Optimal acetabular component position in Total Hip Arthroplasty is vital for avoiding complications such as dislocation and impingement, Transverse acetabular ligament (TAL) have been shown to be a reliable landmark to guide optimum acetabular cup position. Reports of iliopsoas impingement caused by acetabular components exist. The Psoas fossa (PF) is not a well-regarded landmark for Component positioning. Our aim was to assess the relationship of the TAL and PF in relation to Acetabular Component positioning. A total of 22 cadavers were implanted on 4 occasions with the an uncemented acetabular component. Measurements were taken between the inner edge of TAL and the base of the acetabular component and the distance between the lower end of the PF and the most medial end of TAL. The distance between the edge of the acetabular component and TAL was a mean of 1.6cm (range 1.4–18cm). The distance between the medial end of TAL and the lowest part of PF was a mean of 1.cm (range 1,3–1.8cm) It was evident that the edge of PF was not aligned with TAL. Optimal acetabular component position is vital to the longevity and outcome following THA. TAL provides a landmark to guide acetabular component position. However we feel the PF is a better landmark to allow appropriate positioning of the acetabular component inside edge of the acetabulum inside the bone without exposure of the component rim and thus preventing iliopsoas impingement at the psoas notch and resultant groin pain.Abstract
Advanced osteoarthritis of knee is associated with low-backache in a significant number of patients and adversely affects the quality of life. There is a paucity of literature describing outcomes of backache after total-knee-arthroplasty (TKA). We evaluated backache in patients of advanced knee-osteoarthritis and their functional and radiological outcomes after TKA after approval from Institutional ethics committee. Fifty-nine patients (40 females and 19 males) were included. Mean body-mass index was 28.7. Mean visual analogue score (VAS) for knee-pain was 7.98 preoperatively and 1.6 in follow-up. For chronic backache, the mean VAS score improved from 6.08 to 2.4, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improved from 67.5 to 37.8, Knee society score (KSS) from 49.8 to 76.6, Oswestry Disability Index (ODI) Score from 55.44 to 34.65 and SF-36 Quality-of-life score from 44.95 to 74.63. There was a significant correlation between in knee and low-back functional scores. Magnetic resonance imaging-based scoring of degenerative changes (Pfirrmann grading) showed improvement only in 13.5% patients; 56% showed no change and 30.5% showed deterioration of scores. Chronic low backache is a significant co-morbidity in advanced knee-osteoarthritis. TKA has the potential to relieve backache along with knee-pain and improves quality of life.
Trauma & Orthopaedic Department, Bronglais Hospital & Hywel Dda University Health Board, Aberystwyth, UK Auto-CAD study is done to observe the effects of head neck ratio (HNR) in joint replacements. Total hip replacement joints were reconstructed on CAD with increasing diameter of the head keeping neck diameter constant in 1997. Simulation was done and Range of Movement (ROM), impingement and stability of the hip joint was noted. A graph was plotted with HNR on X-axis and ROM on Y-axis. It was observed that as the HNR increases the ROM of the joint is increased, impingement is reduced and stability is also increased. It is also observed that diameter of the head and neck is more important than considering only head diameter of the hip joint. The graphical analysis confirms that different diameters of the head may have same HNR depending on the neck diameter. So even in smaller diameter head the HNR may be more due to smaller diameter neck and may be more advantages than larger diameter head with bigger neck having smaller HNR. We conclude that HNR is more important than the head diameter alone in hip replacements.
Auto-CAD study is done to observe effects of head neck ratio (HNR) in hip replacements. Total hip replacement joints were reconstructed on CAD with increasing diameter of the head keeping neck diameter constant in 1997. Simulation was done and Range of Movement (ROM), impingement and stability of the hip joint was noted. A graph was plotted with Head Neck Ratio (HNR) on X-axis and ROM on Y-axis. It was observed that as the HNR increases the ROM of the joint is increased, impingement is reduced and stability is also increased. It is also observed that diameter of the head and neck is more important than considering only head diameter of the hip joint. The graphical analysis confirms that different diameters of the head may have same HNR depending on the neck diameter. So even in smaller diameter head the HNR may be more due to smaller diameter neck and may be more advantages than larger diameter head with bigger neck having smaller HNR. We conclude that HNR is more important than the head diameter alone in hip replacements.
Tunning fork lines (TFL) were drawn on ankle anterior-posterior radiographs to assess the talar shift in ankle fractures. A 3-D ankle joint reconstruction was prepared by mapping normal ankle joint using auto CAD in 1997. TFL were drawn using normal anatomical landmarks on saggital, coronal and transverse planes. The ankle joint anatomical relationship with talus was studied in various rotation simulating radiographic anterior-posterior views and talar shift was studied. Between 2006 and 2012 on antero-posterior view of ankle radiographs and PACS, TFL were drawn. The premise is that in a normal radiograph the superior-lateral dome of the talus lies medial to the handle of TFL, and in ankle with talar shift the dome of the talus would cross this line laterally. In two district hospitals 100 radiographs were observed by 4 observers in 67 males and 33 females with mean age of 49 (15–82) years. The TFL confirmed talar shift with sensitivity of 99.2 % showing talarshift and inferior tibio-fibular ankle diastasis. We conclude that in ankle anterio-posterior view it is possible to comment on the talar shift and diastasis of the ankle joint, even if proper ankle mortise views were not available.
The PFNA is used routinely at the RUH for unstable peri-trochanteric and femoral fractures. Failure of operative treatment is associated with increased morbidity and financial burden. We analysed surgical and fracture factors, aiming to identify those associated with fixation failure. Retrospective analysis of 76 consecutive patients treated with a PFNA between 2009–2012 was performed. Patient demographics were assessed, along with fracture classification, adequacy of reduction, tip apex distance (TAD) and grade of surgeon. Failure was defined as metal work failure, non-union or need for repeat procedure. The mean age was 78.9 years (25.9–97.4). 21 were male and 49 female. There were 17 failures (24.3%) (7 required further surgery). 10 failures were per-trochanteric, 2 sub-trochanteric and 5 mid-shaft fractures. Complications included 4 broken and 6 backed-out distal locking screws, 2 blade cut-outs, 1 nail fracture and 4 non-unions. All per-trochanteric were adequately reduced with a TAD <25 mm. 11/17 had consultant supervision. A high rate of backed-out distal locking screws was identified. We found no concerns with adequacy of reduction, TAD or consultant supervision.
Microdiscectomies and microdecompressions are traditionally defined as procedures performed with a small incision using magnification. There are no studies in the literature comparing the magnification techniques used in these operations. We compared magnifying loupes and microscopes as the senior author was trained with both instruments and was equally comfortable using both. This is a retrospective comparative study involving 51 consecutive patients in group A (loupes) and same number in group B (microscope). The study included all patients who had single level lumbar microdiscectomy or decompression in the period from the 11th of January 2009 to the 6th of April 2010. To avoid any bias, only patients who failed to attend their follow ups were excluded from the study. The senior author operated on all patients. We noted intra-operative and post-operative complications, further interventions, length of surgery and length of hospital stay. We conducted a telephone questionnaire to collect visual analysis score for pre-op and post-op pain and functional status to calculate Macnab's functional status score. 78 patients (75.6%) answered the questionnaire, 39 patients from each group. There was 1 dural leak in group A.1 patient had discitis in the group A and 1 patient had superficial infection in group B. 4 patients in group A and 1 patient in group B had residual pain requiring intervention. The average length of surgery was one hour and five minutes and one hour and eleven minutes, respectively. Mean hospital stay was 1.43 days and 1.78 days, respectively. The data in the group B was skewed due to one patient who stayed for 9 days after surgery. 25 patients (49%) in group A and 36 patients (70.5%) in group B returned to normal pre-prolapse function and physical activity within 3 months.Introduction
Materials/Methods
A prospective study was done using Kirschner (K) wires to internally fix capitellum fractures and its results were analysed. Since 1989, unstable displaced 17 capitellum fractures were anatomically reduced and internally fixed by inserting K wires in coronal plane from the capitellum into trochlea. The lateral end of wires were bent in form of a staple behind the fracture plane and anchored into the lateral humeral condyle with pre-drilled holes. Additional screws were used in 2 cases to stabilise the lateral pillar comminution. The capitellum was exposed with a limited modified lateral elbow approach between anconeus and extensor carpi ulnaris. The capsule was reflected anteriorly to expose the capitellum and trochlea. The deeper dissection was limited anterior to lateral collateral ligament (LCL) keeping it intact. The capitellum fragment was reposition under the radial head and anatomically reduced by full flexion of elbow and then internally fixed. Total 17 patients (7 males and 10 females) with average ages 34.8 years(14 to 75) had fractures, Type I: (Hans Steinthal #) 12, Type II: (Kocher Lorez #) 1, and Type III: (Broberg and Morrey #) 4. Post-operatively the patients were not given any immobilisation and were mobilised immediately.Introduction
Materials/Methods
There is historical evidence of increased incidence of transitional cell tumours of the renal tract in workers exposed to high levels of metal ions. This study was designed to establish any correlation between Metal on metal bearing hip arthroplasty and TCC. A prospective North-East database of 2900 Urology/Oncology cases was compared with the Freeman Joint Registry, which is a prospective database of all Arthroplasty performed since 2001 to establish any correlation with TCC. After comparing the Urology database with the Freeman Joint Registry from 2001 to 2011, a group of patients was identified who underwent hip replacement and had TCC of bladder. The incidence of TCC was calculated in patients who had metal on metal hip replacement and those who had metal on poly hip replacement. On comparing both the groups no significant difference in incidence of TCC of bladder was recorded.INTRODUCTION
METHODS
Handgrip dynamometry has previously been used to detect pre - operative malnutrition and predict the likelihood of post - operative complications. This study explored whether a relationship exists between pre-operative pinch and power grip strength and length of hospital stay in patients undergoing hip and knee arthroplasty. We investigated whether handgrip dynamometry could be used pre - operatively to identify patients at greater risk of longer inpatient stays. 164 patients (64 male, 100 female) due to undergo lower limb arthroplasty (83 Total Knee Replacement, 81 Total Hip Replacement) were assessed in pre - admission clinic. Average measurements of pinch grip and power grip were taken from each patient using the Jamar hydraulic dynamometer (Jamar, USA). Duration of each inpatient stay was recorded. Patients with painful or disabling conditions involving the upper limb were excluded. Other clinical variables such as age and ASA grade were investigated as potential confounders of the relationship of interest and adjusted for.Purpose
Methods
Tunning fork lines (TFL) were drawn on ankle anterior-posterior radiograph to assess the talar shift. A 3-D ankle joint reconstruction was prepared by mapping normal ankle joint using auto CAD in 1997. Tunning fork lines were drawn using normal anatomical landmarks on saggital, coronal and transverse planes. The ankle joint anatomical relationship with talus was studied in various rotation simulating radiographic anterior-posterior views and talar shift was studied. Between 2006 and 2012 on antero-posterior view of ankle radiographs and PACS, ‘Tunning Fork Lines’ (TFL) were drawn. The superior two vertical lines of the TFL were drawn above the ankle joint perpendicular to the distal tibial articular surface. First line tangent to anterior lip of the inferior tibio-fibular joint and second line tangent to the posterior lip of the inferior tibio-fibular joint parallel to each other. The horizontal third line was drawn parallel to distal tibial articular surface perpendicular to first two lines connecting them. The fourth line (handle of the tunning fork) was drawn vertically below the ankle joint midway between the first two lines perpendicular to the third line. In a normal radiograph the superior-lateral dome of the talus lies medial to the handle of TFL, and in ankle with talar shift the dome of the talus crosses this line laterally. In two district hospitals 100 radiographs were observed by 4 observers in 67 males and 33 females with mean age of 49 (15–82) years. The TFL confirmed talar shift with sensitivity of 99.2 % showing talarshift and inferior tibio-fibular ankle diastasis. We conclude that in ankle anterio-posterior view it is possible to comment on the talar shift and diastasis of the ankle joint if proper ankle mortise view is not available.
The anatomy of the first metatarsophalangeal (MTP) joint and, in particular, the metatarsosesamoid articulation remains poorly understood. The movements of the sesamoids in relation to the metatarsal plays a key role in the function of the first MTP joint. Although the disorders affecting the sesamoids are described well, the movements of the metatarsosesamoid joints and the pathomechanics of these joints have not been described. We have performed a cadaver study detailing and quantifying the three dimensional movements occurring at these joints. Fresh frozen cadaveric specimens without evidence of forefoot deformity were dissected to assess the articulating surfaces throughout a normal range of motion. The dissections were digitally reconstructed in positions ranging from 10 degrees of dorsiflexion to 60 degrees of plantarflexion using a Micro Scribe, enabling quantitative analyses in a virtual 3D environment.Introduction
Methods
