The aim of this retrospective study was to compare the correction achieved using a convex pedicle screw technique and a low implant density achieved using periapical concave-sided screws and a high implant density. We hypothesized that there would be no difference in outcome between the two techniques. We retrospectively analyzed a series of 51 patients with a thoracic adolescent idiopathic scoliosis. There were 26 patients in the convex pedicle screw group who had screws implanted periapically (Group 2) and a control group of 25 patients with bilateral pedicle screws (Group 1). The patients’ charts were reviewed and pre- and postoperative radiographs evaluated. Postoperative patient-reported outcome measures (PROMs) were recorded.Aims
Methods
In recent years, the direct anterior approach (DAA) has become a standard approach for primary total hip arthroplasty (THA). With the increasing use of the DAA in primary cases also more and more revision surgeries are performed through the same interval. With ability to extend the DAA interval proximally and distally, loose cups, loose stems, and even periprosthetic femoral fractures (PPF) can be treated. Especially, PPF are devastating complications causing functional limitations and increased mortality. Therefore, we conducted a study to report the outcome of surgical treatment of PPF with the DAA interval. We report on the one year complications and mortality in 40 cases with a mean clinical follow-up of 1.5 years. Mean age of patients was 74.3 years. Fractures were classified as Vancouver B2 (36), and B3 (N=4). In 14 cases, a standard stem was used, and in 26 cases a modular revision stem. In 30 cases, a distal extension +/- tensor release was used, in 4 cases a proximal tensor release was done, and in the remaining 6 cases revision could be performed without extension of the approach. Median cut/suture time was 152 minutes (IQR 80 – 279). The overall complication rate in our patient group was 12.5%. 2 patients died in the first three months after operation. One patient had a transient femoral nerve palsy, which completely recovered. The DAA interval to the hip for the treatment of PFF showed similar results compared with other approaches regarding mortality, complications, fracture healing, dislocation rate and clinical results. We conclude that femoral revision in case of PPF in the DAA interval is a safe and reliable procedure. Each Vancouver type of periprosthetic fracture can be treated by use of this approach.
We aimed to investigate the clinical consequences of intraoperative acetabular fractures. Between 2003 and 2012, a total of 3391 cementless total hip arthroplasties (THA) were performed at the Dept. of Orthopaedics, Innsbruck Medical University. Of those, a total of 160 patients underwent a CT scan within 30 days postoperatively. The scans of 44 patients were not suitable for analyse due to thick scan layers. Of the remaining 116 patients, 76 had a fracture. Reasons for CT-scans were suspected bleeding, hip pain, abdominal symptoms, etc. The fractures included 59 isolated acetabular fractures, the rest of fractures was in the superior or inferior pubic ramus or the tuber ischiadicum. Four cases out of the 59 acetabular fractures underwent revision surgery due to periprosthetic joint infection after 0, 2, 10 and 23 months. Four patients underwent revision due to cup loosening after 13 and 14 days as well as after 16 and 24 months. Of those, three showed a central acetabular fracture with protrusion. In 33 of the remaining 51 patients, a minimum of 3 x-rays was available for migration analysis with EBRA. In 6 patients, the x-rays were not comparable to each other. The 27 remaining acetabular fractures were categorised according to AO classification in 62A1 (1; posterior wall), 62A2 (16; posterior column), 62A3 (6; anterior wall), and others (4). Four hips showed initial migration of more than 3 mm in the first 6 months. One had a central fracture, and was lost for follow-up after 8 months. Two had an anterior column fracture and showed no further migration after 6 months. One showed also a radiolucency of more than 2 mm in all 3 zones and was lost for follow-up. We conclude that intraoperative acetabular fractures occur more often than we expected. Fractures of the acetabular ring involving one column do not seem to compromise the long-term stability of the implant. Central fractures required revision or showed loosening proved by high cup migration.
Austin Moore cervicocephalic prostheses have been a therapeutical option for femoral neck fractures in patients with a reduced general condition for many years. Since treatments other than total hip arthroplasties have also been included in National arthroplasty registers during the last decade, adequate reference data for comparative analyses have recently become available. Based on a standardised methodology, a comprehensive literature analysis of clinical literature and register reports was conducted. On the one hand, the datasets were examined with regard to validity and the occurrence of possible bias factors, on the other hand, the objective was to compile a summary of the data available. The main criterion is the indicator of Revision Rate. The definitions used with respect to revisions and the methodology of calculations are in line with the usual standards of international arthroplasty registers.Introduction
Materials and Methods
End-stage ankle osteoarthritis is a debilitating condition that results in functional limitations and a poor quality of life. Ankle arthrodesis (AAD) and total ankle replacement (TAR) are the major surgical treatment options for ankle arthritis. The purpose of the present study was to compare preoperative and postoperative participation in sports and recreational activities, assesses levels of habitual physical activity, functional outcome and satisfaction of patients who underwent eighter AAD or TAR. 41 patients (mean age: 60.1y) underwent eighter AAD (21) or TAR (20) by a single surgeon. At an average follow-up of 30 (AAD) and 39 (TAR) months respectively activity levels were determined with use of the University of California at Los Angeles (UCLA) activity scale. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, patients's satisfaction and pre- and postoperative participation in sports were assessed as well.Introduction
Methods
Between 1978 and 1997 all newborns in the Austrian province of Tyrol were reviewed regarding hip dysplasia and related surgery. This involved a mean of 8257 births per year (7766 to 8858). Two observation periods were determined: 1978 to 1982 (clinical examination alone) and 1993 to 1997 (clinical examination and universal ultrasound screening). A retrospective analysis compared the number and cost of interventions due to hip dysplasia in three patient age groups: A, 0 to <
1.5 years; B, ≥ 1.5 to <
15 years; and C, ≥ 15 to <
35 years. In group A, there was a decrease in hip reductions from a mean of 25.2 ( An increase of €57 000 in the overall cost per year for the second period (1993 to 1997) was seen, mainly due to the screening programme. However, there was a marked reduction in costs of all surgical and non-surgical treatments for dysplastic hips from €410 000 (1978 to 1982) to €117 000 (1993 to 1997). We believe the small proportional increase in costs of the universal ultrasound screening programme is justifiable as it was associated with a reduction in the number of non-surgical and surgical interventions. We therefore recommend universal hip ultrasound screening for neonates.
By contrast, worldwide Register data refer to 733,000 primary operations, i.e. approximately 10 times as many as sample-based datasets. In general, sample-based datasets present higher revision rates than register data. The deviations are high, with a maximum factor of 64 for hip stems. Whereas the AAHKS survey exhibits lower deviations than the monocentre trials, they are still too high for this data collection tool being considered as reliable and safe to provide valid data for general conclusions. The incidence of implant fractures after total hip arthroplasty in pooled worldwide arthroplasty register datasets is 304 fractures per 100.000 implants. In other words, one out of 323 patients has to undergo revision surgery due to an implant fracture after THA in their lifetime.
For the detection of rare, but severe complications like implant fractures sample-based studies achieve the goal of providing accurate figures only to a very limited extent, even if the samples are large. Here, too, comprehensive national arthroplasty registers are the most suitable tool to identify such incidents and calculate reliable figures. Contrary to the prevalent opinion, implant fractures still are a relevant problem in arthroplasty.
Compared to other implants for unicompartmental knee arthroplasty in worldwide arthroplasty Registers, the Oxford Uni shows good results. For the assessment of the outcome of implants, register data are to be rated superior and, in terms of reference data for the detection of potential bias factors in the clinical literature, can provide an essential contribution for scientific meta-analyses.
The published results from clinical follow up studies have been compared to Arthroplasty register Results: Results: 24% of all papers were published by the inventor of the implant. These publications show a 3,4 times lower revision rate compared to independent studies and a 4,6 times lower revision rate compared to Register based publications. The cumulative revision rate per 100 observed component years of register based publications is 1,36 times higher compared to independent clinical studies. The difference is statistically not significant. Pooling the published data from all follow up studies the impact of the studies published by the inventor leads to a statistically significant bias.
Arthroplasty Register data are able to detect bias factors and lead to a better quality of assessments concerning the outcome of arthroplasty.
The results showed that in all rim supported conditions, the maximum principal stress were in compressive patterns, a preferred pattern to reduce the potential polyethylene liner fracture. In rim unsupported conditions, the stresses was in tensile on the internal bearing surface when polyethylene liner thickness was bellow 5 mm, or was bellow 9 mm if the average maximum principal stress cross the rim was considered. We conclude that the metal rim support changes the stress pattern in the rim region of UHMWPE liner to compressive for all liner thicknesses. The stress pattern turns to tensile, or there will be a higher potential for rim fracture, if UHMWPE liner is unsupported and the polyethylene rim thickness is less than 9 mm. Although components used this study did not include the locking details which add higher stress concentrations, the trend of stress patterns should follow the results found in this study.
VAS neck pain: Fusion group/arthroplasty group: Preoperatively 6.2/5.9 n.s., 6 weeks 3.5/3.1 n.s., 12 weeks 2.1/1.9 n.s, 1 year 2/2.1 n.s. VAS arm pain: Fusion group/arthroplasty group: Preoperatively 5.5/5.3 n.s., 6 weeks 2.6/2.4 n.s., 12 weeks 1.7/1.8 n.s, 1 year 2/1.9 n.s. Neck disability index: Fusion group/arthroplasty group: Preoperatively 43/40 n.s., 6 weeks 28/23 p<
0.05., 12 weeks 18/14 p<
0.05, 1 year 20/15 p<
0.05. SF-36 subscore pain: Fusion group/arthroplasty group: Preoperatively 36/37 n.s., 6 weeks 42/44 n.s., 12 weeks 52/58 p<
0.05, 1 year 52/60 p<
0.05. SF-36 subscore function: Fusion group/arthroplasty group: Preoperatively 52/54 n.s., 6 weeks 57/59 n.s., 12 weeks 60/62 n.s, 1 year 64/67 n.s. SF-36 subscore vitality: Fusion group/arthroplasty group: Preoperatively 42/44 n.s., 6 weeks 45/46 n.s., 12 weeks 50/52 n.s, 1 year 54/56 n.s. In the fusion group we had 1 recurrent radiculopathy and 1 non union without the need of further intervention. In the arthroplasty group we faced 1 recurrent laryngeus recurrens nerve palsy and 3 spontaneus fusions within 1 year postoperatively, which might not be classified as complication.