Fractures of the humeral diaphysis occur in a bimodal distribution and represent 3-5% of all fractures. Presently, the standard treatment of isolated humeral diaphyseal fractures is nonoperative care using splints, braces, and slings. Recent data has questioned the effectiveness of this strategy in ensuring fracture healing and optimal patient function. The primary objective of this randomized controlled trial (RCT) was to assess whether operative treatment of humeral shaft fractures with a plate and screw construct provides a better functional outcome than nonoperative treatment. Secondary objectives compared union rates and both clinical and patient-reported outcomes.

Eligible patients with an isolated, closed humeral diaphyseal fracture were randomized to either nonoperative care (initial sugar-tong splint, followed by functional coaptation brace) or open reduction and internal fixation (ORIF; plate and screw construct). The primary outcome measure was the Disability Shoulder, Arm, Hand (DASH) score assessed at 2-, 6-, 16-, 24-, and 52-weeks. Secondary outcomes included the Short Musculoskeletal Functional Assessment (SMFA), the Constant Shoulder Score, range of motion (ROM), and radiographic parameters. Independent samples t-tests and Chi-squared analyses were used to compare treatment groups. The DASH, SMFA, and Constant Score were modelled over time using a multiple variable mixed effects model.

A total of 180 patients were randomized, with 168 included in the final analysis. There were 84 patients treated nonoperatively and 84 treated with ORIF. There was no significant difference between the two treatment groups for age (mean = 45.4 years, SD 16.5 for nonoperative group and 41.7, SD 17.2 years for ORIF group; p=0.16), sex (38.1% female in nonoperative group and 39.3% female in ORIF group; p=0.87), body mass index (mean = 27.8, SD 8.7 for nonoperative group and 27.2, SD 6.2 for ORIF group; p=0.64), or smoking status (p=0.74). There was a significant improvement in the DASH scores at 6 weeks in the ORIF group compared to the nonoperative group (mean=33.8, SD 21.2 in the ORIF group vs. mean=56.5, SD=21.1 in the nonoperative group; p < 0 .0001). At 4 months, the DASH scores were also significantly better in the ORIF group (mean=21.6, SD=19.7 in the ORIF group vs. mean=31.6, SD=24.6 in the nonoperative group; p=0.009. However, there was no difference in DASH scores at 12-month follow-up between the groups (mean=8.8,SD=10.9 vs. mean=11.0, SD=16.9 in the nonoperative group; p=0.39). Males had improved DASH scores at all timepoints compared with females. There was significantly quicker time to union (p=0.016) and improved position (p < 0 .001) in the ORIF group. There were 13 (15.5%) nonunions in the nonoperative group and four (4.7%) combined superficial and deep infections in the ORIF group. There were seven radial nerve palsies in the nonoperative group and five (a single iatrogenic) radial nerve palsies in the ORIF group.

This large RCT comparing operative and nonoperative treatment of humeral diaphyseal fractures found significantly improved functional outcome scores in patients treated surgically at 6 weeks and 4 months. However, the early functional improvement did not persist at the 12-month follow-up. There was a 15.5% nonunion rate, which required surgical intervention, in the nonoperative group and a similar radial nerve palsy rate between groups.

Fractures of the humeral diaphysis occur in a bimodal distribution and represent 3-5% of all fractures. Presently, the standard treatment of isolated humeral diaphyseal fractures is nonoperative care using splints, braces, and slings. Recent data has questioned the effectiveness of this strategy in ensuring fracture healing and optimal patient function. The primary objective of this randomized controlled trial (RCT) was to assess whether operative treatment of humeral shaft fractures with a plate and screw construct provides a better functional outcome than nonoperative treatment. Secondary objectives compared union rates and both clinical and patient-reported outcomes.

Eligible patients with an isolated, closed humeral diaphyseal fracture were randomized to either nonoperative care (initial sugar-tong splint, followed by functional coaptation brace) or open reduction and internal fixation (ORIF; plate and screw construct). The primary outcome measure was the Disability Shoulder, Arm, Hand (DASH) score assessed at 2-, 6-, 16-, 24-, and 52-weeks. Secondary outcomes included the Short Musculoskeletal Functional Assessment (SMFA), the Constant Shoulder Score, range of motion (ROM), and radiographic parameters. Independent samples t-tests and Chi-squared analyses were used to compare treatment groups. The DASH, SMFA, and Constant Score were modelled over time using a multiple variable mixed effects model.

A total of 180 patients were randomized, with 168 included in the final analysis. There were 84 patients treated nonoperatively and 84 treated with ORIF. There was no significant difference between the two treatment groups for age (mean = 45.4 years, SD 16.5 for nonoperative group and 41.7, SD 17.2 years for ORIF group; p=0.16), sex (38.1% female in nonoperative group and 39.3% female in ORIF group; p=0.87), body mass index (mean = 27.8, SD 8.7 for nonoperative group and 27.2, SD 6.2 for ORIF group; p=0.64), or smoking status (p=0.74). There was a significant improvement in the DASH scores at 6 weeks in the ORIF group compared to the nonoperative group (mean=33.8, SD 21.2 in the ORIF group vs. mean=56.5, SD=21.1 in the nonoperative group; p < 0 .0001). At 4 months, the DASH scores were also significantly better in the ORIF group (mean=21.6, SD=19.7 in the ORIF group vs. mean=31.6, SD=24.6 in the nonoperative group; p=0.009. However, there was no difference in DASH scores at 12-month follow-up between the groups (mean=8.8,SD=10.9 vs. mean=11.0, SD=16.9 in the nonoperative group; p=0.39). Males had improved DASH scores at all timepoints compared with females. There was significantly quicker time to union (p=0.016) and improved position (p < 0 .001) in the ORIF group. There were 13 (15.5%) nonunions in the nonoperative group and four (4.7%) combined superficial and deep infections in the ORIF group. There were seven radial nerve palsies in the nonoperative group and five (a single iatrogenic) radial nerve palsies in the ORIF group.

This large RCT comparing operative and nonoperative treatment of humeral diaphyseal fractures found significantly improved functional outcome scores in patients treated surgically at 6 weeks and 4 months. However, the early functional improvement did not persist at the 12-month follow-up. There was a 15.5% nonunion rate, which required surgical intervention, in the nonoperative group and a similar radial nerve palsy rate between groups.

A quick, portable and reliable tool for predicting ACL injury could be an invaluable instrument for athletes, coaches, and clinicians. The gold standard, Vicon motion analysis, despite having a high sensitivity and risk specificity, is not practical for coaches or clinicians to use on a routine basis for assessing athletes. The present study validated the Kinect device to the currently used method of chart review in predicting athletes at high risk.

A total of 114 participants were recruited from both the men and women McGill Varsity Sports Program. 69 males and 45 female athletes were evaluated to assess the specificity and sensitivity of the Kinect device in predicting athletes at high risk of injury. Each athlete performed three-drop vertical jumps off of a 31cm box and the data was recorded and risk score was generated. Generation of this data is done by our uniquely programmed software that measures landing angles at different time frames and compares live results to previously known data of injured athletes. A chart review was then performed by a clinician, blinded to these risk scores, to risk stratify the same athletes as high or low risk of ACL injury based on their medical charts. Data reviewed incorporated pre-season physical exams along with documented known risk factors for ACL injury, including previous knee injuries, family history of ACL injury, gender, sport, and BMI. Positive risk factors were assigned one point while negative risk factors assigned zero points.

The Kinect device, powered by our software, identified 40 athletes as having a high-risk score (> 55%), and subsequently, five (4.39%) sustained an ACL injury by the end of their respective sport seasons. Two male and two female basketball players along with one male soccer player sustained non-contact ACL injuries. Given that all five of the injured athletes were in the cohort of 40 identified as high risk by the Kinect, this yielded a sensitivity of 100% for the device. As for the specificity, the Kinect computed 35 false positives, yielding a specificity of 68% for the duration of the study. The medical chart review identified 36 athletes as high risk and 60 as being low risk of ACL injury. Four of the athletes that sustained an ACL injury were in the group of 36 identified as high risk by the clinician. However, one of the five participants who sustained an ACL injury was not captured by the medical chart assessment, yielding a sensitivity of 80% and a specificity of 65% for the clinician.

When it comes to injury prediction, it is preferred to have a high sensitivity even if the specificity is slightly lower as this ensures that all athletes who are at risk will be captured. Our data demonstrated that the chart analysis provided one false negative and led to missing one high-risk athlete who ended up sustaining an ACL injury. Based on the comparison of sensitivity and specificity, the Kinect system provides a slightly better predictive analysis for predicting ACL injury compared to chart review.

Osteoarthritis (OA) is one of the most common causes of knee pain in the aging population and presents with higher odds with increased BMI. Total knee arthroplasty (TKA) has become the standard of care for the treatment of OA. Over “719,000 TKA's were performed in 2010 in the USA alone, with dramatic economic burden- costing 16,000 USD per TKA” (CDC 2012). Over the past two decades, this cost was compounded by the unknown increasing rate of primary TKA and cannot be explained by the expanding population or worldwide obesity epidemic. These facts raise two key questions: are patients' quality of life expectations higher and driving the TKA rate up, or have surgeons changed their indications and started to operate on less disabled people? Our study aimed to determine the average functional profile for patients undergoing TKA using patient reported Outcome Measure (SF-36), to document if preoperative SF-36 scores have changed over the past two decades, and lastly to asses if patient pre-operative SF-36 scores are lower in in the USA vs the rest of the world.

A literature search of Medline, Embase and Cochrane databases was performed extracting data from publishing year 1966 to 2016 with a search date of Dec 12, 2016. Two independent reviewers revised the abstracts and excluded articles with: no TKA, revision TKA, no pre-op SF-36, no SF-36 reported, incomplete scores to calculate SF-36, duplicates, review article, meta-analysis, letter to the editor, conference proceeding or abstract, disagreements were resolved with a third reviewer. All languages were included to maximize the catchment of data. All remaining articles were independently read and excluded if they did not provide data required for our study. Included articles were analyzed for data including: for year of patient enrollment, location (USA vs. non-USA), pre-operative SF-36 mental (MCS) and physical (PCS) component summary, level of evidence. Recorded data was compared post completion to assess inter-observer accuracy as per PRISMA guidelines for meta-analysis.

After applying all the exclusion criteria on 923 selected abstracts, a total of 136 articles of which 30 were randomized control trials, were completely reviewed and included in our study. A total of 56,713 patients' physical component scores were analyzed and revealed an overall pre-operative SF-36 physical component score 31.93. When stratifying the data, it was revealed that patients operated in the USA had an average score of 32.3 whereas Non-US countries were 31.7, with no statistical significance. No statistical difference between SF36 scores was seen over time amongst studies of all nations.

Based on the results of this study, we have shown that orthopaedic surgeons are performing TKA universally at the same pre-operative scores, independent of country of origin or year of surgery. The indications thus have remained consistent for two decades regardless of the advances in technology. Functional profiles of patients appear similar among US and Non-US countries. Further, we infer that based on pre-operative SF-36 PCS scores, the optimal time to undergo a TKA is when PCS is 31.9 +/−3.

Osteoarthritis (OA) is a debilitating disease and the most common joint disorder worldwide. Although the development of OA is considered multifactorial, the mechanisms underlying its initiation and progression remain unclear. A prominent feature in OA is cartilage degradation typified by the progressive loss of extracellular matrix components - aggrecan and type II collagen (Col II). Cartilage homeostasis is maintained by the anabolic and catabolic activities of chondrocytes. Prolonged exposure to stressors such as mechanical loading and inflammatory cytokines can alter the phonotype of chondrocytes favoring cartilage catabolism, and occurs through decreased matrix protein synthesis and upregulation of catabolic enzymes such as aggrecanases (ADAMTS-) 4 and 5 and matrix metalloproteinases (MMPs). More recently, the endoplasmic reticulum (ER) stress response has been implicated in OA. The ER-stress response protects the cell from misfolded proteins however, excessive activation of this system can lead to chondrocyte apoptosis. Acute exposure of chondrocytes to IL-1β has been demonstrated to upregulate ER-stress markers (GADD153 and GRP78), however, it is unclear whether the ER-stress response plays a role on chronic IL-1β exposure. The purpose of this study was to determine whether modulating the ER stress response with tauroursodeoxycholic acid (TUDCA) in human OA chondrocytes during prolonged IL-1β exposure can alter its catabolic effects.

Articular cartilage was isolated from donors undergoing total hip or knee replacement. Chondrocytes were recovered from the cartilage of each femoral head or knee by sequential digestion with Pronase followed by Collagenase, and expanded in DMEM-low glucose supplemented with 10% FBS. Chondrocytes were expanded in flasks for one passage before being prepared for micropellet culture. Chondrocyte pellets were cultured in regular growth medium (Control), medium supplemented with IL-1β [10 ng/mL], TUDCA [100 uM] or IL-1β + TUDCA for 12 days. Medium was replaced every three days. Cartilage explants were prepared from the donors undergoing knee replacement, and included cartilage with the cortical bone approximately 1 cm2 in dimension. Explants were cultured in the above mentioned media, however, the incubation period was extended to 21 days. RNA was extracted using Geneaid RNA Mini Kit for Tissue followed by cDNA synthesis. QPCR was performed using Cyber Green mastermix and primers for the following genes: ACAN (aggreacan), COL1A1, COL2A1, COL10A1, ADAMTS-4, ADAMTS-5, MMP-3, and MMP-13, on an ABI 7500 fast qPCR system.

Although IL-1β did not significantly decrease the expression of matrix proteins, it did increase the expression of ADAMTS-4, −5, and MMP3 and −13 when compared to controls (Kruskal-Wallis, p < 0 .05, n=3). TUDCA treatment alone did not significantly increase the expression of catabolic enzymes but it did increase the expression of collagen type II. When IL-1β was coincubated with TUDCA, the expression of ADAMTS-4, ADAMTS-5, and MMP-13 significantly decreased by ∼40-fold, ∼10-fold, and ∼3-fold, respectfully.

We provide evidence that the catabolic activities of IL-1β on human cartilage can be abrogated through modulation of the ER stress response.

Introduction

Gluteus medius is disrupted during lateral approach total hip arthroplasty (THA) which may impact its function and ability to control the pelvis. The objective was to compare gluteus medius activation and joint mechanics associated with a Trendelenburg sign (pelvic drop, trunk lean) during gait and hip abductor strength between patients that underwent lateral or posterior THA approaches one year post-surgery and healthy adults.

Utilising the (ACS-NSQIP) database, we aimed to evaluate the impact of resident level of training on surgical outcome following (TKA) and to compare the US and Canadian health care training system in regards to 30 days postoperative complications and readmission rates.

Using the (CPT) codes we selected from the 2011 and 2012 NSQIP database elective primary TKA with the resident surgeon involved. Of these, all cases with a primary diagnosis code of infection, fracture, mechanical complication, or malignancy and all cases with incomplete or incongruous demographic information were excluded. We also eliminated all the cases with the Attending not present. A total of 2513 cases were included in the study. The cases were stratified into three groups according to the postgraduate level of training {PGY 1 to 3 (junior resident), PGY 4 to 5 (senior resident), and fellow}. Univariate analysis of all patient demographics, comorbidities, intra and postoperative variables, length of surgery, hospital stay and 30 days readmission rates were conducted in order to identify differences between the groups. A standard student's t test was used for continuous variables while the ChiSquared was used for categorical variables. Multivariable logistic regression models were created to assess the independent effect of the resident level of training on the 30 days major complication and re-admission rates while controlling for all other variables.

We identified, 854 (34%) TKAs with junior residents, 1013 (40%) TKAs with senior residents and 646 (26%) TKAs with fellows' participation. Junior residents had a significant (p<0.0001) longer operative time (107±36 minutes) compared with senior residents and fellows. Length of hospital stay was longer in the fellow group probably because of their involvement in more complicated cases. Additionally, an increased number of blood transfusion was observed for the cases performed with involvement of senior residents when compared with the other two groups. However, no significant difference in complications was observed across training levels. When comparing US (2074 TKAs) versus Canada (423 TKAs) cases, we found that fellow contribution to TKA surgeries is higher in Canada. The occurrence of pulmonary embolism and pneumonia was three times higher in Canada cases, while blood transfusion was more frequent in US. Increased operative time, ASA class, age, diabetes, percutaneous cardiac intervention, and steroid use were all independent risk factors for complications following primary TKA. However, no significant difference was observed between the two groups with regards to major complications suggesting no difference between Canadian and American training system in regards to post operative complication.

Our results support previous study study indicating that involvement of residents did not affect the surgical outcome within 30 days when compared to cases with no resident involvement. Our study suggests that resident level does not independently increase the risk of short term complications and support continuing involvement of junior trainees in TKA.

Hip fractures are among the most common orthopaedic injuries and represent a growing burden on healthcare as our population ages. Despite improvements in preoperative optimisation, surgical technique and postoperative care, complication rates remain high. Time to surgery is one of the few variables that may be influenced by the medical team. The aim of the present study was to evaluate the impact of time to surgery on mortality and major complications following surgical fixation of hip fractures.

Utilising the American College of Surgeons' National Quality Improvement Program (NSQIP) database, we analysed all hip fractures (femoral neck, inter-trochanteric, and sub-trochanteric) treated from 2011 to 2013 inclusively. We divided patients into three groups based on time to surgery: less than one day (<24h), one to two days (24–48h), and two to five days (48–120h). Baseline characteristics were compared between groups and a multivariate analysis performed to compare 30-day mortality and major complications (return to surgery, deep wound infection, pneumonia, pulmonary embolus, acute renal failure, cerebrovascular accident, cardiac arrest, myocardial infarction, or coma) between groups.

A total of 14,730 patients underwent surgical fixation of a hip fracture and were included in our analysis. There were 3,475 (24%) treated <24h, 9,960 (67%) treated 24–48h, and 1,295 (9%) treated 48–120h. Thirty-day mortality and major complication rates were 5.0% and 6.2% for the <24h group, 5.3% and 7.0% for the 24–48h group, 7.9% and 9.7% for the 48–120h group respectively. After controlling for baseline demographic differences between groups (age, sex, race) as well as pertinent comorbidities (diabetes, dyspnea, chronic obstructive pulmonary disease, chronic steroid use, hypertension, cancer, bleeding disorders, and renal failure), time to surgery beyond 48h resulted in greater odds of both mortality (1.45, 95%CI 1.10–1.91) and major complications (1.45, 95%CI 1.12–1.84).

Time to surgery is one of the few variables that can be influenced by timely medical assessment and access to the operation room. Expediting surgery within 48h of hip fracture is of paramount importance as it may significantly reduce the risk of mortality as well as major complications.

The World Health Organisation (WHO) has recently identified musculoskeletal care as a major global health issue in the developing world. However, little is known about the quality and trends of orthopaedic research in resource-poor settings. The purpose of this study was to perform a systematic review of orthopaedic research in low-income countries (LIC). The primary objective was to determine the quality and publication parameters of studies performed in LIC. Secondary objectives sought to provide recommendations for successful strategies to implement research endeavors in LIC.

A systematic review of the literature was performed by searching MEDLINE (1966-November 2014), EMBASE and the Cochrane Library to identify peer-reviewed orthopaedic research conducted in LICs. The PRISMA guidelines for performing a systematic review were followed. LIC were defined by the WHO and by the World Bank as countries with gross national income per capita equal or less than 1045US$. Inclusion criteria were (1) studies performed in a LIC, (2) conducted on patients afflicted by an orthopaedic condition, and (3) evaluated either an orthopaedic intervention or outcome. The Oxford Centre for Evidence-Based Medicine Levels of Evidence, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to objectively rate the overall methodological quality of each study. Additional data collected from these studies included the publication year, journal demographics, orthopaedic subspecialty and authors' country of origin.

A total of 1,809 articles were screened and 277 studies met our inclusion criteria. Eighty-eight percent of studies conducted in LIC were of lower quality evidence according to the GRADE score and consisted mostly of small case series or case reports. Bangladesh and Nepal were the only two LIC with national journals and produced the highest level of research evidence. Foreign researchers produced over 70% of the studies with no collaboration with local LIC researchers. The most common subspecialties were trauma (42%) and paediatrics (14%). The 3 most frequent countries where the research originated were the United States (42%), United Kingdom (11%), and Canada (8%). The 3 most common locations where research was conducted were Haiti (18%), Afghanistan (14%), and Malawi (7%).

The majority of orthopaedic studies conducted in LIC were of lower quality and performed by foreign researchers with little local collaboration. In order to promote the development of global orthopaedic surgery and research in LIC, we recommend (1) improving the collaboration between researchers in developed and LIC, (2) promoting the teaching of higher-quality and more rigorous research methodology through shared partnerships, (3) improving the capacity of orthopaedic research in developing nations through national peer-reviewed journals, and (4) dedicated subsections in international orthopaedic journals to global healthcare research.

Introduction: Several studies have shown the presence of cobalt (Co) and chromium (Cr) ions in blood, urine, and organs of patients after THA using Co-Cr alloy-based implants. Even though it is well known that exposure to heavy metals may lead to significant alterations in human sperm morphology and motility, less is known on the effect of Co and Cr on semen parameters after metal on metal (MOM) hip replacement.

Methods: Semen was collected form 10 patients between 41 and 49 years old (mean=45.9±3.0 years) by masturbation after 2–3 days of abstinence. The time of implantation varied from 1 to 9 years (mean=5.1±3.9 years). Samples were collected in a sterile container and examined within 1h after ejaculation for morphology, motility, and number of sperm cells following standard criteria. All patients were doing well at their follow-up visits (Harris Hip Score=94±4; UCLA activity a score=7±1) and no sign of osteolysis was observed on X-rays.

Co and Cr concentrations were measured in both the seminal plasma and in the blood of patients by inductively coupled plasma-mass spectroscopy (ICP-MS).

Results: results showed that the levels of Co in the seminal plasma and the blood of the patients were not statistically different. However, the level of Cr was significantly lower in the seminal plasma than in the blood of the patients. The ejaculate volume (2.1 ±0.6 ml), the sperm density (66±53 x 106), the total sperm count (151±75 x 106/ml), the pH (8), and the percentage of normal morphology (46±18%) were in the range of the WHO criteria for fertile population and also in the range of reference patients in the city of measurements. However, the viability was lower than that observed in a fertile population without prosthesis (41±19%).

Conclusions: results of the present study strongly suggest that both Co and Cr ions crossover to the semen but that their concentrations were too low to significantly affect sperm parameters of young patients with MM prosthesis. Further longitudinal studies are however necessary to conclusively determine the effect of metal ions from MM prosthesis on sperm parameters.

Introduction: Metal on metal hip implants continue to be successful alternatives to conventional bearings in younger patients with osteoarthritis. Levels of metal ions such as cobalt (Co) and chromium (Cr) increase in patients with metal bearing hip replacements and resurfacings. These particles are cytotoxic, induce bone loss, and lead to malignant tumors in rats. A subset of these patients are considered outliers as they have unusually high levels of Co and Cr ions. Given the increasing prevalence of metal bearings and the potential for cellular toxicity, we attempted to determine whether patient or surgical factors could account for abnormally elevated ion levels.

Methods: We analyzed the Co and Cr levels from whole blood in 661 patients with metal on metal hip bearings. Patient outliers were defined as those who had ion levels ≥ three-fold the mean value. Twenty-four patients (3.6%) had abnormally high metal ion levels, which included 15 patients that underwent total hip replacements and 9 patients following hip resurfacings. These patients were followed prospectively with the Harris Hip Score (HHS) and the University of California Los Angeles (UCLA) activity score. Serial radiographs and ion levels were analyzed at regular intervals. Oxidative stress markers (total anti-oxidants, peroxide, and nitro-tyrosine) were also measured from whole blood to determine if these correlated with an increase ion levels in outlier patients.

Results: Post-operative HHS and UCLA activity scores improved significantly compared to pre-operative values. There was no statistical correlation between outlier ion levels, patient demographics, HHS and UCLA activity scores. Radiologic parameters such as cup inclination and femoral component neck-shaft angle could not account for higher ion levels in these outliers. Oxidative stress markers were similar to the levels observed in the control patients with normal ion values following with metal on metal hip implants.

Conclusion: We could not identify any patient or surgical factors that could explain the abnormally high metal ion levels in the outlier patients. This suggests that the cause of ion level increase is multifactorial. The clinical relevance of such high levels of ions remains unknown given that there was no increase in serum oxidative stress markers. Further studies are necessary to better understand the effect of abnormal elevations in metal ions given the recent concerns of pseudotumours following metal on metal hip implants.

Aim: To determine the MRI findings in patients with persistent painful metal on metal (MOM) hip arthroplasty and compare the results with a control group of patients with MOM or metal on polyethylene THA without symptoms.

Methods: 20 patients with normal inflammatory markers and normal plain radiographic imaging that had undergone primary THA were enrolled to this study. Patients were chosen to be included in 4 groups;

Patients having metal-on-polyethylene THA or resurfacing without pain (Control group),

Operated hips were evaluated with MRI by one musculoskeletal radiologist who was blinded to the radiographic findings and clinical symptoms. All images were assessed for the presence of a juxtaarticular or periprosthetic abnormalities, including fluid collections, soft tissue masses, osseous abnormalities, and patterns of contrast enhancement of lesions.

Results: 5 patients were included in each group. All patients had undergone their THA at least 1 year prior to the MRI examination (mean 18 months). MRI findings including muscle atrophies, joint effusions, stress fractures, bone marrow oedema and muscle avulsions were equally distributed in all groups.

Conclusions: MOM THA or high metal ion levels had no specific MRI findings to explain the hip pain in these groups of patients.

Introduction: Adequate bone in the femoral head and neck is a prerequisite in ensuring the longevity of a surface arthroplasty. The pistol grip deformity is one of the most common bony abnormalities of the femoral head encountered at the time of resurfacing. Severe flattening results in segmental bone loss requiring adjustments in the alignment of the femoral component to achieve optimal orientation. However, very little is known as to how the femoral implant positioning will be affected by increasing deformity. The purpose of this study was to classify the deformity of the femoral head to better understand how it influences the alignment of the femoral component during surface arthroplasty. This classification was then used to determine whether the femoral implant can be safely inserted with optimal alignment despite progressive deformity of the femoral head and neck.

Methods: The classification was developed using plain radiographs and computer tomography scans from 61 patients (66 hips) who presented with primary osteoarthritis prior to hip resurfacing. Surface arthroplasty simulations were generated with three-dimensional computed tomography to quantify the change in femoral component orientation from the neutral position that would allow optimal alignment. The biomechanical parameters were also calculated to determine the influence of the deformity on the final implant position.

Results: There were 47 men and 14 women, with a mean age of 50.3 years (range, 33 to 63 years). Three categories of femoral head deformity were created using a modified femoral head ratio (Normal ≥0.9, Mild = 0.75 – 0.9 and Severe < 0.75). There were a total of 32 normal hips (48%), 23 hips (35%) with mild deformity and 11 hips (17%) with severe deformity of the proximal femur. A severe deformity required significantly more superior translation of the entry point (p=0.027) and greater reaming depth (p=0.012) to allow safe insertion in relative valgus without notching. This could be achieved while preserving length discrepancy (p=0.17) and minimizing the component-head size difference (p=0.16), although femoral offset was significantly reduced (p=0.025).

Conclusion: A classification of femoral head deformity was created to better understand how progressive deformity influences the alignment of the femoral component during surface arthroplasty. This classification is simple and easily measured using standard AP radiographs of the hip. We found that the femoral component can be safely inserted with optimal alignment during surface arthroplasty by modifying the surgical technique in the face of severe deformity.

Radial-sided avulsions of the TFCC (Palmer 1d) remain a challenging pathology to treat. No current procedures have addressed these injuries successfully and reproducibly. Ten preserved dissected cadaveric forearm specimens with intact TFCC and without ulnar positive variance underwent biomechanical testing. Specimens were tested intact, then with Palmer 1d TFCC lesion and finally post-reconstruction. Measurement of total displacement with a −20N to 20N load was performed. The results indicate that our novel anatomic intra-articular reconstruction of unstable radial-sided TFCC avulsions was successful in restoring baseline stability to the DRUJ without interfering with pronation or supination.

Radial-sided avulsions of the TFCC (Palmer 1d) remain a challenging pathology to treat. No current procedures have addressed these injuries successfully and reproducibly. We tested a novel intra-articular reconstruction to address unstable radial-sided TFCC avulsions.

Ten preserved dissected cadaveric forearm specimens with intact TFCC and without ulnar positive variance underwent biomechanical testing using an MTS machine. Measurement of total displacement with a −20N to 20N load was performed. Specimens were tested intact, then with Palmer 1d TFCC lesion and finally post-reconstruction. All tests were performed at neutral, maximal pronation and maximal supination.

Mean total displacements of the specimens at neutral rotation were: 4.122mm ± 0.363 for the intact specimens compared to 11.839mm ± 0.782 after creation of the tear (p< 0.000002) and 3.883mm ± 0.655 for the reconstructed specimens (p=0.77). In maximal pronation mean total displacements were: 2.378mm ± 0.250 intact vs. 4.922 ± 0.657 torn (p< 0.0007) and 2.124mm ± 0.339 post-reconstruction (p=0.61). In maximal supination mean total displacements were: 1.438mm ± 0.222 intact vs. 5.704mm ± 1.258 torn (p< 0.006) and 1.004mm ± 0.091 post-reconstruction (p=0.07). All specimens obtained the same maximal pronation and supination pre and post-reconstruction.

Restoration of stability and joint function have never been achieved with previous reconstruction attempts of radial-sided TFCC avulsions. Current procedures are unable to restore DRUJ stability without a significant sacrifice of motion. Our anatomic intra-articular reconstruction of unstable radial-sided TFCC avulsions succeeded in restoring baseline stability to the DRUJ without interfering with pronation/supination.