This study aimed to assess the impact of using the metal-augmented glenoid baseplate (AGB) on improving clinical and radiological outcomes, as well as reducing complications, in patients with superior glenoid wear undergoing reverse shoulder arthroplasty (RSA). From January 2016 to June 2021, out of 235 patients who underwent primary RSA, 24 received a superior-AGB after off-axis reaming (Group A). Subsequently, we conducted propensity score matching in a 1:3 ratio, considering sex, age, follow-up duration, and glenoid wear (superior-inclination and retroversion), and selected 72 well-balanced matched patients who received a standard glenoid baseplate (STB) after eccentric reaming (Group B). Superior-inclination, retroversion, and lateral humeral offset (LHO) were measured to assess preoperative glenoid wear and postoperative correction, as well as to identify any complications. Clinical outcomes were measured at each outpatient visit before and after surgery.Aims
Methods
This study aimed to compare the performance of survival prediction models for bone metastases of the extremities (BM-E) with pathological fractures in an Asian cohort, and investigate patient characteristics associated with survival. This retrospective cohort study included 469 patients, who underwent surgery for BM-E between January 2009 and March 2022 at a tertiary hospital in South Korea. Postoperative survival was calculated using the PATHFx3.0, SPRING13, OPTIModel, SORG, and IOR models. Model performance was assessed with area under the curve (AUC), calibration curve, Brier score, and decision curve analysis. Cox regression analyses were performed to evaluate the factors contributing to survival.Aims
Methods
Hip fractures are a major cause of morbidity and mortality, and malnutrition is a crucial determinant of these outcomes. This meta-analysis aims to determine whether oral nutritional supplementation (ONS) improves postoperative outcomes in older patients with a hip fracture. A systematic literature search was conducted in August 2022. ONS was defined as high protein-based diet strategies containing (or not containing) carbohydrates, fat, vitamins, and minerals. Randomized trials documenting ONS in older patients with hip fracture (aged ≥ 50 years) were included. Two reviewers evaluated study eligibility, conducted data extraction, and assessed study quality.Aims
Methods
The aim of this study was to compare the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) using small and standard baseplates in Asian patients, and to investigate the impact of a mismatch in the sizes of the glenoid and the baseplate on the outcomes. This was retrospective analysis of 50 and 33 RSAs using a standard (33.8 mm, ST group) and a small (29.5 mm, SM group) baseplate of the Equinoxe reverse shoulder system, which were undertaken between January 2017 and March 2021. Radiological evaluations included the size of the glenoid, the Aims
Methods
Brace treatment is the cornerstone of managing developmental dysplasia of the hip (DDH), yet there is a lack of evidence-based treatment protocols, which results in wide variations in practice. To resolve this, we have developed a comprehensive nonoperative treatment protocol conforming to published consensus principles, with well-defined a priori criteria for inclusion and successful treatment. This was a single-centre, prospective, longitudinal cohort study of a consecutive series of infants with ultrasound-confirmed DDH who underwent a comprehensive nonoperative brace management protocol in a unified multidisciplinary clinic between January 2012 and December 2016 with five-year follow-up radiographs. The radiological outcomes were acetabular index-lateral edge (AI-L), acetabular index-sourcil (AI-S), centre-edge angle (CEA), acetabular depth ratio (ADR), International Hip Dysplasia Institute (IHDI) grade, and evidence of avascular necrosis (AVN). At five years, each hip was classified as normal (< 1 SD), borderline dysplastic (1 to 2 SDs), or dysplastic (> 2 SDs) based on validated radiological norm-referenced values.Aims
Methods
To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation. A retrospective study was conducted using prospectively collected data and patient-reported outcome measures, including the Oswestry Disability Index (ODI), between 2008 and 2019. Postoperative sRDH was identified from clinical notes and the centre’s MRI database, with all imaging providers in the region checked for missing events. The Kaplan-Meier method was used to calculate five-year sRDH incidence. Cox proportional hazards model was used to identify independent variables predictive of sRDH, with any variable not significant at the p < 0.1 level removed. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs).Aims
Methods
This study compared patients who underwent arthroscopic repair of large to massive rotator cuff tears (LMRCTs) with isolated incomplete repair of the tear and patients with incomplete repair with biceps tendon augmentation. We aimed to evaluate the additional benefit on clinical outcomes and the capacity to lower the re-tear rate. We retrospectively reviewed 1,115 patients who underwent arthroscopic rotator cuff repair for full-thickness tears between October 2011 and May 2019. From this series, we identified 77 patients (28 male, 49 female) with a mean age of 64.1 years (50 to 80). Patients were classified into groups A (n = 47 incomplete) and B (n = 30 with biceps augmentation) according to the nature of their reconstruction. Clinical scores were checked preoperatively and at six months, one year, and two years postoperatively. In preoperative MRI, we measured the tear size, the degree of fatty infiltration, and muscle volume ratio of the supraspinatus. In postoperative MRI, the integrity of the repaired rotator cuff tendon was assessed using the Sugaya classification. Tendon thickness at the footprint was evaluated on T2-weighted oblique coronal view.Aims
Methods
The aim of this study was to explore the relationship between reason for revision total hip arthroplasty (rTHA) and outcomes in terms of patient-reported outcome measures (PROMs). We reviewed a prospective cohort of 647 patients undergoing full or partial rTHA at a single high-volume centre with a minimum of two years’ follow-up. The reasons for revision were classified as: infection; aseptic loosening; dislocation; structural failure; and painful THA for other reasons. PROMs (modified Oxford Hip Score (mOHS), EuroQol five-dimension three-level health questionnaire (EQ-5D-3L) score, and visual analogue scales for pain during rest and activity), complication rates, and failure rates were compared among the groups.Aims
Methods
Wear of the polyethylene (PE) tibial insert of total knee arthroplasty (TKA) increases the risk of revision surgery with a significant cost burden on the healthcare system. This study quantifies wear performance of tibial inserts in a large and diverse series of retrieved TKAs to evaluate the effect of factors related to the patient, knee design, and bearing material on tibial insert wear performance. An institutional review board-approved retrieval archive was surveyed for modular PE tibial inserts over a range of in vivo duration (mean 58 months (0 to 290)). Five knee designs, totalling 1,585 devices, were studied. Insert wear was estimated from measured thickness change using a previously published method. Linear regression statistical analyses were used to test association of 12 patient and implant design variables with calculated wear rate.Aims
Methods
The Oswestry-Bristol Classification (OBC) is an MRI-specific assessment tool to grade trochlear dysplasia. The aim of this study is to validate clinically the OBC by demonstrating its use in selecting treatments that are safe and effective. The OBC and the patellotrochlear index were used as part of the Oswestry Patellotrochlear Algorithm (OPTA) to guide the surgical treatment of patients with patellar instability. Patients were assigned to one of four treatment groups: medial patellofemoral ligament reconstruction (MPFLr); MPFLr + tibial tubercle distalization (TTD); trochleoplasty; or trochleoplasty + TTD. A prospective analysis of a longitudinal patellofemoral database was performed. Between 2012 and 2018, 202 patients (233 knees) with a mean age of 24.2 years (SD 8.1), with recurrent patellar instability were treated by two fellowship-trained consultant sports/knee surgeons at The Robert Jones and Agnes Hunt Orthopaedic Hospital. Clinical efficacy of each treatment group was assessed by Kujala, International Knee Documentation Committee (IKDC), and EuroQol five-dimension questionnaire (EQ-5D) scores at baseline, and up to 60 months postoperatively. Their safety was assessed by complication rate and requirement for further surgery. The pattern of clinical outcome over time was analyzed using mixed regression modelling.Aims
Methods
Open discectomy (OD) is the standard operation for lumbar disc herniation (LDH). Percutaneous endoscopic lumbar discectomy (PELD), however, has shown similar outcomes to OD and there is increasing interest in this procedure. However despite improved surgical techniques and instrumentation, reoperation and infection rates continue and are reported to be between 6% and 24% and 0.7% and 16%, respectively. The objective of this study was to compare the rate of reoperation and infection within six months of patients being treated for LDH either by OD or PELD. In this retrospective, nationwide cohort study, the Korean National Health Insurance database from 1 January 2007 to 31 December 2018 was reviewed. Data were extracted for patients who underwent OD or PELD for LDH without a history of having undergone either procedure during the preceding year. Individual patients were followed for six months through their encrypted unique resident registration number. The primary endpoints were rates of reoperation and infection during the follow-up period. Other risk factors for reoperation and infection were also evalulated.Aims
Methods
Rotating-hinge knee prostheses are commonly used to reconstruct the distal femur after resection of a tumour, despite the projected long-term burden of reoperation due to complications. Few studies have examined the factors that influence their failure and none, to our knowledge, have used competing risk models to do so. The purpose of this study was to determine the risk factors for failure of a rotating-hinge knee distal femoral arthroplasty using the Fine-Gray competing risk model. We retrospectively reviewed 209 consecutive patients who, between 1991 and 2016, had undergone resection of the distal femur for tumour and reconstruction using a rotating-hinge knee prosthesis. The study endpoint was failure of the prosthesis, defined as removal of the femoral component, the tibial component, or the bone-implant fixation; major revision (exchange of the femoral component, tibial component, or the bone-implant fixation); or amputation.Aims
Methods
Stemmed tibial components are frequently used in revision total knee arthroplasty (TKA). The purpose of this study was to evaluate patient satisfaction, overall pain, and diaphyseal tibial pain in patients who underwent revision TKA with cemented or uncemented stemmed tibial components. This is a retrospective cohort study involving 110 patients with revision TKA with cemented versus uncemented stemmed tibial components. Patients who underwent revision TKA with stemmed tibial components over a 15-year period at a single institution with at least two-year follow-up were assessed. Pain was evaluated through postal surveys. There were 63 patients with cemented tibial stems and 47 with uncemented stems. Radiographs and Knee Society Scores were used to evaluate for objective findings associated with pain or patient dissatisfaction. Postal surveys were analyzed using Fisher’s exact test and the independent-samples Aims
Methods
Time to treatment initiation (TTI) is generally defined as the time from the histological diagnosis of malignancy to the initiation of first definitive treatment. There is no consensus on the impact of TTI on the overall survival in patients with a soft-tissue sarcoma. The purpose of this study was to determine if an increased TTI is associated with overall survival in patients with a soft-tissue sarcoma, and to identify the factors associated with a prolonged TTI. We identified 23,786 patients from the National Cancer Database who had undergone definitive surgery between 2004 and 2015 for a localized high-grade soft-tissue sarcoma of the limbs or trunk. A Cox proportional hazards model was used to examine the relationship between a number of factors and overall survival. We calculated the incidence rate ratio (IRR) using negative binomial regression models to identify the factors that affected TTI.Aims
Methods
Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions.Aims
Methods
To compare operative and nonoperative treatment for displaced distal radius fractures in patients aged over 65 years. A total of 100 patients were randomized in this non-inferiority trial, comparing cast immobilization with operation with a volar locking plate. Patients with displaced AO/OTA A and C fractures were eligible if one of the following were found after initial closed reduction: 1) dorsal angulation > 10°; 2) ulnar variance > 3 mm; or 3) intra-articular step-off > 2 mm. Primary outcome measure was the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) after 12 months. Secondary outcome measures were the Patient-Rated Wrist and Hand Evaluation (PRWHE), EuroQol-5 dimensions 5-level questionnaire (EQ-5D-5L), range of motion (ROM), grip strength, “satisfaction with wrist function” (score 0 to 10), and complications.Aims
Methods
We have evaluated the survivorship, outcomes, and failures of an interlocking, reconstruction-mode stem-sideplate implant used to preserve the native hip joint and achieve proximal fixation when there is little residual femur during large endoprosthetic reconstruction of the distal femur. A total of 14 patients underwent primary or revision reconstruction of a large femoral defect with a short remaining proximal femur using an interlocking, reconstruction-mode stem-sideplate for fixation after oncological distal femoral and diaphyseal resections. The implant was attached to a standard endoprosthetic reconstruction system. The implant was attached to a standard endoprosthetic reconstruction system. None of the femoral revisions were amenable to standard cemented or uncemented stem fixation. Patient and disease characteristics, surgical history, final ambulatory statusAims
Methods
As the population ages and the surgical complexity of lumbar spinal surgery increases, the preoperative stratification of risk becomes increasingly important. Understanding the risks is an important factor in decision-making and optimizing the preoperative condition of the patient. Our aim was to determine whether the modified five-item frailty index (mFI-5) and nutritional parameters could be used to predict postoperative complications in patients undergoing simple or complex lumbar spinal fusion. We retrospectively reviewed 584 patients who had undergone lumbar spinal fusion for degenerative lumbar spinal disease. The 'simple' group (SG) consisted of patients who had undergone one- or two-level posterior lumbar fusion. The 'complex' group (CG) consisted of patients who had undergone fusion over three or more levels, or combined anterior and posterior surgery. On admission, the mFI-5 was calculated and nutritional parameters collected.Aims
Methods
Scapular notching is thought to have an adverse effect on the outcome of reverse total shoulder arthroplasty (RTSA). However, the matter is still controversial. The aim of this study was to determine the clinical impact of scapular notching on outcomes after RTSA. Three electronic databases (PubMed, Cochrane Database, and EMBASE) were searched for studies which evaluated the influence of scapular notching on clinical outcome after RTSA. The quality of each study was assessed. Functional outcome scores (the Constant-Murley scores (CMS), and the American Shoulder and Elbow Surgeons (ASES) scores), and postoperative range of movement (forward flexion (FF), abduction, and external rotation (ER)) were extracted and subjected to meta-analysis. Effect sizes were expressed as weighted mean differences (WMD).Aims
Methods
Currently, the US Center for Medicaid and Medicare Services (CMS) has been testing bundled payments for revision total joint arthroplasty (TJA) through the Bundled Payment for Care Improvement (BPCI) programme. Under the BPCI, bundled payments for revision TJAs are defined on the basis of diagnosis-related groups (DRGs). However, these DRG-based bundled payment models may not be adequate to account appropriately for the varying case-complexity seen in revision TJAs. The 2008-2014 Medicare 5% Standard Analytical Files (SAF5) were used to identify patients undergoing revision TJA under DRG codes 466, 467, or 468. Generalized linear regression models were built to assess the independent marginal cost-impact of patient, procedural, and geographic characteristics on 90-day costs.Aims
Methods
We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice. Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed. Patients were invited to have their cobalt and chromium levels retested, and were provided an Oxford Hip Score. Serum ion levels were then compared between groups (28 mm, 36 mm, and 40 mm heads) and over time.Aims
Methods
Although internal hemipelvectomy is associated with a high incidence of morbidity, especially wound complications, few studies have examined rates of wound complications in these patients or have identified factors associated with the consequences. The present study aimed to: 1) determine the rate of wound and other complications requiring surgery after internal hemipelvectomy; and 2) identify factors that affect the rate of wound complications and can be used to stratify patients by risk of wound complications. The medical records of 123 patients undergoing internal hemipelvectomy were retrospectively reviewed, with a focus on both overall complications and wound complications. Logistic regression analyses were performed to examine the association between host, tumour, and surgical factors and rates of postoperative wound complications.Aims
Methods
Trochlear dysplasia is a significant risk factor for patellofemoral instability. The Dejour classification is currently considered the standard for classifying trochlear dysplasia, but numerous studies have reported poor reliability on both plain radiography and MRI. The severity of trochlear dysplasia is important to establish in order to guide surgical management. We have developed an MRI-specific classification system to assess the severity of trochlear dysplasia, the Oswestry-Bristol Classification (OBC). This is a four-part classification system comprising normal, mild, moderate, and severe to represent a normal, shallow, flat, and convex trochlear, respectively. The purpose of this study was to assess the inter- and intraobserver reliability of the OBC and compare it with that of the Dejour classification. Four observers (two senior and two junior orthopaedic surgeons) independently assessed 32 CT and axial MRI scans for trochlear dysplasia and classified each according to the OBC and the Dejour classification systems. Assessments were repeated following a four-week interval. The inter- and intraobserver agreement was determined by using Fleiss’ generalization of Cohen’s kappa statistic and S-statistic nominal and linear weights.Aims
Methods
The aim of this study was to compare the osseous reactions elicited by all-suture, polyetheretherketone (PEEK), and two different biodegradable anchors used during rotator cuff repair. Transosseous-equivalent rotator cuff repair was performed in 73 patients. The patients were divided into two groups, in both of which two different medial-row anchors were used. In group 1, anchor A comprised 30% β-tricalcium phosphate (TCP) + 70% fast-absorbing poly lactic-co-glycolic acid copolymer (85% polylactic acid enantiomers + 15% polyglycolic acid) and anchor B comprised all-sutures. In group 2, anchor C comprised 23% micro β-TCP + 77% polylactic acid enantiomers and anchor D comprised PEEK polymer. There were 37 patients in group 1 and 36 patients in group 2. The presence and severity of fluid collection around anchors and healing of the rotator cuff were assessed using MRI scans, approximately one year postoperatively. The severity of the collection was graded as 0 (no perianchor fluid signal), 1 (minimal perianchor fluid), 2 (local collection of fluid), 3 (fluid collection around the whole length of the anchor but of a diameter less than twice the anchor diameter), or 4 (fluid collection around the whole length of the anchor and of a diameter greater than twice the anchor diameter).Aims
Patients and Methods
Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB. We performed a multicentre retrospective cohort study of patients with spinal TB. Unfavourable outcome was defined according to previous studies. The prognostic factors for unfavourable outcomes as the primary outcome were determined using multivariable logistic regression analysis and a linear mixed model was used to compare time course of inflammatory markers during treatment. A total of 185 patients were included, of whom 59 patients had unfavourable outcomes.Aims
Patients and Methods
Little is known about the risk factors that predispose to a rupture of the posterior cruciate ligament (PCL). Identifying risk factors is the first step in trying to prevent a rupture of the PCL from occurring. The morphology of the knee in patients who rupture their PCL may differ from that of control patients. The purpose of this study was to identify any variations in bone morphology that are related to a PCL. We compared the anteroposterior (AP), lateral, and Rosenberg view radiographs of 94 patients with a ruptured PCL to a control group of 168 patients matched by age, sex, and body mass index (BMI), but with an intact PCL after a knee injury. Statistical shape modelling software was used to assess the shape of the knee and determine any difference in anatomical landmarks.Aims
Patients and Methods
Unicompartmental knee arthroplasty (UKA) provides improved early functional outcomes and less postoperative morbidity and pain compared with total knee arthroplasty (TKA). Opioid prescribing has increased in the last two decades, and recently states in the USA have developed online Prescription Drug Monitoring Programs to prevent overprescribing of controlled substances. This study evaluates differences in opioid requirements between patients undergoing TKA and UKA. We retrospectively reviewed 676 consecutive TKAs and 241 UKAs. Opioid prescriptions in morphine milligram equivalents (MMEs), sedatives, benzodiazepines, and stimulants were collected from State Controlled Substance Monitoring websites six months before and nine months after the initial procedures. Bivariate and multivariate analysis were performed for patients who had a second prescription and continued use.Aims
Patients and Methods
The aim of this study was to evaluate the outcome of spinal instrumentation in haemodialyzed patients with native pyogenic spondylodiscitis. Spinal instrumentation in these patients can be dangerous due to rates of complications and mortality, and biofilm formation on the instrumentation. A total of 134 haemodialyzed patients aged more than 50 years who underwent surgical treatment for pyogenic spondylodiscitis were included in the study. Their mean age was 66.4 years (50 to 83); 66 were male (49.3%) and 68 were female (50.7%). They were divided into two groups according to whether spinal instrumentation was used or not. Propensity score matching was used to attenuate the potential selection bias. The outcome of treatment was compared between these two groups.Aims
Patients and Methods
The objective of this study was to investigate bone healing after
internal fixation of displaced femoral neck fractures (FNFs) with
the Dynamic Locking Blade Plate (DLBP) in a young patient population
treated by various orthopaedic (trauma) surgeons. We present a multicentre prospective case series with a follow-up
of one year. All patients aged ≤ 60 years with a displaced FNF treated
with the DLBP between 1st August 2010 and December 2014 were included.
Patients with pathological fractures, concomitant fractures of the
lower limb, symptomatic arthritis, local infection or inflammation,
inadequate local tissue coverage, or any mental or neuromuscular
disorder were excluded. Primary outcome measure was failure in fracture
healing due to nonunion, avascular necrosis, or implant failure
requiring revision surgery.Aims
Patients and Methods
The aim of this study was to compare the efficacy of a corticosteroid injection for the
treatment of carpal tunnel syndrome (CTS) in patients with and without Raynaud’s
phenomenon. In a prospective study, 139 patients with CTS were treated with a corticosteroid
injection (10 mg triamcinolone acetonide); 34 had Raynaud’s phenomenon and 105
did not (control group). Grip strength, perception of touch with a Semmes-Weinstein
monofilament and the Boston Carpal Tunnel Questionnaires (BCTQ) were assessed at
baseline and at six, 12 and 24 weeks after the injection. The Cold Intolerance Severity
Score (CISS) questionnaire was also assessed at baseline and 24 weeks after the
injection.Aims
Patients and Methods
Limb salvage for diabetic foot infections often require multiple
procedures. Some patients will eventually end up with below knee
amputation (BKA) when all limb salvage attempts fail. We seek to
study the patients’ ability to return to normal life, functional
status, prosthesis usage and perspectives on multiple limb salvage
procedures that culminated in BKA to review if they would undertake
a similar path if their situation was repeated. A total of 41 patients who underwent BKA between July 2011 and
June 2013 were reviewed. They were divided into primary and creeping
(prior multiple salvage procedures) amputations. The Barthel’s Index
(BI) and the Reintegration to Normal Living Index (RNLI) were used.
A questionnaire was used to identify whether the patient would undergo
the same multiple attempts at limb salvage again if faced with the
same problem.Aims
Patients and Methods
Positive ulnar variance is an established risk factor for idiopathic
ulnar impaction syndrome (UIS). However, not all patients with positive
ulnar variance develop symptomatic UIS and other factors, including
the morphology of the lunate, may be involved. The aim of this study
was to clarify the relationship between lunate morphology and idiopathic
UIS. A cohort of 95 patients with idiopathic UIS (UIS group) was compared
with 95 asymptomatic controls with positive ulnar variance. The
shape of the lunate was measured using the capitate-triquetrum distance
(CTD), ulnar coverage ratio (UCR), radiolunate distance and radiolunate
angle. The association of radiographic parameters and lunate types
with the development of UIS was investigated in univariable and
multivariable analyses. Receiver operating characteristic curves
were used to estimate a cutoff for any statistically significant
variables.Aims
Patients and Methods
The aim of the study was to compare measures of the quality of
life (QOL) after resection of a chordoma of the mobile spine with
the national averages in the United States and to assess which factors
influenced the QOL, symptoms of anxiety and depression, and coping
with pain post-operatively in these patients. A total of 48 consecutive patients who underwent resection of
a primary or recurrent chordoma of the mobile spine between 2000
and 2015 were included. A total of 34 patients completed a survey
at least 12 months post-operatively. The primary outcome was the
EuroQol-5 Dimensions (EQ-5D-3L) questionnaire. Secondary outcomes were
the Patient-Reported Outcome Measurement Information System (PROMIS)
anxiety, depression and pain interference questionnaires. Data which
were recorded included the indication for surgery, the region of
the tumour, the number of levels resected, the status of the surgical
margins, re-operations, complications, neurological deficit, length
of stay in hospital and rate of re-admission.Aims
Patients and Methods
Our aim was to describe the atypical pattern of increased fatty
degeneration in the infraspinatus muscle compared with the supraspinatus
in patients with a massive rotator cuff tear. We also wished to
describe the nerve conduction and electromyography findings in these
patients. A cohort of patients undergoing surgery for a massive rotator
cuff tear was identified and their clinical records obtained. Their
MRI images were reviewed to ascertain the degree of retraction of
the torn infraspinatus and supraspinatus muscles, and the degree
of fatty degeneration in both muscles was recorded. Nerve conduction studies
were also performed in those patients who showed more degeneration
in the infraspinatus than in the supraspinatus.Aims
Patients and Methods
Diabetes mellitus is the most common co-morbidity associated
with necrotising fasciitis. This study aims to compare the clinical
presentation, investigations, Laboratory Risk Indicator for Necrotising
Fasciitis (LRINEC) score, microbiology and outcome of management
of this condition in diabetic and non-diabetic patients. The medical records of all patients with surgically proven necrotising
fasciitis treated at our institution between 2005 and 2014 were
reviewed. Diagnosis of necrotising fasciitis was made on findings
of ‘dishwater’ fluid, presence of greyish necrotic deep fascia and
lack of bleeding on muscle dissection found intra-operatively. Information
on patients’ demographics, presenting symptoms, clinical signs,
investigations, treatment and outcome were recorded and analysed.Aims
Patients and Methods
The treatment of septic arthritis of the shoulder is challenging.
The infection frequently recurs and the clinical outcome can be
very poor. We aimed to review the outcomes following the use of
continuous negative pressure after open debridement with a large
diameter drain in patients with septic arthritis of the shoulder. A total of 68 consecutive patients with septic arthritis of the
shoulder underwent arthrotomy, irrigation and debridement. A small
diameter suction drain was placed in the glenohumeral joint and
a large diameter drain was placed in the subacromial space with
continuous negative pressure of 15 cm H2O. All patients
received a standardised protocol of antibiotics for a mean of 5.1
weeks (two to 11.1).Aims
Patients and Methods
The purpose of the study was to investigate whether closed intramedullary
(IM) nailing with percutaneous cement augmentation is better than
conventional closed nailing at relieving pain and suppressing tumours
in patients with metastases of the femur and humerus. A total of 43 patients (27 men, 16 women, mean age 63.7 years,
standard deviation (Aims
Patients and Methods
The aim of this study was a quantitative analysis of a surgeon’s
learning curve for scoliosis surgery and the relationship between
the surgeon’s experience and post-operative outcomes, which has
not been previously well described. We have investigated the operating time as a function of the
number of patients to determine a specific pattern; we analysed
factors affecting the operating time and compared intra- and post-operative
outcomes. We analysed 47 consecutive patients undergoing scoliosis
surgery performed by a single, non-trained scoliosis surgeon. Operating time
was recorded for each of the four parts of the procedures: dissection,
placement of pedicle screws, reduction of the deformity and wound
closure.Aims
Patients and Methods
The aims of this study were to report functional
outcomes of salvage procedures for patients with cerebral palsy (CP)
who have chronic dislocation of the hip using validated scoring
systems, and to compare the results of three surgical techniques. We reviewed 37 patients retrospectively. The mean age at the
time of surgery was 12.2 years (8 to 22) and the mean follow-up
was 56 months (24 to 114). Patients were divided into three groups:
14 who underwent proximal femoral resection arthroplasty (PFRA group
1), ten who underwent subtrochanteric valgus osteotomy (SVO group 2),
and 13 who underwent subtrochanteric valgus osteotomy with resection
of the femoral head (SVO with FHR group 3). All patients were evaluated
using the Caregiver Priorities and Child Health Index of Life with
Disabilities (CPCHILD) and the Pediatric Quality of Life Inventory
(PedsQL). Significant improvements occurred in most CPCHILD and PedsQL
subsection scores following surgery in all patients, without significant
differences between the groups. There were 12 post-operative complications.
Less severe complications were seen in group 1 than in groups 2
and 3. Salvage surgery appears to provide pain relief in patients with
CP who have painful chronic dislocation of the hip. The three salvage
procedures produced similar results, however, we recommend the use
of PFRA as the complications are less severe. Take home message: Salvage surgery can be of benefit to patients
with CP with chronic painful hip dislocation, but should be limited
to selected patients considering complications. Cite this article:
The traditional techniques involving an oblique
tunnel or triangular wedge resection to approach a central or mixed-type
physeal bar are hindered by poor visualisation of the bar. This
may be overcome by a complete transverse osteotomy at the metaphysis
near the growth plate or a direct vertical approach to the bar.
Ilizarov external fixation using small wires allows firm fixation
of the short physis-bearing fragment, and can also correct an associated angular
deformity and permit limb lengthening. We accurately approached and successfully excised ten central-
or mixed-type bars; six in the distal femur, two in the proximal
tibia and two in the distal tibia, without damaging the uninvolved
physis, and corrected the associated angular deformity and leg-length
discrepancy. Callus formation was slightly delayed because of periosteal
elevation and stretching during resection of the bar. The resultant
resection of the bar was satisfactory in seven patients and fair
in three as assessed using a by a modified Williamson–Staheli classification. Cite this article:
We investigated whether the presence of a pathological
fracture increased the risk of local recurrence in patients with
a giant cell tumour (GCT) of bone. We also assessed if curettage
is still an appropriate form of treatment in the presence of a pathological
fracture. We conducted a comprehensive review and meta-analysis
of papers which reported outcomes in patients with a GCT with and
without a pathological fracture at presentation. We computed the
odds ratio (OR) of local recurrence in those with and without a
pathological fracture. We selected 19 eligible papers for final analysis. This included
3215 patients, of whom 580 (18.0%) had a pathological fracture.
The pooled OR for local recurrence between patients with and without
a pathological fracture was 1.05 (95% confidence interval (CI) 0.66
to 1.67, p = 0.854). Amongst the subgroup of patients who were treated with
curettage, the pooled OR for local recurrence was 1.23 (95% CI 0.75
to 2.01, p = 0.417). A There is no difference in local recurrence rates between patients
who have a GCT of bone with and without a pathological fracture
at the time of presentation. The presence of a pathological fracture
should not preclude the decision to perform curettage as carefully
selected patients who undergo curettage can have similar outcomes
in terms of local recurrence to those without such a fracture. Cite this article:
There is little evidence on the cost effectiveness
of different brands of hip prostheses. We compared lifetime cost effectiveness
of frequently used brands within types of prosthesis including cemented
(Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite
Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed)
and hybrid (Exeter V40 Trilogy, Exeter V40 Trident, and CPT Trilogy).
We used data from three linked English national databases to estimate
the lifetime risk of revision, quality-adjusted life years (QALYs)
and cost. For women with osteoarthritis aged 70 years, the Exeter V40 Elite
Plus Ogee had the lowest risk of revision (5.9% revision risk, 9.0
QALYs) and the CPT Trilogy had the highest QALYs (10.9% revision
risk, 9.3 QALYs). Compared with the Corail Pinnacle (9.3% revision
risk, 9.22 QALYs), the most commonly used brand, and assuming a
willingness-to-pay of £20 000 per QALY gain, the CPT Trilogy is
most cost effective, with an incremental net monetary benefit of £876.
Differences in cost effectiveness between the hybrid CPT Trilogy
and Exeter V40 Trident and the cementless Corail Pinnacle and Taperloc
Exceed were small, and a cautious interpretation is required, given
the limitations of the available information. However, it is unlikely that cemented brands are among the most
cost effective. Similar patterns of results were observed for men
and other ages. The gain in quality of life after total hip arthroplasty,
rather than the risk of revision, was the main driver of cost effectiveness. Cite this article:
We compared the clinical and radiographic results
of total ankle replacement (TAR) performed in non-diabetic and diabetic
patients. We identified 173 patients who underwent unilateral TAR
between 2004 and 2011 with a minimum of two years’ follow-up. There
were 88 male (50.9%) and 85 female (49.1%) patients with a mean
age of 66 years ( The mean AOS and AOFAS scores were significantly better in the
non-diabetic group (p = 0.018 and p = 0.038, respectively). In all,
nine TARs (21%) in the diabetic group had clinical failure at a
mean follow-up of five years (24 to 109), which was significantly
higher than the rate of failure of 15 (11.6%) in the non-diabetic
group (p = 0.004). The uncontrolled diabetic subgroup had a significantly
poorer outcome than the non-diabetic group (p = 0.02), and a higher
rate of delayed wound healing. The incidence of early-onset osteolysis was higher in the diabetic
group than in the non-diabetic group (p = 0.02). These results suggest
that diabetes mellitus, especially with poor glycaemic control,
negatively affects the short- to mid-term outcome after TAR. Cite this article:
The aim of this study was to find anatomical
landmarks for rotational alignment of the tibial component in total knee
replacement (TKR) in a CT-based study. Pre-operative CT scanning
was performed on 94 South Korean patients (nine men, 85 women, 188
knees) with osteoarthritis of the knee joint prior to TKR. The tibial
anteroposterior (AP) axis was defined as a line perpendicular to
the femoral surgical transepicondylar axis and passing through the centre
of the posterior cruciate ligament (PCL). The angles between the
defined tibial AP axis and anatomical landmarks at various levels
of the tibia were measured. The mean values of the angles between
the defined tibial AP axis and the line connecting the anterior
border of the proximal third of the tibia to the centre of the PCL
was -0.2° (-17 to 14.1, Cite this article:
Opinion remains divided as to whether the development
of pathological fracture affects the prognosis of patients with
an osteosarcoma of the extremities. We conducted a comprehensive systematic review and meta-analysis
of papers which reported the outcomes of osteosarcoma patients with
and without a pathological fracture. There were eight eligible papers
for final analysis which reported on 1713 patients, of whom 303
(17.7%) had a pathological fracture. The mean age for 1464 patients in
six studies was 23.2 years old (2 to 82). The mean follow-up for
1481 patients in seven studies was 90.1 months (6 to 240). The pooled estimates of local recurrence rates in osteosarcoma
patients with and without pathological fractures were 14.4% (8.7
to 20.0) The development of a pathological fracture is a negative prognostic
indicator in osteosarcoma and is associated with a reduced five-year
event-free survival and a possibly higher rate of local recurrence.
Our findings suggest that there is no absolute indication for amputation,
as similar rates of local recurrence can be achieved in patients
who are carefully selected for limb salvage. Cite this article:
Malpositioning of the trochanteric entry point
during the introduction of an intramedullary nail may cause iatrogenic
fracture or malreduction. Although the optimal point of insertion
in the coronal plane has been well described, positioning in the
sagittal plane is poorly defined. The paired femora from 374 cadavers were placed both in the anatomical
position and in internal rotation to neutralise femoral anteversion.
A marker was placed at the apparent apex of the greater trochanter,
and the lateral and anterior offsets from the axis of the femoral
shaft were measured on anteroposterior and lateral photographs. Greater
trochanteric morphology and trochanteric overhang were graded. The mean anterior offset of the apex of the trochanter relative
to the axis of the femoral shaft was 5.1 mm ( Placement of the entry position at the apex of the greater trochanter
in the anteroposterior view does not reliably centre an intramedullary
nail in the sagittal plane. Based on our findings, the site of insertion
should be about 5 mm posterior to the apex of the trochanter to
allow for its anterior offset. Cite this article:
The aim of this study was to evaluate the risk
factors for dislocation of the bearing after a mobile-bearing Oxford medial
unicompartmental knee replacement (UKR) and to test the hypothesis
that surgical factors, as measured from post-operative radiographs,
are associated with its dislocation From a total of 480 UKRs performed between 2001 and 2012, in
391 patients with a mean age of 66.5 years (45 to 82) (316 female,
75 male), we identified 17 UKRs where bearing dislocation occurred.
The post-operative radiological measurements of the 17 UKRs and
51 matched controls were analysed using conditional logistic regression analysis.
The post-operative radiological measurements included post-operative
change in limb alignment, the position of the femoral and tibial
components, the resection depth of the proximal tibia, and the femoral component-posterior
condyle classification. We concluded that a post-operative decrease in the posterior
tibial slope relative to the pre-operative value was the only significant
determinant of dislocation of the bearing after medial Oxford UKR
(odds ratio 1.881; 95% confidence interval 1.272 to 2.779). A post-operative
posterior tibial slope <
8.45° and a difference between the pre-operative
and post-operative posterior tibial slope of >
2.19° may increase
the risk of dislocation. Cite this article:
We used immediate post-operative The bending angles in the sagittal and axial planes were significantly
greater but the coronal-bending angle was significantly less in
the transtibial group than in the anteromedial portal and outside-in
groups (p <
0.001 each). The mean length of the femoral tunnel
in all three planes was significantly greater in the transtibial
group than the anteromedial portal and outside-in groups (p <
0.001 each), but all mean tunnel lengths in the three groups exceeded
30 mm. The only significant difference was the coronal graft- bending
angle in the anteromedial portal and outside-in groups (23.5° Compared with the transtibial technique, the anteromedial portal
and outside-in techniques may reduce the graft-bending stress at
the opening of the femoral tunnel. Despite the femoral tunnel length
being shorter in the anteromedial portal and outside-in techniques
than in the transtibial technique, a femoral tunnel length of more than
30 mm in the anteromedial portal and outside-in techniques may be
sufficient for the graft to heal. Cite this article:
We have investigated whether shape of the knee
can predict the clinical outcome of patients after an anterior cruciate
ligament rupture. We used statistical shape modelling to measure
the shape of the knee joint of 182 prospectively followed patients
on lateral and Rosenberg view radiographs of the knee after a rupture
of the anterior cruciate ligament. Subsequently, we associated knee
shape with the International Knee Documentation Committee subjective
score at two years follow-up. The mean age of patients was 31 years
(21 to 51), the majority were male (n = 121) and treated operatively
(n = 135). We found two modes (shape variations) that were significantly
associated with the subjective score at two years: one for the operatively
treated group (p = 0.002) and one for the non-operatively treated
group (p = 0.003). Operatively treated patients who had higher subjective
scores had a smaller intercondylar notch and a smaller width of
the intercondylar eminence. Non-operatively treated patients who
scored higher on the subjective score had a more pyramidal intercondylar
notch as opposed to one that was more dome-shaped. We conclude that
the shape of the femoral notch and the intercondylar eminence is predictive
of clinical outcome two years after a rupture of the anterior cruciate
ligament. Cite this article:
