Quadriceps strength is crucial for physical function in patients with knee osteoarthritis (KOA). This study aimed to investigate the effect of combining blood flow restriction (BFR) with low-intensity training (LIT) on quadricep strength in patients with advanced KOA. Patients with advanced KOA were block randomized by gender into the control or BFR group. The control group received LIT with leg press (LP) and knee extension (KE) at 30% of 1-repetition maximum (1-RM), while the BFR group underwent the same training with 70% limb occlusion. Physical function and patient-reported outcomes were assessed up to 16 weeks.Introduction and Aim
Methods
The aim of this study was to evaluate the survival of a collarless, straight, hydroxyapatite-coated femoral stem in total hip arthroplasty (THA) at a minimum follow-up of 20 years. We reviewed the results of 165 THAs using the Omnifit HA system in 138 patients, performed between August 1993 and December 1999. The mean age of the patients at the time of surgery was 46 years (20 to 77). Avascular necrosis was the most common indication for THA, followed by ankylosing spondylitis and primary osteoarthritis. The mean follow-up was 22 years (20 to 31). At 20 and 25 years, 113 THAs in 91 patients and 63 THAs in 55 patients were available for review, respectively, while others died or were lost to follow-up. Kaplan-Meier analysis was performed to evaluate the survival of the stem. Radiographs were reviewed regularly, and the stability of the stem was evaluated using the Engh classification.Aims
Methods
The surgical helmet system (SHS) was developed to reduce the risk of periprosthetic joint infection (PJI), but the evidence is contradictory, with some studies suggesting an increased risk of PJI due to potential leakage through the glove-gown interface (GGI) caused by its positive pressure. We assumed that SHS and glove exchange had an impact on the leakage via GGI. There were 404 arthroplasty simulations with fluorescent gel, in which SHS was used (H+) or not (H-), and GGI was sealed (S+) or not (S-), divided into four groups: H+S+, H+S-, H-S+, and H-S-, varying by exposure duration (15 to 60 minutes) and frequency of glove exchanges (0 to 6 times). The intensity of fluorescent leakage through GGI was quantified automatically with an image analysis software. The effect of the above factors on fluorescent leakage via GGI were compared and analyzed.Aims
Methods
Highly crosslinked polyethylene (HXLPE) has been used with great clinical success in total hip arthroplasty (THA) since its debut in the late 1990's. However, reports regarding this bearing couple in its second decade of service are still scant. The aim of this study was to 1. Determine the long term clinical and radiological results and 2. Investigate what factors affect wear rates using a metal-on-HXLPE bearing articulation. 55 THA's using a single brand of HXLPE liner, cementless cup and 28mm hip ball were performed in 44 patients. Age, sex, and Charlson Comorbidity Index (CCI) and need for revision surgery were recorded. Linear and volumetric wear was determined using the Martell method. Mean age at operation was 51.2 (29–73 +/− 12.1) years. Mean duration of follow up was 16.9 years (range 15.0–20.1 +/− 1.1 years). Osteolysis was not present in the latest follow up radiographs. Median linear and volumetric wear rate was 0.035mm/year (95% CI 0.031–0.047) and 7.12mm3/year (95% CI 6.92–17.25) respectively. Acetabular component position was not found to be related to both linear and volumetric wear. No significant difference was found in the linear and volumetric wear rates of thinner and thicker liners (8mm or below and > 8mm) (p=0.827 and p=0.843 respectively). HXLPE is associated with very low linear and volumetric wear rates which has virtually obviated osteolysis and has translated to excellent survivorship even at long term follow up. In-vivo oxidation does not appear to be of clinical concern at this point in its service cycle.
The purpose of this retrospective study was to investigate the
clinical relevance of increased facet joint distraction as a result
of anterior cervical decompression and fusion (ACDF) for trauma. A total of 155 patients (130 men, 25 women. Mean age 42.7 years;
16 to 87) who had undergone ACDF between 1 January 2001 and 1 January
2016 were included in the study. Outcome measures included the Neck
Disability Index (NDI) and visual analogue scale (VAS) for pain.
Lateral cervical spine radiographs taken in the immediate postoperative
period were reviewed to compare the interfacet distance of the operated
segment with those of the facet joints above and below.Aims
Patients and Methods
The success rate of surgical debridement and prostheses retention for acute periprosthetic joint infection (PJI) is controversial. This study aims to report our experience in managing acute PJI following total knee arthroplasty (TKA) with surgical debridement and prostheses retention, and to identify the prognostic factors that may influence the surgical outcomes. A retrospective review from our prospective joint replacement register in Queen Mary Hospital, Hong Kong, of patients who were managed with surgical debridement and prosthesis retention for acute PJI after TKA between 1998 and 2013 was performed. The diagnosis of acute PJI was based on the 2011 Musculoskeletal Infection Society (MSIS) PJI diagnostic criteria. Both the early post-operative infections and the late haematogenous infections were included (Tsukayama type 2 and 3). Surgical outcomes were defined as successful if patients’ clinical symptoms had been relieved; inflammatory marker levels including C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR) and White Blood Cell (WBC) count had returned to normal; X-rays showed no prosthetic loosening; and no lifelong antibiotic suppression was required. Outcomes were defined as failed if patients required any further surgeries (e.g., re-debridement, one or two-stage revision), or needed lifelong antibiotic suppression. All Patients’ perioperative data, i.e., age, primary diagnosis, pre-operative CRP, ESR, WBC, haemoglobin, albumin, glucose level, time lag from symptoms onset to debridement, synovial fluid total cell count and bacteriology were traced and recorded. SPSS 22.0 was used to calculate and compare the statistical differences between surgically successful group and failed group regarding the factors above.Purpose
Methods
Patient specific instruments (PSI) and computer-assisted surgery (CAS) are innovative technologies that offer the potential to improve the accuracy and reproducibility with which a total knee arthroplasty (TKA) is performed. It has not been established whether clinical, functional, or radiographic outcomes between PSI, CAS, and manual TKA differ in the hands of an experienced TKA surgeon. The purpose of this study was to evaluate clinical, functional and radiographic outcomes between TKA performed with PSI, CAS, and manual instruments at short-term follow-up. Our hypothesis was that at early follow-up, we would be unable to elucidate any significant differences between the groups using the most commonly utilized outcomes measures. 40 PSI, 38 CAS, and 40 manual TKA were performed by a single surgeon. The groups were similar in regards to age, sex, and preoperative diagnosis. The Knee Society Scoring System was used to evaluate patient clinical and functional outcome scores preoperatively and at 1 and 6 months postoperatively. Long-standing AP radiographs were obtained pre and postoperative to evaluate mechanical axis alignment.Introduction
Methods
Modic changes(M) have been described in association to Degenerative Disc Disease(DDD). Type-I represents the inflammatory phase whereas Type-II describes fatty changes within the vertebral marrow and endplate. Type-III is more advanced degeneration and it indicates marked sclerosis adjacent to endplates.
Adjacent endplate levels showed worsening of M0 to M2 in 11 patients while no change was seen in 35 levels. Only 4 levels with M2 were seen, of which 3 levels did not change and 1 level continued to M3. 2 M3 improved to M2.
An analysis on prospective data collected on our hip database was carried out on all patients undergoing primary cemented unilateral total hip arthroplasty in the last 5 years comparing the short term outcomes between diabetics and non-diabetics. There were 1220 non-diabetics and 77 diabetics identified from the database with at least 3 years follow up. (average 3.6 years). We found no significant difference with respect to age, sex and diagnosis between the 2 groups. Diabetics did have a significantly higher BMI (30.2 versus 27.7, p<
0.001) and higher incidence of coronary artery disease (31% versus 15%, p<
0.001) We found no increase in the rate of deep periprosthetic infection, superficial wound complications, dislocation, blood loss and DVT between diabetics and non-diabetics even after adjusting for potential confounders of age, sex, diagnosis, BMI and the presence of coronary artery disease. The only factor that was found to be significantly different between the 2 groups was length of stay (10.73 versus 9.56 days, p<
0.05). Further analysis of the diabetic group only showed no difference with regard the same outcomes between insulin-dependent, diet-controlled and diet and oral hypoglycaemic-controlled patient subsets. From this study we conclude that at the time of taking informed consent from diabetic patients undergoing total hip arthroplasty the only potential difference from non-diabetics is that the length of stay may be longer.
We investigated fixed flexion deformity (FFD) after total knee replacement (TKR). Data relating to 369 cruciate-retaining unilateral TKRs performed at a single institution were collected prospectively. Fixed flexion was measured pre-operatively and at one week, six months, 18 months, three years and five years after surgery. Using binary logistic regression, pre-operative FFD was a predictor of post-operative FFD >
10° at one week (p = 0.006) and six months (p = 0.003) following surgery. Gender was a predictor at one week (p = 0.0073) with 24% of women showing a FFD >
10° compared with 37% of men. We have shown that a gradual improvement in knee extension can be expected up to three years after surgery in knees with FFD. By this time residual FFD is mild or absent in the majority of patients, including those who had a severe pre-operative FFD.
The þnal outcome, using the Modiþed Mayo Wrist Score was excellent in 13 cases, good in 7, and fair in 4 cases. Complications were seen in 3 patients and metalwork has subsequently been removed in 7 patients for tendon irritation but there have been no cases of extensor tendon rupture.
In tibial plateau fracture, anatomical reduction of articular surface with stable fixation can restore the mechanical axis and allow early mobilization. Concomitant management of ligamentous and meniscal injury is essential for preservation of knee function. Open reduction and internal fixation has a significant complication rate.Percutaneous,fluoroscopically and arthroscopically assisted osteosynthesis with special fracture reduction and fixation technique can achieve the purpose of management of tibial plateau fracture, while limiting the soft tissue damage. 18 cases, including all J. Schatzker’s type of tibial plateau fracture, were operated with minimal access surgical technique. Male patients were predominant. The age ranged from 22 to 61 (mean 33.5). Detail pre-operatives planning with CT scan were performed in 16 patients. Fluoroscopy, arthroscopy and special fracture reduction and fixation technique were applied to all cases. All 18 cases could be reviewed. Follow up period ranged from 1 to 4 years (mean 2.3 yr.). Outcome was assessed by HSS Knee Score, standing radiograph and arthroscopy (2 cases). According to HSS score, 14 patients were rated as excellent (100 to 85), 3 good (84 to 70), 1 fair (69 to 60) and none poor (<
60). Subjectively, 14 patients were satisfied with the treatment. 13 patients were working and participating in sport before injury. 15 took no analgesic, 2 took it once a week and 1 more often. In standing radiograph, only 2 patients showed minimal narrowing of joint space. There was no significant complication directly associated with the procedure. Percutaneous, fluoroscopically and arthroscopically assisted osteosynthesis is a safe and effective minimal access surgical procedure. Precise pre-operative planning and special fracture reduction and fixation technique are all crucial for success. Short-term clinical outcome is encouraging.
