Sacroiliac joint (SIJ) fusion is a controversial yet last resort operative technique to address SIJ pain. The current study aims to determine the patient outcomes of SIJ fusions, in a single surgeon series utilising an anterior approach with 2 DC plates across the joint and iliac crest autograft. Retrospective case series involving 11 patients who had 13 SIJ fusions performed over an 8 year period (2002–2010). Patients were identified by electronic key word search from databases at Middlemore hospital and the private sector. Dictated clinic letters and operation notes were reviewed to obtain demographic data and outcomes data including complications. Postoperative radiology reports were reviewed to document radiographic fusion status. Telephone interviews were conducted to measure clinical outcome scores via the Majeed Pelvic Score and the 12-item Short-Form Health Survey (SF-12). 10 out of 11 patients (entailing 12 SIJ fusions) responded and participated in the study, equating to over 90% follow up. 2 cases were managed at Middlemore Hospital, with the remainder in the private sector. All cases but one had a ‘post-traumatic arthritis’ etiology. Diagnosis was made by CT guided local/steroid injection into the joint in conjunction with CT/bone scan/MRI imaging. The Majeed score improved markedly for 9 of 12 SIJ fusions (75%). 10 of 12 patients stated they would have the procedure again. 7 of 12 fusions (58%) had postoperative complications including blood loss, haematoma, nerve injury (including one case of permanent foot drop), non-union, infection of the joint/metal ware, hernia and urinary retention. 5 of 12 fusions (42%) experienced altered sensation over the lateral femoral cutaneous nerve distribution. All except one patient eventually had x-rays or CT scans postoperatively that reported radiographic fusion of the joint. In appropriately selected patients with SI joint arthrosis, 3/4 patients reported significant improvement in function and pain level after SIJ fusion. Chronic pain (from other sources) and major complications were a feature amongst those failing to benefit. Lateral femoral cutaneous nerve palsy has high incidence with the current operative technique

Background. Prospective study to compare patient reported outcome measures (PROM) for sacroiliac joint (SIJ) fusion using HA-coated screw (HACS) vs triangular titanium dowel (TTD). First study of its kind in English literature. Methods. 40 patients underwent percutaneous SIJ stabilisation using HACS and TTD was used in 70 patients. Patients were followed up closely and outcome scores were collected prospectively. PROMs were collected preoperatively and 12 months after surgery. Short Form (SF)-36, Oswestry Disability Index, EuroQol-5D-5L and Majeed Pelvic Scores were collected. Shapiro-wilk test was used to determine normality of data. Mann-whitney U test was used to compared non-parametric data and Independent sample T test for parametric data. Results. 33 patients in HACS group and 61 in TTD group completed follow-up. There was no significant difference in all preoperative PROMs in both groups hence the data was considered comparable. All postoperative PROMs were significantly higher in the TTD group. In the HACS group, 21 patients (63%) had lysis around the screw and a sub-group analysis showed that improvement in PROMs was significantly less in patients with lysis around the screw. 4 patients with lysis around the screw were offered revision due to ongoing pain. Revision was successful in only 1 patient. In TTD group only 5 patients (8.2 %) patients had radiological evidence of lysis. Relative risk of developing lysis was 6.7 times higher in HACS group. Conclusion. Percutaneous SIJ fixation procedure has been shown to have good clinical outcomes and TTD leads to significantly better patient reported outcomes compared to HACS. There is a 6.7 time higher risk of lysis with use of HACS and lysis is a risk factor for poor outcomes

Abstract. Background. Prospective study to compare patient reported outcome measures (PROM) for sacroiliac joint (SIJ) fusion using HA-coated screw (HACS) vs triangular titanium dowel (TTD). First study of its kind in English literature. Methods. 40 patients underwent SIJ stabilisation using HACS and TTD was used in 70 patients at CAVUHB, Cardiff. PROMs were collected prospectively before surgery and 12 months post-op. Short Form (SF)-36, Oswestry Disability Index, EuroQol-5D-5L and Majeed Pelvic Scores were collected. Shapiro-wilk test was used to determine normality of data. Mann-whitney U test was used to compared non-parametric data and Independent sample T test for parametric data. Results. 33 patients in HACS group and 61 in TTD group completed follow-up. There was no significant difference in all preoperative PROMs in both groups hence the data was considered comparable. All postoperative PROMs were significantly higher in TTD group. In HACS group, 21 patients (63%) had lysis around screw and sub-group analysis showed that PROMs were lower in patients with lysi. 4 patients with lysis around screw were offered revision due to ongoing pain. Revision was successful in only 1 patient. In TTD group only 5 patients (8.2 %) patients had radiological evidence of lysis. Relative risk of developing lysis was 6.7 times higher in HACS group. Conclusion. Percutaneous SIJ fixation procedure has good clinical outcomes and TTD leads to significantly better patient reported outcomes compared to HACS. There is a 6.7 time higher risk of lysis with use of HACS and lysis is a risk factor for poor outcomes

Crescent fractures are represented by a spectrum of morphological fracture patterns, sharing a common mechanism of injury. We propose three distinct types according to the extent of Sacroiliac (SI) joint involvement and the size of the crescent fragment, which enables a pragmatic choice of surgical approach and stabilisation technique. Crescent fractures are fracture dislocations of the SI joint in which there is variable amount of disruption of the SI ligaments extending proximally as a fracture of the posterior iliac wing. We identified three groups of Crescent fractures according to the extent of SI joint involvement, relationship of the fracture line to the S1 and S2 nerve root foramina on anteroposterior and outlet plain radiograph views, and CT films. Type I involves the less than inferior third of the SI joint with a large posterior iliac fragment left attached to the sacrum. This is best approached anteriorly for stabilisation. Type II has between one-third to two-thirds involvement of the SI joint and is treated according to Helfet's technique. Type III has a very small crescent fragment left attached to the sacrum and the inferior two-thirds of the SI joint is disrupted. This is treated with percutaneous SI screws, but will need anterior open reduction in delayed presentations. Based on this, we treated sixteen patients and followed them for at least two years. There were four Type I, four Type II and eight Type III fractures. Fifteen had anatomical reduction and stabilisation of the SI joint with good functional results. Delayed referral, the presence of significant soft tissue injury posteriorly and infected external fixator pins. From our experience we would like to propose this functional classification of crescent fractures which we find useful in making a choice of surgical approach and stabilisation technique to achieve satisfactory reduction and stabilisation of sacroiliac joint

Over half of postpartum women experience pelvic ring or hip pain, with multiple anatomic locations involved. The sacroiliac joints, pubic symphysis, lumbar spine and pelvic girdle are all well documented pain generators. However, despite the prevalence of postpartum hip pain, there is a paucity of literature regarding underlying soft tissue intra-articular etiologies. The purpose of this systematic review is to document and assess the available evidence regarding underlying intra-articular soft tissue etiologies of peri- and postpartum hip pain. Three online databases (Embase, PubMed and Ovid [MEDLINE]) were searched from database inception until April 11, 2021. The inclusion criteria were English language studies, human studies, and those regarding symptomatic labral pathology in the peri- or postpartum period. Exclusion criteria were animal studies, commentaries, book chapters, review articles and technical studies. All titles, relevant abstracts and full-text articles were screened by two reviewers independently. Descriptive characteristics including the study design, sample size, sex ratio, mean age, clinical and radiographic findings, pathology, subsequent management and outcomes were documented. The methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) instrument. The initial search identified 2472 studies. A systemic screening and assessment of eligibility identified 5 articles that satisfied the inclusion criteria. Twenty-two females were included. Twenty patients presented with labral pathology that necessitated hip arthroscopy with labral debridement or repair with or without acetabuloplasty and/or femoroplasty. One patient presented with an incidental labral tear in the context of osteitis condensans illi. One patient presented with post-traumatic osteoarthritis necessitating a hip replacement. The mean MINORS score of these 5 non-comparative studies was 2.8 (range 0-7) demonstrating a very low quality of evidence. The contribution of intra-articular soft tissue injury is a documented, albeit sparse, etiology contributing to peri- and postpartum hip pain. Further research to better delineate the prevalence, mechanism of injury, natural history and management options for women suffering from these pathologies at an already challenging time is necessary to advance the care of these patients

Anteroposterior (AP) pelvic radiographs are the standard tool used for pre-operative planning and post-operative evaluation during total hip arthroplasty (THA). The accuracy of this imaging modality is, however, limited by errors in pelvic orientation and image distortion. Pelvic obliquity is corrected for by orienting measurements to a reference line such as the interteardrop line or the interischial line, while several methods for correcting for pelvic tilt have been suggested, with varying levels of success. To date, no reliable method for correcting for pelvic rotation on pelvic imaging is available. The purpose of this study was to evaluate a novel method for correcting pelvic rotation on a standard anteroposterior (AP) radiographs. Computed tomography (CT) scans from 10 male cadavers and 10 female THA patients were segmented using 3D Slicer and used to create 3D renderings for each pelvis. Synthetic AP radiographs were subsequently created from the 3D renderings, using XRaySim. For each pelvis, images representing pelvic rotation of 30° left to 30° right, at 5° increments were created. Four unique parameters based on pelvic landmarks were used to develop the correction method: i) the horizontal distance from the upper edge of the pubic symphysis to the sacroiliac joint midline (PSSI), ii) the ratio of the horizontal distances from the upper edge of the pubic symphysis to the outer lateral border of both obturator foramina (PSOF), iii) the width ratio of the obturator foramina (OFW) and iv) the ratio of the horizontal distance from each anterior superior iliac spine to the sacroiliac joint midline (ASISSI). The relationships between the chosen parameters and pelvic rotation were investigated using a series of 260 (13 per pelvis) synthetic AP radiographs. Male and female correction equations were generated from the observed relationships. Validation of the equations was done using a different set of 50 synthetic radiographs with known degrees of rotation. In males, the PSSI parameter was most reliable in measuring pelvic rotation. In females, PSOF was most reliable. A high correlation was noted between calculated and true rotation in both males and females (r=0.99 male, r=0.98 female). The mean difference from the male calculated rotation and true rotation value was 0.02°±1.8° while the mean difference from the female calculated rotation and true rotation value was −0.01°±1.5°. Our correction method for pelvic rotation using four pelvic parameters provides a reliable method for correcting pelvic rotation on AP radiographs. For any figures or tables, please contact authors directly

Conflict in Afghanistan demonstrated predominantly lower extremity and pelvi-perineal trauma secondary to Improvised Explosive Devices (IEDs). Mortality due to pelvic fracture (PF) is usually due to exsanguination. This study group comprised 169 military patients who sustained a PF and lower limb injury. There were 102 survivors and 67 fatalities (39% mortality). Frequent fracture patterns were a widened symphysis (61%) and widening of the sacroiliac joints (SIJ) (60%). Fatality was 20.7% for undisplaced SIJs, 24% for unilateral SIJ widening and 64% fatality where both SIJs were disrupted, demonstrating an increase in fatality rate with pelvic trauma severity. A closed pubic symphysis was associated with a 19.7% mortality rate versus 46% when widened. Vascular injury was present in 67% of fatalities, versus 45% of survivors. Of PFs, 84% were associated with traumatic amputation (TA) of the lower limb. Pelvic fracture with traumatic lower limb amputation presents a high mortality. It is likely that the mechanism of TA and PF are related, and flail of the lower limb(s) is the current hypothesis. This study prompts further work on the biomechanics of the pelvic-lower limb complex, to ascertain the mechanism of fracture. This could lead to evidence-based preventative techniques to decrease fatalities

Acute osteomyelitis and septic arthritis are uncommon diseases in childhood that affect previously healthy children. A high index of suspicion, early diagnosis, initiation of appropriate antibiotic treatment and surgical intervention are essential for a good outcome. The aim of our study was to evaluate our approach, clinical signs and the outcome of the diseases. We retrospectively analyzed clinical, laboratory and microbiologic data in children hospitalized for acute haematogenous osteomyelitis or septic arthritis at the Department of Orthopaedic surgery in a 10-year period (from 2003 to 2013). Follow-up of outpatients was continued for at least 1 year or until the full recovery. Acute haematogenous osteomyelitis or septic arthritis were confirmed in 22 patients, 14/22 (64%) had osteomyelitis and 8/22 (36%) arthritis, 16/22 (73%) were boys. The mean patient age was 9,3 years (SD:3,5), the median of the hospitalization was 32 days (IQR:13 – 60 days). In children with osteomyelitis 10/14 (72%) had affected lower limb and in 4/14 (28%) the spine was affected. Six (80%) children had septic arthritis of the knee, hip joint was affected in one child and sacroiliac joint in one as well. We obtained blood cultures in 19/22 (86%) patients, bone biopsy was performed in 14/22 (64%). All infections were monomycrobial, Staphylococcus aureus was the most common pathogen, as expected. In one patient the cause of the osteomyelitis was Panton-Valentine leucocidin (PVL) producing S. aureus. The characterics are presented in Table 1. All affected children recovered completely. We observed 22 cases of pediatric bone and joint infections in a 10-year period. The most common pathogen was Staphylococcus aureus, as expected, althogh in more than half of cases no pathogens were found. One child suffered from osteomielitis caused by S. aureus strain producing PVL. We observed higher proportion of spine invovelment than previously reported in the literature

Pyogenic sacroiliitis (PS) is one of the less frequent localizations among joint infections, near the 1,5%. A late diagnosis generally exists. So we decided to analyze its behaviour in our uniit. A retrospective study of 39 records was carried out, 32 with diagnosis of entrance of PS and 7 with another pathology's diagnosis that turned out to be a PS, among the years 1999 and 2014 in our unit. 27 only fulfilled the requirements to be classified as PS (Clinic features of infection and sacroiliac localization, laboratory exams and Tc-99 bone scintigraphy alterations). 20 males and 7 females (74% males), 52% right sacroiliac joint, only 7 had clinically predisposing conditions (trauma), aged between 3 and 14 years (average 9.6 years). The half time of clinical evolution foresaw to diagnosis was of 4,7 days (6,7 days between 1999–2005 and 3,5 between 2006–2014) (range between 1 and 10 days). The main symptom that motivates the consultation was fever (96%) accompanied by FABER test positive (70%) by buttock pain (52%) and by limping (48%). Laboratory exams: WBC count was normal in 11 cases and elevated in 16 cases too and only in 5 cases with left deviation (PMNs elevated); CRP higher than 55 mg/dl in 23 patients (100% over 20mg/dl), ERS with value average of 72 mmHg/hour (27–111). Blood cultures were positive in 70% and the Staphylococcus aureus was the main bacteria founded (89%). No radiological alterations were found initially. The TC-99 bone scintigraphy was positive in all cases after the third day. All patients had a 5 to 12 days course of intravenous antibiotics (oxacillin + amikacin in 96% of patients) and then completed 4 weeks with oral oxacillin. All patients recovered without sequel. Blood cultures may be obtained prior the antibiotics’ administration. The Staphylococcus aureus is by far the most frequent germ involved in this process, and it may guide the empiric antibiotic therapy. The precocious antibiotic treatment solves the case without sequels. The PS is an uncommon pathology in children that makes it often not recognized initially. Wrong diagnosis such as appendicitis, transient synovitis of the hip, discitis, etc. can be avoided if PS is sought in a systematic way

Introduction. Long-term success of the cementless acetabular component has been depends on amount of bone ingrowth around porous coated surface of the implant, which is mainly depends on primary stability, i.e. amount of micromotion at the implant-bone interface. The accurate positioning of the uncemented acetabular component and amount of interference fit (press-fit) at the rim of the acetabulum are necessary to reduce the implant-bone micromotion and that can be enhancing the bone ingrowth around the uncemented acetabular component. However, the effect of implant orientations and amount of press-fit on implant-bone micromotion around uncemented acetabular component has been relatively under investigated. The aim of the study is to identify the effect of acetabular component orientation on implant-bone relative micromotion around cementless metallic acetabular component. Materials and Method. Three-dimensional finite element (FE) model of the intact and implanted pelvises were developed using CT-scan data [1]. Five implanted pelvises model, having fixed antiversion angle (25°) and different acetabular inclination angle (30°, 35°, 40°, 45° and 50°), were generated in order to understand the effect of implant orientation on implant-bone micromotion around uncemented metallic acetabular component. The CoCrMo alloy was chosen for the implant material, having 54 mm outer diameter and 48 mm bearing diameter [1]. Heterogeneous cancellous bone material properties were assigned using CT-scan data and power law relationship [1], whereas, the cortical bone was assumed homogeneous and isotropic [1]. In the implanted pelvises models, 1 mm diametric press-fit was simulated between the rim of the implant and surrounding bone. Six nodded surface-to-surface contact elements with coefficient of friction of 0.5 were assigned at the remaining portion of the implant–bone interface [1]. Twenty-one muscle forces and hip-joint forces corresponds to peak hip-joint force of a normal walking cycle (13%) were used for the applied loading condition. Fixed constrained was prescribed at the sacroiliac joint and pubis-symphysis [1]. A submodelling technique was implemented, in order to get more accurate result around implant-bone interface [1]. Results and Discussions. The peak implant-bone sliding interfacial micromotion was observed around 75 microns around superior and supero-posterior regions of the acetabulum, whereas, micromotion was below 50 microns around other regions (area). As compared to other regions, less implant-bone micromotions were observed at the central region of the acetabulum and anterior part of the acetabulum, where micromotions were varied in the range between 5 microns to 30 microns. Although, the generated peak implant-bone sliding micromotion around the uncemented acetabulum was not vary notably due to change in inclination angle of the acetabular component, changes in patterns of implant-bone micromotions were observed and as shown [Fig.1]. Results of the present study indicated that the positioning of the uncemented acetabular component have influence on patterns of implant-bone micromotion and that might have influence on bone ingrowth and long-term success of uncemented acetabular component

Total hip arthroplasty for developmental dysplasia of the hip (DDH) remains a difficult and challenging problem. How to reconstruct acetabular deficiencies has become increasingly important. One of the major causes inducing loosening of acetabular reinforcement ring with hook (Ganz ring) is insufficient initial stability. In this study, three-dimensional finite element models of the pelvis with different degrees of bone defect and acetabular components were developed to investigate the effects of the number of screws, screw insert position (Fig. 1), and bone graf quality on the initial stability under the peak load during normal walking. The size of pelvic bone defect, the number of screws and the position of screws were varied, according to clinical experience, to assess the change of initial stability of the Ganz ring. The Ganz ring was placed in the true acetabulum and the acetabular cup was cemented into the Ganz ring with 45 degrees abduction and 15 degrees of screws. The Insert position, nodes on the sacroiliac joint and the pubic symphysis were fixed in all degrees of freedom as the boundary condition. The peak load during normal walking condition was applied to the center of the femoral head (Fig. 2). According to the Crowe classification, as the degree of acetabular dysplasia was increased, the relative micromotion between the Ganz ring and pelvis was also increased. The peak micromotion increased as the stiffness of bone graft decreased. Increasing the numbers of screws, the relative micromotion tended to be reduced and varied the screw insertion position that affects the relative micromotion in the Ganz ring-pelvic interface (Fig. 3). This study showed that increasing the number of inserted screws can reduce the relative micromotion. Both the insert position and graft bone property affect the stability of the Ganz ring while the insert position has a greater impact. The current study is designed to lay the foundation for a biomechanical rationale that will support the choice of treatment

Introduction. Haemodynamically compromised patients with biomechanically unstable pelvic fractures need reduction of the pelvic volume to effect tamponade of bleeding bone and vessels. Knee binding, to help achieve this, is advocated in standard Advanced Trauma and Life Support teaching but is rarely used. There are no reports in the literature as to the benefits derived from this simple manoeuvre. The aim of this study was to investigate whether there was an effect on symphysis pubis closure by binding the knees together and to quantify this. Methods. 13 consecutive patients who underwent open reduction and internal fixation of pubic symphysis diastasis +/− sacroiliac joint fixation were recruited prospectively. These patients were transferred from peripheral hospitals to this National tertiary referral level 1 trauma centre for definitive pelvic fracture management. All patients had sustained Antero-Posterior Compression (APC) type pelvic injuries. In theatre, a centred antero-posterior (AP) radiograph was taken without any form of binding on the pelvis. A second AP radiograph was then taken with the knees and ankles held together with the hips internally rotated. A third, final AP radiograph was taken post fixation. Measurements of symphysis pubis widening were made of the digital images taken in theatre. Results. The study population included 11 men and 2 women. The mean age was 46. The average percentage closure of symphysis following knee binding in relation to the final reduced symphysis, post fixation was 69%. Conclusion. Our impression is that this manoeuvre is rarely employed on patients with these types of injury. This is the first study to quantify the effects of this simple manoeuvre. Emergency measures to reduce the pelvic volume and thus limit pelvic haemorrhage are well recognised. We have shown that this simple measure is a useful adjunct and that it has a measurable effect on reducing pubic diastasis

Aims. Leg length inequality following total hip replacement remains common. In an effort to reduce this occurrence, surgeons undertake pre-operative templating and use various forms of intra-operative measurements, including computer navigation. This study aims to delineate which measurement technique is most appropriate for measuring leg length inequality from a pelvic radiograph. Method. Three observers took a total of 9600 measurements from 100 pelvic radiographs. Four lines were constructed on each of the radiographs, bisecting the acetabular teardrops (Methods 1/2), ishial spines (Method 3/4), inferior sacroiliac joint (Method 5/6) and inferior obturator foramen (Method 7/8). Measurements were taken from these lines to the midpoint on the LT and to the tip of the GT. The effect of pelvic positioning was also assessed using radiographs of a synthetic pelvis and femur using the same eight methods by a single observer (ED). Intra-observer variability was analysed using within subject standard deviation. Inter-observer variability was analysed using the coefficient of inter-observer variability (CIV). Results. When considering the 100 pelvic radiographs measurement methods 3 (SD 3.5, CIV 0.34) and 8 (SD 3.3 CIV 0.33) showed the best inter and intra observer variability. Methods 4 and 6 performed badly for inter and intra observer variability (SD 3.8 CIV 0.4 and SD 4.6 CIV 0.4). Methods 1, 2, 5 and 7 performed well in one aspect but poorly in the other. When considering the effect of pelvic positioning using radiographs of the synthetic pelvis and femur construct, methods 3 and 7 performed best (SD 6.7 and SD 7.4). Discussion. Measuring from the ischial tuberosities to the LT has the best intra- and interobserver variability. It also performs well despite pelvic malposition. As techniques improve in the measurement of intra-operative leg length, a more accurate measurement of leg length is needed to validate these technologies by

Despite the generally inferior clinical performance of acetabular prostheses as compared to the femoral implants, the causes of acetabular component loosening and the extent to which mechanical factors play a role in the failure mechanism are not clearly understood yet. The study was aimed at investigating the load transfer and bone remodelling around the uncemented acetabular prosthesis. The 3-D FE model of a natural right hemi-pelvis was developed using CT-scan data. The same bone was implanted with two uncemented hemispherical acetabular components, one metallic (CoCrMo alloy) and the other ceramic (Biolox delta), with 54 mm outer diameter and 48 mm bearing diameter. The FE models of the implanted pelvis (containing ∼116000 quadratic tetrahedrals) were generated using a submodelling approach, which were based on an overall full model of implanted pelvis (containing ∼217600 quadratic tetrahedrals) acted upon by hip joint force and twenty one muscle forces. The apparent density (ρ in g cm. −3. ) of each cancellous bone element was calculated using linear calibration of CT numbers of bone, from which the Young's modulus (E in MPa) was determined using the relationship, E = 2017.3 ρ. 2.46. [1]. Implant-bone interface conditions, fully bonded and debonded with friction coefficient μ = 0.5, were simulated using contact elements. Applied loading conditions consist of two load cases during a gait cycle, corresponding to 13% and 52% of the walking cycle. Fixed constraints were prescribed at the pubis and at the sacroiliac joint. The bone remodelling algorithm was based on strain energy based site-specific formulation [2]. The FE analysis, in combination with the bone remodelling simulation, was performed using ANSYS FE software. The predicted changes in peri-prosthetic bone density were similar for the metallic and the ceramic implant. For debonded implant-bone interface, stress shielding led to ∼20% reductions in bone density at supero-anterior, infero-anterior and posterior part of the acetabulum (Fig. 1). However, bone apposition was observed at the supero-posterior part of the acetabulum, where implantation led to ∼60% increase in bone density (Fig. 1). The effect of bone resorption was higher for the fully bonded implant-bone interface, wherein bone density reductions of 20–50% were observed in the cancellous bone underlying the implant (Fig. 1), which is indicative of implant loosening over time. However, implantation led to an increase in bone density around the acetabular rim for both the interface conditions (Fig. 1). These results are well corroborated by the earlier studies [3, 4]. Implantation with a ceramic component resulted in 2–7% increase in bone density at supero-posterior part of the acetabulum as compared to the metallic component, for the debonded interface condition. Considering better wear resistant properties and absence of metal ion release, results of this study suggest that the ceramic component might be a viable alternative to the metallic prosthesis

Aims

Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford.

Aims

The aetiologies of common degenerative spine, hip, and knee pathologies are still not completely understood. Mechanical theories have suggested that those diseases are related to sagittal pelvic morphology and spinopelvic-femoral dynamics. The link between the most widely used parameter for sagittal pelvic morphology, pelvic incidence (PI), and the onset of degenerative lumbar, hip, and knee pathologies has not been studied in a large-scale setting.

Aims

The aim of this paper was to present the clinical features of patients with musculoskeletal sources of methicillin-sensitive Staphylococcus aureus (MSSA) septicaemia.

The use of ultrasound-guided wire localisation of lesions is not well described in the orthopaedic literature. We describe a case of an impalpable schwannoma of the femoral nerve and another of sacroiliitis with an associated pelvic abscess. In both, surgical localisation was difficult. Peri-operative ultrasound-guided wire localisation was used to guide surgery and minimise tissue damage, thereby optimising the results and recovery of the patient.

The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics.

Cite this article: Bone Joint J 2015; 97-B:292–9.

We report our experience using a biodegradable calcium sulphate antibiotic carrier containing tobramycin in the surgical management of patients with chronic osteomyelitis. The patients were reviewed to determine the rate of recurrent infection, the filling of bony defects, and any problems with wound healing. A total of 193 patients (195 cases) with a mean age of 46.1 years (16.1 to 82.0) underwent surgery. According to the Cierny–Mader classification of osteomyelitis there were 12 type I, 1 type II, 144 type III and 38 type IV cases. The mean follow-up was 3.7 years (1.3 to 7.1) with recurrent infection occurring in 18 cases (9.2%) at a mean of 10.3 months post-operatively (1 to 25.0). After further treatment the infection resolved in 191 cases (97.9%). Prolonged wound ooze (longer than two weeks post-operatively) occurred in 30 cases (15.4%) in which there were no recurrent infection. Radiographic assessment at final follow-up showed no filling of the defect with bone in 67 (36.6%), partial filling in 108 (59.0%) and complete filling in eight (4.4%). A fracture occurred in nine (4.6%) of the treated osteomyelitic segments at a mean of 1.9 years (0.4 to 4.9) after operation.

We conclude that Osteoset T is helpful in the management of patients with chronic osteomyelitis, but the filling of the defect in bone is variable. Prolonged wound ooze is usually self-limiting and not associated with recurrent infection.

Cite this article: Bone Joint J 2014; 96-B:829–36