Background

The duration and extent of postoperative wound leakage after joint arthroplasty in patients with or without a complicated course, like a prosthetic joint infection (PJI), is currently unknown. Adequate differentiation between normal postoperative wound leakage and wound leakage due to a postoperative PJI is important and prevents unnecessary surgical procedures. We investigated the association between postoperative wound leakage and development of PJI in patients who used a previously developed mobile wound care app.

Platelet Rich Plasma (PRP) has shown to be a general stimulation for repair and 1 year results showed promising success percentages. To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis with a two-year follow-up.

A double-blind randomized controlled trial was conducted between May 2006 and January 2008. The trial was conducted in two Dutch teaching hospitals. 100 patients with chronic lateral epicondylitis were randomly assigned to a leucocyte-enriched PRP group (n=51) or in the corticosteroid group (n=49). Randomization and allocation to the trial group were carried out by a central computer system. Patients received either a corticosteroid injection or an autologous platelet concentrate injection through a peppering needling technique.

The primary analysis included Visual Analogue Scale (VAS) pain scores and Disabilities of the Arm, Shoulder, and Hand Outcome (DASH) scores. The PRP group was more often successfully treated than the corticosteroid group (p<.0001). Success was defined as a reduction of 25% on VAS or DASH scores without a re-intervention after 2 years. When baseline VAS and DASH scores were compared with the scores at 2 years follow-up, both groups significantly improved across time (intention-to-treat principle). However, the DASH scores of the corticosteroid group returned back to baseline levels, while the PRP significantly improved (as-treated principle). There were no complications related to the use of PRP.

Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and increases function significantly, exceeding the effect of corticosteroid injection even after a follow-up of two years. Future decisions for application of PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits.

OBJECTIVE: The purpose of this study is to examine the effect of a single percutaneous injection of platelet-rich-plasma compared to an injection of corticosteroids in patients with chronic lateral epicondylitis.

BACKGROUND: Lateral epicondylitis is a common problem that usually resolves with nonoperative treatments. Platelet Rich Plasma (PRP) is a component of whole blood that contains concentrated amounts of powerful growth factors. PRP has been used for a variety of orthopedic applications including tendinopathy, wound healing and spinal fusion with varying degrees of success. Buffered PRP has also been used to enhance cell proliferation in-vitro.

HYPOTHESIS: Treatment of chronic severe lateral epicondylitis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem.

METHODS: One hundred patients with persistent lateral epicondylar pain were evaluated in this study. All these patients were initially given a variety of nonoperative treatments. These patients had significant persistent pain for at least 3 months despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma (experimental group, n = 50) or corticosteroids (control group, n = 50).

RESULTS: PRP has a significant better effect on lateral epicondylitis than corticosteroid injections.

CONCLUSION: This in-vivo data suggest that tendon healing is occurring in lateral epicondylitis using PRP.

Background: Body fractures of the scapula are generally treated nonoperatively, and few functional deficits have been reported. Whereas prior investigators have presented radiographic and surgeon-based outcomes, we used a patient-based outcome questionnaires and objective range of motion and muscle-strength testing to evaluate a series of patients who had received nonoperative care for a fracture of the body of the scapula.

Methods: We identified twenty-three patients (seventeen men and four women with a mean age of forty-four yours) who had sustained an isolated fracture of the body of the scapula. All patients were treated non-operatively. At a mean of sixty months, and a minimum of thirty months, outcomes were measured with the Constant shoulder score, the DASH (Disabilities of the Arm, Shoulder and Hand) and the RAND 36 (Rand 36 item Health Survey) patient questionnaires. Additionally we …

Results: On all scores a good to excellent result was obtained in those patients with an isolated scapular fracture. In those cases in which the scapular fracture was a part of a multi-trauma, the amount of accompanying injuries correlated with the inferior result.

Conclusions: Overall outcome of scapular fractures is good but the final result is dictated by the severity of accompanying injuries.

We prospectively studied 48 hips in 47 patients with a mean age of 59.6 years and reviewed the results after a mean period of follow up of 9 (range 7 – 12) years following revision arthroplasty for aseptic loosening using a primary HA-coated femoral stem. 1.8 Previous operations per patient were performed, ranging from 1 to 8, all patients had a femoral defect class 1 or 2 according to Paprosky. Clinical outcome was good with a mean postoperative HHS of 90 points. Pain was absent in 89%, a limp was present in 36% and 41% used a walking aid. There were 5 re-operations: 4 recurrent dislocations and 1 progressive PE wear necessitated cup revision. At 6 years, 39% cancellous densifications were seen, especially in non-tightly fitted prostheses, mainly in zone 2 and 6. Cortical thickening was seen in 30%, especially in tightly-fitted prostheses, mainly in zone 3 and 5. These differences in bone behaviour were significant (p‘0.001) and were not related with various clinical parameters. These phenomena started to appear from 6 months onwards with increasing frequency with longer follow up. The stem survival up till 9 years is 100%, no stem is pending revision at the latest follow up. We conclude that the primary Mallory Head HA-coated femoral prosthesis is a suitable prosthesis to use in revision procedures in younger patients with a lower class femoral defect. We also noticed that the radiological remodelling phenomena are not prosthesis related but femoral canal fit dependent.

Introduction Periprosthetic bone loss is a major cause of concern in patients undergoing total hip arthroplasty (THA). In this study we monitored the periprosthetic bone loss around two different types of femoral implant to evaluate their design and investigate the relationship with the preoperative bone mineral density (BMD).

Materials and Methods Sixty patients (35 female, 25 male, mean age 63 (range, 46–75) years) undergoing THA were randomised to either the ABG or Mallory Head femoral stem. Preoperative DEXA scans were acquired of the posteroanterior (PA) and lateral lumbar spine, the contra-lateral hip and the non-dominant forearm. Postoperative DEXA scans were performed at 10 days (treated as baseline), six weeks, and 3, 6, 12, 24 and 36 months after THA.

Results A total of 50 patients (24 ABG, 26 MH) completed the study. Three months after THA there was a statistically significant BMD decrease in every Gruen zone that varied between 5.6% and 13.8% for the ABG pros-thesis and between 3.8% and 8.7% for the MH prosthesis. Subsequently, in most zones BMD reached a plateau or showed a small recovery. However, BMD continued to fall in Gruen zones 1 and 7 in ABG patients and Gruen zone 1 in MH patients. Bone loss was less in every Gruen zone in MH patients compared with ABG with the largest difference (10%, P = 0.018) in Gruen zone 7. After adjustment for multiple comparisons the relationship between peri-prosthetic bone loss and preoperative BMD was highly statistically significant for spine, hip and radius BMD.

Discussion The present study showed that statistically significant bone loss occurred with both stems during the first three months following implantation, and confirmed that prosthesis design influences peri-prosthetic bone loss. Although the greater bone loss in patients with lower spine, hip or forearm BMD may not adversely affect the outcome for patients in the short and mid-term, preservation of femoral bone stock may be important in the longer term because a low femoral BMD can adversely affect the results of a subsequent revision. Greater femoral bone stock may be particularly advantageous in younger patients in whom a future revision is more likely.

Because we encountered a high failure rate of the acetabular component of the uncemented, hydroxy-apatite coated, Omnifit total hip prosthesis (Osteonics corporation, Allendale, NJ, USA), we conducted a retrospective study of 418 consecutive total hip arthroplasties with a mean follow up of 60 months.

The results of 418 hydroxy-apatite coated, uncemented Omnifit total hip arthroplasties, conducted between 1989 and 1996 were evaluated. Two different acetabulum cups were used: 145 screwcups with one central screwhole, and 273 press fit (PF) cups with several screwholes. The internal geometry of these cups and the fixation of the polyethylene insert in the metal cups were identical. In 339 arthroplasties a 32-mm femur-head was used, in 79 a 28-mm head. Patients’ records and x-rays were evaluated for clinical findings, polyethylene (PE) wear, acetabular and femoral osteolysis and findings during revision surgery.

Revision surgery was performed in 73 patients, mainly because of symptomatic acetabular osteolysis (79%). Mean PE wear was 0.16 mm/year (0.19 mm in PF cups, 0.11 mm in screwcups). Acetabular osteolysis was found to be present in178 hips (70 screwcups and 108 PF cups). In both cupdesigns the osteolysis was mainly found around the screwholes of the metal cups. During revision surgery these osteolytic defects were a lot larger than suggested by x-ray imaging. In 22.6% of the hips osteolysis was also present in the proximal femur.

Kaplan-Meier survival analysis showed, after 6 year follow up, a better survival for of the screwcup (96%, confidence interval 93–99%) than the PF cup (66%, 95%CI 56–77%).

We hypothesized that this specific combination of metal cup and polyethylene insert -possibly due to an insufficient fitting- is responsible for the migration of polythylene wear particles through the screwholes in the metal cup, causing acetabular osteolysis and neces-satating revision surgery.

For this reason we abandonned the use of this type of uncemented acetabular component.

Aims: The results of the Mallory Head prosthesis were already described after 10 years. About the hydroxy-apatite coated Mallory Head prosthesis almost no literature is known. We chose a hydroxyapatite coating because of the sealing effect according to Soballe. Methods: In this þrst European study, we followed 152 consecutive primary hip replacements in 126 patients with a proximal hydroxyapatite coated femoral prosthesis for 5.2 to 11.1 years. Results: All but two prostheses showed osseointegration. No osteolysis was seen even in cases with PE-wear. The mean Harris Hip Score increased from 40 (16 Ð 48) to 92 (10 Ð 100). No or only mild pain reported 97%, limping reported 11% postoperatively (90% preop). There was a very low incidence in thigh pain: 3.2%. The morphology of positive bone remodeling depended on the stem þt in the medullary canal. The correlation between tight stem þt and symmetrical cortical thickening was signiþcant (p ≤ 0.001 chi-square test). The same correlation existed between non tight þt and cancellous densiþcations. There was no correlation between the clinical parameters and the radiological phenomena. The 11 year survival was 98.7 (±6.4)%. Conclusion: TheMallory Head hydroxyapatite coated femoral stem has a reliable long-term survival and clinical and radiological result. The hydroxyapatite coating has a protective effect against wear particle migration. The morphology of remodeling depends on stem þt.

Today more and more papers are published about the operative treatment of femoral fractures in children and even uncomplicated and isolated fractures are treated by using elastic nails, plates or an external fixator. Advantages are said to be a shorter stay in the hospital, easier handling by parents and nurses, less costs and better control of rotational disorders, and without complications from anaesthesia or an operation. We summarised our results in treating conservatively 50 femoral fractures in 49 children treated between 1992 and 1997.

The mean age was 6.2 years; male/female ratio was 30/19. We included five children with minor polytraumatisation (including one girl with a bilateral femoral fracture) and two children with complicated fractures (grade I). Children younger than three years of age were treated by Bryant-traction (18), and children older than three years were treated by Weber-traction (23). In both groups the callus was palpable after 2 to 3 weeks and a “one-legged” hipspica-plaster-cast was applied. Full weight bearing was permitted. Children needing surgery (major polytraumas, brain damage, etc.) were excluded. Seven cases had a fracture without dislocation and were treated by early casting. One boy was treated by Russell-traction.

An unacceptable dislocation of the fracture still existed in two cases after one week with Weber-traction. Peroperatively, interposition of the soft tissues appeared to be the reason. There were no problems of alignment and rotation, but differences in leg length or problems in consolidation were seen in the group treated with Bryant- traction. In the Weber-traction group, the girl with the bilateral femoral fracture developed a mild endorotation in the left leg, but we saw no further complications.

We think that these results in treating femoral fractures conservatively are satisfying and there is still a place for conservative treatment of femoral fractures in children. In our hospital we try to advance this type of conservative treatment by selecting cases that are appropriate for home traction, which is better for children and their parents and also less expensive for the Health Care System.

The purpose of the study was to analyse the clinical and radiological results of cementless HAP-coated Mallory- Head hip replacement in dysplastic hips. The collective included 20 males and 30 females (64 hips), with a mean age of 52.6 (range 20–68) years at operation. We also included two patients (4 hips) with spondyloepiphy-seal dysplasia (dwarfism). All patients were operated by one surgeon (EvL) during the period 1991–1997. A majority had “champaign flute” type femur. A minority had a normal or “stove pipe” type femur (Dörr). Most patients had acetabular dysplasia classified as A or B (Eftekar); some were classified as C and one as D (after Schanz osteotomy). Previous operations included: derotating varous osteotomy (11), acetabular shelf plasty (9), Salter or Chiari pelvic osteotomy (4) and tenotomy of the hip adductors (2).

After a mean follow-up of 57 (range 32 to 97) months, a clinical and radiological analysis was performed by an independent investigator (TG). Postoperatively no or only mild pain was reported by 89% of all patients. The VAS for pain (0–10) was excellent: 1.70 (0–7). Limping was reported in 23% and 75% used no support when walking. The HHS increased from 42 to 90 points.

Complications were marginal and there were no infections. One patient developed habitual dislocation and a revision of the cup was perfomed. We saw two periprosthetic fractures of the femur: once during surgery (treated conservatively) and once after a fall (treated by plating). We saw one case of temporary ischiadical nerve palsy after leg lenghtening of 5 cm. There were two cases in which we had used 32mm heads, and PE-wear necessitated revision of the cup after seven and eight years follow-up, respectively.

Cortical hypertrophy indicating stress transfer was found in 28% and located mostly on the borders of Gruen-zones 2, 3 and 5, 6. This cortical hypertrophy (“ballooning”) started to appear after 0.5 to 1 year and did not disappear after a longer follow up. Endosteal spotwelds were infrequently seen (9%) and in 13% of all patients we saw some form of halo- or shelf-formation at the distal stem. The criteria of Enghs fixation scale are not signs of loosening in the Mallory-Head HAP-coated femoral prosthesis.

No radiolucent or radiodense lines were seen around the acetabular cup. In all cases but one (Schanz osteotomy) the anatomical centre of rotation could be restored.

We conclude that the cementless Mallory-Head HAPcoated femoral prosthesis has shown, up to present time, excellent clinical and radiological results in hip dysplasia.