The purpose of this study was to report bone adaptive changes after anatomical total shoulder arthroplasty (TSA) using a standard-length hydroxyapatite (HA)-coated humeral component, and to report on a computer-based analysis of radiographs to determine changes in peri-implant bone density objectively. A total of 44 TSAs, performed between 2011 and 2014 using a cementless standard-length humeral component proximally coated with HA, were included. There were 23 males and 21 females with a mean age of 65 years (17 to 65). All shoulders had good quality radiographs at six weeks and five years postoperatively. Three observers graded bone adaptive changes. All radiographs were uploaded into a commercially available photographic software program. The grey value density of humeral radiological areas was corrected to the grey value density of the humeral component and compared over time.Aims
Methods
Total knee arthroplasty (TKA) is a routine, cost-effective treatment for end-stage arthritis. While the evidence for good-to-excellent patient-reported outcomes and objective clinical data is present, approximately 20% of patients continue to be dissatisfied with results of their surgery. Dissatisfaction is strongly correlated with unmet patient expectations, and these patients may experience a higher cost of care due to recurring office and emergency visits. Therefore, this survey asked a large group of United States (U.S) and international surgeons to prioritize areas of opportunity in primary TKA. Specifically, we compared surgeon responses regarding: 1) the top 5 areas needing improvement; which were stratified by: 2) surgeons' years of experience; and 3) surgical case volume. A total of 418 orthopaedic surgeons were surveyed. Two hundred U.S. surgeons and 218 international surgeons participated from 7 different countries including: The United Kingdom (40), France (40), Germany (43), Italy (40), Spain (38), and Australia (17). To participate, surgeons had to be board certified, in practice for 2 years, spend 60% of their time in clinical practice, and perform a minimum of 25 joint arthroplasties per year. Surgeons were asked to choose the top 5 areas of improvement for TKA from a list of 17 attributes including clinical and functional outcomes, procedural workflow and economic variables. Surgeons were able to specify additional options if needed. Results were stratified by annual case volume (25 to 50; 51 to 100; greater than 100 cases) and years of experience (1 to 10; 11 to 20; greater than 20). Single-tail proportion tests were used to compare results between cohorts, where an alpha of 0.05 was set as significant.Background
Methods
Single focal grade IV cartilage lesion in the knee has a poor healing capacity. Instead these lesions often progress to severe and generalized osteoarthritis that may result in total knee replacement. Current treatment modalities aim at biological repair and, although theoretically appealing, the newly formed tissue is at the best cartilage-like, often fibrous or fibrocartilaginous. This at the expense of sophisticated laboratory resources, delicate surgery and strict compliance from patients. An alternative may be small implants of biomaterial inserted to replace the damaged cartilage. We investigated the response of the opposing tibia cartilage to a metallic implant inserted at different depth into the surrounding cartilage level. The medial femoral condyle of both knees of 12 sheep, 70–90kg, 2 year of age and from the same breeder, was operated. A metallic implant with an articulating surface of 316L stainless steel, diameter of 7mm, HA plasma sprayed press-fit peg and a tailored radius and contour to the sheep femoral condyle was placed at the most weight-bearing position. The level of the implant was aimed flush, 0,3 and 0,8 mm below surrounding cartilage. The animals were stabled indoors, allowed to move freely and euthanized after 6 and 12 weeks. Postoperatively the knees were high resolution photographed for macroscopic evaluation. The position and depth of the implant were analysed using a laser scan device. Tibial and femoral condyles specimen were decalcified and slices were prepared for microscopic evaluation. Implant position and cartilage damage was assessed from two independent observers using a macroscopic ICRS score and a modified histologic score according to Mankin. 22 tibia condyles showed a variety of cartilage damage ranging from severe damage down to subchondral bone to an almost pristine condition. There was a strong correlation between implant position and damage to opposing cartilage surface. Mankin score correlated significantly with implant position (p<0.001 regression analysis, r2=.45) as did the ICRS score (p<0.001, regression analysis, r2=.67). Implants sitting proud were associated with poor Mankin score. There was no difference between 6-week and 3-months knees.Methods
Results
Muscle atrophy has been demonstrated in patients suffering from osteoarthritis of the hip, but little is known about muscular recovery after total hip replacement (THR). A total of 20 patients with unilateral osteoarthritis of the hip were assessed before, six months and two years after THR. The cross-sectional area and radiological density of the muscles of the hip, thigh, calf and back were measured using CT. We hypothesised that the muscles would not recover fully after operation. After two years comparison of the limb with the THR with the healthy limb showed that there was such a reduction in the cross-sectional area in iliopsoas (7.0%; p = 0.006) and the hip adductors (8.4%, p = 0.003) and in the radiological density in gluteus maximus (10.1 Hounsfield units; p <
0.001), gluteus medius/minimus (5.6 Hounsfield units; p = 0.011), iliopsoas (3.9 Hounsfield units; p <
0.001) and the adductors (2.4 Hounsfield units; p = 0.022). Thus, there was persistent muscle atrophy in muscles acting about the hip two years after THR. We suggest that an earlier operation or a more intensive rehabilitation may reverse these changes.
In order to regain preinjury activities following an Achilles tendon rupture while reducing the potential complications of open surgery and non-operative treatment, we developed a new protocol that involved the use of a modified local anaesthetic technique, percutaneous repair and early function. We prospectively treated 32 patients with acute Achilles tendon ruptures according to our protocol with a 12 month minimal follow-up. Surgery was performed on an outpatient basis and within 48 hours from rupture for all cases. Our local anaesthetic technique allowed us to have a comprehensive control over sural nerve location by the definition of a “safe area” (video will be shown) and has proved to be effective to avoid sural nerve damage during surgery. The 28 male and 4 female patients had a mean age of 35 years (range, 26 to 47 years). The percutaneous repair was performed with a #2 nonabsorbable monofilament. Patients began range-of-motion exercise at 48 hours, used a posterior splint for 2 weeks, and then began ambulation with crutches and a 2 cm heel wedge incorporated on sport shoes or alternatively country boots. At 5 weeks, the wedge shoe was discontinued, full weight-bearing was allowed, and progressive resistive exercises were initiated. There were no reruptures, wound infections, sural nerve damage, recurrent pain, or skin necrosis in our group of patients. One patient (with an hemathological disorder) developed a deep venous thrombosis that resolved uneventfully. Mean AOFAS score was 80 at 6 months and reached 98 at 12 months. High-demand patients (police officer, firemen, athletes, professional soccer player) returned to their activities by 5–6 months. Patients were very satisfied with the procedure and subjetive evaluation turned to be very good or excellent for all cases. Achilles tendon management using our protocol is an efficacious method demonstrating a low morbidity rate together with a return to preinjury level by 6 months. In addition, this protocol is cost effective (saves on hospital admission, anaesthesia, complications) and athletes in our group were able to obtain their athletics goals with minimal or no deficits.
