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The Journal of Bone & Joint Surgery British Volume
Vol. 57-B, Issue 2 | Pages 209 - 213
1 May 1975
Hampson WGJ Hill P

The authors wished to determine the late results of the Hauser operation, with special reference to the development of osteoarthritis. Predisposing factors associated with recurrent dislocation of the patella were also investigated. Thirty-five patients with forty-our surgically treated knees attended for review, ten to twenty-fve (aerage sixteen) years after operation. Two patients had subsequently undergone excision of the patella. Ten patients gave a family history of recurrent dislocation of the patella and seven patients showed generalised joint laxity. Pain was present in eight knees before operation and was present in thirty-three knees (75 per cent) at the time of review. Patellar crepitus was present in thirty-seven out of forty-two knees (88 per cent) at review. Osteoarthritis was present in thirty out of forty-two knees (70 per cent). The incidence increases with time since operation and the present age of the patient. It is concluded that the Hauser operation prevents further dislocation but does not prevent the development of osteoarthritis. It is possible that a simple soft-tissue operation which effectively prevents dislocation might achieve the same results


The Bone & Joint Journal
Vol. 102-B, Issue 3 | Pages 276 - 279
1 Mar 2020
Oussedik S Abdel MP Victor J Pagnano MW Haddad FS

Dissatisfaction following total knee arthroplasty is a well-documented phenomenon. Although many factors have been implicated, including modifiable and nonmodifiable patient factors, emphasis over the past decade has been on implant alignment and stability as both a cause of, and a solution to, this problem. Several alignment targets have evolved with a proliferation of techniques following the introduction of computer and robotic-assisted surgery. Mechanical alignment targets may achieve mechanically-sound alignment while ignoring the soft tissue envelope; kinematic alignment respects the soft tissue envelope while ignoring the mechanical environment. Functional alignment is proposed as a hybrid technique to allow mechanically-sound, soft tissue-friendly alignment targets to be identified and achieved.

Cite this article: Bone Joint J 2020;102-B(3):276–279.


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 3 | Pages 348 - 354
1 Apr 2001
Eriksson K Anderberg P Hamberg P Löfgren AC Bredenberg M Westman I Wredmark T

In a two-centre study, 164 patients with unilateral instability of the anterior cruciate ligament were prospectively randomised to arthroscopic reconstruction with either a patellar tendon graft using interference screw fixation or a quadruple semitendinosus graft using an endobutton fixation technique. The same postoperative rehabilitation protocol was used for all patients and follow-up at a median of 31 months (24 to 59) was carried out by independent observers. Four patients (2%) were lost to follow-up. No significant differences were found between the groups regarding the Stryker laxity test, one-leg hop test, Tegner activity level, Lysholm score, patellofemoral pain score, International Knee Documentation Committee (IKDC) score or visual analogue scale, reflecting patient satisfaction and knee function. Slightly decreased extension, compared with the non-operated side, was found in the patellar tendon group (p < 0.05). Patients with associated meniscal injuries had lower IKDC, visual analogue (p < 0.01) and Lysholm scores (p < 0.05) than those without such injuries. Patients in whom reconstruction had been carried out less than five months after the injury had better final IKDC scores than the more chronic cases (p < 0.05). We conclude that patellar tendon and quadruple semitendinous tendon grafts have similar outcomes in the medium term. Associated meniscal pathology significantly affects the final outcome and early reconstruction seems to be beneficial


The Journal of Bone & Joint Surgery British Volume
Vol. 50-B, Issue 3 | Pages 664 - 668
1 Aug 1968
Mulder JD Landsmeer JMF

1. The claw position of a finger with intrinsic paralysis is caused by the blocking effect of the transverse lamina on the long extensor. This starts as soon as the metacarpo-phalangeal joint is hyperextended, and increases with further hyperextension. Thus the long extensor loses its pull on the interphalangeal joints and allows them to flex. Therefore, in intrinsic paralysis the claw position can be prevented or cured by keeping the metacarpo-phalangeal joint in flexion, however slight, which can be done by splinting, by tenodesis or by capsulorrhaphy. 2. Replacement of the intrinsics by some active element, although it may improve the action of the fingers, is not necessary for the correction of claw finger. The function of the intrinsics in the prevention of claw finger is not to be found in their extending effect on the interphalangeal joints, but in the flexion effect on the metacarpo-phalangeal joint, or at least in preventing its hyperextension. This is in accordance with the fact that loss of intrinsic function is disastrous only in supple fingers, in which the metacarpo-phalangeal joints tend to assume extreme degrees of hyperextension (Riordan 1953, Brand 1958). In such fingers, the wide range of hyperextension available at the metacarpo-phalangeal joints is, of course, part of a generalised laxity of the soft parts of the fingers. These soft parts generally tend to counteract the tendency to clawing; the less their resistance, the more the human finger as a whole will tend to behave like a musculo-articular model, and such a model without intrinsics will always immediately assume the claw position


The Bone & Joint Journal
Vol. 101-B, Issue 4 | Pages 435 - 442
1 Apr 2019
Zambianchi F Franceschi G Rivi E Banchelli F Marcovigi A Nardacchione R Ensini A Catani F

Aims

The purpose of this multicentre observational study was to investigate the association between intraoperative component positioning and soft-tissue balancing on short-term clinical outcomes in patients undergoing robotic-arm assisted unicompartmental knee arthroplasty (UKA).

Patients and Methods

Between 2013 and 2016, 363 patients (395 knees) underwent robotic-arm assisted UKAs at two centres. Pre- and postoperatively, patients were administered Knee Injury and Osteoarthritis Score (KOOS) and Forgotten Joint Score-12 (FJS-12). Results were stratified as “good” and “bad” if KOOS/FJS-12 were more than or equal to 80. Intraoperative, post-implantation robotic data relative to CT-based components placement were collected and classified. Postoperative complications were recorded.


Bone & Joint Open
Vol. 2, Issue 1 | Pages 66 - 71
27 Jan 2020
Moriarty P Kayani B Wallace C Chang J Plastow R Haddad FS

Aims

Graft infection following anterior cruciate ligament reconstruction (ACLR) may lead to septic arthritis requiring multiple irrigation and debridement procedures, staged revision operations, and prolonged courses of antibiotics. To our knowledge, there are no previous studies reporting on how gentamicin pre-soaking of hamstring grafts influences infection rates following ACLR. We set out to examine this in our study accordingly.

Methods

This retrospective study included 2,000 patients (1,156 males and 844 females) who underwent primary ACLR with hamstring autografts between 2007 to 2017. This included 1,063 patients who received pre-soaked saline hamstring grafts for ACLR followed by 937 patients who received pre-soaked gentamicin hamstring grafts for ACLR. All operative procedures were completed by a single surgeon using a standardized surgical technique. Medical notes were reviewed and data relating to the following outcomes recorded: postoperative infection, clinical progress, causative organisms, management received, and outcomes.


Bone & Joint 360
Vol. 9, Issue 1 | Pages 35 - 39
1 Feb 2020


The Journal of Bone & Joint Surgery British Volume
Vol. 54-B, Issue 1 | Pages 18 - 39
1 Feb 1972
MacKenzie IG

1. A scheme was started in 1960 with the object of ensuring that the hips of all babies born in the North-Eastern Region of Scotland were examined shortly after birth. 2. 1,671 children with suspected abnormalities have been seen during the ensuing ten years, and the findings are discussed. 3. Clinical examination is essential. Radiographic examination of the newborn is not necessary and may be misleading, but it does prove that some hips with limited abduction but no instability are in fact dislocated. 4. Treatment is not started when the diagnosis is made shortly after birth. The children are re-examined at three weeks, when spontaneous recovery has occurred in about half. The others, whether they show instability or only limitation of abduction of the hips, are treated in a simple splint until they are three months old. Any residual stiffness is an indication for further splintage. 5. The first radiographs are taken when the children are three months old, and no child is discharged until the radiographs show that the upper femoral epiphyses have appeared and are in normal position. 6. We appreciate that we are treating some children who would have recovered spontaneously, but we do not know how to distinguish them. There is no evidence that splintage harms a hip. 7. Eighty-six children (5 per cent of the total) needed operation usually because the diagnosis was missed at birth. 8. Children with familial joint laxity or genu recurvatum should be examined especially carefully for associated hip abnormality. 9. The incidence of abnormality of the hips at birth is about one in fifty live births


The Journal of Bone & Joint Surgery British Volume
Vol. 31-B, Issue 4 | Pages 547 - 559
1 Nov 1949
Harris H Joseph J

1. The range of variation in full extension at the interphalangeal and metacarpo-phalangeal joints of the thumbs of 133 male and 100 female Europeans, and of 31 male Indians and 30 male Africans, has been investigated. 2. There is considerable variation between individuals in the maximum extension of both joints of the right and left thumbs in all groups studied. 3. The distribution for each joint in both thumbs in all groups is fairly symmetrical. 4. There is a high correlation between the right and left thumbs for both joints in all groups. 5. The mean angle of extension at the right and left metacarpo-phalangeal joints in all groups is similar. Female Europeans, however, show a significantly greater mean angle than male Europeans. 6. The mean interphalangeal angle of extension in male Europeans is significantly greater than that in female Europeans and the mean in the Indian and African groups is significantly greater than in the male European group. 7. There is slight negative correlation between the metacarpo-phalangeal angle and interphalangeal angle in each thumb in the European groups. 8. Many subjects in all groups can increase extension at the metacarpo-phalangeal joint after flexing the carpo-metacarpal joint. Marked hyperextension (over 40°) is more frequent in the left than in the right thumb, in females than in males, and in male Indians than in male Europeans and Africans. 9. Maximum extension at the interphalangeal joints is not related to the presence of a sesamoid bone in the anterior part of the capsule of the joint. 10. The surfaces of the metacarpo-phalangeal joints vary considerably in shape. Those which are flat form about 10 per cent. of the sample and do not show hyperextension. 11. The factors influencing the amount of extension at the interphalangeal joint is the degree of laxity of the anterior capsule. The problem at the metacarpo-phalangeal joint is more complex; both the capsule and the shape of the joint surfaces play important roles


The Bone & Joint Journal
Vol. 100-B, Issue 3 | Pages 271 - 284
1 Mar 2018
Hexter AT Thangarajah T Blunn G Haddad FS

Aims

The success of anterior cruciate ligament reconstruction (ACLR) depends on osseointegration at the graft-tunnel interface and intra-articular ligamentization. Our aim was to conduct a systematic review of clinical and preclinical studies that evaluated biological augmentation of graft healing in ACLR.

Materials and Methods

In all, 1879 studies were identified across three databases. Following assessment against strict criteria, 112 studies were included (20 clinical studies; 92 animal studies).


The Bone & Joint Journal
Vol. 100-B, Issue 12 | Pages 1585 - 1591
1 Dec 2018
Kaneko T Kono N Mochizuki Y Hada M Sunakawa T Ikegami H Musha Y

Aims

Patellofemoral problems are a common complication of total knee arthroplasty. A high compressive force across the patellofemoral joint may affect patient-reported outcome. However, the relationship between patient-reported outcome and the intraoperative patellofemoral contact force has not been investigated. The purpose of this study was to determine whether or not a high intraoperative patellofemoral compressive force affects patient-reported outcome.

Patients and Methods

This prospective study included 42 patients (42 knees) with varus-type osteoarthritis who underwent a bi-cruciate stabilized total knee arthroplasty and in whom the planned alignment was confirmed on 3D CT. Of the 42 patients, 36 were women and six were men. Their mean age was 72.3 years (61 to 87) and their mean body mass index (BMI) was 24.4 kg/m2 (18.2 to 34.3). After implantation of the femoral and tibial components, the compressive force across the patellofemoral joint was measured at 10°, 30°, 60°, 90°, 120°, and 140° of flexion using a load cell (Kyowa Electronic Instruments Co., Ltd., Tokyo, Japan) manufactured in the same shape as the patellar implant. Multiple regression analyses were conducted to investigate the relationship between intraoperative patellofemoral compressive force and patient-reported outcome two years after implantation.


The Journal of Bone & Joint Surgery British Volume
Vol. 48-B, Issue 3 | Pages 424 - 435
1 Aug 1966
Reeves B

1. Arthrography demonstrates two types of injury to the capsule in acute anterior dislocations of the shoulder. 2. The first is a capsular rupture which does not appear to lead to recurrent dislocation of the shoulder unless there is concomitant humeral head damage. In this group healing is complete in ten days and it should be safe to start exercises early. 3. The second is associated with labral detachment from the glenoid and most heal with immobilisation for three weeks. Failure to heal leads to recurrent dislocation. It is not known whether immobilisation had any influence on healing of the lesion in these patients and this remains the subject of further investigation. 4. In recurrent anterior dislocation of the shoulder there is constant enlargement of the subscapular bursa, the outline of which becomes continuous with the inferior pouch. Axial arthrographs show either an absence of the glenoid labral outline or an enlarged entrance to the subscapular bursa. 5. Ruptures of the supraspinatus portion of the tendinous cuff were seen in five patients out of a total of twenty-seven acute dislocations, suggesting that this associated injury is more common than was previously believed. POSTERIOR DISLOCATIONS. 6. When the dislocation is voluntary there is marked elasticity of the capsule but the joint is only unstable in one direction when examined under anaesthesia. Both shoulders appear equally affected when examined radiologically under general anaesthesia even though the patient only has the ability to dislocate one. 7. All patients with voluntary dislocation had a curious voluntary muscle control and were able to contract the anterior and posterior parts of deltoid separately. Each dislocation was preceded by scapular movement. 8. No evidence of increased joint laxity was found in other joints in any of the patients. 9. In two patients with acute dislocations the defect of the humeral head was seen after the initial dislocation and in the third patient it occurred at the time of the second dislocation. In all three there was a spill of fluid beneath the subscapularis but no leakage into the axilla as occurred in anterior dislocation with capsular rupture. The capacity for healing appeared greater than in anterior dislocations with labral detachment; one patient treated in a sling had a better functional result than another treated with the shoulder in lateral rotation


The Journal of Bone & Joint Surgery British Volume
Vol. 44-B, Issue 4 | Pages 913 - 927
1 Nov 1962
Moseley HF Övergaard B

1 . The concept of the capsular mechanism of the shoulder joint with regard to recurrent anterior dislocation of the shoulder has been defined and a survey of the literature presented. 2. An anatomical, including an embryological, investigation of shoulder joints with special reference to the structure and function of the glenoid labrum and to the variations in the arrangement of the gleno-humeral ligaments and the synovial recesses of the anterior capsular mechanism is reported. The labrum, which is generally believed to be a consistent, fibrocartilaginous structure, is shown to be a redundant portion of capsular tissue and a continuation of the capsule as it attaches to the osseous glenoid rim. The fibrocartilaginous element is confined to a small transition zone at the capsular attachment in the great majority of cases. The great variability in the arrangement of the gleno-humeral ligaments and synovial recesses is stressed, and it is shown that an anterior pouch of variable size is present when the middle gleno-humeral ligament is attached to the scapular neck and not to the labrum. 3. The basic lesions of the anterior capsular mechanism found at operation for recurrent anterior dislocation of the shoulder in twenty-five consecutive cases using a modified Bankart procedure with a standard anterior approach to the joint are reported, and the findings are correlated with the results of the anatomical investigation. In most cases the lesions were found to be of the Bankart type with or without avulsion of the periosteum of the scapular neck. In four cases, however, the soft-tissue attachment to the anterior glenoid rim was intact; in those cases a large synovial pouch was present and the middle gleno-humeral ligament was either not discernible or it arose from the scapular neck. In all cases a postero-lateral notch on the humeral head was palpable and laxity of the subscapularis could be demonstrated. When measured, the joint capacity was always greatly augmented. 4. The present work shows, from a basic standpoint, that Bankart's original idea that the recurrent state was due to the failure of healing of the fractured fibrocartilaginous glenoid labrum is no longer tenable. 5. Finally, the anomalous attachment or the insufficient development of the middle gleno-humeral ligament in certain cases of recurrent anterior shoulder dislocation is shown to provide the anatomical basis for the recurrent state in these cases; this is the weak area in the antero-inferior part of the capsule which has been described in the literature for the past hundred years. Thus we have returned to the original view of Hippocrates


The Bone & Joint Journal
Vol. 101-B, Issue 11 | Pages 1348 - 1355
1 Nov 2019
Gascoyne T Parashin S Teeter M Bohm E Laende E Dunbar M Turgeon T

Aims

A retrospective study was conducted to measure short-term in vivo linear and volumetric wear of polyethylene (PE) inserts in 101 total knee arthroplasty (TKA) patients using model-based radiostereometric analysis (MBRSA).

Patients and Methods

Nonweightbearing supine RSA exams were performed postoperatively and at six, 12, and 24 months. Weightbearing standing RSA exams were performed on select patients at 12 and 24 months. Wear was measured both linearly (joint space) and volumetrically (digital model overlap) at each available follow-up. Precision of both methods was assessed by comparing double RSA exams. Patient age, sex, body mass index, and Oxford Knee Scores were analyzed for any association with PE wear.


The Bone & Joint Journal
Vol. 101-B, Issue 9 | Pages 1058 - 1062
1 Sep 2019
van Kuijk KSR Reijman M Bierma-Zeinstra SMA Waarsing JH Meuffels DE

Aims

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.

Patients and Methods

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.


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 2 | Pages 232 - 236
1 Mar 2002
Krips R Brandsson S Swensson C van Dijk CN Karlsson J

In this retrospective study, we assessed the outcome in 99 patients who underwent reconstruction of the lateral ligaments of the ankle for chronic anterolateral instability with a minimum follow-up of 15 years. Two techniques were compared: 54 patients had an anatomical reconstruction (AR group) and 45 had an Evans tenodesis (ET group). They were followed up for 19.9 ± 3.6 years and 21.8 ± 4.6 years, respectively. During follow-up, seven patients in the AR group and 17 in the ET group required a further operation (p = 0.004). At follow-up, significantly more patients (n = 15) in the ET group had limited dorsiflexion than in the AR group (n = 6, p = 0.007) and 18 in the ET group had a positive anterior drawer test compared with seven in the AR group (p = 0002). In the ET group 27 had tenderness on palpation of the ankle compared with 15 in the AR group (p = 0.001). Stress radiographs showed ligamentous laxity significantly more often in the ET group (n = 30) than in the AR group (n = 13, p < 0.001). The mean values for talar tilt and anterior talar translation were significantly higher in the ET group than in the AR group (p < 0.001, p = 0.007, respectively). There were degenerative changes on standard radiographs in 32 patients in the AR group and 35 in the ET group (p = 0.05). Four patients in the ET group had developed severe osteoarthritis compared with none in the AR group (p = 0.025). Assessment of functional stability revealed a mean Karlsson score of 83.7 ± 10.4 points in the AR group and 67.0 ± 15.8 points in the ET group (p < 0.001). According to the Good rating system, 43 patients in the AR group had good or excellent results compared with 15 in the ET group (p < 0.001). Compared with anatomical reconstruction, the Evans tenodesis does not prevent laxity in a large number of patients. Long-standing ligamentous laxity leads to degenerative change in the ankle, resulting in chronic pain, limited dorsiflexion and further operations. The functional result deteriorates more rapidly after the Evans tenodesis than after anatomical reconstruction


The Bone & Joint Journal
Vol. 101-B, Issue 7_Supple_C | Pages 104 - 107
1 Jul 2019
Greenwell PH Shield WP Chapman DM Dalury DF

Aims

The aim of this study was to establish the results of isolated exchange of the tibial polyethylene insert in revision total knee arthroplasty (RTKA) in patients with well-fixed femoral or tibial components. We report on a series of RTKAs where only the polyethylene was replaced, and the patients were followed for a mean of 13.2 years (10.0 to 19.1).

Patients and Methods

Our study group consisted of 64 non-infected, grossly stable TKA patients revised over an eight-year period (1998 to 2006). The mean age of the patients at time of revision was 72.2 years (48 to 88). There were 36 females (56%) and 28 males (44%) in the cohort. All patients had received the same cemented, cruciate-retaining patella resurfaced primary TKA. All subsequently underwent an isolated polyethylene insert exchange. The mean time from the primary TKA to RTKA was 9.1 years (2.2 to 16.1).


The Bone & Joint Journal
Vol. 101-B, Issue 10 | Pages 1218 - 1229
1 Oct 2019
Lerch TD Eichelberger P Baur H Schmaranzer F Liechti EF Schwab JM Siebenrock KA Tannast M

Aims

Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT.

Patients and Methods

A retrospective, institutional review board (IRB)-approved, controlled study of 85 symptomatic patients (148 hips) with FAI or hip dysplasia was performed in the gait laboratory. All patients had a measurement of FT (pelvic CT scan), TT (CT scan), and FPA (optical motion capture system). We allocated all patients to three groups with decreased FT (< 10°, 37 hips), increased FT (> 25°, 61 hips), and normal FT (10° to 25°, 50 hips). Cluster analysis was performed.


Bone & Joint 360
Vol. 8, Issue 3 | Pages 18 - 19
1 Jun 2019


The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 123 - 126
1 Jun 2019
El-Husseiny M Masri B Duncan C Garbuz DS

Aims

We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores.

Patients and Methods

We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 after more than three revisions. A total of 75 hips (73 patients) were treated with Tripolar liners due to recurrent instability with abductor deficiency, In addition, six patients had associated cerebral palsy, four had poliomyelitis, two had multiple sclerosis, two had spina bifida, two had spondyloepiphyseal dysplasia, one had previous reversal of an arthrodesis, and 21 had proximal femoral replacements. The mean age of patients at time of Tripolar insertions was 72 years (53 to 89); there were 69 female patients (two bilateral) and 42 male patients. All patients were followed up for a mean of 15 years (10 to 24). Overall, 55 patients (57 hips) died between April 2011 and February 2018, at a mean of 167 months (122 to 217) following their tripolar liner implantation. We extracted demographics, implant data, rate of dislocations, and incidence of other complications.