We wanted to study the risk of systemic toxic effect of gentamycin/vancomycin loaded spacers, and to investigate whether there is any difference in the elution of gentamycin and vancomycin to the joint fluid between theatre- made and in factory ready-made spacers

The study consists of 28 patients.

In group one, 14 patients were given a in factory ready-made spacer containing gentamycin 1,1g – 3,2g and vancomycin 1,1g – 3,2g depending of the size of the spacer.

In group two, 14 patients were given spacers made in the operating theatre. from PMMA containing 0,5 g gentamycin in each 40 g batch. 4 g vancomycin were added to each batch of 40 g PMMA.

The concentration of gentamycin and vancomycin was measured from drainfluid and in serum day 1 and 2 after the operation

Group one Group two Significance

Vancomycin drain day 1 10,3 (2,0–23.3) 88,5 (11,7–242,9) p<0,001

Vancomycin drain day 2 6,3 (2,0–17,5) 55,2 (7,5–161,0) p<0,001

Vancomycin serum day 1 2,0 (2,0–2,0) 1,8 (0,7–2.0) ns

Vancomycin serum day 2 2,0 (1,6–2,2) 1,9 (1,0–2,0) ns

Gentamycin drain day 1 23,4 (0,5–68,0) 44,3 (11,0–117,5) p=0,05

Gentamycin drain day 2 8,7 (0,8–16,1) 18,0 (6,8–45,3) p<0,005

Gentamycin serum day 1 0,2 (0,2–0,2) 0,3 (0,2–1,3) ns

Gentamycin serum day 2 0,2 (0,0–0,2) 0,3 (0,2–1,1) ns

In theatre-made spacers had a significant higher concentration of both gentamycin and vancomycin in the joint fluid. Even with very high consentrations of gentamycin and vancomycin in the joint fluid the concentrations in serum were far below the toxic limit and no toxic reactions were observed

Gentamycin and vancomycin added to the hip spacers only to a very small degree passes to the circulation system.

In theatre-made spacers have a significantly higher elution of gentamycin and vancomycin than in factory ready-made spacers. If a high initial concentration of gentamycin and vancomycin in joint fluid is desired. in theatre-made spacers should be considered.

Purpose

To evaluate outcome in patients with late onset juvenile scoliosis or adolescent idiopathic scoliosis 15 years or more after Boston brace treatment.

Purpose

To evaluate comorbidity and health-related quality of life in patients with idiopathic scoliosis.

Conventional non-steroidal anti-inflammatory drugs (NSAIDs) and newer specific cyclo-oxygenase-2 (cox-2) inhibitors are commonly used in musculoskeletal trauma and orthopaedic surgery to reduce the inflammatory response and pain. These drugs have been reported to impair bone metabolism. In reconstruction of the anterior cruciate ligament the hamstring tendons are mainly used as the graft of choice, and a prerequisite for good results is healing of the tendons in the bone tunnel. Many of these patients are routinely given NSAIDs or cox-2 inhibitors, although no studies have elucidated the effects of these drugs on tendon healing in the bone tunnel.

In our study 60 female Wistar rats were randomly allocated into three groups of 20. One received parecoxib, one indometacin and one acted as a control. In all the rats the tendo-Achillis was released proximally from the calf muscles. It was then pulled through a drill hole in the distal tibia and sutured anteriorly. The rats were given parecoxib, indometacin or saline intraperitoneally twice daily for seven days. After 14 days the tendon/bone-tunnel interface was subjected to mechanical testing.

Significantly lower maximum pull-out strength (p < 0.001), energy absorption (p < 0.001) and stiffness (p = 0.035) were found in rats given parecoxib and indometacin compared with the control group, most pronounced with parecoxib.

The variability in measurement of angles in congenital scoliosis is not known, but it is postulated that it is larger than that in adolescent idiopathic scoliosis due to skeletal immaturity, incomplete ossification, and anomalous development of the end-vertebrae. To determine this variability, we selected 54 radiographs of adequate quality showing 67 scoliotic curves from children with congenital scoliosis. The end-vertebrae were preselected. Each curve was measured by the Cobb method on two separate occasions by six different observers, using the same goniometer and marker. The intraobserver variability was +/- 9.6 degrees and the interobserver variability +/- 11.8 degrees. If 'significant progression' is to be used as a criterion for surgical fusion in congenital scoliosis, there should be at least a 23 degrees increase, the entire range of the interobserver variability, in the curvature to ensure that the perceived increase is not due to variability in measurement.

We performed isokinetic knee testing to assess thigh muscle function in ten patients (12 legs) before and after mid-shaft femoral shortening averaging 46 mm (27 to 70). Tests were at angular velocities of 60 degrees/sec and 180 degrees/sec, and were performed preoperatively and after 3, 6, 12 and 24 months. Isokinetic tests at two years showed a significant reduction in muscle function in both quadriceps and hamstrings, but recovery of function was significantly better for the hamstrings. There was a linear relationship with correlation of r2 = 0.31 to 0.86 between loss of muscle force at two years and the magnitude of shortening. Long-term loss of muscle force should be expected after a mid-shaft shortening of the femur of more than 10%.

We performed bilateral femoral shortening operations on 15 skeletally mature patients (11 women and four men). Their mean height pre-operatively was 193.5 cm and they were shortened by 5 to 9 cm. We used a subtrochanteric Z-osteotomy with an AO condylar plate in 11 patients, and mid-diaphyseal osteotomy with an intramedullary locking nail in four. After an average follow-up of 8.1 years, isokinetic muscle testing showed that muscle strength was reduced bilaterally in five patients. The strength ratio between hamstrings and quadriceps muscles was normal in all those treated by subtrochanteric shortening; in those shortened at the mid-shaft the quadriceps was relatively weaker. The result was rated as excellent by 11 patients, very good by three, and good by one.