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Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 139 - 139
1 Feb 2003
O’Shea K McCarthy T Moore D Dowling F Fogarty E
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Neonatal septic arthritis is a true orthopaedic emergency posing significant threat to life and limb. Objective: To examine the clinical presentation, diagnosis, treatment and outcome of children presenting with septic arthritis in the neonatal period. Design: Retrospective review of clinical notes and radiographs of children presenting over a 20 year period (1977–97). Subjects: 34 patients with septic arthritis in a total of 36 joints. Outcome measures: Clinical outcome was classified as satisfactory or unsatisfactory as per Morrey et al. Radiological outcome was graded I–IV as per Choi et al. Joint instability, destruction, limb length discrepancy and angular deformity were assessed. Results: The hip joint was affected in 24 of the 34 cases. Pseudoparalysis was the most reliable clinical finding occurring in 29 out of 34 cases. Staph Aureus was isolated as the infecting pathogen in 22/34 patients. Sequelae occurred in 16 hips and 1 knee. Poor prognostic indicators were delayed diagnosis (p< 0.05) and the hip as site of infection (p< 0.01). Clinical outcome was unsatisfactory in 15 patients and satisfactory in 17 patients. Radiological outcome was Choi I or IIA (good) in 12 hips and Choi II to IV in 13 hips (poor). Multiple further reconstructive procedures were required in 15 cases. Conclusions: Despite optimum treatment, neonatal septic arthritis results in significant long-term morbidity for a high proportion of cases


Bone & Joint Open
Vol. 2, Issue 3 | Pages 191 - 197
1 Mar 2021
Kazarian GS Barrack RL Barrack TN Lawrie CM Nunley RM

Aims

The purpose of this study was to compare the radiological outcomes of manual versus robotic-assisted medial unicompartmental knee arthroplasty (UKA).

Methods

Postoperative radiological outcomes from 86 consecutive robotic-assisted UKAs (RAUKA group) from a single academic centre were retrospectively reviewed and compared to 253 manual UKAs (MUKA group) drawn from a prior study at our institution. Femoral coronal and sagittal angles (FCA, FSA), tibial coronal and sagittal angles (TCA, TSA), and implant overhang were radiologically measured to identify outliers.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 269 - 269
1 Jul 2008
LECUIRE F JALOUL K RUBINI J BASSO M BENAREAU I
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Purpose of the study: The Alpina unicompartimen-tal knee prosthesis (Biomet) is an anatomic prosthesis inserted with a femoral cut, a tibial base plate made of titanium and a flat modular polyethylene insert. Cemented and non-cemented versions are available with hydroxyapatite ceramic (HAC) coating. Material and methods: We retrospectively reviewed the radiological outcome at more than five years (fie to eight years follow-up) in a consecutive series of patients who had an Alpina HAC prosthesis with tibial fixation completed with a titanium screw. Clinical and radiological findings were recorded. Radiologically: pre- and postoperative angles, implant position, reliability of the instrument set. At last follow-up, we studied the presence of lucent lines, polyethylene wear easily measured on the flat insert, and bone remodeling around the tibial fixation screw. Results: At last follow-up (5 to 8 years), three patients were lost to follow-up and three had died. Radiological outcome was thus assessed for 44 implants (41 medial and 3 lateral). One patient required an early total knee prosthesis (diagnostic error). Three patients underwent revision at 5–7 years (for rupture of the polyethylene insert in two very active patients, and for significant polyethylene wear in the third). Two had a revision procedure for a partial knee prosthesis and the third for a total knee prosthesis. For the 40 other patients, the following observations were made: partial lucent line along the tibial polyethylene plate with no functional impact (n=1), polyethylene wear visible but measuring less than 1 mm (n=12), remodeling around the tibial fixation screw probably corresponding to a granuloma but not threatening the implant (n=10). Discussion: The clinical results of partial knee prostheses are well known. Mid-term radiographic results of non-cemented unicompartmental prostheses with a flat tibial plateau producing a minimal contact surface has shown: good reliability of the instrument set, excellent bony integration of the HAC-coated implants, but measurable polyethylene wear on more than one quarter of the prostheses, with two ruptures of the polyethylene insert at 5 and 6 years. Conclusion: A study currently under way will examine finished pieces on a simulator to study wear and failure as a function of several parameters: polyethylene thickness, lateral restraint with a metal rim, presence of a basal stem fixing the polyethylene on the metal base, importance of the femur-polyethylene surface contact


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_15 | Pages 10 - 10
7 Nov 2023
Arnolds D Marie-Hardy L Dunn R
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Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine, affecting 1–3% of the population.

Most cases are treated conservatively. Curves exceeding 45° in the thoracic spine and 40° in the lumbar spine may require correction and fusion surgery, to limit the progression of the curve and prevent restrictive pulmonary insufficiency (curves above 70°). When fusion is required, it may be performed either by posterior or anterior approaches. Posterior is useful for thoracic (Lenke I) curves, notably to correct the thoracic hypokyphosis frequently observed in AIS. Anterior approaches by thoraco-lombotomies allow an effective correction of thoraco-lumbar and lumbar curves (Lenke V and VI), with fewer levels fused than with posterior approaches. However, the approach requires diaphragm splitting and one may be concerned about the long-term pulmonary consequences. The literature provides conflicting insight regarding the consequences of the approach in anterior scoliosis correction, the interpretation of the results being difficult knowing that the correction of the scoliosis itself may improve pulmonary function.

This is a retrospective observational study done at a Tertiary Institution. The HRQOL scores have been collected as a prospective cohort. Clinical and radiographic data was collected from patients charts and analysed by two senior surgeons

A cohort of 64 patients were operated in the given time period. 50 patients met the inclusion criteria. No major complications were reported. The Union rate was 100% and no post operative complications were noted. Pre and post SRS scores improved in all patients.

The Anterior approach for Lenke V AIS gives great surgical exposure and allows for excellent correction of Cobb angle with minimal risk to the patient.


The Bone & Joint Journal
Vol. 105-B, Issue 9 | Pages 993 - 999
1 Sep 2023
van Delft EAK van Bruggen SGJ van Stralen KJ Bloemers FW Sosef NL Schep NWL Vermeulen J

Aims

There is no level I evidence dealing with the optimal period of immobilization for patients with a displaced distal radial fracture following closed reduction. A shorter period might lead to a better functional outcome due to less stiffness and pain. The aim of this study was to investigate whether this period could be safely reduced from six to four weeks.

Methods

This multicentre randomized controlled trial (RCT) included adult patients with a displaced distal radial fracture, who were randomized to be treated with immobilization in a cast for four or six weeks following closed reduction. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score after follow-up at one year. Secondary outcomes were the abbreviated version of the Disability of Arm, Shoulder and Hand (QuickDASH) score after one year, the functional outcome at six weeks, 12 weeks, and six months, range of motion (ROM), the level of pain after removal of the cast, and complications.


The Bone & Joint Journal
Vol. 105-B, Issue 1 | Pages 29 - 34
1 Jan 2023
Fransen BL Bengoa FJ Neufeld ME Sheridan GA Garbuz DS Howard LC

Aims

Several short- and mid-term studies have shown minimal liner wear of highly cross-linked polyethylene (HXLPE) in total hip arthroplasty (THA), but the safety of using thinner HXLPE liners to maximize femoral head size remains uncertain. The objective of this study was to analyze clinical survival and radiological wear rates of patients with HXLPE liners, a 36 mm femoral head, and a small acetabular component with a minimum of ten years’ follow-up.

Methods

We retrospectively identified 55 patients who underwent primary THA performed at a single centre, using HXLPE liners with 36 mm cobalt-chrome heads in acetabular components with an outer diameter of 52 mm or smaller. Patient demographic details, implant details, death, and all-cause revisions were recorded. Cox regression and Kaplan-Meier survival was used to determine all-cause and liner-specific revision. Of these 55 patients, 22 had a minimum radiological follow-up of seven years and were assessed radiologically for linear and volumetric wear.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 516 - 516
1 Oct 2010
Grabmeier G Berger C Engel A Newrkla S Seidl S
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Background: Patients with femoral head osteonecrosis usually tend to be younger and more active when compared with osteoarthritis patients. Second generation metal-on-metal THA was reintroduced to reduce poly-ethylene-induced wear debris, and therefore increase longevity of implants. The aim of this retrospective study was to compare full blood cobalt-chrome levels, patient activity, clinical/radiological outcome and implant survival in patients with osteonecrosis and osteoarthritis after a minimum follow up of 12 years. Methods: Full blood cobalt-chrome levels of a consecutive series of 125 patients, consisting of 40 patients (38 male, 2 female, average age 35 years, range 28 to 46 years) with osteonecrosis (ON group) and 85 patients (60 male, 25 female, average age 58 years, range 52 to 68 years) with osteoarthritis (OA group) as primary diagnosis were retrospectively compared. Patient activity level was assessed using UCLA Score and clinical outcome was evaluated using HHS. Radiological outcome and implant survival (Kaplan Meyer analysis) was determined in both groups. Results: Patients with osteonecrosis of the femoral head showed significant higher UCLA scores when compared to OA group (4 versus 7) (p < 0.05). Despite this higher patient activity no significant difference was found between cobalt-chrome full blood levels (2.1/1.6 μg/l, ON group, 1.9/1.8 μg/l OA group, respectively) (p > 0.05). No positive correlation between patient activity, acetabular cup abduction angle and cobalt-chrome levels was found (r. 2. < 0.01). Clinical and radiological outcome were equal in both groups. Harris hip score was 91 points in the OA and 92 in the ON group (p > 0.05). Average cup inclination angle was 47° (range 32° to 55°) and 44° (range 30° to 56°) respectively (p > 0.05). Implant survival at 12 years follow up was 96% in the OA and 97% in the ON group. Conclusion: After a minimum follow up of 12 years, we could not find increased metal levels in osteonecrosis patients when compared to the osteoartrithis group. Regarding our clinical and radiological outcome we cannot confirm previously published reports showing suboptimal results of THA in patients with osteonecrosis. Implant survival data did not differ among both group. Metal on metal THA seems to be an effective and safe treatment option for these patients


Aims

The primary aim of this study was to report the radiological outcomes of patients with a dorsally displaced distal radius fracture who were randomized to a moulded cast or surgical fixation with wires following manipulation and closed reduction of their fracture. The secondary aim was to correlate radiological outcomes with patient-reported outcome measures (PROMs) in the year following injury.

Methods

Participants were recruited as part of DRAFFT2, a UK multicentre clinical trial. Participants were aged 16 years or over with a dorsally displaced distal radius fracture, and were eligible for the trial if they needed a manipulation of their fracture, as recommended by their treating surgeon. Participants were randomly allocated on a 1:1 ratio to moulded cast or Kirschner wires after manipulation of the fracture in the operating theatre. Standard posteroanterior and lateral radiographs were performed in the radiology department of participating centres at the time of the patient’s initial assessment in the emergency department and six weeks postoperatively. Intraoperative fluoroscopic images taken at the time of fracture reduction were also assessed.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_3 | Pages 50 - 50
1 Jan 2016
Moo IH Pagkaliwagan EH Poon KB
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Interest in minimal-incision total knee arthroplasty (TKA) has increased in recent years. The advantages of minimally invasive techniques (MIS) used for TKA are faster functional recovery, shorter hospital stay and better early knee range of motion. It is known that the long-term outcome after TKA is related to component position and ligament balance. The smaller incision in MIS might be associated with increased risk of malalignment of components due to limited visualisation. Malalignment of implants in TKA has been associated with implant failure and poor long-term functional results. There is a lack of evidence in the literature that MIS can achieve the same results as the standard TKR approach in terms of component alignment precision. Seventy patients scheduled for a primary TKA were prospectively evaluated postoperatively with coronal and sagittal radiographic long limb films. Mini-midvastus approach was used for all TKA. There were no complications and the radiographic evaluation found no implant or limb malalignment, or signs of early loosening. We did not observe wound healing problems, fractures or implant notching. The mini-midvastus approach can reproduces the same accuracy in component positioning as the standard medial parapatellar approach. A precise operation technique and adequate visualisation of anatomical landmarks during implantation are the key points of success in mini-midvastus approach.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_15 | Pages 88 - 88
1 Dec 2015
Weerwag L Schreurs B Rijnen W
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Prosthetic joint infection (PJI) is a severe complication of prosthetic joint implantation, with an estimated incidence of 2.18%. Most frequently used treatment strategy for PJI is a two-stage revision procedure. However there are specific patients with a new or persisting infection after primary or revision surgery where further surgical treatment is not attractive. This may be because of medical or local surgical conditions, or patient's refusal to undergo (further) surgical therapy. For these patients suppressive antibiotic therapy (SAT) may be an alternative treatment.

The aim of this study is to describe the clinical and radiological outcome of patients with a PJI of a hip arthroplasty, treated with SAT.

Twenty-four patients with a hip arthroplasty treated with suppressive antibiotic therapy for PJI between January 1, 2008 and December 31, 2013 were included. All patients had a proven prosthetic joint infection, either by ≥2 intraoperative cultures or joint aspiration. SAT was defined as treatment with antibiotic therapy for more than three months. Most used antibiotics were doxycycline in 15 patients and cotrimoxazole in six patients.

Patients were supposed to have a successful outcome when their prosthesis remained in situ and they had no relapse or new infection.

Suppressive antibiotic therapy was considered successful in 15 (62.5%) patients with a mean follow-up of 20.6 months. Two patients (8.3%) had to stop the antibiotic therapy due to adverse effects.

The mean duration of the SAT was 20.4 months (range 0.92–92.65 months).

Mean modified Oxford hip score of the successfully treated patients at the latest follow up was 35 (range 16–49) and mean Harris hip score 71 (range 40–93). The mean visual analogue scale (VAS) was 16 (range 0–70) in rest, 32 (range 0–85) during exercise and 65 (range 10–100) for satisfaction.

Of the 9 patients with an unsuccessful outcome, there was a radiological loosening of the cup in 4 patients. In the group of 15 patients that were considered successful, 2 patients had a radiological loosening of the cup and one patient loosening of the stem.

Suppressive antibiotic therapy can be an attractive alternative treatment in selected patients with a prosthetic joint infection of a hip arthroplasty who cannot or will not undergo (further) surgical therapy.

Further research with a larger number of patients is required. Also the optimal dosage and duration of suppressive antibiotic therapy and possible resistance to the antibiotic therapy is unknown.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 593 - 593
1 Oct 2010
Dornacher D Nelitz M Reichel H
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Reduction therapy in developmental dysplasia of the hip (DDH) is initialized in the newborn period. Harness treatment is continued until normal ultrasound-values are reached. Above the age of one year the assessment of DDH relies mainly on interpretation of plain radiographs of the pelvis. In order to rule out residual dysplasia after ultrasound controlled treatment radiological control is advised to the time children start walking. The purpose of this study is to evaluate the early radiological outcome after ultrasound controlled treatment of DDH and to examine whether there is a correlation between the initial severitiy of DDH, measured by ultrasound, and the severity of residual DDH on the radiograph at the time of the first follow-up.

A. p. pelvic radiographs of 90 children (72 girls, 18 boys, 180 hips) with DDH (29 unilateral, 61 bilateral) were reviewed retrospectively. To the beginning of the ultrasound surveilled therapy (mean age 7,2 weeks) the morphologic findings were staged according to the Graf classification. Ultrasound surveilled abduction treatment was continued until normal ultrasound findings were reached. To the time children started walking (mean age 14,8 months) an a. p. radiograph of the pelvis was performed. The acetabular index (AI) was measured and classified according to the normal values of the hip joint described by Tönnis. The initial ultrasound findings expressed by the Graf classification were compared with the AI in the radiographic follow-up and Tönnis’ normal values.

To simplify matters the 180 Graf-classified hips were distributed into 4 categories: Graf Ia/b=category 1, Graf IIa-D=category 2, Graf IIIa/b=category 3, Graf IV=category 4. The initially normal contralateral hips in ultrasound (n=29, category 1) presented in 37,9% a normal AI, in 41,4% with a mild dysplasia (between 1SD and 2SD) and in 20,7% with a severe dysplasia (beyond 2SD). The Graf type IIa-D hips (n=81, category 2) presented in 37% a normal AI, 32,1% showed a mild dysplasia and 30,9% a severe dysplasia. The Graf type III a/b hips (n=60, category 3) showed 35%, 30% and 35%, Graf type IV hips (n=10, category 4) 60%, 30% and 10%, respectively.

The mean AI in all four categories differed only marginally.

In our setting of patients different conclusions can be drawn:

Even after successful ultrasound guided therapy with a sonographically normal hip at the time bracing is finished there is a risk for residual dysplasia. Therefore radiological follow-up of every once treated hip is necessary.

To reduce the number of radiographs the time for the first radiographic follow up may be delayed to the age of two. We only see a minimal risk to miss a dislocated hip in time. In very rare cases the indication for an acetabuloplasty is generally seen before the age of two, in our patient population we saw no immediate indication for surgery.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_VIII | Pages 14 - 14
1 Mar 2012
Zhao G Yamamoto T Ikemura S Motomura G Nakashima Y Mawatari T Iwamoto Y
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Introduction

Transtrochanteric curved varus osteotomy is one of the effective joint-preserving operations for osteonecrosis (ON) of the femoral head. We correlated various factors with the radiological outcome of this procedure.

Methods

We reviewed 74 hips in 63 patients who had a minimum follow-up of 5 years after transtrochanteric curved varus osteotomy for the treatment of ON. There were 28 men and 35 women who had a mean age of 33 years (range, 15 to 68 years) at the time of surgery. Clinical assessment was made based on the Harris hip score (HHS). Radiographically, we investigated various factors; affected lesion, stage and type (localization of the necrotic lesion) of ON, varus degree, post-operative intact ratio, progression of collapse, and joint-space narrowing. On the basis of postoperative radiographs, the hips were divided into 2 groups (Group I: either the progression of collapse or joint-space narrowing, Group II: neither progression of collapse or joint-space narrowing). The related factors with radiological outcome were analyzed by using multivariate analysis (Stepwise discriminant analysis).


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_II | Pages 146 - 146
1 Apr 2005
McAllen C Eyres K
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Study Aims The purpose of this study is to determine whether the cement mantle produced when a suction cement technique is used leads improved radiological results in the medium term.

Methods 74 patients who had a cemented total knee replacement were prospectively studied. In 51 patients the cement was applied in a standard fashion. In 23 patients an intraosseous cannula was used to apply suction within the bone to improve cement penetration. The cannula was inserted into the medial femoral condyle and the medial tibial plateau prior to the bone preparation to vent both bones. Suction is applied to help dry the cancellous surface and draw the cement into the bone.

The radiological appearance of the tibial components were prospectively examined to for the appearance of bone lysis.

Conclusion This study shows that this technique produces superior radiological appearances in the medium term, which may lead to longer implant survival.

A previously published study has shown that if total knee replacement is performed without a tourniquet but using the suction cement technique an excellent cement mantle can reliably be produced.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_I | Pages 81 - 81
1 Jan 2004
Moran M Soon YL Walmsley P Brenkel IJ
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Introduction: There is little published on the outcome of orthopaedic surgery performed by surgeons in training. The individual results of orthopaedic units and consultants are coming under increasing scrutiny. There may be concerns that trainee performed THR will negatively impact on these figures. This study compares the outcome of THR’s performed by consultants and supervised trainees.

Methods: Data was prospectively collected on 139 THR’s carried out by supervised specialist registrars (years 1 to 4) and 397 THR’s carried out by consultants. The Harris Hip Score (HHS) was used as the primary outcome measure and scores were taken at 7days pre-operatively, 6 and 18 months post-operatively. In addition data on co-morbidity, blood loss, transfusion requirements, re-operation, dislocation and death were recorded. Radiographs of 110 trainee and 110 consultant performed THR’s were compared at 6 months. Acetabular anteversion and abduction and femoral orientation were assessed on lateral and AP films. Cementation was judged using methods described by Hodgkinson and Barrack.

Results: Blood loss, transfusion requirement, dislocation, revision, deep infection and the HHS at 6 and 18 months showed no statistically significant difference between trainee and consultant (all p< 0.05). Component orientation and cementation quality again showed no significant difference (p< 0.05).

Discussion: This paper reveals no difference in the short term results of THR performed by consultants and supervised trainees. Our results show that quality can be maintained whilst training juniors to operate.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_4 | Pages 53 - 53
1 Feb 2017
Kawamoto T Iida S Suzuki C
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Background

Variability in component alignment continues to be a major in total knee arthroplasty(TKA). In the long term, coronal plane malalignment has been associated with an increased risk of loosening, insatability, and wear. Recently portable navigation system(PNS) in TKA have been introduced. The goal of PNS are to improve the accuracy of post operative alignment and eliminate outlier cases. The aim of this study is to evaluate clinical results and quantify the coronal plane alignment between a group of patients who underwent TKA using PNS versus CT-free large-console navigation system.

Patients and Method

An unselected consecutive series of ninety-four patients undergoing primary TKA using the cruciate retaining cemented total knee system between April 2012 and August 2015 were studied. Patients were included only if they were deemed to be candidates for a Cruciate retaining TKA. Patients were excluded if they had a flexion contracture greater than 40°, or severe valgus or varus deformity. Forty eight knees was operated a TKA with CT-free large-console navigation system(The OrthoPilot system; Aesculap, Tuttlingen, Germany). Subsequently forty six knees was received a TKA using portable navigation system (KneeAlign2TM). Postoperatively standing AP hip-to-ankle radiographs were obtained, from which the lower extremity mechanical axis, component angle were measured. The alignment goals were a neutral mechanical axis defined as a hip-to-ankle angle of 0°with the femoral and tibial components aligned perpendicular to the mechanical axis. The total operating time were quantified utilising an operating room database. The total operating time between TKAs performed with CT-free navigation system and those performed with portable navigation system was compared in each group. All patients postoperatively was evaluated of clinical results the Japan Orthopedics Association(JOA) Knee scores.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 390 - 390
1 Jul 2011
Ball S Windley J Harnett P Nathwani D
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Computer navigation has the potential to revolutionise orthopaedic surgery. It is widely accepted that component malalignment and malrotation leads to early failure in knee arthroplasty. We aimed to assess the use and reliability of computer navigation in both total (TKR) and unicompartmental (UKR) knee replacement surgery.

We analysed 40 consecutive UKRs and 40 consecutive TKRs. All procedures were carried out with the Brain-LAB navigation system and all were carried out by one consultant orthopaedic surgeon. Preoperative aim was neutral tibial cuts with 3 degrees posterior slope. Coronal and sagittal alignment of tibial components were measured on postoperative radiographs. Patients were also scored clinically with regards to function and pain.

In the TKR group, mean tibial coronal alignment was 0° (range 1 to −2.) Mean sagittal alignment was 2° posterior slope (range 0 to 4.) In the UKR group, mean tibial coronal alignment was 0.55° (range 0 to −3.) Mean sagittal alignment was 2.1° posterior slope (range 0 to 4°.) Clinical outcome scores were very satisfactory for the majority of patients, with far superior functional scores in the UKR group.

Our results demonstrate very accurate placement of the prosthesis in both the TKR and UKR group with computer navigation. There is a very narrow range with no outliers, (all within +/−3 degrees of desired alignment.) Functional outcome scores are good. We advocate the use of computer navigation in unicompartmental as well as total knee replacment surgery, in order to minimise early failures.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 123 - 123
1 May 2011
Salvo D Holzer N Lübbeke A Hoffmeyer P Assal M
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Introduction: An ankle fracture represents the most frequent osseous injury in both the elderly and non-elderly population. To date, only a limited number of retrospective studies have addressed medium-term outcome following ankle Open Reduction and Internal Fixation (ORIF). The purpose of this study was to assess residual pain and functional outcome 10 to 20 years after operative treatment of ankle fractures and to evaluate the incidence of symptomatic and radiographic ankle osteoarthritis (OA).

Methods: We designed a retrospective study including all consecutive patients who underwent ankle ORIF between January 1988 and December 1997 in a University Hospital setting. Pilon and talus fracture as well as pediatric patients were excluded. Patients were seen by two senior residents 10–20 years after their index surgery. Residual pain was measured using the Visual Analog pain Scale. Function and general health status were assessed using the Olerud and Molander Ankle Score, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and the 12-item short-form health survey (SF-12). Ankle OA on standard radiographs was scored according to the revised Kellgren and Lawrence (K& L) scale.

Results: 374 patients (56% men) underwent ankle surgery during the defined period. 10% of the patients had a Weber A fracture, 57% a Weber B and 33% a Weber C fracture. Mean age at the time of operation was 42.9 years (+/− 17.1; range 16–86 years). 10–20 years after surgery, 47 patients had died, 126 had left the country and were lost to follow-up, 99 did not respond or refused to participate, and 102 patients were seen at the follow-up visit. These patients did not differ in terms of age, gender distribution, BMI and type of fracture from those who were not seen. The mean duration of follow up was 17.3 years (+/− 3.3). Advanced radiographic OA (K& L grade 3 and 4) was present in 34.3 % of the patients. Symptomatic OA was reported by 34.3 % of the patients (AOFAS pain score < 40). Both clinically symptomatic and radiographic ankle OA was found in 18 patients (17.6%). Function was good in 85% of the cases (total AOFAS hindfoot score between 80 and 100 points; mean total AOFAS hindfoot score 89.9, +/−14.6). The mean Olerud and Molander ankle score was 86.5 (+/−18.7). The general health status (SF-12) was similar to representative values of the general population with a similar mean age.

Conclusion: 10–20 years after operative treatment of an ankle fracture, the incidence of advanced radiographic post-traumatic ankle OA was 35%, symptomatic OA was present in one third of the patients and about one fifth had both. The majority of the patients reported good function.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 28 - 28
1 Jan 2011
Khurana A Guha A Mohanty K Ahuja S
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Sacroiliac joint (SIJ) is a diarthrodial joint and can often be a source of chronic low back pain complex. We present a percutaneous technique for SIJ fusion and the functional and radiological outcome following arthrodesis with HMA (Hollow modular anchorage; Aesculap Ltd, Tuttlingen) screws.

Fifteen consecutive patients operated for SIJ fusion between Sep 2004 and Aug 2007 were included in the study. The diagnosis was confirmed with MRI and diagnostic injections. Pre-operative and post-operative functional evaluation was performed using SF-36 questionnaire and Majeed’s scoring system. Postoperative radiological evaluation was performed using plain radiographs. The HMA screws packed with bone substitute were implanted percutaneous under fluoroscopic guidance.

The study group included 11 females and 4 males with a mean age of 48.7 years. Mean follow-up was 14 months. Mean SF-36 scores improved from 37 to 80 for physical function and from 53 to 86 for general health. The differences were statistically significant (Wilcoxon signed rank test; p < 0.05). Majeed’s score improved from mean 37 preoperative to mean 79 postoperative. The difference was statistically significant (student t test, p< 0.05). 13 had good to excellent results. The remaining 2 patients had improvement in SF-36 from mean 29 to 48. Persisting pain was potentially due to coexisting lumbar pathology. Intra-operative blood was minimal and there were no post-operative or radiological complications.

Percutaneous HMA screws are a satisfactory way to achieve sacroiliac stabilisation.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 535 - 535
1 Oct 2010
Daniilidis K Fischer F Skuginna A Skwara A Tibesku C
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Aim: Cementation of tibial implants in total knee arthroplasty is a gold-standard considering the high loosening rates of cementless implants. In contrast, only sparse data exist regarding unicondylar arthroplasty due to limited use. In this study, we compare cemented with cementless unicondylar knee arthroplasty and aim to define both clinical and radiological differences in treatment outcome.

Materials and Methods: In a retrospective study, 106 patients who had undergone a medial unicondylar replacement were examined after a mean postoperative period of 8 years. Of these, 42 patients (median age 81±7 years) had received a cemented and 64 (median age 73±7 years) a cementless knee arthroplasty by the same surgeon while 7 patients were deceased or could not be reached. Well-established clinical (VAS, HSS, KSS, UCLA, WOMAC) and quality of life (SF-36) scores were used to evaluate treatment outcome. X-rays were performed to evaluate periprosthetic loosening zones, according to Ewald’s criteria.

Results: The cementless patient group presented significantly better clinical scores (HSS, KSS, UCLA, WOMAC), except in the Visual Analogue Scale (VAS) for pain assessment. The quality of life was significantly better in the cementless group except in the subgroups concerning physical function, vitality and social role, which resembled normal population. Moreover, radiographic analysis using antero-posterior X-rays revealed significantly more and larger periprosthetic loosening areas in tibial zone 2 in the cementless group.

Conclusion: The inferior clinical results characterising the cemented group could be attributed to the higher mean age. Regarding the radiological loosening zones, we did not detect any differences in the techniques of fixation, although physical activity and mechanical stresses were higher in the cementless group.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_19 | Pages 23 - 23
1 Apr 2013
Iqbal S Iqbal HJ Hyder N
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Introduction

The distal radius is the most frequently fractured bone in the forearm with an annual fracture incidence in the UK of about 9–37 in 10,000. Restoration of normal anatomy is an important factor that dictates the final functional outcome. A number of operative options are available, including Kirschner wiring, bridging or non-bridging external fixation and open reduction and internal fixation by means of dorsal, radial or volar plates. We designed this study to analyse the clinical and radiological outcome of distal radial fracture fixation using volar plating.

Materials/Methods

Thirty-seven patients with distal radius fractures undergoing open reduction and internal fixation using volar plates were included. Tilt of the fractured distal radial fragment was recorded from the initial radiograph and classification of fractures was done using the Orthopaedic Trauma Association system. The QuickDASH questionnaire was used for evaluation of symptomatic and functional outcome six months to one year after surgery. The radiological outcome was assessed using measurements of radial inclination, ulnar variance and volar tilt. Of the thirty-seven patients, 13 were male and 24 were female. The mean age was 55.6 years (range 18–87 years). According to the AO classification, there were 8 cases each of C2 and C3 fractures, 6 cases of C1 fractures and 3 cases each of class A2, A3, B1 and B3 fractures. There were 2 patients with class B2 fracture.