from our departmental database who had undergone circular frame surgery to reduce the radial head during the past 6 years. Results. 20 patients were identified with a mean age of 11 years (3 – 17). Fourteen patients had a diagnosis of missed Monteggia fracture, three patients had Hereditary Multiple Exostoses, one had Nail Patella syndrome, one had Osteogenesis Imperfecta and one had rickets. The average delay between trauma and frame surgery was three years (0 – 7). All patients achieved union of their ulnar or radial osteotomy. The average frame duration was 167 days (61 – 325) and complications included delayed union and residual radial head subluxation. Thirteen patients achieved at least 40 degrees of supination, and 10 patients achieved at least 40 degrees of pronation. Eighteen patients achieved an arc of movement from full extension to at least 110 degrees of flexion. Eleven patients reported their
Introduction. Latissimus dorsi transfer is a procedure used in massive irreparable posterosuperior rotator cuff tears, in young patient with severe pain and significant functional impairment. The purpose of this retrospective study was to evaluate its clinical, radiological and electromyographic results. Methods. Forteen massive irreparable posterosuperior rotator cuff tears were performed with latissimus dorsi transfer between 2000 and 2008, and were reviewed at an average follow-up of 56 months and minimum of 19 months. Five transfers were primary reconstructions, and nine were revision surgeries. Patients’ mean age was 52.7 years. Clinical outcomes were measured by the Constant score,
Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired Aims
Methods
Background. The degree of postoperative pain is usually moderate to severe following Total Hip Arthroplasty (THA). Comfort and lack of pain are important for optimal mobilization and earlier home discharge. Aim. To evaluate the efficacy and safety of Ropivacaine, a long- acting local anaesthetic, when infiltrated in the wound at the end of operation of THA. Methods. Seventy patients, 39 women and 31 men, ASA I-III, underwent Total Hip Arthroplasty in our clinic from January 2008 to June 2009. Patients were randomized into two groups. In group A, a solution of 100 ml Ropivacaine 2mg/ml (Naropeine 0,2%) was infiltrated in the deep tissues (capsule, gluteus medius, gluteus maximus and rotators) (50 ml) while the fascia, subcutaneous tissues and skin were infiltrated with the remaining 50ml. Group B was the control group. All patients received standardized general anesthesia or spinal anesthesia and a PCA morphine using a self-administered pain pump was applied in the recovery room for 48 hours. All patients took 1gr x 3 Apotel i.v., 40mg x2 Dynastat i.v., and 4mg x2 Zofron i.v. for 48 hours postoperative. Pain scores with Visual Analogue Scale (0–10) at 1, 2, 4, 8, 12, 24 and 48 hours postoperatively, time to the first analgesic requirement and side effects were recorded. Results. There were no significant differences in demographic characteristics of the patients and duration of the surgery between two groups. Morphine consumption was statistically significantly lower in group A for the first 48 hours, resulting in a lower frequency of nausea, itching and sedation. Postoperative
Background. We compared pain relief after total hip arthroplasty using periarticular intraoperative injection along with single dose post operative injection of local anesthetic (THA) with the well-established practice of epidural infusion. Methods. 70 patients undergoing elective THA under combined spinal anaesthesia were randomly assigned to receive either (1) continuous epidural infusion (group B) or (2) infiltration around the hip joint with a mixture of 100 ml of bupivacaine (2 mg/ml) + 1ml ketorolac (30mg/ml) and 0.5ml epinephrine (1mg/ml) at the conclusion of surgery combined with one postoperative intraarticular injection of 20 ml. of Bupivacaine 0.5% + 1ml ketorolac (30mg/ml)+ 0.5 ml. epinephrine (1mg/ml) through an intraarticular catheter (group A). All patients received acetoaminophen 1gm 8 hourly for 72 hrs and injection ketoralac 30mg every 6 hourly IV(15mg if >65 yr 30mg if <65 yr). Breakthrough pain in any group (VAS >7) was treated by injection fentanyl 20 μg bolus at 10 min. interval till VAS reduced to < 4. If VAS 4–7 injection tramadol 50mg IV was given if VAS continued to be >4 after 15 min. then injection fentanyl 20 μg bolus was given at 10 min interval till VAS <4. Results. Narcotic consumption was significantly reduced in group A compared to group B (p=0.007).
The reported results of compression fractures are poor. These results are not influenced by the severity of compression, the fracture site or the residual deformity. Otherwise, the factors that determine a patient's recovery are unknown. This study wants to identify the factors determining a patient's recovery after surgical treatment of compression fractures of the thoracolumbar spine. Therefore, in 31 surgically treated patients the pre-injury versus the 12-month follow-up differences in back pain, in global outcome and in participation were prospectively recorded. For this, the visual analogue scale for pain (VAS scale) and the Greenough and Fraser low back outcome scale were used. Of the latter scale, the 3 questions pertaining to participation were combined to create a participation subscale. For these differences and for time lost from work multiple linear regressions with combinations of 16 possible predictors were performed. At one year patients who smoke report a 25% less favorable global outcome and return 2.8 points (out of 10) less closely to their pre-injury
Introduction. The main symptoms in multiple myeloma are the result of skeletal destruction mainly the vertebral column. The current treatments for multiple myeloma include radiotherapy and chemotherapy but unfortunately it is still incurable. However, the symptoms and quality of life of these patients can be improved by cement augmentation which has gained popularity in the recent years. Aim. To analyse the efficacy and safety of cement augmentation and to assess the survival and outcome of the patients with vertebral fractures secondary to multiple myeloma. Material and Methods. In this retrospective study, we reviewed the data over the last 3 years. Medical records review included correction of vertebral angle (VA), assessment of disability, survival and postoperative improvement in pain and functional status. Results. We reviewed 12 patients with 48 vertebral compression fractures including 9 male and 3 female patients. Mean age was 62.5 years (41–85). 5 patients had single vertebral involvement while 7 had multiple fractures at different levels in thoracolumbar spine. Average length of follow-up was 20.3 months (14–33 months). Based on Modified Tokuhashi score, the expected survival was less than 12 months in 2 patients and more than 12 months in the remaining patients. 11 patients are alive till date with average survival of 26 months (18–42 months) while 1 patient died, 23 months after the initial correction surgery. Prior to correction, the average vertebral angle (VA) was 10.60 (2.30 to 25.20) and after cement augmentation the average VA was 7.00 (1.60–22.80). Mean correction achieved was 3.60. There was no loss of vertebral height in any patient until their latest follow-up. Karnofsky performance score was more than 70 in 5 patients, 50–70 in 6 and less than 50 in 1 patient preoperatively while it improved to more than 70 in all patients postoperatively which indicates improvement in their functional status. All patients reported improvement in their
Distal radial fractures are the most common fracture sustained by the adult population. Most can be treated using cast immobilization without the need for surgery. The aim of this study was to assess the feasibility of a definitive trial comparing the commonly used fibreglass cast immobilization with an alternative product called Woodcast. Woodcast is a biodegradable casting material with theoretical benefits in terms of patient comfort as well as benefits to the environment. This was a multicentre, two-arm, open-label, parallel-group randomized controlled feasibility trial. Patients with a fracture of the distal radius aged 16 years and over were recruited from four centres in the UK and randomized (1:1) to receive a Woodcast or fibreglass cast. Data were collected on participant recruitment and retention, clinical efficacy, safety, and patient acceptability.Aims
Methods
Background. Balloon kyphoplasty (BKP) is a minimally invasive cementing procedure, occasionally used in patients with painful vertebral compression fractures (VCF). In this multicenter Swedish RCT, we evaluated the cost-effectiveness of BKP compared with standard medical treatment, Control, in osteoporotic patients with acute/sub-acute VCF (<3 months). In a multicenter European clinical study (FREE trial) including 300 patients and FU after one year, BKP was suggested to be a safe and effective procedure in selected patients. The current study includes the Swedish patients in the FREE trial Method: Hospitalized patients with a back
We identified 11 women with a mean age of 74 years (65 to 81) who sustained comminuted distal radial and ulnar fractures and were treated by volar plating and slight shortening of the radius combined with a primary Sauvé-Kapandji procedure. At a mean of 46 months (16 to 58), union of distal radial fractures and arthrodesis of the distal radioulnar joint was seen in all patients. The mean shortening of the radius was 12 mm (5 to 18) compared to the contralateral side. Flexion and extension of the wrist was a mean of 54° and 50°, respectively, and the mean pronation and supination of the forearm was 82° and 86°, respectively. The final mean disabilities of the arm, shoulder and hand score was 26 points. According to the Green and O’Brien rating system, eight patients had an excellent, two a good and one a fair result. The good clinical and radiological results, and the minor complications without the need for further operations related to late ulnar-sided wrist pain, justify this procedure in the elderly patient.