Tibial shaft fractures require surgical stabilization preferably by intramedullary nailing. However, patients often report functional limitations even years after the injury. This study investigates the influence of the surgical approach (transpatellar vs. parapatellar) on gait performance and patient reported outcome six months after surgery. Twenty-two patients with tibial shaft fractures treated by intramedullary nailing through a transpatellar approach (TP: n=15,
An international Consensus Group has by a Delphi approach identified the topic of host factors affecting pin site infection to be one of the top 10 priorities in external fixator management. The aim of this study was to report the frequency of studies reporting on specific host factors as a significant association with pin site infection. Host factors to be assessed was:
Wearable inertial sensors can detect abnormal gait associated with knee or hip osteoarthritis (OA). However, few studies have compared sensor-derived gait parameters between patients with hip and knee OA or evaluated the efficacy of sensors suitable for remote monitoring in distinguishing between the two. Hence, our study seeks to examine the differences in accelerations captured by low-frequency wearable sensors in patients with knee and hip OA and classify their gait patterns. We included patients with unilateral hip and knee OA. Gait analysis was conducted using an accelerometer ipsilateral with the affected joint on the lateral distal thighs. Statistical parametric mapping (SPM) was used to compare acceleration signals. The k-Nearest Neighbor (k-NN) algorithm was trained on 80% of the signals' Fourier coefficients and validated on the remaining 20% using 10-fold cross-validation to classify the gait patterns into hip and knee OA. We included 42 hip OA patients (19 females,
Abstract. Objectives. The aim of this study was to investigate whether mechanical loading induced by physical activity can reduce risk of sarcopenia in middle-aged adults. Methods. This was a longitudinal study based on a subset of UK Biobank data consisting of 1,918 participants (902 men and 1,016 women, mean age 56 years) who had no sarcopenia at baseline (assessed between 2006 and 2010). The participants were assessed again after 6 years at follow-up, and were categorized into no sarcopenia, probable sarcopenia, or sarcopenia according to the definition and algorithm developed in 2018 by European Working Group on Sarcopenia in Older People (EWGSOP). Physical activity was assessed at a time between baseline and follow-up using 7-day acceleration data obtained from wrist worn accelerometers. Raw acceleration data were then analysed to study the mechanical loading of physical activity at different intensities (i.e. very light, light, moderate-to-vigorous). Multinominal logistic regression was employed to examine the association between the incidence of sarcopenia and physical activity loading, between baseline and follow up, controlled for other factors at baseline including
Abstract. Objective. Meta-analysis of clinical trials highlights that non-operative management of degenerative knee meniscal tears is as effective as surgical management. Surgical guidelines though support arthroscopic partial meniscectomy which remains common in NHS practice. Physiotherapists are playing an increasing role in triage of such patients though it is unclear how this influences clinical management and patient outcomes. Methods. A 1-year cohort (July 2019–June 2020) of patients presenting with MRI confirmed degenerative meniscal tears to a regional orthopaedic referral centre (3× ESP physiotherapists) was identified. Initial clinical management was obtained from medical records alongside subsequent secondary care management and routinely collected outcome scores in the following 2-years. Management options included referral for surgery, conservative (steroid injection and rehabilitation), and no active treatment. Outcome scores collected at 1- and 2-years included the Forgotten Joint Score-12 (FJS-12) questionnaire and 0–10 numerical rating scales for worst and average pain. Treatment allocation is presented as absolute and proportional figures. Change in outcomes across the cohort was evaluated with repeated measures ANOVA, with Bonferroni correction for multiple testing, and post-hoc Tukey pair-wise comparisons. As treatment decision is discrete, no direct contrast is made between outcomes of differing interventions but additional explorative outcome change over time evaluated by group. Significance was accepted at p=0.05 and effect size as per Cohen's values. Results. 81 patients, 50 (61.7%) male, mean age 46.5 years (SD13.13) presented in the study timeframe. 32 (40.3%) received conservative management and 49 (59.7%) were listed for surgery. Six (18.8%) of the 32 underwent subsequent surgery and nine of the 49 (18.4%) patients switched from planned surgery to receiving non-operative care. Two post-operative complications were noted, one cerebrovascular accident and one deep vein thrombosis. The cohort improved over the course of 2-years in all outcome measures with improved mean FJS-12 (34.36 points), mean worst pain (3.74 points) average pain (2.42 points) scores. Overall change (all patients) was statistically significant for all outcomes (p<0.001), with sequential year-on-year change also significant (p<0.001). Effect size of these changes were large with all Cohen-d values over 1. Controlling for
Osteoporosis is a common disorder characterized by low bone mass and reduced bone quality that affects the bone strength negatively and leads to increased risk of fracture. Bone mineral density (BMD) has been the standard instrument for the diagnosis of osteoporosis and the determination of fracture risk. Despite the approximation of the bone mass, BMD does not provide information about the bone structure. Trabecular bone score (TBS), which provides an indirect evaluation of skeletal microarchitecture, is calculated from dual X-ray absorptiometry and a simple and noninvasive method that may contribute to the prediction of osteoporotic fractures in addition to the measure of bone density. The goal of this study was to determine the mean TBS values in healthy postmenopausal women and the overall association between TBS and demographic features, bone mineral density of the lumbar spine and femoral neck and bone mineral density to body mass index ratio (BMD/BMI) of the lumbar spine. Fifty-three postmenopausal healthy women participated. The bone mineral density of the lumbar spine and femoral neck were measured dual X-ray absorptiometry. Anteroposterior lumbar spine acquisitions were used to calculate TBS for L1-L4.
Abstract. Objectives. Ankle fractures have an incidence of around 90,000 per year in the United Kingdom. They affect younger patients following high energy trauma and, in the elderly, following low energy falls. Younger patients with pre-existing comorbidities including raised BMI or poor bone quality are also at risk of these injuries which impact the bony architecture of the joint and the soft tissues leading to a highly unstable fracture pattern, resulting in dislocation. At present, there is no literature exploring what effect ankle fracture-dislocations have on patients’ quality of life and activities of daily living, with only ankle fractures being explored. Methods. Relevant question formatting was utilised to generate a focused search. This was limited to studies specifically mentioning ankle injuries with a focus on ankle fracture-dislocations. The number of patients, fracture-dislocation type, length of follow up, prognostic factors, complications and outcome measures were recorded. Results. 939 fractures were included within the studies. Eight studies looked at previously validated foot and ankle scores, two primarily focused on the American Orthopaedic Foot and Ankle Society score (AOFAS), three on the Foot and Ankle Outcome Score (FAOS), and one study on the Olerud–Molander Score (OMAS). Patient, injury, and management factors were identified as being associated with poorer clinical outcomes. Conclusions. Not only are
Introduction and Objective. TKA have shown both excellent long-term survival rate and symptoms and knee function improvement. Despite the good results, the literature reports dissatisfaction rates around 20%. This rate of dissatisfaction could be due to the overstuff that mechanically aligned prostheses could produce during the range of motion. Either size discrepancy between bone resection and prosthetic component and constitutional mechanical tibiofemoral alignment (MTFA) alteration might increase soft tissue tension within the joint, inducing pain and functional limitation. Materials and Methods. Total knee arthroplasties performed between July 2019 and September 2020 were examined and then divided into two groups based on the presence (Group A) or absence (Group B) of patellofemoral overstuff, defined as a thickness difference of more than 2 mm between chosen component and bone resection performed, taking into account at least one of the following: femoral medial and lateral condyle, medial or lateral trochlea and patella. Based on pre and post-operative MTFA measurements, Group A was further divided into two subgroups whether the considered alignment was modified or not. Patients were assessed pre-operatively and at 6 months post-op using the Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Visual Analogue Scale (VAS) and Range of Motion (ROM). Results. One hundred total knee arthroplasties were included in the present study, 69 in Group A and 31 in group B. Mean
Posterior spinal surgery is associated with a significant amount of blood loss. The factors predisposing the patient to excessive bleeding-and therefore transfusion- are not well established nor is the effect of transfusion on the outcomes following spinal surgery. We had two goals in this study. First, we were to investigate any suspected risk factors of transfusion in posterior thoraco-lumbar fusion patients. Second, we wanted to observe the negative impact-if one existed- of transfusion on the outcomes of surgery. All adults undergoing posterior thoraco-lumbar spine fusion in our institution from May 2015 to May 2018 were included. Data collected included demographic data as well as BMI, preoperative hemoglobin, American Society of Anesthesiologists classification (ASA), delta Hemoglobin, estimated blood loss, incidence of transfusion, number of units transfused, number of levels fused, length of stay and re-admission within 30 days. The data was analyzed to correlate these variables with the frequency of transfusion and then to assess the association of adverse outcomes with transfusion. 125 patients were included in the study. Only 6 patients (4.8%) required re-admission within the first 30 days after discharge. Length of stay averaged 8.4 days (3–74). 18 patients (14.4%) required transfusion peri-operatively. When multiple variables were analyzed for any correlation, the number of levels fused,
Abstract. Objectives. Patella resurfacing in primary total knee arthroplasty (TKA) remains a contentious issue. Australian rates of patellar resurfacing are 66.6%, significantly higher compared to UK rates of 8–15% and Swedish rates of 2%. Resurfacing has gained popularity in Australia since registry data has shown decreased revision rates with no increase in patellar component related complications. We present for discussion an analysis of 113,694 total knee arthroplasties using commonly implanted prostheses in the UK. Methods. We included all TKA's since the Australian register's conception on 01/09/1999 for a primary diagnosis of osteoarthritis involving the use of either the Triathlon or Duracon implant with and without patellar components. The primary outcome of the study was time to revision for Triathlon's resurfaced and non-resurfaced prosthesis compared to the Duracon's equivalent data. We also analysed the reasons for revision between the 4 groups, type of revision and complication rates. We then compared minimally stabilised and posterior stabilised prostheses. Results. The cumulative revision rate for Triathlon prostheses with resurfacing after 12 years was 3.2% (95% CI, 2.9% to 3.6%) compared to 5.6% (95% CI, 5.0% to 6.2%) without resurfacing. Duracon's equivalent data was 6.3% with resurfacing and 5.9% without resurfacing. Triathlon prosthesis with resurfacing have much lower rates of revision due to loosening, patellofemoral pain, patellar erosion compared to unresurfaced Triathlon prostheses. Conclusion. Triathlon with re-surfacing has lower revision rates regardless of
Introduction. Infections in total joint arthroplasty (TJA) are a burden to the healthcare system. An infection in total joint arthroplasty costs nearly $60,000–80,000 to the system. 3 major tenets to decrease surgical site infections, focus on patient preoperative optimization, intraoperative techniques, and postoperative care. Intraoperative vancomycin powder been successful in lowering infection rates in other areas of orthopaedics. The purpose of our study was to investigate whether topical intraoperative vancomycin powder had any effect on surgical site infection, complication rate, or reoperation rate. Our hypothesis was vancomycin powder may decrease the rate of surgical site infections without any effect on wound complications. Materials & Methods. 208 consecutive patients undergoing either total hip or total knee arthroplasty (THA or TKA) were given intraoperative vancomycin powder or none. 64 patients received vancomycin poweder compared to 164 patients who did not. All preoperative, intraoperative and postoperative management was similar. Preoperative data including
Abstract. Purpose. The aim of this study was to assess how biomechanical gait parameters (kinematics, kinetics, and muscle force estimations) differ between patients with camtype FAI and healthy controls, through a systematic search. Methods. A systematic review of the literature from PubMed, Scopus, and Medline and EMBASE via OVID SP was undertaken from inception to April 2020 using PRISMA guidelines. Studies that described kinematics, kinetics, and/or estimated muscle forces in cam-type FAI were identified and reviewed. Results. The search strategy identified 404 articles for evaluation. Removal of duplicates and screening of titles and abstracts resulted in full-text review of 37 articles with 12 meeting inclusion criteria. The 12 studies reported biomechanical data on a total of 173 cam-FAI (151 cam specific, 22 mixed type) patients and 177 healthy
Abstract. Objectives. Conventional approaches (including Tobit) do not accurately account for ceiling effects in PROMs nor give uncertainty estimates. Here, a classifier neural network was used to estimate postoperative PROMs prior to surgery and compared with conventional methods. The Oxford Knee Score (OKS) and the Oxford Hip Score (OHS) were estimated with separate models. Methods. English NJR data from 2009 to 2018 was used, with 278.655 knee and 249.634 hip replacements. For both OKS and OHS estimations, the input variables included
Osteoarthritis (OA) is a prevalent, age-related joint disease, characterized by diverse progressive changes in articular cartilage and subchondral bone. Disease management is severely hampered by the absence of tools to classify patients based on underlying disease mechanisms. For that matter, increased BMI is a known risk factor for OA in the weight bearing knee joint, but also for hand OA. 1. The increased risk for OA is therefore thought to be influenced by systemic factors accompanying BMI. It was hypothesized that differences in metabolic state could be underlying OA phenotypes. In the current study we set out to explore the potential role of a large range of metabolites in blood as sensitive biomarker of OA. Plasma samples were taken from the Rotterdam Study, CHECK-, GARP/NORREF- and the LUMC-arthroplasty cohorts. OA was defined as having had arthroplasty for primary OA, stratified per location (any, hip or knee). In total 647 persons with Total Joint Arthroplasty (TJA) were included and 2125 persons were considered as controls (i.e. they had a Kellgrenn-Lawrence Score of <2 indicating no radiographic OA was present) in any of the studied joints. A total of 231 different metabolites were assessed by using the BrainShake NMR platform. Since parts of the metabolites were highly correlated, we used Principal Component Analyses (PCA) to reduce the data. 23 factors were identified, accounting for 91,4% of the variance in the data. Logistic regression models were applied to investigate the identified factors for their association to arthroplasty for primary OA, independent of
Hip resurfacing arthroplasty (HRA) became a popular procedure in the early 90s because of the improved wear characteristic, preserving nature of the procedure and the optimal stability and range of motion. Concerns raised since 2004 when metal ions were seen in blood and urine of patients with a MoM implant. Design of the prosthesis, acetabular component malpositioning, contact-patch-to-rim distance (CPR) and a reduced joint size all seem to play a role in elevated metal ion concentrations. Little is known about the influence of physical activity (PA) on metal ion concentrations. Implant wear is thought to be a function of use and thus of patient activity levels. Wear of polyethylene acetabular bearings was positively correlated with patient's activity in previous studies. It is hypothesized that daily habitual physical activity of patients with a unilateral resurfacing prosthesis, measured by an activity monitor, is associated with habitual physical activity. A prospective, explorative study was conducted. Only patients with a unilateral hip resurfacing prosthesis and a follow-up of 10 ± 1 years were included. Metal ion concentrations were determined using ICP-MS. Habitual physical activity of subjects was measured in daily living using an acceleration-based activity monitor. Outcome consisted of quantitative and qualitative activity parameters. In total, 16 patients were included. 12 males (75%) and 4 females (25%) with a median age at surgery of 55.5 ± 9.7 years [43.0 – 67.9] and median follow-up of 9.9 ± 1.0 years [9.1 – 10.9]. The median cobalt and chromium ion concentrations were 25 ± 13 and 38 ± 28 nmol/L. A significant relationship, when adjusting for
Summary Statement. This project proves that Patellofemoral (PF) joint degeneration is not a contraindication to medial unicompartmental knee replacement. Introduction. Unicompartmental knee arthroplasty (UKA) is a recognised procedure for treatment of medial compartment osteoarthritis. Patellofemoral (PF) joint degeneration is widely considered to be a contraindication to medial unicompartmental knee replacement. We examined the validity of this preconception using information gathered prospectively on consecutive patients who underwent UKA using the Repicci II® UKA prosthesis for medial compartment osteoarthritis. Methods. We prospectively collected data on 147 consecutive patients who underwent the Repicci II® UKA for medial compartment osteoarthritis. All operations were performed between July 1999 and September 2000 by the same surgeon. The status of the PF joint was assessed intra-operatively in all patients, and accordingly patients were divided into two groups, one group with a normal PF joint, and the second group with degenerative changes of the PF joint. Variables measured for outcome included the International Knee Society (IKS) score, limb alignment, and range of motion. Radiographs were assessed for progression of disease or failure of implant. The mean follow-up was 9.4 years (range: 5–10.7 years). Patients were reviewed initially at 2 weeks, and then at 6 months post-operatively. They were subsequently reviewed on an annual basis.. All patients completed an IKS score preoperatively and at last follow-up.
Fragility fractures are an increasing cause of morbidity and mortality in the elderly population. Their association with reduced bone mineral density (BMD) is well documented. It is a reasonable assumption that hip fracture severity is linked to the magnitude of bone loss, (the lower the BMD, the more severe the fracture), however it is not known whether this correlation exists. Our aim therefore was to investigate the relationship between BMD and hip fracture severity. We reviewed 142 patients, 96 females and 46 males, mean age 74 years (49-92), who had sustained a hip fracture following a simple ground level fall. All had subsequently undergone DEXA bone scanning of the contralateral hip and lumbar spine. Fractures were classified as intra-capsular, extra-capsular or subtrochanteric, then sub-classified using the Garden, Jensen and Seinsheimer classifications respectively. They were grouped into simple (stable) or comminuted (unstable) fracture patterns. Risk factors for osteoporosis were recorded. A low hip BMD (<2.5) was associated with an increased risk of extra-capsular fracture (p=0.025). However, no association with fracture type (extra vs. intra-capsular, p>0.05) was identified with the following variables;
Background. Smoking has been associated with poor tissue oxygenation and vascularisation, predisposing smokers to a higher risk for postsurgical infections. The aim of this study was to estimate and compare the incidence of prosthetic joint infection (PJI) following primary total joint arthroplasty (TJA) according to smoking status. Methods. A prospective hospital-registry based cohort was used including all primary total knee and hip arthroplasties performed between 03/1996 and 12/2013 and following them until 06/2014. Smoking status at time of surgery was classified in never, former and current smoker. Incidence rates and incidence rate ratios (IRR) for PJI according to smoking status were assessed within the first year and over the whole study period. Adjusted IRRs were obtained using cox regression model. Adjustment was performed for the following baseline characteristics:
GIRFT was published in the United Kingdom with the aim of streamlining primary care pathways, secondary care, creating a network of hospitals and treatment centres and to better regulate introduction of new implants. It also proposed the use of Orthopaedic Devices Evaluation Panel (ODEP) 10A* rated cemented implants in hip arthroplasty. Aim: The purpose of this study was to assess the effects of adopting GIRFT on surgical time, length of stay, changes to the implants used and number of cases per surgical list. Prior to adopting GIRFT, elective primary total hip replacement (THR) was predominantly uncemented THR. Age, sex, Body Mass Index (BMI), American Society of Anesthetiss (ASA), closure technique and surgical time of 50 consecutive primary uncemented THR were analysed to identify the appropriate statistical methods. Mean and standard deviation for surgical time were identified. Threshold increase in surgical time was set at 20 minutes. Based on expected difference of 20 minutes and standardised difference, minimum sample size was calculated to be 19. Prospective data on 60 consecutive uncemented THR and 30 consecutive cemented primary THR were included in this study. Inclusion criteria – primary THR for arthritis by single surgeon. Exclusion criteria – previous hip surgery, complex primary, abnormal anatomy. No differences in
Eliminating pain and restoring physical activity are the main goals of total hip arthroplasty (THA). Despite the high relevance of activity as a rehabilitation goal of and criterion for discharge, in-hospital activity between operation and discharge has hardly been investigated in orthopaedic patients. Therefore, the aim of this study was to a) measure for reference the level of in-hospital physical activity in patient undergoing a current rapid discharge protocol, b) compare these values to a conventional discharge protocol and c) test correlations with pre-operative activities and self-reported outcomes for possible predictors for rapid recovery and discharge. Patients (n=19, M:F: 5:14, age 65 ±5.7 years) with osteoarthritis treated with an elective primary THA underwent a rapid recovery protocol with discharge on day 3 after surgery (day 0). Physical activity was measured using a 3D accelerometer (64×25×13mm, 18g) worn on laterally on the unaffected upper leg. The signal was analysed using self-developed, validated algorithms (Matlab) calculating: Time on Feet (ToF), steps, sit-stand-transfers (SST), mean cadence (steps/min), walking bouts, longest walk (steps). For the in-hospital period (am: ca. 8–13h; pm: ca. 13–20h) activity was calculated for day 1 (D1) and 2 (D2). Pre-operative activity at home was reported as the daily averages of a 4-day period. Patient self-report included the HOOS, SQUASH (activity) and Forgotten Joint Score (FJS) questionnaires. In-hospital activity of this protocol was compared to previously collected data of an older (2011), standard conventional discharge protocol (day 4/5, n=40, age 71 ±7 years, M:F 16:24). All activity parameters increased continuously between in-hospital days and subsequent am and pm periods. E.g. Time-on-feet increased most steeply and tripled from 21.6 ±14.4min at D1am to 62.6 ±33.4min at D2pm. Mean Steps increased almost as steep from 252 to 655 respectively. SST doubled from 4.9 to 10.5. All these values were sign. higher (+63 to 649%) than the conventional protocol data. Cadence as a qualitative measure only increased slowly (+22%) (34.8 to 42.3steps/min) equalling conventional protocol values. The longest walking bout did not increase during the in-hospital period. Gender,
