Aims. The primary objective of this registry-based study was to compare patient-reported outcomes of cementless and cemented medial unicompartmental knee arthroplasty (UKA) during the first postoperative year. The secondary objective was to assess one- and three-year implant survival of both fixation techniques. Methods. We analyzed 10,862 cementless and 7,917 cemented UKA cases enrolled in the Dutch Arthroplasty Registry, operated between 2017 and 2021. Pre- to postoperative change in outcomes at six and 12 months’ follow-up were compared using mixed model analyses. Kaplan-Meier and Cox regression models were applied to quantify differences in implant survival. Adjustments were made for patient-specific variables and annual hospital volume. Results. Change from baseline in the Oxford Knee Score (OKS) and activity-related pain was comparable between groups. Adjustment for covariates demonstrated a minimally greater decrease in rest-related pain in the cemented group (β = -0.09 (95% confidence interval (CI) -0.16 to -0.01)). Cementless fixation was associated with a higher probability of achieving an excellent OKS outcome (> 41 points) (adjusted odds ratio 1.2 (95% CI 1.1 to 1.3)). The likelihood of one-year implant survival was greater for cemented implants (adjusted hazard ratio (HR) 1.35 (95% CI 1.01 to 1.71)), with higher revision rates for periprosthetic fractures of cementless implants. During two to three years’ follow-up, the likelihood of implant survival was non-significantly greater for cementless UKA (adjusted HR 0.64 (95% CI 0.40 to 1.04)), primarily due to increased revision rates for tibial loosening of cemented implants. Conclusion. Cementless and cemented medial UKA led to comparable improvement in physical function and pain reduction during the initial postoperative year, albeit with a greater likelihood of achieving excellent OKS outcomes after cementless UKA. Anticipated differences in early physical function and pain should not be a decisive factor in the choice of fixation technique. However, surgeons should consider the differences in short- and long-term implant survival when deciding which implant to use. Cite this article: Bone Jt Open 2024;5(5):401–410

Objectives. In order to address acetabular defects, porous metal revision acetabular components and augments have been developed, which require fixation to each other. The fixation technique that results in the smallest relative movement between the components, as well as its influence on the primary stability with the host bone, have not previously been determined. Methods. A total of 18 composite hemipelvises with a Paprosky IIB defect were implanted using a porous titanium 56 mm multihole acetabular component and 1 cm augment. Each acetabular component and augment was affixed to the bone using two screws, while the method of fixation between the acetabular component and augment varied for the three groups of six hemipelvises: group S, screw fixation only; group SC, screw plus cement fixation; group C, cement fixation only. The implanted hemipelvises were cyclically loaded to three different loading maxima (0.5 kN, 0.9 kN, and 1.8 kN). Results. Screw fixation alone resulted in up to three times more movement (p = 0.006), especially when load was increased to 100% (p < 0.001), than with the other two fixation methods (C and SC). No significant difference was noted when a screw was added to the cement fixation. Increased load resulted in increased relative movement between the interfaces in all fixation methods (p < 0.001). Conclusion. Cement fixation between a porous titanium acetabular component and augment is associated with less relative movement than screw fixation alone for all implant interfaces, particularly with increasing loads. Adding a screw to the cement fixation did not offer any significant advantage. These results also show that the stability of the tested acetabular component/augment interface affects the stability of the construct that is affixed to the bone. Cite this article: N. A. Beckmann, R. G. Bitsch, M. Gondan, M. Schonhoff, S. Jaeger. Comparison of the stability of three fixation techniques between porous metal acetabular components and augments. Bone Joint Res 2018;7:282–288. DOI: 10.1302/2046-3758.74.BJR-2017-0198.R1

Introduction: The introduction of bioabsorbable materials has improved the ability to offer a simple, fast and friendly user solution, to specific meniscal tears. The technique of meniscal suture with bioabsorbable tacks is associated with lower morbidity and lower complication rate. Methods: Between 1997 and 2004, 14 patients underwent arthroscopic all-inside meniscus repair. We used Biofix bioabsorbable tacks fixation technique. Fourteen patients were followed-up: 11 males and 3 females. Their mean age was ~23 years (range 16–34). Follow-up average ~35 (range 6–72) months. Sport injuries were the main cause of meniscal tears (60%). Other causes included: work accidents (20%) and military accidents (20%). All the tears were located in red-on-red and red-on-white area. The mean length of tear was 9.6 mm. we used in average 2.5 tacks per meniscus tear. Furthermore, 4 patients had an associated ACL tear. Results: The evaluation was based on Lisholm score. The results were excellent in 10 patients (71%), good in 1 patient (7%), fair in 2 patients (15%) and poor in 1 patient (7%). One patient suffered from transitory tender point on the medial aspect due to a protruded tack. One patient needed a menisectomy due to unresolved symptoms. One patient underwent ACL reconstruction. Conclusion: This technique is an easy and reproducible procedure as compared to the classical meniscal suture techniques. It seems to be of a lower complication rate and further studies are needed to establish any associated morbidity

We have evaluated four different fixation techniques for the reconstruction of a standard Mason type-III fracture of the radial head in a sawbone model. The outcome measurements were the quality of the reduction, and stability. A total of 96 fractures was created. Six surgeons were involved in the study and each reconstructed 16 fractures with 1.6 mm fine-threaded wires (Fragment Fixation System (FFS)), T-miniplates, 2 mm miniscrews and 2 mm Kirschner (K-) wires; four fractures being allocated to each method using a standard reconstruction procedure. The quality of the reduction was measured after definitive fixation. Biomechanical testing was performed using a transverse plane shear load in two directions to the implants (parallel and perpendicular) with respect to ultimate failure load and displacement at 50 N. A significantly better quality of reduction was achieved using the FFS wires (Tukey’s post hoc tests, p < 0.001) than with the other devices with a mean step in the articular surface and the radial neck of 1.04 mm (. sd. 0.96) for the FFS, 4.25 mm (. sd. 1.29) for the miniplates, 2.21 mm (. sd. 1.06) for the miniscrews and 2.54 mm (. sd. 0.98) for the K-wires. The quality of reduction was similar for K-wires and miniscrews, but poor for miniplates. The ultimate failure load was similar for the FFS wires (parallel, 196.8 N (. sd. 46.8), perpendicular, 212.5 N (. sd. 25.6)), miniscrews (parallel, 211.8 N (. sd. 47.9), perpendicular, 208.0 N (. sd. 65.9)) and K-wires (parallel, 200.4 N (. sd. 54.5), perpendicular, 165.2 N (. sd. 37.9)), but significantly worse (Tukey’s post hoc tests, p < 0.001) for the miniplates (parallel, 101.6 N (. sd. 43.1), perpendicular, 122.7 N (. sd. 40.7)). There was a significant difference in the displacement at 50 N for the miniplate (parallel, 4.8 mm (. sd. 2.8), perpendicular, 4.8 mm (. sd. 1.7)) vs FFS (parallel, 2.1 mm (. sd. 0.8), perpendicular, 1.9 mm (. sd. 0.7)), miniscrews (parallel, 1.8 mm (. sd. 0.5), perpendicular, 2.3 mm (. sd. 0.8)) and K-wires (parallel, 2.2 mm (. sd. 1.8), perpendicular, 2.4 mm (. sd. 0.7; Tukey’s post hoc tests, p < 0.001)). The fixation of a standard Mason type-III fracture in a sawbone model using the FFS system provides a better quality of reduction than that when using conventional techniques. There was a significantly better stability using FFS implants, miniscrews and K-wires than when using miniplates

Introduction: The complex anatomy and biomechanics of the atlantoaxial motion segment impose technical challenges in the achievement of safe and successful surgical stabilization and fusion. The coauthors have recently reported successful clinical results using a novel C1-C2 stabilization technique employing C1 multi-axial posterior arch screws (MA-PAS). This study compares biomechanical stability of MA-PAS with two established multi-point fixation techniques (Magerl-Gallie and Harms) using non-destructive and destructive testing. Methods: 15 human fresh-frozen cadaveric occipital-C5 cervical spines (average age 77.4 [51–95], sourced from ScienceCare, USA) were randomly allocated to 3 equal groups. Screws were passed up through adjacent end vertebrae such that motion was limited to between C0 and C4. Each spinal column was non-destructively tested in flexion/extension (±1.5Nm), lateral bend (±1.5Nm) and axial rotation (±1.5Nm), firstly in their INTACT state and then after Type 2 odontoid fracture destabilization combined with MAGERL-GALLIE (n=5), HARMS (n=5) or MA-PAS (n=5) instrumentation. All 15 reconstructed spines were finally loaded to failure in forward flexion only. Results: Non-destructive testing: The C1-C2 joint of the INTACT spines all demonstrated high flexibility in flexion/ extension (ave 16.5deg) and axial rotation (ave 52.6 deg) while lateral bending (ave 2.7deg) was less compliant (see Fig.3). After instrumentation all specimens showed significantly reduced ROM in flexion/extension (MAGERL-GALLIE=4.2deg, HARMS=4.4deg, MA-PAS=4.2deg) and axial rotation (MAGERL-GALLIE=4.05deg, HARMS=0.59deg, MA-PAS=3.7deg) while lateral bend ROM of all instrumented specimens was similar or slightly greater than INTACT (HARMS=2.3deg, MAGERL-GALLIE=3.8deg, MA-PAS=5.3deg). There was no significant difference between the instrumented groups in each loading direction. Destructive testing: MAGERL-GALLIE was the strongest requiring an average of 13.5Nm to cause failure while HARMS was the weakest requiring 7.8Nm of torque. MA-PAS technique averaged 12.2Nm of torque to cause failure. Conclusions: The MA-PAS technique was shown to have similar ultimate strength in flexion to the MAGERL-GALLIE and HARMS techniques and stability in flexion-extension, axial rotation and lateral bend. The MA-PAS failure load in flexion was greater than the HARMS technique, and nearly as high as the MAGERL-GALLIE. Given the biomechanical stability of the MA-PAS technique, it is proposed that this technique is an alternative to the technically demanding, and possibly more hazardous, conventional multi-point fixation techniques in patients with normal, as well as anomalous, C1/2 segmental anatomy

Existing techniques of posterior multi-point C1/2 stabilisation are technically demanding and can be hazardous. The coauthors have recently reported successful atlantoaxial fusion using a novel C1/2 stabilisation technique employing C1 multi-axial posterior arch screws (MA-PAS) in a clinical series of three patients where anatomical anomalies precluded established techniques. The technically less demanding nature of this new technique, and possible wider application in patients with normal anatomy, led the authors to investigate its biomechanical stability compared to other established techniques. Twenty-four human fresh-frozen cadaveric spines were harvested C0-C5. Motion was restricted to between C0 and C4. Each spine was non-destructively tested in flexion/extension, lateral bending and axial rotation, firstly in the intact state and then after Type 2 odontoid fracture destabilisation and insertion of Magerl-Gallie, Unicortical Harms, Bicortical Harms or MA-PAS instrumentation. ROM between C1 and C2 was monitored using two digital cameras. Results for each technique were compared statistically compared using ANOVA. The C1-C2 joint of the intact spines demonstrated high flexibility in flexion/extension (16.5deg). After instrumentation all specimens showed significantly reduced ROM in flexion/extension (Magerl-Gallie FE = 4.2deg, Unicort Harms FE = 7.2deg, Bicort Harms FE = 4.4deg). Lateral bend ROM of instrumented specimens (Magerl-Gallie LB =3.8deg, Unicort Harms LB = 3.8deg, Bicort Harms LB =2.3 deg) was, however, similar or slightly greater than intact (2.7 deg) . MA-PAS showed similar ROM in flexion/extension (4.2 deg) as the Magerl-Gallie and Harms techniques but was slightly higher in lateral bend (5.3 deg). The MA-PAS technique was shown to have similar biomechanical stability to the Magerl-Gallie and Harms techniques. Given the demonstrated biomechanical stability of the MA-PAS technique, it may be a suitable alternative to the existing technically demanding, and possibly more hazardous, multi-point fixation techniques in patients with normal, as well as anomalous, C1/2 segmental anatomy

Anatomic reduction (subcapital re-alignment osteotomy) via surgical hip dislocation – increasingly popular. While the reported AVN rates are very low, experiences seem to differ greatly between centres. We present our early experience with the first 29 primary cases and a modified fixation technique. We modified the fixation from threaded Steinman pins to cannulated 6.5mm fully-threaded screws: retrograde guidewire placement before reduction of the head ensured an even spread in the femoral neck and head. The mean PSA (posterior slip angle) at presentation (between 12/2008 and 01/2011) was overall 68° (45–90°). 59% (17/29) were stable slips (mean PSA 68°), and 41% (12/29) were unstable slips unable to mobilise (mean PSA 67°). The vascularity of the femoral head was assessed postoperatively with a bone scan including tomography. The slip angle was corrected to a mean PSA of 5.8° (7° anteversion to 25° PSA). We encountered no complications related to our modified fixation technique. All cases with a well vascularised femoral head on the post-operative bone scan (15/17 stable slips and 8/12 unstable slips) healed with excellent short term results. Both stable slips with decreased vascularity on bone scan (2/17, 12%) had been longstanding severe slips with retrospectively suspected partial closure of the physis, which has been described as a factor for increased risk of avascular necrosis (AVN). One of these cases was complicated by a posterior redislocation due to acetabular deficiency. In the unstable group, 4/12 cases (33%) had avascular heads intra-operatively and cold postoperative bone scans, 3 have progressed to AVN and collapse. Anatomic reduction while sparing the blood supply of the femoral head is a promising concept with excellent short term results in most stable and many unstable SCFE cases. Extra vigilance for closed/closing physes in longstanding severe cases seems advisable. Regardless of treatment, some unstable cases inevitably go on to AVN

Distal radial fractures represent 17% of fractures in the Italian E.R. In the last years many different techniques accompanied the traditional treatment of closed reduction and cast immobilization such as closed reduction + pinning + cast, “epi-block” fixation, ORIF with dorsal and/or volar plates, screws and external fixation. These techniques are mostly followed by a period of immobilization with cast which is optional in A.O. type A fractures and is usually necessary in type B and C fractures. At the University Hospital “Policlinico Umberto I” of Rome E.R. we have started treating these fractures with a new fixation system which we projected. This system provides a non-bridging external fixation. The synthesis is guaranteed by two or more K-wires which can be intramedullary or x-crossing the cortex and/or inter-fragmentary. These K-wires are connected with two radial pins by an external bar. This radial to radial system gives stability to the fracture and allows the patient to move the wrist immediately. We remove this fixation system after 40 days. From July 2008 to August 2009 we treated 56 distal radial fractures. Clinical assessment was performed every seven days until removal of external fixation system, then at 2, 3, 6 and 12 months. Radiographic assessment was performed at 30 and 40 days, consequently at 2, 3, 6 and 12 months. Outcome was measured on the basis of range of motion, grip and pinch strength, DASH and PRWE scores. A questionnaire was used to determine patient satisfaction, and a detailed analysis of complications was carried out. All patients had excellent or good results and were satisfied with the clinical outcome. At 60 days after surgery 90% of patients demonstrated complete clinical and functional recovery. After 3 months 100% of patients demonstrated complete clinical and functional recovery. After 6 months and 12 months no modification of the obtained result was detected

In Displaced Intracapsular Hip Fractures (ICHF) in young active patients, preservation of the femoral head and its blood supply are of high importance and urgent surgical treatment with anatomic reduction and internal fixation is the preferred intervention. Due to the strong varus displacement shear forces exerted across the hip, there are relatively high complication rates after fixation. There is no consensus regarding the optimal fixation device or technique. This retrospective study compared closed reduction internal fixation method using cannulated cancellous screw (CCS) with the Targon Femoral Neck (TFN) hip fixed angle screw. Data regarding, gender, operational data, duration of surgery, complications, NAS (Numerical Analogue Scale) pain score, Modified Harris Hip Score (MHHS) and SF-12 scores were retrieved for patients younger than 65 with displaced ICHF. Eighty-two patients were included in the study, 30 patients treated with CCS were compared to 52 patients treated with TFN. Fracture configuration (Garden and Pauwel classifications), mean time to surgery and complication rate did not differ significantly. Operative time did differ significantly between groups (CCS 56 minutes, TFN 92 minutes, p<0.001). At final follow-up the CCS group reported less pain (NAS 2.3 vs 3.5, p< 0.049) and better Mental Health Composite score of SF-12 (p=0.017) compared to the TFN group. Complication rates for the treatment of displaced ICHF with TFN and CCS showed no significant differences; however, the functional outcomes, as presented by the NAS and Mental Health Composite score of SF-12, showed superiority for CCS treatment. As this fixation method is related to reduce costs, we suggest CCS for the treatment of displaced ICHF in the young population.

Introduction: Internal fixation of distal radius fractures with dorsal plates (when needed) comprise two potential problems: efficacy of stabilization and the high frequency of tendonitis which forced us to early removal of the hardware. Our purpose is to study the efficacy of the method of stabilization with 2 plates (2mm) the central and radial columns of distal radius according to the technique presented by Regazzoni (1993).

Material and Methods: Eight patients (5 males and 3 females), average 35 years old (range, 20–52 years) were treated with comminuted intraarticular fracture type C (6 patients) or malunion of distal radius (2 patients). A combined approach was used in 4 patients and only dorsal approach in the rest 4 patients. In all patients with recent comminuted fractures a supplementary fixation method with allograft were used. In patients with mal-united fractures the technique with two plates together with iliac graft were applied.

Results: Results estimated after mean follow-up of 14 months (range 9–18 months) according to clinical (pain, range of motion, and grip strength) and radiological (articular congruency, radial height, radial inclination and palmar tilt) criteria. Six patients revealed excellent or good result although two patients with loss of reduction needed a second operation.

Conclusion: We concluded, that when the technique with 2 plates was applied correctly the stability of fixation enhanced because the detrimental rotational forces were cancelled while the frequency of tendon irritation decreased.

Post operative stability is of paramount importance to obtain bone in growth and a tight interface in uncemented implants. Although hemispherical press fit cups are widely used different opinions exists according optimal fixation and a variety of principles are preferred. Lab studies show better stability if a cup is augmented by screws or pegs. However, cups with screws and holes increases penetration of joint fluid, pressure and particles to the interface with a risk for osteolyses. HA coating is in many studies favourable to obtain a quick in growth but is by many regarded unnecessary or even a risk for increased wear. This RSA studie was done to investigate stability and wear in cups with different fixation.

Material: 80 hips in 75 patients with a mean age of 58 years (36–70) were operated with a cemented Spectron stem and a porous coated Reflection cup of titanium (Smith a Nephew) All cups were oversized 1–2 mm and fixed with press fit by experienced surgeons. Great care was taken to achieve a good rim fit. They hips were by randomisation allocated to one of four groups with different fixation methods. One group was done with only press fit technique, one with additional screws, one additional pegs and another with HA coating on the porous surface. Migration and wear was investigated with RSA at 2, 12 and 24 months and standard radiography was done post op and at 2 years.

Mann-Whitneys U-test was used on signed values for evaluation of group differencies.

Results: At 2 years the mean cup migration for the whole group was 0.2 mm longitudinally, 0.3 mm horizontally and 0.3 mm anterior-posteriorly. (SEM 0.03–0.05) The inclination changed 0.4 dgr and anteversion 0.4 dgr as well. Most cups moved laterally, proximally and anteriorly with increased anteversion and decreased inclination. No major differences in mean values were found between the groups according translations or rotations and no significant differences. Nor did we find differences between the press fit only and the augmented cups.

Wear was 0.45 mm proximally and in total 0. 6 mm without any sign of differences between the HA and porous coated groups. HA coated cups had less radiolucent lines after 2 years. (p=0.01)

Discussion: The Reflection cups were stable fixed ad we found no indication of inferior stability for cups without augmentation as might have been anticipated. The reason is probably the firm press fit fixation obtained with a stable cup, good bone and forceful impaction. Many use screws for safety but such cups are not sealed for leakage of joint fluid and pressure gradients and the risk for backside osteolyses is higher… Pegs are easier and safer to insert and tighten the holes better. A tight, no hole cup with HA is preferred by us in normal younger patients since HA gave a better interface. Such a solution should minimise the risk for penetration of particles and pressure gradients with less risk for lyses.

Purpose: Instrumentation and cementoplasty have been used individually or synergistically to augment screw fixation for better stabilization. A pilot study was performed to develop a new way to use this relationship to solve problematic screw loosening in both healthy and osteoporotic bone. Results show there may be indication to use the following characterized method.

Methods: In 12 cases of patients, pedicle fixation was used for complex decompression. The ages range from 70–85 years and included 8 females and 4 males. All patients underwent a bone tamp bolus formation in cancellous bone through each pedicle at the superior level of construct (3–4 cc. in each site, injected under low pressure) followed by pedicle screw insertion into the bolus, and subsequent levels were fixated by only pedicle screws.

Results: The preoperative, postoperative, and 3 month follow-up plain x-ray films were evaluated for stable bone tamp implantation, cement leakage, and screw placement. In all 12 cases there was no evidence of screw migration, pull-out, fracture, spinal cord compression, nerve root compression, or complication with cement placement. There was no example of cement extrusion into spinal canal. All patients had uneventful recoveries which included physical therapy, mild analgesics, and bracing.

Conclusion: This new technique may solve the problem of loosening of screws in healthy and osteoporotic bone by providing a more secure anchorage system not yet seen in previous studies. Further study is needed to develop more specific outcomes to determine the best technique using the balloon bone tamp system.

Purpose of the study: Conservative surgical treatment of osteochondritis dissecans (OCD) in adults raises the problem of integration of the sequestered bone. Mechanical techniques using screw fixation are often insufficient to achieve healing. Adjunction of a biological fixation with osteochondral graft tissue for a mosaicplasty might favour integration of the fragment. The purpose of this study was to assess the short-term outcomes in an initial series using a technique called fixation plus where screw fixation is associated with mosaiplasty. Material and methods: This was a retrospective analysis of eight adults who underwent surgery from 2003 to 2008 for stage IIB or III (Bedouelle) OCD of the medial condyle. Loss of subchondral tissue could be filled with a cancellous graft. Clinical and radiographic (Hugston) parameters were noted. At three months, the screws were removed arthroscopically. The ICRS-OCD score was noted. At six months, five patients had an arthroMRI to evaluate fragment integration, determine its signal and vitality. Results: Mean follow-up was 17.4 months (range 3–36). The Hugston score improved from 1.6 (0–3) preoperatively to 3.4 (2–4) postoperatively and the radiological score from 2.5 (2–4) to 3.2 (3–4). The arthroscopy performed to remove the screws revealed integration of the OCD fragment. The ICRS-OCD score was I in two cases, II in five and III in one. The postoperative arthroMRI confirmed continuity with the cartilage at the periphery of the fragment, with no passage of contrast agent into the defect. Discussion: Screw fixation of OCD fragments is often followed by nonunion and thus failure. Moasaicplasty is an alternative but does not preserve quality cartilage cover (curvature, thickness, cover). The technique proposed here ensures osseous integration of he fragment, complete cartilage cover, and a smaller number of osteochondral pits. Fixation Plus associates mechanical and biological fixation with good preliminary clinical results. Comparative longer term assessment is needed to confirm its pertinence

We studied the radiographs of 211 low-friction arthroplasties, followed for five to 15 years after operation. The first 92 simple hemispherical sockets were fixed with an old technique: eburnated bone in the acetabular roof was removed and only a few large anchor holes were bored for cement fixation. With the next 119 sockets, 111 of which were flanged, the eburnated and subchondral bone was preserved and multiple small anchor holes were used. The modified technique and the use of flanged sockets significantly improved the late radiological findings as regards socket demarcation and wear. On the femoral side, the intramedullary canal filling ratio, the distal packing of cement, calcar resorption and atrophy of the femoral cortex were correlated with prosthetic subsidence.

Tibiotalocalcaneal fusion is generally reserved for complex cases such as severe deformity or bone loss, infection, Charcot and revision procedures. Subsequently published series have been small and there are no studies comparing plate fixation and intramedullary nailing. We present the outcomes in the largest series to date and have also compared the union rate and complication rate between blade plate fixation (36) and intramedullary nailing (46). Both groups were well matched for patient and disease factors.

There was a non-statistically significant trend towards better outcomes with nails. Further analysis was conducted comparing the two fixation methods by the indication for surgery, there were no statistically significant differences, the reasons for these findings are discussed.

There exists two important pathologies in degenerative lumbosacral kyphosis (flat back), such as loss of lumbar lordosis and posterior rotation of the pelvis. Patients with this deformity complaint marked fatigue in lumbosacral region and disturbances on standing and walking.

Conservative treatment is seemed to be difficult, and surgical treatment may be selected for this deformity. Our surgical strategy is posterior shortening and anterior rotation of pelvis. Surgical procedure is tranvertebral decancellation closed wedge osteotomy, correction by shortening and lumbosacral fixation by intrasacral method. Radiographic assessment around the hip axis was performed by Jackson method on standing entire spine film.

5 females and 2 males were operated on by this method. Mean age at the operation was 67 yrs (57–82). Mean follow-up was 24 months (12–36). Mean operative time was 480 minutes (320–600). Mean estimated blood loss was 1440ml (985–2415). Mean pelvic angle was 41 degrees before the operation. At follow-up, mean value was 33 degrees. Preoperative mean local kyphosis was 4.7 degrees. Postoperative mean local lordosis was 24.1 degrees, average correction was 30 degrees. No loss of correction occurred in fused area. Clinical symptoms were remarkably improved after the operation. There was no major complication in this series.

Repair of large rotator cuff tears can be a demanding technical exercise, particularly when patients are elderly and tissue quality for repair is poor. In 25 patients we have used a method of tying rotator cuff sutures over a screw fixation post at the level of the surgical neck to secure the torn cuff to the greater tuberosity while healing occured. This study reports the results of these patients. 25 patients (27 shoulders) of average age 68.5 years were reviewed at an average of 22 months post surgery (range 3– 52 months). 4 patients (6 shoulders) were workers compensation injuries. The Constant method of shoulder assessment and visual analogue pain scores were used. Constant scores improved from an average of 30.6 pre-operatively to 75.2 post operatively. Pain scores improved from an average of 7.2 pre-operatively to 2.2 post operatively.

Over 80 % of patients reported being very satisfied with the results of their procedure. 2 patients reported being unsatisfied with their procedure. Workers compensation patients had poorer results for pain and function than the group average but still reported good satisfaction with the procedure. 4 complications occurred. 2 patients had re- tears of their cuff after falls. One was repaired with side to side suturing and the other was re-repaired to the post. 1 wound infection occurred requiring arthroscopic shoulder lavage and final removal of the implant.

This shoulder subsequently healed with good function. One patient had significant shoulder pain requiring surgery and removal of the fixation post. There were no other cases of screw irritation and no axillary nerve palsy or deltoid avulsions were found.

Conclusions: This method of fixation is simple, strong, safe and gives results at least equivalent to if not better than other reported methods. The technique is a useful one to have in the surgical repertoire when dealing with large rotator cuff tears in older patients.

Meniscal root tears can result from traumatic injury to the knee or gradual degeneration. When the root is injured, the meniscus becomes de-functioned, resulting in abnormal distribution of hoop stresses, extrusion of the meniscus, and altered knee kinematics. If left untreated, this can cause articular cartilage damage and rapid progression of osteoarthritis. Multiple repair strategies have been described; however, no best fixation practice has been established. To our knowledge, no study has compared suture button, interference screw, and HEALICOIL KNOTLESS fixation techniques for meniscal root repairs. The goal of this study is to understand the biomechanical properties of these fixation techniques and distinguish any advantages of certain techniques over others. Knowledge of fixation robustness will aid in surgical decision making, potentially reducing failure rates, and improving clinical outcomes. 19 fresh porcine tibias with intact medial menisci were randomly assigned to four groups: 1) native posterior medial meniscus root (PMMR) (n = 7), 2) suture button (n = 4), 3) interference screw (n = 4), or 4) HEALICOIL KNOTLESS (n = 4). In 12 specimens, the PMMR was severed and then refixed by the specified group technique. The remaining seven specimens were left intact. All specimens underwent cyclic loading followed by load-to-failure testing. Elongation rate; displacement after 100, 500, and 1000 cycles; stiffness; and maximum load were recorded. Repaired specimens had greater elongation rates and displacements after 100, 500, and 1000 cycles than native PMMR specimens (p 0.05). The native PMMR showed greater maximum load than all repair techniques (p 0.05). In interference screw and HEALICOIL KNOTLESS specimens, failure occurred as the suture was displaced from the fixation and tension was gradually lost. In suture button specimens, the suture was either displaced or completely separated from the button. In some cases, tear formation and partial failure also occurred at the meniscus luggage tag knot. Native PMMR specimens failed through meniscus or meniscus root tearing. All fixation techniques showed similar biomechanical properties and performed inferiorly to the native PMMR. Evidence against significant differences between fixation techniques suggests that the HEALICOIL KNOTLESS technique may present an additional option for fixation in meniscal root repairs. While preliminary in vitro evidence suggests similarities between fixation techniques, further research is required to determine if clinical outcomes differ

Aims. The purpose of this systematic review was to determine the rates of union for vascularized versus non-vascularized grafting techniques in the operative management of scaphoid nonunion. Secondary aims were to determine the effect of the fixation techniques used, the source of grafting, as well as the influence of fracture location (proximal pole) and avascular necrosis (AVN). Methods. A search of PubMed, MEDLINE, and Embase was performed in June 2021 using the Preferred Reporting Items for Systematic Review and Meta-Analyses statement and registered using the PROSPERO International prospective register of systematic reviews. The primary outcome was union rate. Results. There were 78 studies that met the inclusion criteria with a total of 7,671 patients (87.8% male, 12.2% female). The mean age was 27.9 years (SD 3.8) and the mean follow-up was 30.9 months (SD 25.9). The mean union rate was 88.7% (95% confidence interval (CI) 85.0 to 92.5) for non-vascularized grafts versus 87.5% (95% CI 82.8 to 92.2) for vascularized grafts (p = 0.685). Pooled analysis of trial data alone found a mean union rate of 82.4% (95% CI 66.9% to 97.9%) for non-vascularized grafts and 89.4% (95% CI 84.1% to 94.7%) for vascularized grafts (p = 0.780). No significant difference was observed in union rates between any of the fixation techniques used in the studies (p = 0.502). Distal radius and iliac crest graft source had comparable mean union rates (86.9% (95% CI 83.1 to 90.7) vs 87.6% (95% CI 82.2 to 92.9); p = 0.841). Studies that excluded patients with both proximal pole fractures and AVN (n = 14) had a mean union rate of 96.5% (95% CI 94.2 to 98.9) that was significantly greater than the mean union rate of 86.8% (95% CI 83.2 to 90.4) observed in the remaining studies (p < 0.001). Conclusion. Current evidence suggests vascularized bone grafting does not yield significantly superior results to non-vascularized grafting in scaphoid nonunion management. However, potential selection bias lessens the certainty of these findings. The fixation type or source of the graft used was not found to influence union rates either. Sufficiently designed and powered prospective randomized controlled trials in this area are needed. Cite this article: Bone Joint J 2022;104-B(5):549–558

Aims. Total hip arthroplasty (THA) is a very successful and cost-effective operation, yet debate continues about the optimum fixation philosophy in different age groups. The concept of the 'cementless paradox' and the UK 'Getting it Right First Time' initiative encourage increased use of cemented fixation due to purported lower revision rates, especially in elderly patients, and decreased cost. Methods. In a high-volume, tertiary referral centre, we identified 10,112 THAs from a prospectively collected database, including 1,699 cemented THAs, 5,782 hybrid THAs, and 2,631 cementless THAs. The endpoint was revision for any reason. Secondary analysis included examination of implant survivorship in patients aged over 70 years, over 75 years, and over 80 years at primary THA. Results. Cemented fixation had the lowest implant survival in all age groups, with a total ten-year survivorship of 97.0% (95% confidence interval (CI) 95.8 to 97.8) in the cemented group, 97.6% (95% CI 96.9 to 98.1) in the hybrid group, and 97.9% (95% CI 96.9 to 98.6) in the cementless group. This was not statistically significant (p = 0.092). There was no age group where cemented fixation outperformed hybrid or cementless fixation. Conclusion. While all fixation techniques performed well at long-term follow-up, cemented fixation was associated with the lowest implant survival in all age groups, including in more elderly patients. We recommend that surgeons should carefully monitor their own outcomes and use fixation techniques that they are familiar with, and deliver the best outcomes in their own hands. Cite this article: Bone Joint J 2022;104-B(2):206–211