Recent projections expect the number of revision knee replacements performed to grow from 38,000 in 2005 to 270,000 by the year 2030. 1. Although the results of primary total knee arthroplasty are well documented, with overall implant survivorship at 15 years greater than 95%. 2. the results of revision procedures are not as well known. What if the revision TKR fails and what is the prevalence of failure of revision TKRs, the complications and
Introduction:. Mayo 2A Olecranon fractures are traditionally managed with a tension band wire device (TBW) but locking plates may also be used to treat these injuries. Objectives:. To compare clinical outcomes and treatment cost between TBW and locking plate fixation in Mayo 2A fractures. Methods:. All olecranon fractures admitted 2008–2013 were identified (n=129). Patient notes and radiographs were studied. Outcomes were recorded with the QuickDASH (Disabilies of Arm, Shoulder and Hand) score. Incidence of infection, hardware irritation, non-union, fixation failure and
Abstract. Objectives. The outcomes from patella fracture have remained dissatisfactory despite advances in treatment, especially from operative fixation1. Frequently, reoperation is required following open reduction and internal fixation (ORIF) of the patella due to prominent hardware since the standard technique for patella ORIF is tension band wiring (TBW) which inevitably leaves a bulky knot and irritates soft tissue given the patella's superficial position2. We performed a systematic review to determine the optimal treatment of patella fractures in the poor host. Methods. Three databases (EMBASE/Medline, ProQuest and PubMed) and one register (Cochrane CENTRAL) were searched. 476 records were identified and duplicates removed. 88 records progressed to abstract screening and 73 were excluded. Following review of complete references, 8 studies were deemed eligible. Results. Complication rates were shown to be high in our systematic review. Over one-fifth of patients require
Introduction. Recurrent patellar dislocation is often reported in bilateral knees in young active individuals. The medial patellofemoral ligament (MPFL) tear is the attributable cause behind many of them and warrants reconstruction of the ligament to stabilize the patellofemoral joint. Besides, trochleoplasty and Fulkerson's osteotomy are some other procedures that are performed to treat this problem. This study aimed to compare the clinical and functional outcomes in a cohort of patients with single-stage bilateral realignment procedures vs staged procedures. Methods. It was a retrospective matched cohort study with prospectively collected data. A total of 36 patients (mean age-26.9 years, range 13 years to 47 years) with recurrent patellar dislocations, who underwent a surgical correction in both the knees, were divided into two matched groups (age, sex, follow-up, and type of procedure). Among them, 18 patients had surgeries in one knee done at least six months later than the other knee. The remaining 18 patients had surgical interventions for both knees done in a single stage. Lysholm, Kujala, Tegner, and subjective knee scores of both groups were compared and analyzed. The rate of complications and return to the theatre were noted in both groups. Results. With a mean follow-up of 7.3 years (2.0 years to 12.3 years), there was a significant improvement in PROMS observed in both the groups (p<0.05). No significant difference could be found between the two groups in terms of the Lysholm, Kujala, and subjective knee scores (p> 0.05). The rate of complication and the
Background. Focal resurfacing can treat localised articular damage of the knee not appropriate for arthroplasty or biological repair. Independent results on these implants are limited. We previously published early results showing significantly improved Knee Injury & Osteoarthritis Outcome Score (KOOS4) without complication or
We undertook a retrospective audit to assess quality of service provided by Nurse-Led Review Clinic at Glasgow Royal Infirmary for patients sustaining ankle fracture requiring surgical stabilisation. Nursing staff had received training from the senior author regarding clinical examination and radiograph interpretation. We retrospectively reviewed the clinical documentation and radiographs of 104 patients who attended from January 2009 to December 2009. Any clinical issues were identified and radiographs were scrutinised by two of the authors to assess accuracy of interpretation. Nurse-led management was then assessed as to its appropriateness. Finally two retrospective questionnaires were used to assess both the nurses and patients satisfaction with the clinic. Nurse-led clinic protocol: First appointment 10 days: Wound review, application of lightweight plaster. Second appointment 6 weeks: Removal of plaster, check radiographs. Final appointment 12 weeks: Clinical assessment, radiographs, discharge. Clinical assessment: ensure wound satisfactory, range of movement and weight-bearing are improving. Radiographic criteria: 6 weeks: Assess for talar shift, lucency or metal-work concerns. 12 weeks: Assess evidence of fracture union, infection, loosening or backing out. If any concerns with the patients' progress nursing staff would discuss with the consultant. First appointment: 7 wound problems. 5 managed by nurses and resolved. 2 discussed with surgeon, 1 settled, 1 required oral antibiotics. 3 radiographs discussed with surgeon. 2 conservative management. 1
Total ankle replacement (TAR) is increasingly used in the treatment of end-stage ankle arthropathy, but much debate exists about the clinical result. The goals of present study are: 1) to provide an overview of the clinical outcome of 58 TAR's in a single centre and 2) to assess the association between radiological characteristics and clinical outcome. We reviewed a prospective included cohort of 58 TAR's in 54 patients with a mean age of 66.9 (range 54–82) and a mean follow-up of 21.6 months (range 1.45–66.0). The TAR's where performed by a single surgeon in a single centre (MUMC) between 2010 and 2015, using the CCI ankle replacement. A standard surgical protocol and standardized post-op rehabilitation was used. Patients were followed-up pre-op and at 1 day, 6 weeks, 3–6–12 months and yearly thereafter post-op. The AOFAS and range of motion (ROM) were assessed and all complications, re-operations and the presence of pain were recorded. Radiographic assessment consisted of the estimation of prosthesis alignment, migration, translation and radiolucent lines using the Rippstein protocol (1). The clinical outcome was compared with a systematic review of TAR outcome. Ten intra-operative complications occurred and 9 were malleolar fractures. Post-operative complications occurred in 20 out of the 54 patients (37.0%). Impingement (5/54 patients), deep infection (4/54 patients), delayed wound healing (3/54 patients) and minor nerve injuries (3/54 patients) were the most frequently recorded. 18 patients (31.0%) underwent one or more re-operations and 12 of these 18 patients underwent a component revision (mostly the PE insert) or a conversion to arthrodesis. Despite the complications and revisions, the functional outcome improved. Radiologically 15.8% of the TAR's were positioned in varus and 1.8% in valgus. Migration in the frontal and sagittal plane is seen in 3 and 2 TAR's respectively. Radiolucency is significantly increasing with the follow-up time (p=0.009). Migration in the frontal plane is significantly associated with conversion to arthrodesis (p=0.005) and migration in the sagittal plane to revision of a component or conversion to arthrodesis (p=0.04). Finally, pain is significantly associated with re-operations (p=0.023) and complications (p=0.026). Remarkable is that the clinical outcome is independent of the direct post-op alignment of the TAR. The complication-,
The international literature base demonstrates that individuals living with diabetes mellitus (DM) are at increased risk of mortality and post-operative complications following hip fracture surgery (HFS) than non-diabetics. Studies investigating databases in American, European or Asiatic populations highlight the impact geography can have on the resultant investigation. We aim to quantify the impact DM has on HFS patients in a single university hospital. The HIPE dataset of fragility fractures occurring in Galway University Hospital from 2014–2016 were analysed and cross referenced with hospital laboratory and public databases. A database of 759 individuals was created including 515 females and 237 males, with a mean age of 78+/−12.2 years, of which 110 patients had DM. The patient length-of-stay (PLOS) was comparable in all groups with patient age being the primary influencing factor. An extended PLOS correlated with an increased long-term mortality. A trend toward increased occurrence of sub-trochanteric fractures was observed in diabetics with fewer periprosthetic and intertrochanteric fractures. Patients with DM had a significant increased risk of post-operative mortality compared to non-diabetics. Males with DM where at a greater risk of death after HFS [HR 2.29, 95% CI 1.26–4.17. p=0.006] than females with DM [HR 1.69, 95% CI 0.99–2.91. p=0.056]. The presence of DM did not directly impact a patient's PLOS or increase the need for a
Contrary to NICE guidance there remains a role for Austin-Moore hemiarthroplasty (AM) for patients with significant pre-existing comorbidities who are at higher risk of death and complications following cemented hemiarthroplasty. We analysed prospectively-collected data comparing uncemented AM hemiarthroplasty in frail, poorly-mobile patients, and cemented hemiarthroplasty. We analysed age, pre-operative morbidity, duration of operation, death rate and complication rate. AM patients were significantly older with significantly higher ASA grades. It took significantly longer to optimise them before surgery. AM was significantly shorter to perform. There was no significant difference in complications requiring
UKA with mobile bearing is a one of the treatment of medial osteoarthritis. However, some reports refer to the risk of dislocation of the mobile bearing. Past reports pointed out that medial gap might be enlarged in deep flexion position (over 120 degrees), and says that it will lead to instability of the mobile bearing. The purpose of this study is to research the risk factors of enlargement of medial gap in deep flexion position. We performed 81 UKAs with mobile bearing system from November 2013 to December 2015, and could evaluate 41 knees. This study of 41 knees included 9 males and 32 females, with average operation age of 75.4years(63–89years). The diagnosis was osteoarthritis in 39 knees and osteonecrosis in 2 knees. The UKA(Oxford partial knee microplasty, Biomet, Warsaw, IN) was used in all cases. We performed distal femur and proximal tibia osteotomy using CT-Free navigation system(Stryker Navigation System II/precision Knee Navigation ver4.0). And we inserted femoral and tibial trial component, then we placed an UKA tensioner on the medial component of the knee. Using tensioner under 30 lbs, we measured joint medial gap at 0,20,45,90,130(deep flexion) degrees. When we compared medial gap at 90 degrees position with at 130 degrees, we defined it as ‘instability group’ if there was gap enlargement more than 1mm, and defined it as ‘stability group’ if there wasn't. We compared this two groups with regard to age, BMI, femoro-tibial angle (FTA), the diameter of anterior cruciate ligament (ACL), tibial angle and tibial posterior slope angle of the implant. We evaluated preoperative and postoperative FTA by weightbearing long leg antero-posterior alignment view X-rays. We measured ACL diameter at its condyle level in coronal view of MRI. Also we evaluated tibial component implantation angle by postoperative CT using 3D template system. These measurement were analyzed statistically using t test. The stability group contained 26 knees, and the instability group contained 15 knees. Compared with the stability group, the instability group indicated higher FTA (p=0.001). Between 20 and 90 degrees flexion position, there was no change of medial gap. Dislocation of the mobile bearing is one of the complications of UKA and it will need
The surgical treatment options for patients who have sustained an intra-capsular hip fracture can vary depending on a number of patient and fracture related factors. Currently most national guidelines support the use of cemented prostheses for patient undergoing hemiarthroplasty surgery. Uncemented prostheses are commonly used for a variety of indications including those patients who have significant medical co-morbidities. To determine whether cemented hemiarthroplasty is associated with a higher post operative mortality when compared to uncemented procedures. Data were extracted from the Scottish SMR01 database from 01/04/1997 from all patients who were admitted to hospital after sustaining a hip fracture. We investigated mortality at day 1,2,4,7,30, 120 and 1 year from surgery vs. that on day 0. In order to control for the effects of confounding variables between patients cohorts, 12 case-mix variable were used to construct a multivariable logistic regression analysis model to determine the independent effect of prosthesis design. There were 52283 patients included in the study. Mortality for osteosynthesis of extra-capsular fractures was consistently lower when compared to that for surgical procedures for intra-capsular fractures. At day 0, uncemented hemiarthroplasty had a lower associated mortality (p<0.001) when compared to cemented implant designs. However, this increased mortality was equal to 1 extra death per 2000 procedures. From day 1 onward mortality for cemented procedures was equal to or lower than that of uncemented. By day 4, cumulative mortality was less for cemented than for uncemented procedures. Complication and
Background. The treatment of olecranon fractures frequently involves the use of tension band fixation. Although associated with high union rates, this method has a high incidence of morbidity associated with soft tissue compromise and limitation of range of movement requiring frequent
Rebound growth after hemiepiphysiodesis may be
a normal event, but little is known about its causes, incidence
or factors related to its intensity. The aim of this study was to
evaluate rebound growth under controlled experimental conditions. A total of 22 six-week-old rabbits underwent a medial proximal
tibial hemiepiphysiodesis using a two-hole plate and screws. Temporal
growth plate arrest was maintained for three weeks, and animals
were killed at intervals ranging between three days and three weeks
after removal of the device. The radiological angulation of the proximal
tibia was studied at weekly intervals during and after hemiepiphysiodesis.
A histological study of the retrieved proximal physis of the tibia
was performed. The mean angulation achieved at three weeks was 34.7° (standard
deviation ( In our rabbit model, rebound was an event of variable incidence
and intensity and, when present, did not appear immediately after
restoration of growth, but took some time to appear. Cite this article:
To review the systemic impact of smoking on bone healing as evidenced
within the orthopaedic literature. A protocol was established and studies were sourced from five
electronic databases. Screening, data abstraction and quality assessment
was conducted by two review authors. Prospective and retrospective
clinical studies were included. The primary outcome measures were
based on clinical and/or radiological indicators of bone healing.
This review specifically focused on non-spinal orthopaedic studies.Objectives
Methods
We used a goat model of a contaminated musculoskeletal defect to determine the effectiveness of rapidly-resorbing calcium-sulphate pellets containing amikacin to reduce the local bacterial count. Our findings showed that this treatment eradicated the bacteria quickly, performed as well as standard polymethylmethacrylate mixed with an antibiotic and had many advantages over the latter. The pellets were prepared before surgery and absorbed completely. They released all of the antibiotic and did not require a subsequent operation for their removal. Our study indicated that locally administered antibiotics reduced bacteria within the wound rapidly. This method of treatment may have an important role in decreasing the rate of infection in contaminated wounds.
External fixation of distal tibial fractures is often associated with delayed union. We have investigated whether union can be enhanced by using recombinant bone morphogenetic protein-7 (rhBMP-7). Osteoinduction with rhBMP-7 and bovine collagen was used in 20 patients with distal tibial fractures which had been treated by external fixation (BMP group). Healing of the fracture was compared with that of 20 matched patients in whom treatment was similar except that rhBMP-7 was not used. Significantly more fractures had healed by 16 (p = 0.039) and 20 weeks (p = 0.022) in the BMP group compared with the matched group. The mean time to union (p = 0.002), the duration of absence from work (p = 0.018) and the time for which external fixation was required (p = 0.037) were significantly shorter in the BMP group than in the matched group. Secondary intervention due to delayed healing was required in two patients in the BMP group and seven in the matched group. RhBMP-7 can enhance the union of distal tibial fractures treated by external fixation.