Background. We compared pain
Unicompartmental knee osteoarthritis can be treated with either Total Knee Arthroplasty (TKA) or Unicompartmental Knee Arthroplasty (UKA) and controversy remains as to which treatment is best. UKA has been reported to offer a variety of advantages, however many still see it as a temporary procedure with higher revision rates. We aimed to clarify the role of UKA and evaluate the long-term and revision outcomes. We retrospectively reviewed the pain, function and total Knee Society Score (KSS) for 602 UKA and 602 TKA in age and gender matched patients over ten years. The total pre-operative KSS scores were not significantly different between UKA and TKA (42.67 vs 40.54 P=0.021). KSS (pain) was significantly better in the TKA group (44.39 vs 41.38 P= 0.007) at one year and at five years post-operatively (45.33 vs 43.12 P=0.004). There was no statistically significant difference for KSS (total) in TKA and UKA during the study period. 16.3% of UKA and 20.1% of TKA had a documented complication. 79 UKA (13%) and 36 TKA (6%) required revision surgery. Despite the higher revision rate, pre-operative KSS (total) before revision was not significantly different between UKA and TKA (42.94 vs 42.43 P=0.84). Performance for UKAs was inferior to TKAs in Kaplan-Meier cumulative survival analysis at 10 years (P<0.001). Both UKA and TKA are viable treatment options for unicompartmental knee osteoarthritis, each with their own merits. UKA is associated with fewer complications whereas TKA provides better initial pain
Aims. The aim of this study was to explore the patients’ experience
of recovery from open fracture of the lower limb in acute care. Patients and Methods. A purposeful sample of 20 participants with a mean age of 40
years (20 to 82) (16 males, four females) were interviewed a mean
of 12 days (five to 35) after their first surgical intervention took
place between July 2012 and July 2013 in two National Health Service
(NHS) trusts in England, United Kingdom. The qualitative interviews
drew on phenomenology and analysis identified codes, which were
drawn together into categories and themes. Results. The findings identify the vulnerability of the patients expressed
through three themes; being emotionally fragile, being injured and
living with injury. The participants felt a closeness to death and
continued uncertainty regarding loss of their limb. They experienced strong
emotions while also trying to contain their emotions for the benefit
of others. Their sense of self changed as they became a person with
visible wounds, needed intimate help, and endured pain. When ready,
they imagined what it would be like to live with injury. Conclusion. Recovery activities require an increased focus on emotional wellbeing.
Surgeons are aware of the need for clinical expertise and for adequate
pain
Fracture-related infections (FRIs) are a devastating complication of fracture management. However, the impact of FRIs on mental health remains understudied. The aim of this study was a longitudinal evaluation of patients’ psychological state, and expectations for recovery comparing patients with recurrent FRI to those with primary FRI. A prospective longitudinal study was conducted at a level 1 trauma centre from January 2020 to December 2022. In total, 56 patients treated for FRI were enrolled. The ICD-10 symptom rating (ISR) and an expectation questionnaire were assessed at five timepoints: preoperatively, one month postoperatively, and at three, six, and 12 months.Aims
Methods
The aim of this study was to explore current use of the Global Fragility Fracture Network (FFN) Minimum Common Dataset (MCD) within established national hip fracture registries, and to propose a revised MCD to enable international benchmarking for hip fracture care. We compared all ten established national hip fracture registries: England, Wales, and Northern Ireland; Scotland; Australia and New Zealand; Republic of Ireland; Germany; the Netherlands; Sweden; Norway; Denmark; and Spain. We tabulated all questions included in each registry, and cross-referenced them against the 32 questions of the MCD dataset. Having identified those questions consistently used in the majority of national audits, and which additional fields were used less commonly, we then used consensus methods to establish a revised MCD.Aims
Methods
BACKGROUND. As life expectancy in the population rises, osteoporotic fractures are seen most frequently in the vertebral column. Percutaneous kyphoplasty is increasingly used for pain reduction and stabilization in these patients, but the efficacy, cost-effectiveness, and safety of the procedure remain uncertain. OBJECTIVE. To clarify whether kyphoplasty has additional value compared with optimum pain treatment in patients with acute vertebral fractures. MATERIALS & METHODS. From January 2004 to June 2009, 122 patients (31 males and 91 females), from 56 to 85 years old (mean age 68.5) were treated for 165 osteoporotic vertebral fractures of the thoracic or lumbar spine (minimum 15% height loss; level of fracture at Th5 or lower; bone oedema on MRI), with back pain for 6 weeks or less, and a visual analogue scale (VAS) score of 5 or more. Twelve patients (15 fractures) were lost at follow-up period and excluded. Patients were randomly allocated to percutaneous kyphoplasty (75 patients) or conservative treatment by computer-generated randomization codes. All fractures were analyzed for improvement in sagittal alignment (Cobb angle, kyphotic angle, sagittal index, vertebral height); and pain
The study objective was to prospectively assess clinical outcomes for a pilot cohort of tibial shaft fractures treated with a new tibial nailing system that produces controlled axial interfragmentary micromotion. The hypothesis was that axial micromotion enhances fracture healing compared to static interlocking. Patients were treated in a single level I trauma centre over a 2.5-year period. Group allocation was not randomized; both the micromotion nail and standard-of-care static locking nails (control group) were commercially available and selected at the discretion of the treating surgeons. Injury risk levels were quantified using the Nonunion Risk Determination (NURD) score. Radiological healing was assessed until 24 weeks or clinical union. Low-dose CT scans were acquired at 12 weeks and virtual mechanical testing was performed to objectively assess structural bone healing.Aims
Methods
Minimally invasive fixation of pelvic fragility fractures is recommended to reduce pain and allow early mobilization. The purpose of this study was to evaluate the outcome of two different stabilization techniques in bilateral fragility fractures of the sacrum (BFFS). A non-randomized, prospective study was carried out in a level 1 trauma centre. BFFS in 61 patients (mean age 80 years (SD 10); four male, 57 female) were treated surgically with bisegmental transsacral stablization (BTS; n = 41) versus spinopelvic fixation (SP; n = 20). Postoperative full weightbearing was allowed. The outcome was evaluated at two timepoints: discharge from inpatient treatment (TP1; Fitbit tracking, Zebris stance analysis), and ≥ six months (TP2; Fitbit tracking, Zebris analysis, based on modified Oswestry Disability Index (ODI), Majeed Score (MS), and the 12-Item Short Form Survey 12 (SF-12). Fracture healing was assessed by CT. The primary outcome parameter of functional recovery was the per-day step count; the secondary parameter was the subjective outcome assessed by questionnaires.Aims
Methods
Patients receiving cemented hemiarthroplasties after hip fracture have a significant risk of deep surgical site infection (SSI). Standard UK practice to minimize the risk of SSI includes the use of antibiotic-loaded bone cement with no consensus regarding type, dose, or antibiotic content of the cement. This is the protocol for a randomized clinical trial to investigate the clinical and cost-effectiveness of high dose dual antibiotic-loaded cement in comparison to low dose single antibiotic-loaded cement in patients 60 years and over receiving a cemented hemiarthroplasty for an intracapsular hip fracture. The WHiTE 8 Copal Or Palacos Antibiotic Loaded bone cement trial (WHiTE 8 COPAL) is a multicentre, multi-surgeon, parallel, two-arm, randomized clinical trial. The pragmatic study will be embedded in the World Hip Trauma Evaluation (WHiTE) (ISRCTN 63982700). Participants, including those that lack capacity, will be allocated on a 1:1 basis stratified by recruitment centre to either a low dose single antibiotic-loaded bone cement or a high dose dual antibiotic-loaded bone cement. The primary analysis will compare the differences in deep SSI rate as defined by the Centers for Disease Control and Prevention within 90 days of surgery via medical record review and patient self-reported questionnaires. Secondary outcomes include UK Core Outcome Set for hip fractures, complications, rate of antibiotic prescription, resistance patterns of deep SSI, and resource use (more specifically, cost-effectiveness) up to four months post-randomization. A minimum of 4,920 patients will be recruited to obtain 90% power to detect an absolute difference of 1.5% in the rate of deep SSI at 90 days for the expected 3% deep SSI rate in the control group.Aims
Methods
Fracture-dislocations of the tarsometatarsal (Lisfranc) joints are frequently overlooked or misdiagnosed at initial presentation. This is a comparative cohort study over a period of five years comparing primary open reduction and internal fixation in 22 patients (23 feet) with secondary corrective arthrodesis in 22 patients (22 feet) who presented with painful malunion at a mean of 22 months (1.5 to 45) after injury. In the first group primary treatment by open reduction and internal fixation for eight weeks with Kirschner-wires or screws was undertaken, in the second group treatment was by secondary corrective arthrodesis. There was one deep infection in the first group. In the delayed group there was one complete and one partial nonunion. In each group 20 patients were available for follow-up at a mean of 36 months (24 to 89) after operation. The mean American Orthopaedic Foot and Ankle Society midfoot score was 81.4 (62 to 100) after primary treatment and 71.8 (35 to 88) after corrective arthrodesis (t-test; p = 0.031). We conclude that primary treatment by open reduction and internal fixation of tarsometatarsal fracture-dislocations leads to improved functional results, earlier return to work and greater patient satisfaction than secondary corrective arthrodesis, which remains a useful salvage procedure providing significant
There is a paucity of published literature regarding the long-term outcomes of the modern generations of total joint arthroplasty (TJA) of the first metatarsophalangeal joint. Between 1999 and 2001, we recruited 63 patients into a randomised controlled trial of arthrodesis vs TJA. The 2 year results were published in 2005. At a mean follow-up 15.2 years (range 13.2–17.2), all patients from the original trial were contacted. Data were collected in the form of visual analogue score for pain (VAS), visual-Analogue-Scale Foot and Ankle (VAS FA) as well as information on any revision procedures. Data were available from all surviving patients (66 toes 53 patients). There was no difference in pain scores between the arthrodesis group and arthroplasty group 7.4 ± 15.7 vs 15.7 ± 19.7 (p=0.06). There was also no difference in the VAS FA scores as a whole 88.9 ± 12.9 vs 86.1 ± 17.1 (p = 0.47), or when divided into its 3 components (pain, function and other complaints). There was however a significant difference with regards to patient satisfaction with the arthrodesis group outperforming the TJA group: 95.5 ± 10.4 vs 83.6 ± 20.9 (p<0.01). There was a significantly higher rate of revision surgery in the TJA group when compared to the arthrodesis group (p= 0.009). At 15 years the patients that underwent arthrodesis were more satisfied and had a greater survivorship compared to TJA, however there was no difference in outcome with regards to pain or function between the two groups. Based on the results of this study arthrodesis remains the ‘gold standard’ due to excellent pain
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
Our study aims to demonstrate the efficacy of using endobutton and interference screw technique in the repair of acute distal biceps ruptures. From April 2009 to May 2013, 25 consecutive patients had acute distal biceps tendon repairs using an endobutton and interference screw technique. 3 patients were lost to follow up leaving 22 patients available for review. Mean follow up was 24 months(1–51). All were evaluated using a questionnaire, examination, radiographs, power measurements, and Oxford Elbow and MAYO scores. Overall 95% patients (21/22) felt that their surgery was successful and rated their overall experience as excellent or good. Mean return to work was at 100 days(0–280) and mean postoperative pain
The prevalence of Parkinson's disease (PD) is expected to rise however reports of the outcomes of total knee arthroplasty (TKA) in patients with PD in the literature are sparse. We present the first study to compare short to medium term outcomes of TKA in patients with and without PD. We performed a retrospective analysis of data from our regional arthroplasty database. In our PD group 32 TKAs were implanted. In our age-matched control group 33 TKAs were implanted. Mean age at operation was 73 years and the primary indication was osteoarthritis in both groups. Data was collected pre-operatively and at routine 1, 3 and 5 year follow-up attendances. Median in-patient stay was comparable in both groups (P=0.714). Pre-operatively, there were no between-group differences in range of movement, Knee Society Function Score (KSFS), Knee Society Score (KSS) or Pain score taken as an independent variable (P=0.108, 0.079, 0.478 and 0.496). KSS improved in both groups post-operatively with no significant between-group differences (P=0.707). Improvement was maintained to Year 5 (median 30 points pre-operatively and 91 points at Year 5 in PD group). Pain score also improved in both groups. There was no functional improvement following TKA in the PD group. In the controls, an increase in KSFS at Year 1 was followed by a return to pre-operative values at Year 5. Complications in the PD group included 1 case of bilateral quadriceps tendon avulsion and 1 dislocation requiring revision. Patients with PD benefit from excellent pain
Aims. The objective of our study is to identify the causes for recurrence and to evaluate the results of our technique. Material and Methods. We retrospectively analysed 18 patients (12 females; 6 males) who had both clinical and electrophysiological confirmation (7 focal entrapments; 11 severe entrapments) of recurrent carpal tunnel syndrome. In all the patients, after releasing the nerve a vascularised fat pad flap was mobilised from hypothenar region and sutured to the lateral cut end of flexor retinaculum. All the patients were assessed post-operatively for
Objective. Surgical treatment of trigger finger is usually performed as an outpatient surgery under local anesthesia n this study we present our results of surgical treatment of trigger finger performed with an ophthalmic knife which is less invasive for patient and easer for surgeon. Material and Method. 19 gauges microvitreoretinal ophthalmic knifes have a rhombus like edge with both sharp sides. The length of the knife's cutting side is 3 mm at each side. There were 40 women and 10 men with a mean age of 51.7 ± 5.7 (min: 40 max: 62). The thumb was involved in 32, the index finger in 10, and the middle in 8 patients. The procedure can be performed as an outpatient surgery under local anesthesia. The surface landmarks of the proximal and distal edges of the A1 pulley are marked on the skin. Percutaneous placement of a 25-gauge needle 5mm proximal to the PDC marked the distal extent of the release. The duration of procedure was under five minutes. Clinical examination was repeated on the postoperative 3rd day, 10th day and patients were re-examined or spoken to by telephone at a mean follow-up of 6.4 months. Results. Of the 50 digits treated, there was complete resolution of symptoms in 45 digits (90%). 3 thumbs had residual grade 1–2 triggering at the second follow up. 2 patients with locked trigger thumbs had persistent, despite
Background. There is growing evidence in literature that meniscal allograft transplantation performed with the right indications results in significant pain
Introduction. Viscosupplementation is used widely to provide symptomatic
The aim is to evaluate the effectiveness of pericardium patch as a tendon augmentation graft in the repair of massive rotator cuff tear. This is prospective study analysis of a consecutive series of 60 patients who underwent open repair of a massive rotator cuff tear with patch between 1999 and 2007. The inclusion criteria were: symptomatic with pain, deficit of elevation, not responsive to the physiotherapy, tear size (massive: 2 or more tendons), minimum follow-up of 2 years since surgery, active and motivated patients. All were assessed preoperatively with plain radiographs (anteroposterior and axillary views), ultrasound and NMR of the shoulder. The study group consistent of 60 patients (39 men and 21 women) with the mean age of was 66 years (range, 46–81). The mean duration of symptoms before repair was 18 months (range 3–48). Patients were assessed with UCLA score, visual analog scale (Vas scale) and ultrasound preoperatively, at 1 year, and at 3 years. The change in UCLA scores, Vas scale were analyzed with the paired Student's test, assuming a normal distribution of the total score. Satisfactory results were achieved in 49 patients: mean preoperative UCLA score improved from 9.3 to 16.9 at final follow-up. For pain, the mean preoperative value of Vas scale was 9,1, postoperative mean value was 4.9. Range of motion and abduction power improved not significantly after surgery, although patients satisfaction levels were high. Imaging studies identified intact patch in 15 patients and patch detachment in 45. No adverse side effects (infection, rejection, allergy) were reported during the study period. The results of our study suggest that patients (appropriately selected) with a massive full-thickness rotator cuff tear can be expected to have a pain
Purpouse. We hypothesized that patients receiving a medial collagen meniscus implant (MCMI) would show better clinical, radiograpich and Magnetic Resonanace Imaging (MRI) outcomes than patients treated with partial medial meniscectomy (PMM) at minimum 10 year FU. Material and Methods. Thirty-three non-randomized patients (males, mean age 40 years) were enrolled in the study to receive a MCMI (17 patients) or as control treated with a PMM (16 patients). All of them were clinically evaluated at time zero, 5 and minimum 10 years after surgery (mean FU 133 months, range 120–145) by Lysholm, VAS for pain, objective IKDC knee form and Tegner activity level. SF-36 score was performed pre-operatively and at final FU. Bilateral weight-bearing XRays were executed at time zero and at final FU. Minimum 10 years FU MRI images were compared with collected pre-operative MRI images by means of Yulish score. Genovese score was also used to evalute MCMI MRI survivorship. Results. MCMI group showed significantly lower VAS for pain (p = 0.0091), higher objective IKDC (p = 0.0026), Teger index (p = 0.0259) and SF-36 (p = 0.0259 for PHI and p = 0.0036 for MHI) scores compared with PMM group at minimum 10 year FU. Radiographic evaluation showed a significantly lower medial joint line height (p = 0.0002) and side-to-side difference (p = 0.0003) narrowing in MCMI group respect to PMM group at final FU. Discussion. Improvements in pain