Gluteal Tendinopathy is a poorly understood condition that predominantly affects post-menopausal women. It causes lateral hip pain, worse when lying on the affected side or when walking up a hill or stairs. It has been labelled ˜Greater Trochanteric Pain Syndrome” a name that recognises the lack of understanding of the condition.

Surgical reconstruction of the gluteal cuff is well established and has been undertaken numerous times over the last 16 years by the senior author (AJL). However, the quality of collagen in the tendons can be very poor and this leads to compromised results. We present the results of gluteal cuff reconstruction combined with augmentation using a bioinductive implant.

14 patients (11 female, 3 male; mean age 74.2 ± 6.3 years) with significant symptoms secondary to gluteal tendinopathy that had failed conservative treatment (ultrasound guided injection and structured physiotherapy) underwent surgical reconstruction by the senior author using an open approach. In all cases the iliotibial band was lengthened and the trochanteric bursa excised. The gluteal cuff was reattached using Healicoil anchors (3–5×4.75mm anchors; single anchors but double row repair) and then augmented using a Regeneten patch. Patients were mobilised fully weight bearing post-operatively but were asked to use crutches until they were no longer limping. All had structured post-surgery rehabilitation courtesy of trained physiotherapists.

There were no post-operative complications and all patients reported an improvement in pain levels (Visual Analogue Scale 7.8 pre-op; 2.6 post-op) and functional levels (UCLA Activity Score 3.5 pre-op; 7.1 post-op) at 6 months post surgery.

Surgery for gluteal tendinopathy produces good outcomes and the use of Regeneten as an augment for poor quality collagen is seemingly a safe, helpful addition. Further comparative studies would help clarify this.

Background

Following endosteal uncemented orthopaedic device implantation, the initial implant/bone interface retains spaces and deficiencies further exacerbated by pressure necrosis and resultant bone resorption. This implant-bone space requires native bone infill through the process of de novo osteogenesis. New appositional bone formation on the implant surface is known as contact osteogenesis and is generated by osteogenic cells, including skeletal stem cells (SSCs), colonising the implant surface and depositing the extracellular bone matrix. Surface nanotopographies provide physical cues capable of triggering SSC differentiation into osteoblasts, thus inducing contact osteogenesis, translated clinically into enhanced osseointegration and attainment of secondary stability. The current study has investigated the in vitro and in vivo effects of unique nanotopographical pillar substrates on SSC phenotype and function.

Background

In 2012, the National Joint Registry recorded 86,488 primary total hip replacements (THR) and 9,678 revisions (1). To date aseptic loosening remains the most common cause of revision in hip and knee arthroplasty, accounting for 40% and 32% of all cases respectively and emphasising the need to optimise osseointegration in order to reduce revisions. Clinically, osseointegration results in asymptomatic stable durable fixation of orthopaedic implants. Osseointegration is a complex process involving a number of distinct mechanisms affected by the implant surface topography, which is defined by surface orientation and surface roughness. Micro- and nano-topography levels have discrete effects on implant osseointegration and yet the role on cell function and subsequent bone implant function is unknown. Nanotopography such as collagen banding is a critical component influencing the SSC niche in vivo and has been shown to influence a range of cell behaviours in vitro (2,3). We have used unique fabricated nanotopographical pillar substrates to examine the function of human bone stem cells on titanium surfaces.

AIMS

We present a retrospective study of bilateral CDH. We analysed the correlation of complications to the confounding factors.

Aim: To determine the value of the Pirani clubfoot-scoring system at initial presentation in predicting subsequent relapse.

Method: All clubfoot patients treated by one surgeon from 2002 to 2006 were included. Treatment followed the standard protocol, involving weekly stretching and casting until the foot was corrected, followed by Achilles tenotomy and plasters for 3 weeks. Thereafter, the child was placed in a foot abduction splint.

Relapses within 6 months of instigating the foot abduction splint were classed as early and subsequent relapses as late.

The severity of clubfoot was assessed using the Pirani scoring system which comprises two sub-scores – Midfoot Contracture Score (MFCS) and Hindfoot Contracture Score (HFCS). MFCS and HFCS can each be 0.0–3.0, giving rise to a Total Pirani Score (TPS) of 0.0–6.0.

Results: Sixty-one clubfoot patients were treated, with five lost to the follow-up. A total of 89 clubfeet were treated. There were 3 early and 19 late relapses. The average interval between initiating the foot abduction splint and late relapse was 23 months. TPS median was 4.5 in the no relapse group, 4.0 in the early relapse group, and 5.0 in the late relapse group. MFCS median was 2.0 in the no relapse group, 2.0 in the early relapse group, and 2.0 in late relapse group. HFCS median was 2.5 in the no relapse group, 2.5 in the early relapse group, and 3.0 in the late relapse group. Higher HFCS was statistically significant when comparing the late and no relapse groups (p< 0.05, 95% CI −0.5–0.0).

Conclusions: Higher Pirani scores were associated with late relapses, but HFCS is a stronger predictor of potential late relapse. Close follow-up is advised for patients at risk.