Historically avoidance of avascular necrosis (AVN) has been the primary objective in the management of an acute unstable slipped upper femoral epiphysis (SUFE). When achieved through pinning in situ it was invariably associated with significant malunion. With increasing appreciation of the consequences of femoroacetabular impingement, modern techniques aim to correct deformity and avoid AVN. Exactly what constitutes an acute unstable SUFE is a source of debate but should represent 5–10% of all cases. This audit reviewed cases over the past 25 years treated in one region. Of 89 patients with 113 slips, 21 hips were recorded as unstable. During this period the management has evolved from closed reduction and stabilization through pinning in situ, to open reduction. Radiographic outcomes following these three treatment methods were compared with record of any subsequent surgery in the form of osteotomy or total hip arthroplasty. Currently the lowest reported incidence of AVN in patients with an acute unstable slip is associated with the Parsch technique which combines open arthrotomy, digital reduction and screw fixation. Early outcomes with this technique are in accordance with those reported in the literature and represents a significant improvement in outcome when compared to earlier techniques used in the management of the severe unstable SUFE

Introduction. This study compares outcomes of vertebroplasty(VP) and kyphoplasty(KP) in 125 consecutive female Asian patients above 65 years with L1 osteoporotic vertebral compression fractures. Methods. 57 and 68 patients underwent VP and KP respectively from 2004 to 2008. Outcomes were measured prospectively at pre-operation, 1 month, 6 months and 2 years post-operation by blinded assessors. Radiographic outcome: Anterior, middle and posterior vertebral heights of the L1 vertebral body Functional outcome: Short-Form 36(SF-36) score, Visual Analogue Scale(VAS) score for back pain. Results. There was greater improvement of anterior and middle vertebral heights immediately post-surgery for the KP group as compared to the VP group(P<0.001). At 2 years post-surgery, the KP group had better maintenance of L1 vertebral body height with percentage loss of 16.4%, 17.3% and 8.84% of anterior, middle and posterior vertebral height respectively as compared to the VP group who had a greater loss of 29.2%, 42.3% and 17% respectively(p<0.001). Back pain improved post-operatively in both groups with no significant difference in VAS back pain score between the two groups at each follow-up time point(P>0.05). SF-36 score improved post-operatively in both groups (P=0.001). At 2 years post-surgery, the physical functioning domain of SF-36 was better in the KP group (P=0.01). Conclusion. KP provides better restoration and maintenance of anterior and middle vertebral heights with better physical function outcome”

Introduction. A recent review of the literature on metal-on-metal total hip arthroplasties (THA) revealed the lack of comparative clinical studies with a sufficient sample size and the inclusion of patient-reported outcomes as well as patient activity levels. Methods. We conducted a prospective cohort study including all metal-on-metal and conventional polyethylene (PE)-ceramic THAs with an uncemented cup (Morscher press-fit cup), a 28mm head and operated upon via a lateral approach at our University hospital between 1/1999 and 12/2008. Only THAs for primary osteoarthritis were included. The study population is part of the Geneva Hip Arthroplasty Registry, a prospective cohort followed since 1996. The following outcomes were compared between the two groups (metal-on-metal=group 1 vs. PE-ceramic bearing=group 2): (1) Complication rates with respect to infection, dislocation and revision, (2) Radiographic outcomes (presence of linear or focal femoral osteolysis, loosening), and (3) Clinical outcomes (Harris Hip score increase, SF-12, activity and patient satisfaction evaluation, presence of groin pain). Patients operated between 1/1999 and 12/2004 were evaluated five years postoperatively by an independent assessor. Cox regression analysis was used to compare incidence rates while adjusting for differences in baseline characteristics. Results. 1988 THAs were included, 544 with a metal-on-metal and 1444 with a PE-ceramic bearing. The two groups differed significantly with respect to gender distribution (men 56% vs. 41%), mean age (66 vs. 73 years), co-morbidities and type of stem (uncemented 16% vs. 2%). Crude incidence rates for complications were: 0.16 vs. 0.11 cases/100 person-years for infection; 0.37 vs. 0.35 cases/100 person-years for dislocation; and 0.29 vs. 0.16 cases/100 person-years for all-cause revision (incidence rate ratio 1.8, 95% CI 0.7; 4.6). After adjusting for baseline differences the slightly higher risks for infection and revision in group 1 were attenuated. Osteolytic lesions were found in 3.7% of metal-on-metal vs. 4.7% of PE-ceramic THAs. After adjustment for age, gender and activity the OR was 0.6 (95% CI 0.2;2.1). Five years postoperative, 176 THAs of group 1 and 695 THAs of group 2 were seen at follow-up. Clinical outcomes were similar among the two groups with a mean Harris Hip score increase of 39.2 vs. 40.9 points. SF-12 mental and physical health, patient satisfaction (9.3 vs. 8.9 on visual analogue scale) as well as the incidence of groin pain (1.7% vs. 1.2%) was also similar among the two groups. The activity level was significantly higher in group 1 (6.4 vs. 5.4, p<0.001). Conclusion. Mid-term results with respect to complications, revision rates, presence of osteolysis and clinical outcomes were similar among patients with metal-on-metal and PE-ceramic total hip arthroplasties

Introduction. We compared standard NexGen Cruciate substituting-flex prosthesis with gender-specific NexGen Cruciate substituting flex prosthesis in patients undergoing bilateral total knee arthroplasty with regard to Coverage of the bone by femoral component, Clinical outcome, Radiographic outcome, Survival and complication rates, with special emphasis on patellofemoral complications. Material & Methods. 30 female patients with osteo-arthritis of the knees with similar deformity and preoperative range of motion were randomized to have one knee replaced with a gender non-specific Nexgen Cruciate substituting (Zimmer) prosthesis and the other with Gender Cruciate substituting (Zimmer) prosthesis. Follow-up clinical evaluation was done at 6, and 12 months postoperatively and then at yearly interval using “Knee Society” Recommendations. Clinical assessment of the patellofemoral joint of the replaced knees was done with the help of “Hospital for Special Surgery” patellar scoring system. The overall patient satisfaction after surgery was evaluated with use of the British Orthopaedic Association patient satisfaction score. Results. The mean age was 63.8 years (range 49–76 years). 14 patients had standard NexGen Cruciate substituting-flex gender knee prosthesis on right side and 16 patients had on left side. On the other sides, standard NexGen Cruciate substituting-flex prosthesis implant was used. Preop Clinical findings were similar in both groups. The average Preop range of motion was identical in both the groups. The average follow up was 2.5 years (2–3.8 years). The mean post-operative Knee Society knee scores were 88,90,94, (70 to 100) and 87,92, 93 (70 to 100) points and the function scores were 83,85,88 (60 to 100) and 84.86.88 (60 to 100) points for the standard implants and the gender-specific designs, respectively at 6 months, 1 year and 2 year follow up. Mean improvement in patella score was 65, 71.1 and 73.3 points in Gender group at the end of 6 month, 1 yr and 2 yr respectively as compared to 65.6, 71.1 and 72.2 in Nexgen group. No patient had malpositioning of components or radiolucencies at the end of 2 year follow up. Mean improvement in BOA functional score was 20.6, 22.6 and 24.1 points in Gender group at the end of 6 months, 1 year and 2 year respectively as compared to 20.7, 21.8 and 23.2 in Nexgen group. In those with a standard prosthesis, the femoral component was closely matched in 30 knees, overhung in 17 and undercovered the bone in 13. In those with a gender-specific prosthesis, it was closely matched in 45 knees and undercovered the bone in 15. Conclusion. Although gender specific knee matched the femoral anatomy of Indian female knees better than the standard nexgen Knee, we found no significant differences between the two groups with regard to the clinical and radiological results, patient satisfaction or complication rate

Aims

The aim of this study was to compare the functional and radiological outcomes in patients with a displaced fracture of the hip who were treated with a cemented or a cementless femoral stem.

Aims

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.

Aims

The aim of this prospective randomised controlled trial was to compare non-operative and operative management for acute isolated displaced fractures of the olecranon in patients aged ≥ 75 years.