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.

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

Aims

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

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

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.

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

Pelvic discontinuity is a challenging acetabular defect without a consensus on surgical management. Cup-cage reconstruction is an increasingly used treatment strategy. The present study evaluated implant survival, clinical and radiological outcomes, and complications associated with the cup-cage construct.

Aims

This study aimed to assess the impact of using the metal-augmented glenoid baseplate (AGB) on improving clinical and radiological outcomes, as well as reducing complications, in patients with superior glenoid wear undergoing reverse shoulder arthroplasty (RSA).

Aims

Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions.

Aims

The aim of this study was to longitudinally compare the clinical and radiological outcomes of anatomical total shoulder arthroplasty (aTSA) up to long-term follow-up, when using cemented keel, cemented peg, and hybrid cage peg glenoid components and the same humeral system.

Aims

Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give rise to complications, such as nonunion, limited forearm pronation and supination, restricted elbow range of motion, radioulnar synostosis, and prolonged pain. Treatment options for this injury remain a topic of debate, with limited research available and no consensus on the optimal approach. Therefore, this trial aims to compare clinical, radiological, and functional outcomes of two treatment methods: open reduction and internal fixation (ORIF) versus nonoperative treatment in patients with isolated ulnar diaphyseal fractures.

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.

Aims

The aim of this study was to compare the clinical and radiological outcomes of patients with early-onset scoliosis (EOS), who had undergone spinal fusion after distraction-based spinal growth modulation using either traditional growing rods (TGRs) or magnetically controlled growing rods (MCGRs).

Aims

The aim of this study was to compare the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) using small and standard baseplates in Asian patients, and to investigate the impact of a mismatch in the sizes of the glenoid and the baseplate on the outcomes.

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.

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.

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.

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.

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.

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.