Introduction: Unicompartmental knee arthroplasty (UKA) is a proven for treatment of knee osteoarthritis (OA). Survival rates have been found comparable with total knee arthroplasty (TKA) in specialty hospitals series, but registry based studies show worse results of survival of UKA. High BMI, age of the patient, patellofemoral arthritis or learning curve have been found to have only mild consequences to the survival rates. Original indications for Oxford UKA in OA are severe pain and full thickness cartilage loss with bone-on-bone contact in the medial side. After widespread use of UKA surgeons are broadening their indications. Purpose of this study was to evaluate the influence of preoperative degree of OA on survival rate of UKA. Material and Methods: 113 knees in 103 patients were operated with Oxford phase 3 UKA. We evaluated all the patient data retrospectively and patient age, body mass index (BMI), sex, earlier arthroscopies, operation time, follow-up time, preoperative medial
Scaphoid fractures are a common injury accounting for more than 58% of all carpal bone fractures(1,2). Biomechanical studies have suggested that scaphoid mal-union may lead to altered carpal contact mechanics causing decreased motion, pain and arthritis(1,2). The severity of mal-union required to cause deleterious effects has yet to be established. This limits the ability to define surgical indications or impacts on prevention of posttraumatic arthritis. Computed tomography has been shown to be a useful in determining the 3D implications of altered bony alignment on the joint contact mechanics of surrounding joints. The objective of this study was to report mid-term follow-up image-based outcomes of patients with scaphoid mal-unions to determine the extent to which arthritic changes and decreased
Introduction. Although surgical remedies tend to be the long-term solutions for patients with osteoarthritis (OA), many alternatives exist that offer the potential to slow progression, alleviate pain, and/or restore function. One such option is the unloader OA knee brace. The objective of this study was to assess the in vivo medial
INTRODUCTION. Controversy exists regarding the ability of unicompartmental knee arthroplasty (UKA) to restore native knee kinematics, with some studies suggesting native kinematics are restored in most or all patients after UKA. 1–3. , while others indicate UKA fails to restore native knee kinematics. 4,5. Previous analysis of UKA articular contact kinematics focused on the replaced compartment. 2,5. , neglecting to assess the effects of the arthroplasty on the contralateral compartment which may provide insight to future pathology such as accelerated degeneration due to overload. 6. or a change in the location of cartilage contact. 7. The purpose of this study was to assess the ability of medial UKA to restore native knee kinematics, contact patterns, and lateral compartment dynamic
Aims. To explore the clinical relevance of
In a longitudinal case-control study, we followed 81 subjects with dysplasia of the hip and 136 control subjects without dysplasia for ten years assessing radiological evidence of degeneration of the hip at admission and follow-up. There were no cases of subluxation in the group with dysplasia. Neither subjects with dysplasia nor controls had radiological signs of ongoing degenerative disease at admission. The primary radiological discriminator of degeneration of the hip was a change in the minimum
Purpose: Radial head replacement with a prosthesis that is too thick has been reported to be associated with stiffness, pain and capitellar wear. Radiographic widening of the lateral ulnohumeral joint following radial head replacement has been used as a criterion to diagnose overstuffing of the radiocapitellar joint. The purpose of this study was to show that widening of the lateral ulnohumeral joint is a normal anatomic variant and therefore cannot be used conclusively to diagnose radiocapitellar joint overstuffing. Methods: Fifty normal standardized anteroposterior elbow radiographs from 50 patients with a mean age of 48 years were reviewed to evaluate variations in the
Purpose: The aetiology of primary omarthrosis is still unclear. Typical radiological changes are
Femoral lengthening has been associated with narrowing of the
Introduction: Evaluation of the hip
Introduction. Chronic uneven distribution of forces over the articular cartilage, which are present in OA, has been shown to be a risk factor for the development of OA. Certain regions of the articular cartilage will be exposed to increased chronic peak loads, whereas other regions encounter a corresponding relative reduction of transmitted forces. This has a well known influence on cartilage viability and is a precursor of degenerative progression. Congruence of joints has an important impact on force distribution across articular surfaces. Therefore, tibiofemoral incongruence could lead to alterations of load distribution and ultimately to progressive degenerative changes. In clinical practice the routine method for evaluation of progressive OA is analysis of
Objectives. An important measure for the diagnosis and monitoring of knee osteoarthritis is the minimum
There have been many reports which suggest that in patients with tibiofemoral osteoarthritis, a reduction in
Aims. Although there are various pelvic osteotomies for acetabular dysplasia of the hip, shelf operations offer effective and minimally invasive osteotomy. Our study aimed to assess outcomes following modified Spitzy shelf acetabuloplasty. Methods. Between November 2000 and December 2016, we retrospectively evaluated 144 consecutive hip procedures in 122 patients a minimum of five years after undergoing modified Spitzy shelf acetabuloplasty for acetabular dysplasia including osteoarthritis (OA). Our follow-up rate was 92%. The mean age at time of surgery was 37 years (13 to 58), with a mean follow-up of 11 years (5 to 21). Advanced OA (Tönnis grade ≥ 2) was present preoperatively in 16 hips (11%). The preoperative lateral centre-edge angle ranged from -28° to 25°. Survival was determined by Kaplan-Meier analysis, using conversions to total hip arthroplasty as the endpoint. Risk factors for
Background/Objective: Since estrogen receptors (ERα/ERβ) were identified in human chondrocytes, animal-and experimental studies have demonstrated the importance of continued estrogen production for the integrity of articular cartilage. However, human epidemiological support of the hypothesis has been inconclusive. The present study investigated the relationship between reduced bone mineral densities (BMD), as a surrogate parameter of endogenous estrogen status – assessed by digital x-ray radiogrammetry (DXR), and reduced minimum hip
The purpose of this study was to determine the effect of sectioning the relevant soft tissues and a TKA on the medial and lateral knee joint gap. Twelve intact lower extremity cadaveric specimens (mean (SD) age 76.5 (11.6) years) were tested. A custom designed knee tensioner was developed that allowed the separate application of forces to the medial and lateral components of the knee. The distance between the bottom of the load cell and the top of a compression rod was measured with digital calipers (precision = 0.1mm). Loads of 100N and 200N were then applied to each compartment and the resulting displacement was measured. The two loads were applied to the knee in the following conditions: i) All soft tissues intact; ii) an arthrotomy; iii) ACL sectioned; iv) PCL sectioned; v) release of the mid-coronal tissues; and vi) TKA. Finally, tensions were applied for all conditions from 90° to 0° of knee flexion in 30° increments. There was a significant effect of soft tissue release on the magnitude of the gap at the 100N load application, such that there was an increase in the when the mid-coronal MCL release was performed compared to the intact (2.2mm) and arthrotomy (1.75mm) conditions. With respect to the 200N load application there was a statistically significant tissue release effect, where differences were detected between the mid-coronal MCL release and intact (3.04mm) and arthrotomy conditions (2.31mm). At the 100N load there was a significance increase in the gap compared to the intact knee. There was also a significant condition by knee angle interaction where the gap was approximately 4mm larger following the TKA compared to the intact condition when the knee was flexed at 90°. Furthermore, there was a statistically significant 4.8mm and 3.8mm difference between 90° and 0° and 60° and 0° of knee flexion respectively, for the TKA condition only. At the 200N load application the gap width increased significantly by 2.5mm following the TKA. Finally, there was a significant condition by knee angle interaction where the change in gap width increased significantly from the intact (7.54mm) to the TKA condition (13.88mm) at 90° of knee flexion. There was a statistically significant difference in the TKA condition between 60° and 0° of knee flexion. Releasing the soft tissues increases the gap between the tibia and femur, when compared to the intact condition, with significance occurring only following the mid-coronal release. Furthermore, the TKA did not return the knee to its intact state as was evident by the significant difference between the TKA and intact conditions. This suggests that the resulting kinematics may not accurately match those pre-surgery resulting in un-physiological motion patterns and the possibility of early failure and revision.
Purpose. It is well known that meniscus extrusion is associated with structural progression of knee OA. However, it is unknown whether medial meniscus extrusion promotes cartilage loss in specific femorotibial subregions, or whether it is associated with a increase in cartilage thickness loss throughout the entire femorotibial compartment. We applied quantitative MRI-based measurements of subregional cartilage thickness (change) and meniscus position, to address the above question in knees with and without radiographic
Aims. We aimed to determine the concentrations of synovial vancomycin and meropenem in patients treated by single-stage revision combined with intra-articular infusion following periprosthetic joint infection (PJI), thereby validating this drug delivery approach. Methods. We included 14 patients with PJI as noted in their medical records between November 2021 and August 2022, comprising eight hip and seven knee joint infections, with one patient experiencing bilateral knee infections. The patients underwent single-stage revision surgery, followed by intra-articular infusion of vancomycin and meropenem (50,000 µg/ml). Synovial fluid samples were collected to assess antibiotic concentrations using high-performance liquid chromatography. Results. The peak concentrations of vancomycin and meropenem in the joint cavity were observed at one hour post-injection, with mean values of 14,933.9 µg/ml (SD 10,176.3) and 5,819.1 µg/ml (SD 6,029.8), respectively. The trough concentrations at 24 hours were 5,495.0 µg/ml (SD 2,360.5) for vancomycin and 186.4 µg/ml (SD 254.3) for meropenem. The half-life of vancomycin was 6 hours, while that of meropenem ranged between 2 and 3.5 hours. No significant adverse events related to the antibiotic administration were observed. Conclusion. This method can achieve sustained high antibiotic concentrations within the