We report the results of six trauma and orthopaedic
projects to Kenya in the last three years. The aims are to deliver both
a trauma service and teaching within two hospitals; one a district
hospital near Mount Kenya in Nanyuki, the other the largest public
hospital in Kenya in Mombasa. The Kenya Orthopaedic Project team
consists of a wide range of multidisciplinary professionals that
allows the experience to be shared across those specialties. A follow-up
clinic is held three months after each mission to review the patients.
To our knowledge there are no reported outcomes in the literature
for similar projects. A total of 211 operations have been performed and 400 patients
seen during the projects. Most cases were fractures of the lower
limb; we have been able to follow up 163 patients (77%) who underwent
surgical treatment. We reflect on the results so far and discuss
potential improvements for future missions.
With the rising rates, and associated costs, of total knee arthroplasty (TKA), enhanced clarity regarding patient appropriateness for TKA is warranted. Towards addressing this gap, we elucidated in qualitative research that surgeons and osteoarthritis (OA) patients considered TKA need, readiness/willingness, health status, and expectations of TKA most important in determining patient appropriateness for TKA. The current study evaluated the predictive validity of pre-TKA measures of these appropriateness domains for attainment of a good TKA outcome. This prospective cohort study recruited knee OA patients aged 30+ years referred for TKA at two hip/knee surgery centers in Alberta, Canada. Those receiving primary, unilateral TKA completed questionnaires pre-TKA assessing TKA need (WOMAC-pain, ICOAP-pain, NRS-pain, KOOS-physical function, Perceived Arthritis Coping Efficacy, prior OA treatment), TKA readiness/willingness (Patient Acceptable Symptom State (PASS), willingness to undergo TKA), health status (PHQ-8, BMI, MSK and non-MSK comorbidities), TKA expectations (HSS KR Expectations survey items) and contextual factors (e.g., age, gender, employment status). One-year post-TKA, we assessed for a ‘good outcome’ (yes/no), defined as improved knee symptoms (OARSI-OMERACT responder criteria) AND overall satisfaction with TKA results. Multiple logistic regression, stepwise variable selection, and best possible subsets regression was used to identify the model with the smallest number of independent variables and greatest discriminant validity for our outcome. Receiver Operating Characteristic (ROC) curves were generated to compare the discriminative ability of each appropriateness domain based on the ‘area under the ROC curve’ (AUC). Multivariable robust Poisson regression was used to assess the relationship of the variables to achievement of a good outcome. f 1,275 TKA recipients, 1,053 (82.6%) had complete data for analyses (mean age 66.9 years [SD 8.8]; 58.6% female). Mean WOMAC pain and KOOS-PS scores were 11.5/20 (SD 3.5) and 52.8/100 (SD 17.1), respectively. 78.1% (95% CI 75.4–80.5%) achieved a good outcome. Stepwise variable selection identified optimal discrimination was achieved with 13 variables. The three best 13-variable models included measures of TKA need (WOMAC pain, KOOS-PS), readiness/willingness (PASS, TKA willingness), health status (PHQ-8, troublesome hips, contralateral knee, low back), TKA expectations (the importance of improved psychological well-being, ability to go up stairs, kneel, and participate in recreational activities as TKA outcomes), and patient age. Model discrimination was fair for TKA need (AUC 0.68, 95% CI 0.63-0.72), TKA readiness/willingness (AUC 0.61, 95% CI 0.57-0.65), health status (AUC 0.59, 95% CI 0.54-0.63) and TKA expectations (AUC 0.58, 95% CI 0.54-0.62), but the model with all appropriateness variables had good discrimination (AUC 0.72, 95% CI 0.685-0.76). The likelihood of achieving a good outcome was significantly higher for those with greater knee pain, disability, unacceptable knee symptoms, definite willingness to undergo TKA, less depression who considered improved ability to perform recreational activities or climb stairs ‘very important’ TKA outcomes, and lower in those who considered it important that TKA improve psychological wellbeing or ability to kneel. Beyond
Aim. Early fracture-related infections (FRIs) are a common entity in hospitals treating trauma patients. It is important to be aware of the consequences of FRI in order to be able to counsel patients about the expected course of their disease. Therefore, the aims of this study were to evaluate the recurrence rate, to establish the number of secondary
INTRODUCTION. Important surgical requirements for optimal function are accurate bone cut alignments and soft tissue balancing. From an unbalanced state, balancing can be achieved by Surgical Corrections including soft tissue releases, bone cut modifications, and changing tibial insert thickness. Surgical balancing can now be quantified using an instrumented tibial trial, but the procedures and results need further investigation. Our major purpose was to determine the initial balancing after making the bone cuts, and the final accuracy of balancing after Surgical Corrections. A related purpose was to determine the number and effectiveness of different Corrections in achieving balancing. METHODS. During 101 surgeries of a PCL-retaining TKA, screen capture software recorded the video feed of surgery, angular data from the navigation system, and lateral and medial contact forces from the instrumented tibial trial. Initial bone cuts were made using navigation based on measured resection. The instrumented tibial trial measured the magnitudes and locations of the contact forces on the lateral and medial sides throughout flexion. The Heel Push Test (Walker 2014) determined the initial balancing, defined as a ratio of the medial/total force at 0, 30, 60 and 90 degrees flexion. A balanced knee with equal lateral and medial forces would show a value of 0.5. Surgical Corrections were then performed with the goal of achieving balancing. The most common Corrections were soft tissue releases (total 63 incidences), including MCL, postero-lateral corner, postero-medial corner; and increasing/decreasing tibial insert thicknesses (34 incidences). RESULTS. After the bone cuts and inserting the trials, the average medial/total force ratio was 0.49 +/− 0.27. After final balancing, the ratio was 0.52 +/− 0.14 (Figure 1). The initial data was scattered between 0.0 (lateral force only) and 1.0 (medial force only). The final data showed a clear narrowing of the range of imbalance. The different Surgical Corrections achieved an improvement of the medial/total ratio between 0.11–0.18. A 2mm insert increase increased the total force by 106 Newtons. A final medial/total ratio between 0.35–0.65 was achieved in 80% of cases from 0–30 degrees; 77% from 0–90 degrees. In 84% of the cases, 0–2 Corrections were required. The average total force on the condyles from 0–90 degrees was 290.5+/−166.8 Newtons initially and 215.3+/−86.3 Newtons after balancing, the large range due to patient variations in ligament stiffness. DISCUSSION. Acceptable balancing was achieved in the majority of cases with only 0–2 Surgical Corrections. The sensitivity of the balancing values to the Surgical Corrections was consistent with a previous study showing that changes of 2mm or 2 degrees could correct most imbalanced states (Walker 2014), related to collateral stiffness being in the region of 50N/mm (Wilson 2012, Robinson 2005). With only 2
Methods. A pericapsular approach was used with capsulotomy and then correction of the lesions both in the pelvic and in the femoral aspects. The traction times and total surgery times for the conventional method and the new out-inside technique were compared. Results. Conventional Hip Arthroscopy. –. 61 Hips done. –. Total surgery time was 110 minutes. –. Traction time was 50 minutes. –. 6 Weeks non weight bearing. New out-inside technique of hip arthroscopy. –. 24 Hips done. –. Total surgery time was 90 minutes. –. Traction time was 20 minutes. –. 4 weeks non weight bearing. New out-inside technique – E Margalet results. –. 68 Hips done. –. Total surgery time was 80.5 minutes. –. Traction time was 18.2 minutes. –. 3-4 weeks non weight bearing. Conclusion. Hip arthroscopy for femoral-acetabular impingement involves time spent working on the central and peripheral compartment. This new therapeutic approach requires a less aggressive exposure and is technically easier than conventional arthroscopy. A 30 degree optic system and shoulder and knee arthroscopic instruments were used without the need for fluoroscopy and the 70 degree optic was only used in the central compartment. No new surgical portals are used but rather a new surgical approach. It is important to note that new
Introduction. Total hip arthroplasty (THA) using the direct anterior approach (DAA) in a supine position is a minimally invasive surgery that reduces postoperative dislocation. Excellent exposure of both the acetabulum and proximal femoral part is important to reduce intraoperative complications. Generally, two