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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_13 | Pages 21 - 21
1 Dec 2022
Kim D Dermott J Lebel D Howard AW
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Primary care physicians rely on radiology reports to confirm a scoliosis diagnosis and inform the need for spine specialist referral. In turn, spine specialists use these reports for triage decisions and planning of care. To be a valid predictor of disease and management, radiographic evaluation should include frontal and lateral views of the spine and a complete view of the pelvis, leading to accurate Cobb angle measurements and Risser staging. The study objectives were to determine 1) the adequacy of index images to inform treatment decisions at initial consultation by generating a score and 2) the utility of index radiology reports for appropriate triage decisions, by comparing reports to corresponding images.

We conducted a retrospective chart and radiographic review including all idiopathic scoliosis patients seen for initial consultation, aged three to 18 years, between January 1-April 30, 2021. A score was generated based on the adequacy of index images to provide accurate Cobb angle measurements and determine skeletal maturity (view of full spine, coronal=two, lateral=one, pelvis=one, ribcage=one). Index images were considered inadequate if repeat imaging was necessary. Comparisons were made between index radiology report, associated imaging, and new imaging if obtained at initial consultation. Major discrepancies were defined by inter-reader difference >15°, discordant Risser staging, or inaccuracies that led to inappropriate triage decisions. Location of index imaging, hospital versus community-based private clinic, was evaluated as a risk factor for inadequate or discrepant imaging.

There were 94 patients reviewed with 79% (n=74) requiring repeat imaging at initial consultation, of which 74% (n=55) were due to insufficient quality and/or visualization of the sagittal profile, pelvis or ribcage. Of index images available for review at initial consult (n=80), 41.2% scored five out of five and 32.5% scored two or below. New imaging showed that 50.0% of those patients had not been triaged appropriately, compared to 18.2% of patients with a full score. Comparing index radiology reports to initial visit evaluation with <60 days between imaging (n=49), discrepancies in Cobb angle were found in 24.5% (95% CI 14.6, 38.1) of patients, with 18.4% (95% CI 10.0, 31.4) categorized as major discrepancies. Risser stage was reported in only 14% of index radiology reports. In 13.8% (n=13) of the total cohort, surgical or brace treatment was recommended when not predicted based on index radiology report. Repeat radiograph (p=0.001, OR=8.38) and discrepancies (p=0.02, OR=7.96) were increased when index imaging was obtained at community-based private clinic compared to at a hospital. Re-evaluation of available index imaging demonstrated that 24.6% (95% CI 15.2, 37.1) of Cobb angles were mis-reported by six to 21 degrees.

Most pre-referral paediatric spine radiographs are inadequate for idiopathic scoliosis evaluation. Standardization of spine imaging and reporting should improve measurement accuracy, facilitate triage and decrease unnecessary radiation exposure.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_5 | Pages 1 - 1
1 Apr 2018
Jo S Lee S Lim W Kim D Lee J
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Introduction

Cobalt chrome femoral head has been used widely in total hip arthroplasty and has shown favorable outcome. However, there is still of concern of potential metal toxicity from the wear debris. In the other hand, titanium is well known for its biocompatibility but it is not used in bearing surface of arthroplasty due to its brittleness. Recently, coating of the prosthesis using plasma electrolytic oxidation (PEO) has shown favorable surface protection. Thus, in this study, we tried to find out whether the PEO coating on the titanium surface would provide surface protection.

Materials and methods

Five Titanium alloy (Ti-6Al-4V) ball mimicking femoral head was manufactured and was coted using plasma electrolytic oxidation. Wear rate was tested using validated wear tester with 10N compression force at 80rpm. The amount of wear was detected by measuring change of weight after wear test was completed. This was compared with femoral head manufactured with titanium alloy without PEO coating. Toxicity of the debris was also tested using MTT assay with human osteoblast cell line.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_5 | Pages 31 - 31
1 Apr 2018
Kim W Kim D Rhie T Oh J
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Background

Humeral retroversion is variable among individuals, and there are several measurement methods. This study was conducted to compare the concordance and reliability between the standard method and 5 other measurement methods on Twodimensional (2D) computed tomography (CT) scans.

Methods

CT scans from 21 patients who underwent shoulder arthroplasty (19 women and 2 men; mean age, 70.1 years [range, 42 to 81 years]) were analyzed. The elbow transepicondylar axis was used as a distal reference. Proximal reference points included the central humeral head axis (standard method), the axis of the humeral center to 9 mm posterior to the posterior margin of the bicipital groove (method 1), the central axis of the bicipital groove –30° (method 2), the base axis of the triangular shaped metaphysis +2.5° (method 3), the distal humeral head central axis +2.4° (method 4), and contralateral humeral head retroversion (method 5). Measurements were conducted independently by two orthopedic surgeons.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_8 | Pages 144 - 144
1 May 2016
Park K Lee G Kim D Rim Y
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Purpose

There are still some controversies over the routine use of negative suction drainage after primary total hip arthroplasty (THA). In this study we are to know the benefits of new suction drainage management strategy after primary THA.

Materials and methods

From 2010 to 2012, two hundred patients who had unilateral primary THA were randomly allocated into two groups. One group had negative suction drainage immediately after THA (Group 1). In the other group, the suction drainage was inserted but negative pressure was applied more than 12 hours after surgery, in the morning postoperative day one (Group 2). All surgeries were performed by one single hip surgeon using the same technique and postoperative rehabilitation protocol was all same. We checked the amount of blood loss, changes in hemoglobin (Hb), volume of blood transfusion, superficial or deep wound infection and hematoma. Clinical results were evaluated using HHS score.


Introduction

Ultra high molecular weight polyethylene (UHMWPE) has been used successfully as a bearing material in hip, knee, and shoulder joint replacements. However, there are problems to cause a failure in UHMWPE component, which are wear behavior and creep deformation. Continuous bearing motion and dynamic load have occurred to UHMWPE wear debris caused osteolysis in periprosthetic tissue and to plastic deformation of joint component, and subsequent aseptic loosening of components. Therefore, many studies have being carried out in order to reduce wear debris and to improve mechanical strength from UHMWPE, and there is tremendous improvement of mechanical property in UHMWPE from gamma irradiated conventional UHMWPE (GIPE), highly crosslinked PE (XLPE), and XLPE with vitamin E1, 2. Friction has a significant one of the factors effect on the wear and creep deformation. In this study, the short-term frictional behaviors of three typical types of GIPE, remelted XLPE (R-XLPE), and s annealed XLPE (A-XLPE), and XLPE with Vitamin E against Co-Cr alloy were compared under three levels of contact pressures which occured in hip, knee, and shoulder joints.

Methods

Friction tests were conducted with UHMWPE against Co-Cr alloy by using pin-on-disk type triboteter. For test, tribotester performed in a repeat pass rotational slidintg motion with a velocity of 60rpm. Applied contact pressure selected three kinds of levels, 5, 10, and 20MPa which were within the range of maximum contact pressures for total hip, knee, and shoulder joint replacements. To analyze the frictional effect of UHMWPE type, it conducted t-test and p-values less than 0.05 were used to determine the statistically significant difference.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_9 | Pages 117 - 117
1 May 2016
Park K Kim D Lee G Rim Y
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Introduction

Total hip arthroplasty (THA) is the most common surgery performed for complications of bipolar arthroplasty. The present study evaluated the functional results and complications associated with this surgery.

Patients and Methods

Forty eight hips (48 patients) who had conversion of bipolar arthroplasty to THA between 1998 June and 2013 June, and who were followed-up for more than one year were evaluated. Twenty one hips had conversion surgery to THA using a Fitmore cup with metal-on-metal articulation (28 mm head). Six hips had surgery using the SecurFit cup and three hips, using the Lima LTO cup with ceramic-on-ceramic articulation (28 mm or 32 mm head). Eighteen hips had surgery using a large head metal-on-metal bearing: –MMC (seven hips), ACCIS (six hips) and Magnum (five hips). The average time of follow-up duration was 3.9 years (range, 1.0–11.3). There were 22 men and 26 women between the ages of 28 and 80 years (average, 68.9 years) at the time of conversion surgery. Conversion arthroplasty was performed for acetabular erosion without femoral stem loosening in 19 hips, acetabular cartilage erosion with femoral stem loosening in 13 hips, periprosthetic fracture in 12 hips, and recurrent dislocation in four hips. Results were evaluated using Harris hip score (HHS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score. The radiographs were analyzed for evidence of acetabular and femoral osteolysis or loosening. The complications were evaluated.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_3 | Pages 119 - 119
1 Jan 2016
Park Y Moon Y Lim S Kim D Ko Y
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Introduction

Cementless grit-blasted tapered-wedge titanium femoral stems are being used with increasing frequency in hip arthroplasty because of excellent long-term outcomes. However, periprosthetic femur fracture is a potentially worrisome phenomenon in these types of femoral stems. The aim of this study is to report the incidence of stem loosening in association with periprosthetic femur fractures following hip arthroplasty using cementless grit-blasted tapered-wedge stems.

Materials & Methods

A total of 36 Vancouver Type B1 and B2 periprosthetic femur fractures following either hemiarthroplasty or total hip arthroplasty using cementless grit-blasted tapered-wedge titanium femoral stems (GB group) were identified from a retrospective review of the medical records at three participating academic institutions. The control group consisted of 21 Vancouver Type B1 and B2 periprosthetic femur fractures following either hemiarthroplasty or total hip arthroplasty using cementless proximal porous-coated femoral stems (PC group) at the same institutions during the same period of the study. All femoral stems included in this study had been a well-fixed state before the occurrence of periprosthetic femur fractures. All patients in both groups were treated surgically with either open reduction and internal fixation or femoral stem revision. Femoral stem stability was assessed by preoperative radiographs and was confirmed by intraoperative scrutinization. The incidence of stem loosening was compared between the groups.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_3 | Pages 117 - 117
1 Jan 2016
Park Y Moon Y Lim S Kim D Jang S
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Introduction

Micro-arc oxidation (MAO) is an electrochemical method used to treat metal surfaces. It provides nanoporous pits, and thick oxide layers, and incorporates calcium and phosphorus into the coating layer of titanium alloy. This modification on the surface of titanium alloy by MAO coating would improve the ability of cementless stems to osseointegrate. In spite of these structural and chemical advantages, clinical study of total hip arthroplasty (THA) using MAO coated stem has not yet been reported. In this study, we evaluated the clinical and radiographic results associated with cementless grit-blasted tapered-wedge stems that were identical in geometry but differed with regard to surface treatment with or without MAO coating.

Materials & Methods

We performed a retrospective review of 141 THAs using MAO coated stem for a minimum of 5 years and compared them to 219 THAs using the same geometry stem without MAO coating. A cementless Bencox femoral component (Corentec, Seoul, Korea) was used in all hips. It is made of titanium alloy with a straight, double wedged, tapered stem with a rectangular cross-section. Surface treatment was performed using grit blasting with a roughness of 5.5ųm that was available either with or without MAO coating. Clinical and radiographic evaluations were performed preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively, and then annually.