Traditionally, radiological union of fractures treated with an Ilizarov frame is confirmed by a period of dynamization - destabilisation of the frame for a period prior to removal. Reduced clinic availability during the COVID-19 pandemic caused a shift to selective dynamisation in our department, whereby lower risk patients had their frames removed on the same day as destabilisation. This study investigates the effects of this change in practice on outcomes and complication rates. Adult patients treated with circular frames between April 2020 and February 2022 were identified from our Ilizarov database. Patients were divided into 2 groups: - “dynamised” if their frame was destabilised for a period to confirm union prior to removal; or “not dynamised” if the decision was taken to remove the frame without a period of dynamisation, other than a short period in the clinic. A retrospective review of clinical notes was conducted to determine outcome.Introduction
Materials & Methods
This study compares the incidence of post-operative complications (within 90 days) following primary total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). 2,919 Consecutive patients were retrospectively reviewed over 5 years at three institutions; 2,290 underwent primary TKA and 629 underwent UKA. Simultaneous bilateral procedures and diagnoses other than osteoarthritis were excluded. Regression analysis was performed to isolate the effects of TKA versus UKA on the rate of post-operative complications.Introduction
Methods
Modular tapered implants have been suggested as the optimal treatment in patients with severe femoral bone loss undergoing revision total hip arthroplasty (THA). The purpose of this study is to describe minimum 2 year follow up of patients treated with modular tapered prostheses for Paprosky type IIIB and IV femoral bone loss in revision THA. 44 Consecutive patients with Paprosky type IIIB (23) or IV (21) femurs undergoing revision total hip arthroplasty to cementless modular tapered prostheses were studied. Harris Hip Scores were obtained prior to revision on all patients except those presenting with acute implant failure or periprosthetic fracture. 10 Patients were deceased within 2 years of surgery; the remaining 18 were followed for an average of 42 months (range 25-69 months). Clinical outcomes were measured using the Harris Hip Score, and radiographs were assessed for signs of stem loosening or subsidence >4mm.Introduction
Methods
When using press-fit stems in revision total knee arthroplasty (TKA), diaphyseal engagement optimizes stability. Attempts to maximize press fit may lead to periprosthetic fracture; however, the literature offers no guidance regarding the prevalence or management of this complication. The purpose of this study is to report the incidence, risk factors, and outcomes of these fractures. 634 Stemmed implants (307 femoral and 327 tibial) from 413 consecutive revision TKAs were reviewed. Immediate and 6 week post-operative radiographs were examined. Patient age, gender, stem length, diameter, and offset were evaluated as potential risk factors for fracture occurrence using a paired t-test for continuous and a chi-square analysis for categorical variables.Introduction
Methods
Serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and synovial fluid white blood cell (WBC) count and differential are effective in diagnosing periprosthetic joint infection (PPJI); however their utility in patients with inflammatory arthritis is unknown. The purpose of this study is to determine the utility of these tests in patients with inflammatory arthritis. 934 Consecutive revision hip and knee arthroplasties were prospectively evaluated for PPJI. 202 Cases were excluded due to acute post-operative or hematogenous infection. 690 Patients had non-inflammatory and 42 had inflammatory arthritis. Receiver operating characteristic (ROC) curves were used to establish optimal ESR, CRP, WBC, and % neutrophil values for diagnosis of PPJI, and the area under the curve (AUC) was calculated to determine the overall accuracy.Introduction
Methods
The purpose of this study was to determine the rate of complications and re-operations after operative treatment of peri-prosthetic femur fractures sustained within 90 days following primary total hip arthroplasty (THA). 4,433 patients (5,196 consecutive primary THAs) over 10 years at a single institution were retrospectively reviewed. Thirty-five (0.67%) peri-prosthetic fractures that were treated operatively in 32 patients were identified and classified using the Vancouver Classification. There were 9 patients with a type Ag fracture, 2 patients with a type B1 fracture, 17 patients with a type B2 fracture, 1 patient with a type B3 fracture, and 3 patients with a concomitant type Ag and B2 fracture. Eleven (34%) patients were treated with isolated ORIF: greater trochanter (9) or femoral shaft (2). Twenty-one (66%) were treated with femoral revision combined with (14) or without (7) attempted fracture fragment reduction; a diaphseal engaging stem was utilized in all revisions. One patient was lost to follow-up leaving 31 patients for evaluationINTRODUCTION
METHODS
