To simplify sagittal plane spinal assessment by describing a single novel angle in the lumbar spine equivalent to the difference between pelvic incidence (PI) and lumbar lordosis (LL) and evaluate its reliability. New sagittal modifiers in the classification of adult degenerative spinal deformity have been shown to be valid and reliable with the greatest variability being for pelvic incidence minus lumbar lordosis (PI-LL). This measurement can be simplified to a new angle (alpha) without the need to determine either PI or LL. This angle is between a line intersecting the bicoxofemoral centre and perpendicular to the L1 endplate (alpha line) and a line from the bicoxofemoral centre to the centre of the sacral endplate. Two readers graded 40 non-premarked cases twice each, approximately 1 week apart. Inter- and intra-rater variability and agreement were determined for PI-LL and alpha angle separately. Fleiss' kappa was used for reliability measures.Aim:
Methods:
The management of acute tendo-Achilles (TA) rupture still divides orthopaedic opinion. The advent of minimally invasive endoscopic or percutaneous techniques is thought to allow faster rehabilitation. We report the outcome of 30 patients with acute TA ruptures that have undergone percutaneous repair followed by an accelerated rehabilitation programme with early weight-bearing. A single centre, prospective cohort study was undertaken. 30 patients (21 men, 9 women; mean age: (40±9 years) with an acute TA rupture were enrolled and followed-up for an average of 12.5±2.9 months. All operations were performed under local anaesthesia, using a modified percutaneous technique, within 2 weeks of injury. Following surgery, patients were immobilised in an equinus cast for only 2 weeks then allowed to weight bear through a walker boot with 3 heel wedges, which were removed sequentially over a 6-week period. A standardised physiotherapy programme was started 2 weeks post-operatively and continued until 4 months. The primary outcome measure was the TA re-rupture rate and the Achilles tendon Total Rupture Score (ATRS) at 3 and 6 months. There were no re-ruptures in the study group. The mean 3- and 6-month ATRS was 57.75 and 86.95 respectively. This improvement was statistically significant (p<0.001). All patients were able to fully weight bear on the operated leg by the eighth week, without the walker boot. At the 6-month follow-up, the average satisfaction rate was 87±7.5%. Patients returned to their pre-rupture sports at an average of 10.4±3 months. The results of this study demonstrate that minimally invasive repair of acute TA ruptures, combined with an accelerated rehabilitation programme provides a safe and reproducible treatment option.
The MITCH PCR is an anatomic, flexible, horse-shoe shaped acetabular component, with 2 polar fins. The rationale of the PCR cup design is to reproduce a near-physiological stress distribution in the bone adjacent to the prosthesis. The thin composite cup is designed to fuse and flex in harmony with the surrounding bony structure. Only the pathological acetabular cartilage and underlying subchondral bone of the horseshoe-shaped, load-bearing portion of the acetabular socket is replaced, thus preserving viable bone stock. The PCR is manufactured from injection moulded carbon fibre reinforced polyetheretherketone (PEEK), with a two layer outer surface comprising hydroxyapatite and plasma sprayed commercially pure titanium. It is implanted in conjunction with a large diameter low wear femoral head, producing a bearing that will generate minimal wear debris with relatively inert particles. Pre-clinical mechanical testing, finite element analysis and biocompatibility studies have been undertaken. FEA evaluation predicts preservation of host bone density in the load bearing segments. A pilot clinical study was completed on a proto-type version of the PCR cup (the “Cambridge” cup), achieving excellent 5 and 10 year results. We report the three-year results from a two-centre, prospective clinical evaluation study of the MITCH PCR cup. Patient outcome has been assessed using standardised clinical and radiological examinations and validated questionnaires. The change in physical level of activity and quality of life has been assessed using the Oxford Hip Score, Harris Hip score and the EuroQol-5D score, at scheduled time-points. Serial radiographs have been analysed to monitor the fixation and stability of the components.Introduction
Subjects and Methods
Developmental dysplasia of the hip predisposes to premature degenerative hip disease. A number of operations have been described to improve acetabular cover and have achieved varying degrees of success. We present the case of an 84-year-old woman, who underwent a shelf procedure to reconstruct a dysplastic hip 75 years ago. To date, the shelf remains intact and the hip is asymptomatic. We believe this represents the longest documented outcome of any procedure to stabilise the hip.
