The ageing population and an increase in both
the incidence and prevalence of cancer pose a healthcare challenge, some
of which is borne by the orthopaedic community in the form of osteoporotic
fractures and metastatic bone disease. In recent years there has
been an increasing understanding of the pathways involved in bone
metabolism relevant to osteoporosis and metastases in bone. Newer
therapies may aid the management of these problems. One group of
drugs, the antibody mediated anti-resorptive therapies (AMARTs)
use antibodies to block bone resorption pathways. This review seeks
to present a synopsis of the guidelines, pharmacology and potential pathophysiology
of AMARTs and other new anti-resorptive drugs. We evaluate the literature relating to AMARTs and new anti-resorptives
with special attention on those approved for use in clinical practice. Denosumab, a monoclonal antibody against Receptor Activator for
Nuclear Factor Kappa-B Ligand. It is the first AMART approved by
the National Institute for Health and Clinical Excellence and the
US Food and Drug Administration. Other novel anti-resorptives awaiting
approval for clinical use include Odanacatib. Denosumab is indicated for the treatment of osteoporosis and
prevention of the complications of bone metastases. Recent evidence
suggests, however, that denosumab may have an adverse event profile
similar to bisphosphonates, including atypical femoral fractures.
It is, therefore, essential that orthopaedic surgeons are conversant
with these medications and their safe usage. Take home message: Denosumab has important orthopaedic indications
and has been shown to significantly reduce patient morbidity in
osteoporosis and metastatic bone disease. Cite this article:
Gathering reliable information about joint movement during activities of daily living is of clinical interest. Here we present pilot data regarding a new wearable knee joint sensing system by comparing the outcomes of this device to a gold standard. Initial results show a complex, but repetitive pattern. These outcomes generate potential for future work.
People with severe degenerative conditions, such as osteoarthritis (OA), have been shown to have altered movement patterns during sit-to-stand. However it remains unclear whether such alterations exist in people with early OA, in the absence of pain. This study aimed to determine if a novel seat could be used to discriminate people with early OA compared with controls. The sit-to-stand task was performed by 20 people with early medial knee OA and 20 age and gender-matched control subjects, using an instrumented seat. OA subjects showed altered weight distribution in the transition phase from sit to stand, in that they placed more load through their unaffected side. Task duration was also significantly longer for OA subjects. This study has demonstrated that a novel instrumented seat can be used to discriminate people with early medial knee OA during the sit-to-stand activity. These results may be relevant for early interventions to delay or prevent changes in muscle function of the affected limb as well as contralateral knee or hip osteoarthritis in these patients.
This paper could not be resubmitted: The paper was initially presented at the BHS and they have already published it in the JBJS Supplement.
We report the experience of a Grade 1 Trauma Centre in treating distal femoral and tibial fractures with the Less Invasive Stabilisation System (LISS). Medium term outcomes are presented with a discussion of clinical indications. We conducted retrospective study of patients presenting to St James University Hospital with distal femoral and proximal tibial fractures. Case notes were reviewed for demographics, mode and severity of injury, clinical time to union and complications. AO fracture classification and radiological time to union were assessed. 24 patients (10 males, 14 females) underwent LISS fixation. Average age was 69.7 years (range 31–95 years). Mean injury severity score was 14 (Range 9–36). Overall, there were five patients with isolated proximal tibial fractures, seventeen with isolated femoral fractures and two with fractures of both the distal femur and proximal tibia. Two of the distal femoral fractures were open (Gustillo type IIb). According to the AO classification, the distal femoral fractures were sub-divided into 4 Type 33A fractures, 5 Type 33B fractures, 6 Type 33C fractures, 2 Type 32B fractures and 2 Type 32C fractures. The proximal tibial fractures comprised 3 Type 41-A2, 2 Type 41-C1 and 2 Type 41-C2 fractures. HSS scores for the 24 acute cases were 8 excellent, 8 good, 6 fair and 2 poor results. Average HSS score was 78.8 points. Time to union was determined clinically and radiologically. Bony union was achieved in 23 cases (95.8%). Mean time to radiological union was 3.9 months (range 2–5 months), and clinical union at a mean of 4.46 months (range 3–6 months). We illustrate that the LISS is a useful technique for treating distal femoral and proximal tibial fractures which are often a complex management problem in the elderly population. With increasing incidence of fragility fractures we suggest that this may be an underused treatment option.
