The dichotomy between surgical repair and conservative management of acute Achilles tendon ruptures has been eliminated through appropriate functional management. The orthoses used within functional management however, remains variable. Functional treatment works on the premise that the ankle/hindfoot is positioned in sufficient equinus to allow for early weight-bearing on a ‘shortened’ Achilles tendon. Our aim in this study was to test if 2 common walking orthoses achieved a satisfactory equinus position of the hindfoot. 10 sequentially treated patients with 11 Achilles tendon injuries were assigned either a fixed angle walking boot with wedges (FAWW) or an adjustable external equinus corrected vacuum brace system (EEB). Weight bearing lateral radiographs were obtained in plaster and the orthosis, which were subsequently analysed using a Carestream PACS system. The Mann-Whitney test was used to compare means.Introduction
Methods
Traditional treatment of idiopathic flatfoot in the adult population include calcaneal neck lengthening or fusions. These surgical methods result in abnormal function with significant complication rates. Our prospective study aimed to quantify the functional and radiological outcome of a new technique for spring ligament reconstruction using a hamstring graft, calcaneal osteotomy and medial head of gastrocnemius recession if appropriate. 22 feet were identified from the senior authors flatfoot reconstructions over a 3 year period (Jan 2013 to Dec 2015). 9 feet underwent a spring ligament reconstruction. The control group were 13 feet treated with standard tibialis posterior reconstruction surgery. Follow up ranged from 8 to 49 months. Functional assessment comprised VAS heath and pain scales, EQ-5D and MOXFQ scores. Radiographic analysis was performed for standardised parameters.Introduction
Methods
We evaluated the rates of survival and cause
of revision of seven different brands of cemented primary total
knee replacement (TKR) in the Norwegian Arthroplasty Register during
the years 1994 to 2009. Revision for any cause, including resurfacing
of the patella, was the primary endpoint. Specific causes of revision
were secondary outcomes. Three posterior cruciate-retaining (PCR) fixed modular-bearing
TKRs, two fixed non-modular bearing PCR TKRs and two mobile-bearing
posterior cruciate-sacrificing TKRs were investigated in a total
of 17 782 primary TKRs. The median follow-up for the implants ranged
from 1.8 to 6.9 years. Kaplan-Meier 10-year survival ranged from
89.5% to 95.3%. Cox’s relative risk (RR) was calculated relative
to the fixed modular-bearing Profix knee (the most frequently used
TKR in Norway), and ranged from 1.1 to 2.6. The risk of revision
for aseptic tibial loosening was higher in the mobile-bearing LCS
Classic (RR 6.8 (95% confidence interval (CI) 3.8 to 12.1)), the
LCS Complete (RR 7.7 (95% CI 4.1 to 14.4)), the fixed modular-bearing
Duracon (RR 4.5 (95% CI 1.8 to 11.1)) and the fixed non-modular
bearing AGC Universal TKR (RR 2.5 (95% CI 1.3 to 5.1)), compared
with the Profix. These implants (except AGC Universal) also had
an increased risk of revision for femoral loosening (RR 2.3
(95% CI 1.1 to 4.8), RR 3.7 (95% CI 1.6 to 8.9), and RR 3.4 (95%
CI 1.1 to 11.0), respectively). These results suggest that aseptic
loosening is related to design in TKR. Cite this article:
Cobalt chrome on polyethylene remains a widely used bearing combination in total joint replacement. However wear induced osteolysis, bulk material property degradation of highly cross-linked polyethylene (HXLPE) [1], and oxidation after implantation (thought to be as a result of lipid absorption or cyclic loading [2]) remains a concern. ECIMA is a cold-irradiated, mechanically annealed, vitamin E blended next generation HXLPE developed to maintain mechanical properties, minimise wear and to improve the oxidation resistance in the long-term. The aim of this study was to compare the in-vitro wear rate and mechanical properties of three different acetabular liners; conventional UHMWPE, HXLPE and ECIMA. Twelve liners (Corin, UK) underwent a 3 million cycle (mc) hip simulation. Three conventional UHMWPE liners (GUR1050, Ø32 mm, 30 kGy sterilised in Nitrogen), three HXLPE liners (GUR1020, Ø40 mm, 75 kGy cross-linking and EtO sterilised) and six ECIMA liners (0.1 wt% vitamin E GUR1020, Ø40 mm, 120 kGy cross-linking, mechanically deformed and annealed, and EtO sterilised) articulated against CoCrMo alloy femoral heads to ASTM F75 (Corin, UK). Wear testing was performed in accordance with ISO 14242 parts 1 and 2, with a maximum force of 3.0 kN and at a frequency of 1 Hz. The test lubricant used was calf serum with a protein content of 30 g/l and 1% (v/v) patricin added as an antibacterial agent. Volumetric wear rate was determined gravimetrically after the first 0.5 mc and every 1 mc thereafter. ASTM D638 type V specimens (3.2 mm thick) were machined from ECIMA material for uniaxial tension testing to ASTM D638. Ultimate tensile strength (UTS), yield strength and elongation values were measured. These values were compared to mechanical data available for the other material types.Introduction
Methods
