Aims

To compare time dependent functional improvement for patients with medial, respectively lateral knee osteoarthritis (OA) after treatment with opening wedge osteotomy relieving the pressure on the osteoarthritic part of the knee.

Objectives

Experimental studies indicate that non-steroidal anti-inflammatory drugs (NSAIDs) may have negative effects on fracture healing. This study aimed to assess the effect of immediate and delayed short-term administration of clinically relevant parecoxib doses and timing on fracture healing using an established animal fracture model.

Aim

Acute postoperative infection is reported to occur in 0.3–2% after arthroscopic rotator cuff repair. Few reports have addressed this dreaded complication although the costs are high both for the patient and for society. The aim of this prospective study was to describe incidence, treatment and outcome after acute postoperative infections following arthroscopic rotator cuff repair.

Conventional non-steroidal anti-inflammatory drugs (NSAIDs) and newer specific cyclo-oxygenase-2 (cox-2) inhibitors are commonly used in musculoskeletal trauma and orthopaedic surgery to reduce the inflammatory response and pain. These drugs have been reported to impair bone metabolism. In reconstruction of the anterior cruciate ligament the hamstring tendons are mainly used as the graft of choice, and a prerequisite for good results is healing of the tendons in the bone tunnel. Many of these patients are routinely given NSAIDs or cox-2 inhibitors, although no studies have elucidated the effects of these drugs on tendon healing in the bone tunnel.

In our study 60 female Wistar rats were randomly allocated into three groups of 20. One received parecoxib, one indometacin and one acted as a control. In all the rats the tendo-Achillis was released proximally from the calf muscles. It was then pulled through a drill hole in the distal tibia and sutured anteriorly. The rats were given parecoxib, indometacin or saline intraperitoneally twice daily for seven days. After 14 days the tendon/bone-tunnel interface was subjected to mechanical testing.

Significantly lower maximum pull-out strength (p < 0.001), energy absorption (p < 0.001) and stiffness (p = 0.035) were found in rats given parecoxib and indometacin compared with the control group, most pronounced with parecoxib.

Introduction: The operational technique for opening wedge osteotomies has been simplified by the use of the Puddu-plate. This study presents results after use of Puddu-plates on distal femoral and proximal tibial osteotomies.

Methods: Fifteen distal femoral and 25 proximal tibial osteotomies have been performed with opening wedge technique due to knee osteoarthritis with malalignment in the period 2000–2004. The knee osteoarthritis was mainly due to a previous meniscal extirpation. Ten patients had an additional rupture of the anterior cruciate ligament. The mean age of the patients was 49 years (31–66 years), and 17 females and 23 males were operated. The patients with femoral osteotomies had a mean preoperative tibiofemoral valgus angle of 12° (8°–20°) whereas those with tibial osteotomies had a mean tibiofemora varus angel of 1° (7° varus – 3° valgus). The osteotomy was fixed with a Puddu-plate securing the planned angular correction, and the osteotomy cleft was filled by autogenous pelvic bone. The mean follow-up time was 18 months (3–42 months).

Results: The width of the osteotomy cleft was determined by the tooth of the implant. The mean width of the tooth was 8.6 mm (5–12.5 mm), and the mean angular correction measured on pre- and postoperative radiographs was 8.4° (5–15°). The osteotomy cleft healed after a mean of 13 weeks (7–26 weeks). One patient suffered venous thrombosis of the leg and one a postoperative wound infection. The knee injury and osteoarthritis outcome score (KOOS) increased significantly during the observation period. For pain the mean preoperative score was 53 and the score at follow-up was 82. The corresponding scores for symptoms were 56 and 75, for activity of daily life (ADL) 65 and 86, for sport and recreation 26 and 52 and for quality of life 33 and 64 (P< 0.001).

Conclusion: The results after opening wedge osteotomy using the Puddu-plate seem satisfactory. The operational technique is simpler compared to previous methods, and the degree of angular correction is accurate depending on the width of the tooth of the implant which in mm corresponds relatively well with the degrees of angular correction.

Aims: The complications and functional long time results after glenohumeral arthrodesis are described. Methods: 22 patients (9 men, 13 women) with a median age of 64 (19 – 75) years were operated with a glenohumoral arthrodesis between 1982 and 2000. The indications for surgery were fracture sequelae (11), severe osteoarthritis (4), deltoid dysfunction (3), failed revision arthroplasty (1), chronic posterior dislocation (1), tuberculosis (1) and gunshot wound (1). Standard AO surgical technique with stable plating was used. 6 patients are dead and 1 refused examination. The remaining 15 patients were examined retrospectively after a mean of 7.8 years. The American Shoulder and Elbow Surgeons (ASES) score and Oxford score were registered and radiographs taken. Results: 8 patients had intermittent or continuous pain with a mean pain score (VAS) of 1.5 (0–8). 1 patient was reoperated after 4 months due to excessive pain and one was operated due to a humeral shaft fracture after 8 months. The implants had been removed in 5 patients and 1 had a lateral clavicle resection after 3 years. No patients had infections, but 1 had reflex sympathetic dystrophy. Radiologically all but two arthrodesis fused, the remaining 2 were painfree. Mean Oxford score was 33 (20 – 49), mean ASES score was 59 (15 – 95). Conclusions: The functional results after glenohumeral arthrodesis are comparable with results reported after shoulder arthroplasty. The he arthrodesis has a wide range of indications and the long time complications related to shoulder prosthesis may be avoided.