Introduction

Motorised intramedullary lengthening nails are considered more expensive than external fixators for limb lengthening. This research aims to compare the cost of femoral lengthening in children using the PRECICE magnetic lengthening nail with external fixation

Introduction

The purpose of this research is to compare the quality of life in children during gradual deformity correction using external fixators with intramedullary lengthening nails.

Introduction

This is a report of the outcome of management of congenital pseudoarthrosis of the tibia (CPT) at skeletal maturity.

Background

Surgical wound closure is not the surgeon”s favorite part of the total knee arthroplasty (TKA) surgery however it has vital rule in the success of surgery. Knee arthoplasty wounds are known to be more prone to infection, breakdown or delayed healing compared to hip arthroplasty wounds, and this might be explained by the increased tensile force applied on the wound with knee movement. This effect is magnified by the enhanced recovery protocols which aim to obtain high early range of movement. Most of the literature concluded that there is no difference between different closure methods

Keywords

Complete Abductor Detachament, Direct Lateral Approach, Abductor Insuffenciency, Hip Arthroplasty

Background

The knee joint morphology varies according to gender and morphotype of the patients.

Aim: To compare between the number of steps and instruments required for total knee arthroplasty (TKA) using 3 different techniques. The proposed techniques were conventional technique, conventional technique with patient-specific pin locators and CAOS technique using patient-specific templates (PST). Patients and methods: Zimmer/Nexgen was used as the standard implant and templating system for TKA. A Comparison was done on the number of steps and instruments required for TKA when performed with conventional technique, conventional technique with patient-specific pin locators and CAOS technique with patient-specific templates (PST) used as cutting guides. Results: The essential steps and instruments required for conventional TKA without surgical approach or bone exposure were average 70 steps with 183 different instruments; for conventional technique with patient-specific pin locators, they were average 20 steps with 40 instruments and two templates; for CAOS technique using PST, they were average 10 steps with two templates and 15 accessory instruments. CAOS PST technique required an average of 4 days for preoperative preparation and templates fabrication. Conclusion: CAOS technique using PST could make TKA less complicated in light of essential steps and instrumentation required. Although this technique required accurate preoperative preparation, it could offer less technical errors and shorter operative time compared to conventional TKA techniques. The errors’ rate for each technique was still depending on the surgeon's skills and training; however, CAOS technique with PST required shorter learning curve.

Objectives

To compare computer-assisted total knee arthroplasty with the conventional technique in operative time.

Aim

To create a more “normal” anatomy for the repaired joint structure, which can be provided that by the following factors: (1) the available implant component require a normalized anatomical support structure, (2) the available repair components are designed and/or tested to only recreate and/or replicate more normalized anatomical structures and/or joint motion, (3) the surgeon is familiar and comfortable with more normalized joint motion and thus attempts to create such “normal” motion within the repaired anatomical structures.

Introduction

Total knee arthroplasty is the standard treatment for advanced knee osteoarthritis. Patient-specific instrument (PSI)has been reported by several authors using different techniques produced by implant companies. The implant manufacturers produce PSI exclusively for their own knee implants and for easy straightforward cases. However, the PSI has become very expensive and unusable as a universal or an open platform. In addition, planning the implant is done by technicians and not by surgeons and needs long waiting time before surgery (6 weeks).

Computer assisted orthopaedic surgery (CAOS) is an emerging and expanding filed. There are some old classification systems that are too comprehensive to cover all new CAOS tools and hybrid devises that are currently present and others that are expected to appear in the near future. Based on our experience and on the literature review, we grouped CAOS devises on the basis of their functionality and clinical use into 6 categories, which are then sub-grouped on technical basis. In future, new devices can be added under new categories or subcategories. This grouping scheme is meant to provide a simple guide on orthopaedic systems rather than a comprehensive classification for all computer assisted systems in surgical practice. For example, the number and diversity of tasks of surgical robots is enormous, up to 159 surgical robots with different mechanisms and functions reported in the literature. These can be classified according to their tasks, mechanism of actions, degree of freedom and level of activity but for the purpose of simplicity we subcategorised the orthopaedic robots to only industrial, hand-held and bone-mounted. Table 1 shows the classification system with the 6 categories and other subcategories.

Introduction

This community Arthroplasty Register is an individual initiative to document arthroplasty procedures performed from 2007 to date in a sample area in Cairo, Egypt. Currently, there is no published study or official documentation of the indications for arthroplasty, types of implants or the rate of total hip and knee arthroplasty (THA & TKA). Although the population of Egypt reached 80,394,000, the unofficial estimate of the rate of joint replacement is less than 10,000 per year. This rate is less than 10% of what is currently done in UK, a country with similar or even less population than Egypt. This indicates the unmet need for TKA in Egypt, where the knee OA is prevailing and there is a call for documentation and a registry.

Recently, a new technique of custom-made cutting guides for TKA is introduced to clinical practice. However, no published data yet on the comparison between this new technique against both navigation and conventional techniques.

The author prospectively compared between custom-made cutting guides, navigation and conventional techniques. A total number of 90 cases were included in this study with 30 consecutive cases for each technique. The highest number of medically unfit patients and those with articular and extra articular deformities were in custom guides groups.

The results showed one case of aseptic loosening after one year in custom guides, one case of superficial infection and loose pins but with no fracture in navigation group, and higher need for blood transfusion in conventional. One case in the custom guide group had a periprosthetic fracture 3 weeks postoperatively diagnosed as insufficiency fracture after a relatively minor trauma to an osteoporotic bone. Navigation was the most accurate in alignment but custom guides was the most accurate in implant sizing and had the least bleeding.

This clinical study showed some advantages of custom-made cutting guides over conventional instrumentation. It eliminated medullary guides, reduced operative time, and provided better accuracy. The technique was proved to be useful in complex cases of deformities and unfit patients.

Introduction

The purpose of this retrospective study was to review the outcome of THA in the treatment of bilateral hip ankylosis of different causes; surgical, septic or spontaneous.

Digital templating was used in 50 patients who underwent THA using Merge Ortho software, Cedara. Clinical examination was performed first, to measure leg lengths and account for pelvic obliquity and flexion deformity. Good quality digital radiographs were obtained with anteroposterior and lateral views extending beyond the tip of the femoral component and the cement restrictor. A coin was placed on the ASIS to help in determining radiological magnification

Digital radiographs were saved in DICOM format and imported to EndoMap software system.

A 6-step technique was used for templating as follows:

Radiographic assessment; looking at the quality of bone, amount of bone stock, dysplasia, osteophytes, and other abnormalities

Correction of leg length discrepancy and measuring length of neck resection; the height of the femoral stem was adjusted to correct any leg length discrepancy by placing the center of the head above the center of the cup by the same length of discrepancy. Then the level of the neck resection was marked at the level of the stem collar and the femoral neck cut was measured by a digital ruler from the tip of the lesser trochanter to the mark of neck resection. In case of leg length discrepancy, the height of the femoral neck cut was adjusted accordingly to compensate for the leg length discrepancy. For example, if the affected leg is 20 mm short, place the centre of the head 20 mm above the centre of the cup.

Intraoperatively, the surgeon performed the femoral neck osteotomy at the level determined by preoperative templating. Postoperatively, the leg length was measured and compared to the preoperative leg length. Preoperatively, the leg length discrepancy ranged from 5 to 30 mm. In all cases, the leg was short on the side of THR (ipsilateral). Leg length discrepancy was adjusted in all THR cases. Postoperatively, the accuracy of the correction was found to be within 5 millimeters i.e. less than 5mm of shortening or lengthening). Intraoperatively, the level of femoral neck cut ranged from 1 to 44 mm.

Digital templating is useful in adjusting leg length discrepancy. In addition, there were other benefits such as predication of femoral and acetabular implant sizes, restoration of normal hip centre, and optimization of femoral offset.

Introduction

There is a controversy with regard to the treatment of osteoarthritis (OA) of the knee in patients with considerable deformities of the femoral or tibial shafts. Some surgeons prefer to correct the deformity while performing TKA at the level of the knee joint. However, this technique requires accurate planning and execution of the planned cuts. In addition, the use of intramedullary guides in such cases may not be possible or desirable and may lead to complications. There is a strong indication for using navigation in such cases.

Shockwave treatment in our unit is provided in conjunction with our Urological colleagues. Shock Wave Therapy has been used as a last option in patients with difficult and chronic Orthopaedic conditions with an informed consent for all patients.

Material and Methods: 28 patients from Ealing Hospital and West Middlesex Hospital were referred to The Lithotripsy unit at Charing Cross Hospital for Shock wave therapy.

Patients were consented by the Orthopaedic surgeon and the treatment was administered by urologist

The cases included:

4 Humeral fractures: 1 Case in HIV +ve 19 years old

Results: There was complete resolution of symptoms in the 4 cases of soft tissues.

– Clinical and radiological union in 3 of the 4 Humeral Fracture including HIV+ve and in 2 of 3 tibial fracture and 1 of 2 scaphoid.

Discussion: Shock wave therapy is a new consevative treatment modality used in orthopaedic as the last option before surgery but there is a need for RCT.

Aim: To develop a 3-D pre-surgical planner that facilitates selection and placement of correct prosthetic components in the joint, and the design of patient specific templates to use intra-operatively to reproduce the pre-planned implantation procedure, in total knee replacement (TKR) surgery.

Design/Methods: The process begun with loading of pre-operative CT scan data of cadaver knee, onto medical software, followed by reconstructions of 3D models of the joint. Then measurements of anterior-posterior diameter of the femoral condyles of the 3D models of the joint were used to select and import a correct CAD drawing of prostheses from a database of electronic files available in a range of sizes. The selected prosthetic components were positioned and aligned on the 3-d model of the joint, making sure that the anterior flange of the femoral prosthesis component did not violate superior cortical bone of trochlea. Whilst the tibial stem was placed central within the medullar space of the bone, and the plane of the tibial cut was perpendicular to the long axis of the tibia. The planned data were next exported to a CAD environment where template to prepare the bone to receive the prostheses, was designed. A template was designed to press fit on a bone (e.g. femur), via minimum number of cylindrical protrusions with their ends made to conform to the geometry of that bone at the regions of contact. The integrated surgical tools were secured to the bones with pins through each of the protrusions, and were equipped with saw guide slits for cutting the bone, and with drill guides for drilling the fixation holes. Thereafter the files describing templates and prosthetic components selected for cadaveric joint concerned were sent to rapid prototyping machine for manufacturing.

Results: Fourteen procedures were performed on cadaveric knees to date. Visual examination of the joint has revealed the 3-D planning system enabled correct selection of appropriate prosthetic components and alignment, as evidenced by absence of protrusions or overhanging beyond the edges of the bones. The resected bone surfaces were visually smooth and flat. Gaps between the bones and the internal surfaces of the prosthetic components were measured using steel shim gauges, and largest recorded was 0.9mm. Laxity between the femur and tibia was absent and the joint attained full range of flexion. Dimensional deviations of post-operative scans of the prepared bones from the pre-planned ones were between 0.5 and 0.9mm. The templates after their use were shown capable to withstand the rigors of theatre environment.

Conclusion: With the planning software, it has been shown that it is possible to design a simple to use implantation guidance system according to the final position of the restorative prosthesis and the bone pathological condition. Pre-operative planner system relieves the clinician from multiple intra-operative decisions. The system is ideal for critical anatomical situations and eliminates possible manual placement errors such as those from extra and intra-medullary alignment tool. Less inventory required of both implants and instrumentation means reduced complexity of procedure, surgical time and cost.

Introduction: rapidly destructive hip arthropathy is a recognised condition. Some authors considered it as a subset of osteoarthritis but none has identiþed the aetiology, pathogenesis or risk factors. Patients and methods: Authors present 14 cases of an extreme subset of rapidly destructive hip arthropathy. The radiological deterioration occurred dramatically over a short period ranging from 2 weeks up to few months. Loss of femoral head ranged from 25% up to 100% of the head volume. Acetabulum was damaged in all cases and femoral neck was partially lost in 9 cases (up to 75%). 4 cases were associated with dislocation. Age ranges from 53 to 85, female to male ratio (8 to 6), 2 patients had bilateral disease. Results: Clinical and radiological features were similar to those of neuropathic joint, infection, neoplasia, or avascular necrosis. However these conditions were excluded by further investigations; laboratory, imaging, surgical exploration and histopathology. All patients underwent hip arthroplasty. Some common (at risk) features included elderly patients, long history of receiving strong NSAIDs, radiologically atrophic and predominantly lateral disease. Conclusion: It appears that this condition represents a new entity but authors were not able to identify the aetiology. Awareness of this condition is important and at risk patients should be closely monitored.

Introduction: There are more than 60 different hip prostheses currently available for total hip replacement (THR). Cemented prostheses make up about 90 to 95% of current total UK market. The cost of THR prosthesis varies widely with some prostheses cost 5 times more than others. Furlong Stainless steel cemented is a low-cost prosthesis that has been used in few hospitals in UK and Europe. There is no published data to report its survival and performance. Aim: To evaluate the outcome of a low-cost THR prosthesis (Furlong stainless steel) that has been in use in our hospital since 1993. Patients and Methods: we retrospectively reviewed 142 THR performed between 1993 and 2001. The average age was 72 and osteoarthritis was the primary pathology in 92%. Operations were performed by different grades of surgeons. 25 patients were dead at the time of the study. Results: 4 cases underwent revision (2.8%) with survival rate of 97.2%. 6 cases of dislocation, 17 cases of heterotopic calcifications, 5 cases of DVT and one neurological injury. 88% reported no pain and 79.6% were satisfied. Conclusions: The results of this study compare favourably with Furlong Titanium cemented prosthesis and other popular THR prostheses (e.g. Charnley). It is rational to continue using this prosthesis, which appears to be cost effective.