Total Of the 54 patients who underwent TES for a primary tumour between
1993 and 2010, 19 died and four were lost to follow-up. In January
2012, a questionnaire was sent to the 31 surviving patients. This
included the short form-36 to assess HRQoL and questions about the
current condition of their disease, activities of daily living (ADL)
and surgery. The response rate was high at 83.9% (26/31 patients).
We found that most patients were satisfied and maintained good performance
of their ADLs. The mental health status and social roles of the HRQoL scores
were nearly equivalent to those of healthy individuals, regardless
of the time since surgery. There was significant impairment of physical
health in the early post-operative years, but this usually returned
to normal approximately three years after surgery. Cite this article:
This study describes the Osseointegration Group of Australia’s
Accelerated Protocol two-stage strategy (OGAAP-1) for the osseointegrated
reconstruction of amputated limbs. We report clinical outcomes in 50 unilateral trans-femoral amputees
with a mean age of 49.4 years (24 to 73), with a minimum one-year
follow-up. Outcome measures included the Questionnaire for persons
with a Trans-Femoral Amputation, the health assessment questionnaire
Short-Form-36 Health Survey, the Amputation Mobility Predictor scores
presented as K-levels, 6 Minute Walk Test and timed up and go tests.
Adverse events included soft-tissue problems, infection, fractures
and failure of the implant.Aims
Patients and Methods
Patients with osteoarthritis of the knee commonly have degenerative
meniscal tears. Arthroscopic meniscectomy is frequently performed,
although the benefits are debatable. Recent studies have concluded
that there is no role for arthroscopic washout in osteoarthritis
of the knee. Our aim was to perform a systematic review to assess
the evidence for the efficacy of arthroscopic meniscectomy in patients
with meniscal tears and degenerative changes in the knee. A literature search was performed, using the PubMed/MEDLINE database,
for relevant articles published between 1975 and 2015. A total of
six studies, including five randomised controlled trials and one
cross-sectional study of a prospective cohort, met the inclusion
criteria. Relevant information including study design, operations,
the characteristics of the patients, outcomes, adverse events and
further operations were extracted.Aims
Patients and Methods
To define Patient Acceptable Symptom State (PASS) thresholds
for the Oxford hip score (OHS) and Oxford knee score (OKS) at mid-term
follow-up. In a prospective multicentre cohort study, OHS and OKS were collected
at a mean follow-up of three years (1.5 to 6.0), combined with a
numeric rating scale (NRS) for satisfaction and an external validation
question assessing the patient’s willingness to undergo surgery
again. A total of 550 patients underwent total hip replacement (THR)
and 367 underwent total knee replacement (TKR).Objectives
Methods
Advances in polyethylene (PE) in total hip arthroplasty
have led to interest and increased use of highly crosslinked PE
(HXLPE) in total knee arthroplasty (TKA). Biomechanical data suggest
improved wear characteristics for HXLPE inserts over conventional
PE in TKA. Short-term results from registry data and few clinical
trials are promising. Our aim is to present a review of the history
of HXLPEs, the use of HXLPE inserts in TKA, concerns regarding potential mechanical
complications, and a thorough review of the available biomechanical
and clinical data. Cite this article:
Patients seeking cervical spine surgery are thought to be increasing
in age, comorbidities and functional debilitation. The changing
demographics of this population may significantly impact the outcomes
of their care, specifically with regards to complications. In this
study, our goals were to determine the rates of functionally dependent
patients undergoing elective cervical spine procedures and to assess
the effect of functional dependence on 30-day morbidity and mortality
using a large, validated national cohort. A retrospective analysis of the American College of Surgeons
National Surgical Quality Improvement Program data files from 2006
to 2013 was conducted to identify patients undergoing common cervical
spine procedures. Multivariate logistic regression models were generated
to analyse the independent association of functional dependence
with 30-day outcomes of interest.Aims
Patients and Methods
The purpose of this study was to evaluate the
long-term outcome of adults with spina bifida cystica (SBC) who
had been treated either operatively or non-operatively for scoliosis
during childhood. We reviewed 45 patients with a SBC scoliosis (Cobb angle ≥ 50º)
who had been treated at one of two children’s hospitals between
1991 and 2007. Of these, 34 (75.6%) had been treated operatively
and 11 (24.4%) non-operatively. After a mean follow-up of 14.1 years
(standard deviation ( Although patients in the two groups were demographically similar,
those who had undergone surgery had a larger mean Cobb angle (88.0º
( Spinal fusion in SBC scoliosis corrects coronal deformity and
stops progression of the curve but has no clear effect on HRQOL. Cite this article:
Oxidised zirconium (OxZi) has been developed
as an alternative bearing surface for femoral heads in total hip arthroplasty
(THA). This study has investigated polyethylene wear, functional
outcomes and complications, comparing OxZi and cobalt–chrome (CoCr)
as part of a three-arm, multicentre randomised controlled trial.
Patients undergoing THA from four institutions were prospectively
randomised into three groups. Group A received a CoCr femoral head
and highly cross-linked polyethylene (XLPE) liner; Group B received
an OxZi femoral head and XLPE liner; Group C received an OxZi femoral
head and ultra-high molecular weight polyethylene (UHMWPE) liner.
At five years, 368 patients had no statistically significant differences
in short-form-36 (p = 0.176 mental, p = 0.756 physical), Western
Ontario and McMaster Universities Osteoarthritis Index (p = 0.847),
pain scores
(p = 0.458) or complications. The mean rate of linear wear was 0.028
mm/year (standard deviation ( Cite this article:
The December 2014 Trauma Roundup360 looks at: infection and temporising external fixation; Vitamin C in distal radial fractures; DRAFFT: Cheap and cheerful Kirschner wires win out; femoral neck fractures not as stable as they might be; displaced sacral fractures give high morbidity and mortality; sanders and calcaneal fractures: a 20-year experience; bleeding and pelvic fractures; optimising timing for acetabular fractures; and tibial plateau fractures.
The purpose of this study was to evaluate the
natural history of rheumatoid disease of the shoulder over an eight-year
period. Our hypothesis was that progression of the disease is associated
with a decrease in function with time. A total of 22 patients (44 shoulders; 17 women, 5 men, (mean
age 63)) with rheumatoid arthritis were followed for eight years.
All shoulders were assessed using the Constant score, anteroposterior
radiographs (Larsen score, Upward-Migration-Index (UMI)) and ultrasound
(US). At final follow-up, the Short Form-36, disabilities of the
arm, shoulder and hand (DASH) Score, erythrocyte sedimentation rate
and use of anti-rheumatic medication were determined. The mean Constant score was 72 points (50 to 88) at baseline
and 69 points (25 to 100) at final follow-up. Radiological evaluation
showed progressive destruction of the peri-articular structures
with time. This progression of joint and rotator cuff destruction
was significantly associated with the Constant score. However, at
baseline only the extent of rotator cuff disease and the UMI could
predict the Constant score at final follow-up. A plain anteroposterior radiograph of the shoulder is sufficient
to assess any progression of rheumatoid disease and to predict functional
outcome in the long term by using the UMI as an indicator of rotator
cuff degeneration. Cite this article:
Patients with transfemoral amputation (TFA) often
experience problems related to the use of socket-suspended prostheses.
The clinical development of osseointegrated percutaneous prostheses
for patients with a TFA started in 1990, based on the long-term
successful results of osseointegrated dental implants. Between1999 and 2007, 51 patients with 55 TFAs were consecutively
enrolled in a prospective, single-centre non-randomised study and
followed for two years. The indication for amputation was trauma
in 33 patients (65%) and tumour in 12 (24%). A two-stage surgical
procedure was used to introduce a percutaneous implant to which
an external amputation prosthesis was attached. The assessment of
outcome included the use of two self-report questionnaires, the
Questionnaire for Persons with a Transfemoral Amputation (Q-TFA)
and the Short-Form (SF)-36. The cumulative survival at two years’ follow-up was 92%. The
Q-TFA showed improved prosthetic use, mobility, global situation
and fewer problems (all p <
0.001). The physical function SF-36
scores were also improved (p <
0.001). Superficial infection
was the most frequent complication, occurring 41 times in 28 patients
(rate of infection 54.9%). Most were treated effectively with oral
antibiotics. The implant was removed in four patients because of loosening
(three aseptic, one infection). Osseointegrated percutaneous implants constitute a novel form
of treatment for patients with TFA. The high cumulative survival
rate at two years (92%) combined with enhanced prosthetic use and
mobility, fewer problems and improved quality of life, supports
the ‘revolutionary change’ that patients with TFA have reported
following treatment with osseointegrated percutaneous prostheses. Cite this article:
The aim of this study was to evaluate the ten-year
clinical and functional outcome of hip resurfacing and to compare it
with that of cementless hip arthroplasty in patients under the age
of 55 years. Between 1999 and 2002, 80 patients were enrolled into the study:
24 were randomised (11 to hip resurfacing, 13 to total hip arthroplasty),
18 refused hip resurfacing and chose cementless total hip arthroplasty
with a 32 mm bearing, and 38 insisted on resurfacing. The mean follow-up
for all patients was 12.1 years (10 to 14). Patients were assessed clinically and radiologically at one year,
five years and ten years. Outcome measures included EuroQol EQ5D,
Oxford, Harris hip, University of California Los Angeles and University
College Hospital functional scores. No differences were seen between the two groups in the Oxford
or Harris hip scores or in the quality of life scores. Despite a
similar aspiration to activity pre-operatively, a higher proportion
of patients with a hip resurfacing were running and involved in
sport and heavy manual labour after ten years. We found significantly higher function scores in patients who
had undergone hip resurfacing than in those with a cementless hip
arthroplasty at ten years. This suggests a functional advantage
for hip resurfacing. There were no other attendant problems. Cite this article:
To investigate psychosocial and biomedical outcomes following
total hip replacement (THR) and to identify predictors of recovery
from THR. Patients with osteoarthritis (OA) on the waiting list for primary
THR in North West England were assessed pre-operatively and at six
and 12 months post-operatively to investigate psychosocial and biomedical
outcomes. Psychosocial outcomes were anxiety and depression, social
support and health-related quality of life (HRQoL). Biomedical outcomes
were pain, physical function and stiffness. The primary outcome
was the Short-Form 36 (SF-36) Health Survey Total Physical Function.
Potential predictors of outcome were age, sex, body mass index,
previous joint replacement, involvement in the decision for THR,
any comorbidities, any complications, type of medication, and pre-operative
ENRICHD Social Support Instrument score, Hospital Anxiety and Depression
scores and Western Ontario and McMaster Universities osteoarthritis index
score.Objectives
Methods
Flexor digitorum longus transfer and medial displacement
calcaneal osteotomy is a well-recognised form of treatment for stage
II posterior tibial tendon dysfunction. Although excellent short-
and medium-term results have been reported, the long-term outcome
is unknown. We reviewed the clinical outcome of 31 patients with
a symptomatic flexible flat-foot deformity who underwent this procedure
between 1994 and 1996. There were 21 women and ten men with a mean
age of 54.3 years (42 to 70). The mean follow-up was 15.2 years
(11.4 to 16.5). All scores improved significantly (p <
0.001).
The mean American Orthopedic Foot and Ankle Society (AOFAS) score improved
from 48.4 pre-operatively to 90.3 (54 to 100) at the final follow-up.
The mean pain component improved from 12.3 to 35.2 (20 to 40). The
mean function score improved from 35.2 to 45.6 (30 to 50). The mean
visual analogue score for pain improved from 7.3 to 1.3 (0 to 6).
The mean Short Form-36 physical component score was 40.6 ( Cite this article:
We have evaluated the clinical effectiveness
of a metal resurfacing inlay implant for osteochondral defects of
the medial talar dome after failed previous surgical treatment.
We prospectively studied 20 consecutive patients with a mean age
of 38 years (20 to 60), for a mean of three years (2 to 5) post-surgery.
There was statistically significant reduction of pain in each of
four situations (i.e., rest, walking, stair climbing and running;
p ≤ 0.01). The median American Orthopaedic Foot and Ankle Society
ankle-hindfoot score improved from 62 (interquartile range (IQR)
46 to 72) pre-operatively to 87 (IQR 75 to 95) at final follow-up
(p <
0.001). The Foot and Ankle Outcome Score improved on all
subscales (p ≤ 0.03). The mean Short-Form 36 physical component
scale improved from 36 (23 to 50) pre-operatively to 45 (29 to 55)
at final follow-up (p = 0.001); the mental component scale did not
change significantly. On radiographs, progressive degenerative changes
of the opposing tibial plafond were observed in two patients. One
patient required additional surgery for the osteochondral defect.
This study shows that a metal implant is a promising treatment for
osteochondral defects of the medial talar dome after failed previous
surgery. Cite this article: