We carried out a further study of the long-term results of the
cemented Exeter femoral component in patients under the age of 40
with a mean follow-up of 13.6 years (10 to 20). We reviewed our original cohort of 104 cemented Exeter stems
in 78 consecutive patients with a mean age of 31 years (16 to 39).
Only one patient was lost to radiological follow-up.Aims
Patients and Methods
To employ a simple and fast method to evaluate those patients with neurological deficits and misplaced screws in relatively safe lumbosacral spine, and to determine if it is necessary to undertake revision surgery. A total of 316 patients were treated by fixation of lumbar and lumbosacral transpedicle screws at our institution from January 2011 to December 2012. We designed the criteria for post-operative revision scores of pedicle screw malpositioning (PRSPSM) in the lumbosacral canal. We recommend the revision of the misplaced pedicle screw in patients with PRSPSM = 5′ as early as possible. However, patients with PRSPSM < 5′ need to follow the next consecutive assessment procedures. A total of 15 patients were included according to at least three-stage follow-up.Objectives
Methods
A total of 30 patients with thoracolumbar/lumbar adolescent idiopathic
scoliosis (AIS) treated between 1989 and 2000 with anterior correction
and fusion surgery using dual-rod instrumentation were reviewed. Radiographic parameters and clinical outcomes were compared among
patients with lowest instrumented vertebra (LIV) at the lower end
vertebra (LEV; EV group) (n = 13) and those treated by short fusion
(S group), with LIV one level proximal to EV (n = 17 patients). Aims
Patients and Methods
The incidence of periprosthetic fractures of
the ankle is increasing. However, little is known about the outcome
of treatment and their management remains controversial. The aim
of this study was to assess the impact of periprosthetic fractures
on the functional and radiological outcome of patients with a total
ankle arthroplasty (TAA). A total of 505 TAAs (488 patients) who underwent TAA were retrospectively
evaluated for periprosthetic ankle fracture: these were then classified
according to a recent classification which is orientated towards
treatment. The outcome was evaluated clinically using the American
Orthopedic Foot and Ankle Society (AOFAS) score and a visual analogue
scale for pain, and radiologically. A total of 21 patients with a periprosthetic fracture of the
ankle were identified. There were 13 women and eight men. The mean
age of the patients was 63 years (48 to 74). Thus, the incidence
of fracture was 4.17%. There were 11 intra-operative and ten post-operative fractures,
of which eight were stress fractures and two were traumatic. The
prosthesis was stable in all patients. Five stress fractures were
treated conservatively and the remaining three were treated operatively. A total of 17 patients (81%) were examined clinically and radiologically
at a mean follow-up of 53.5 months (12 to 112). The mean AOFAS score
at follow-up was 79.5 (21 to 100). The mean AOFAS score in those
with an intra-operative fracture was 87.6 (80 to 100) and for those
with a stress fracture, which were mainly because of varus malpositioning,
was 67.3 (21 to 93). Periprosthetic fractures of the ankle do not
necessarily adversely affect the clinical outcome, provided that
a treatment algorithm is implemented with the help of a new classification
system. Cite this article:
The outcome of surgery for recurrent lumbar disc
herniation is debatable. Some studies show results that are comparable
with those of primary discectomy, whereas others report worse outcomes.
The purpose of this study was to compare the outcome of revision
lumbar discectomy with that of primary discectomy in the same cohort
of patients who had both the primary and the recurrent herniation
at the same level and side. A retrospective analysis of prospectively gathered data was undertaken
in 30 patients who had undergone both primary and revision surgery
for late recurrent lumbar disc herniation. The outcome measures
used were visual analogue scales for lower limb (VAL) and back (VAB)
pain and the Oswestry Disability Index (ODI). There was a significant improvement in the mean VAL and ODI scores
(both p <
0.001) after primary discectomy. Revision surgery also
resulted in improvements in the mean VAL (p <
0.001), VAB (p
= 0.030) and ODI scores (p <
0.001). The changes were similar
in the two groups (all p >
0.05). Revision discectomy can give results that are as good as those
seen after primary surgery. Cite this article:
The April 2015 Spine Roundup360 looks at: Hyperostotic spine in injury; App based back pain control; Interspinous process devices should be avoided in claudication; Robot assisted pedicle screws: fad or advance?; Vancomycin antibiotic power in spinal surgery; What to do with that burst fracture?; Increasing complexity of spinal fractures in major trauma pathways; Vitamin D and spinal fractures
The February 2015 Spine Roundup360 looks at: Paracetamol use for lower back pain; En-bloc resection of vertebra reported for the first time; Spinopelvic disassociation under the spotlight; Hope for back pain; Disc replacement and ACDF equivalent in randomised study; Interspinous process devices ineffective
The purpose of this prospective study was to evaluate the outcomes
of coccygectomy for patients with chronic coccydynia. Between 2007 and 2011, 98 patients underwent coccygectomy for
chronic coccydynia. The patients were aged >
18 years, had coccygeal
pain, local tenderness and a radiological abnormality, and had failed
conservative management. Outcome measures were the Short Form 36
(SF-36), the Oswestry Disability Index (ODI) and a visual analogue
scale (VAS) for pain. Secondary analysis compared the pre-operative
features and the outcomes of patients with successful and failed
treatment, two years post-operatively. The threshold for success
was based on a minimum clinically important difference (MCID) on
the ODI of 20 points. All other patients, including those lost to
follow-up, were classified as failures.Aims
Patients and Methods
There is conflicting evidence about the benefit
of using corticosteroid in periarticular injections for pain relief
after total knee arthroplasty (TKA). We carried out a double-blinded,
randomised controlled trial to assess the efficacy of using corticosteroid
in a periarticular injection to control pain after TKA. A total of 77 patients, 67 women and ten men, with a mean age
of 74 years (47 to 88) who were about to undergo unilateral TKA
were randomly assigned to have a periarticular injection with or
without corticosteroid. The primary outcome was post-operative pain
at rest during the first 24 hours after surgery, measured every
two hours using a visual analogue pain scale score. The cumulative
pain score was quantified using the area under the curve. The corticosteroid group had a significantly lower cumulative
pain score than the no-corticosteroid group during the first 24
hours after surgery (mean area under the curve 139, 0 to 560, and
264, 0 to 1460; p = 0.024). The rate of complications, including
surgical site infection, was not significantly different between
the two groups up to one year post-operatively. The addition of corticosteroid to the periarticular injection
significantly decreased early post-operative pain. Further studies
are needed to confirm the safety of corticosteroid in periarticular
injection.
Cite this article:
The April 2015 Research Roundup360 looks at: MCID in grip strength and distal radial fracture; Experiencing rehab in a trial setting; Electrical stimulation and nerve recovery; Molecular diagnosis of TB?; Acetabular orientation: component and arthritis; Analgesia after knee arthroplasty; Bisphosphonate-associated femoral fractures
Recurrence of back or leg pain after discectomy
is a well-recognised problem with an incidence of up to 28%. Once conservative
measures have failed, several surgical options are available and
have been tried with varying degrees of success. In this study,
42 patients with recurrent symptoms after discectomy underwent less
invasive posterior lumbar interbody fusion (LI-PLIF). Clinical outcome
was measured using the Oswestry Disability Index (ODI), Short Form
36 (SF-36) questionnaires and visual analogue scales for back (VAS-BP)
and leg pain (VAS-LP). There was a statistically significant improvement
in all outcome measures (p <
0.001). The debate around which
procedure is the most effective for these patients remains controversial. Our results show that LI-PLIF is as effective as any other surgical
procedure. However, given that it is less invasive, we feel that
it should be considered as the preferred option.
A total of 187 patients with primary osteoarthritis
(OA) of the knee undergoing total knee replacement (TKR) were randomly
divided into two groups, one of which underwent synovectomy. The
patients and assessors were blinded to the randomisation both before
and after surgery. The duration of surgery, hospitalisation period,
concealed bleeding, drainage volume, blood transfusion rate and
range of movement of the knee at three days after the operation
were analysed. Patients were followed up at four weeks and 12 months
after their operation, and a visual analogue score (VAS) for pain,
Knee Society score (KSS) and a patellar ballottement test were compared
between the groups. The mean amount of concealed bleeding was higher in the synovectomy
group compared with the control group (1.24 l (0.08 to 3.28) Cite this article:
To assess the effectiveness of a modified tibial tubercle osteotomy
as a treatment for arthroscopically diagnosed chondromalacia patellae. A total of 47 consecutive patients (51 knees) with arthroscopically
proven chondromalacia, who had failed conservative management, underwent
a modified Fulkerson tibial tubercle osteotomy. The mean age was
34.4 years (19.6 to 52.2). Pre-operatively, none of the patients
exhibited signs of patellar maltracking or instability in association
with their anterior knee pain. The minimum follow-up for the study
was five years (mean 72.6 months (62 to 118)), with only one patient
lost to follow-up.Objectives
Methods
The aim of this study was to determine the effect
of radial extracorporeal shock-wave therapy (rESWT) on patients with
chronic tendinitis of the rotator cuff. This was a randomised controlled
trial in which 82 patients (mean age 47 years (24 to 67)) with chronic
tendinitis diagnosed clinically were randomly allocated to a treatment
group who received low-dose rESWT (three sessions at an interval
10 to 14 days, 2000 pulses, 0.11 mJ/mm2, 8 Hz) or to
a placebo group, with a follow-up of six months. The patients and
the treating orthopaedic surgeon, who were both blinded to the treatment,
evaluated the results. A total of 44 patients were allocated to
the rESWT group and 38 patients to the placebo group. A visual analogue
scale (VAS) score for pain, a Constant–Murley (CMS) score and a simple
shoulder test (SST) score significantly improved in both groups
at three and six months compared with baseline (all p ≤ 0.012).
The mean VAS was similar in both groups at three (p = 0.43) and
six months (p = 0.262). Also, the mean CMS and SST scores were similar
in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or
improve function in patients chronic rotator cuff tendinitis compared
with placebo treatment. Cite this article:
We investigated the safety and efficacy of treating osteoporotic vertebral compression fractures with an intravertebral cleft by balloon kyphoplasty. Our study included 27 patients who were treated in this way. The mean follow-up was 38.2 months (24 to 54). The anterior and middle heights of the vertebral body and the kyphotic angle were measured on standing lateral radiographs before surgery, one day after surgery, and at final follow-up. Leakage of cement was determined by CT scans. A visual analogue scale and the Oswestry disability index were chosen to evaluate pain and functional activity. Statistically significant improvements were found between the pre- and post-operative assessments (p <
0.05) but not between the post-operative and final follow-up assessments (p >
0.05). Asymptomatic leakage of cement into the paravertebral vein occurred in one patient, as did leakage into the intervertebral disc in another patient. We suggest that balloon kyphoplasty is a safe and effective minimally invasive procedure for the treatment of osteoporotic vertebral compression fractures with an intravertebral cleft.
Minimal clinically important differences (MCID)
in the scores of patient-reported outcome measures allow clinicians to
assess the outcome of intervention from the perspective of the patient.
There has been significant variation in their absolute values in
previous publications and a lack of consistency in their calculation. The purpose of this study was first, to establish whether these
values, following spinal surgery, vary depending on the surgical
intervention and their method of calculation and secondly, to assess
whether there is any correlation between the two external anchors
most frequently used to calculate the MCID. We carried out a retrospective analysis of prospectively gathered
data of adult patients who underwent elective spinal surgery between
1994 and 2009. A total of 244 patients were included. There were
125 men and 119 women with a mean age of 54 years (16 to 84); the
mean follow-up was 62 months (6 to 199) The MCID was calculated
using three previously published methods. Our results show that the value of the MCID varies considerably
with the operation and its method of calculation. There was good
correlation between the two external anchors. The global outcome
tool correlated significantly better. We conclude that consensus needs to be reached on the best method
of calculating the MCID. This then needs to be defined for each
spinal procedure. Using a blanket value for the MCID for all spinal
procedures should be avoided. Cite this article:
We performed a systematic review and meta-analysis
of modern total ankle replacements (TARs) to determine the survivorship,
outcome, complications, radiological findings and range of movement,
in patients with end-stage osteoarthritis (OA) of the ankle who
undergo this procedure. We used the methodology of the Cochrane Collaboration,
which uses risk of bias profiling to assess the quality of papers
in favour of a domain-based approach. Continuous outcome scores
were pooled across studies using the generic inverse variance method
and the random-effects model was used to incorporate clinical and
methodological heterogeneity. We included 58 papers (7942 TARs)
with an interobserver reliability (Kappa) for selection, performance,
attrition, detection and reporting bias of between 0.83 and 0.98.
The overall survivorship was 89% at ten years with an annual failure
rate of 1.2% (95% confidence interval (CI) 0.7 to 1.6). The mean
American Orthopaedic Foot and Ankle Society score changed from 40 (95%
CI 36 to 43) pre-operatively to 80 (95% CI 76 to 84) at a mean follow-up
of 8.2 years (7 to 10) (p <
0.01). Radiolucencies were identified
in up to 23% of TARs after a mean of 4.4 years (2.3 to 9.6). The
mean total range of movement improved from 23° (95% CI 19 to 26)
to 34° (95% CI 26 to 41) (p = 0.01). Our study demonstrates that TAR has a positive impact on patients’
lives, with benefits lasting ten years, as judged by improvement
in pain and function, as well as improved gait and increased range
of movement. However, the quality of evidence is weak and fraught
with biases and high quality randomised controlled trials are required
to compare TAR with other forms of treatment such as fusion. Cite this article:
The treatment of osteochondral lesions is of
great interest to orthopaedic surgeons because most lesions do not heal
spontaneously. We present the short-term clinical outcome and MRI
findings of a cell-free scaffold used for the treatment of these
lesions in the knee. A total of 38 patients were prospectively evaluated
clinically for two years following treatment with an osteochondral
nanostructured biomimetic scaffold. There were 23 men and 15 women; the
mean age of the patients was 30.5 years (15 to 64). Clinical outcome
was assessed using the Knee Injury and Osteoarthritis Outcome Score
(KOOS), the Tegner activity scale and a Visual Analgue scale for
pain. MRI data were analysed based on the Magnetic Resonance Observation
of Cartilage Repair Tissue (MOCART) scoring system at three, 12
and 24 months post-operatively. There was a continuous significant
clinical improvement after surgery. In two patients, the scaffold
treatment failed (5.3%) There was a statistically significant improvement
in the MOCART precentage scores. The repair tissue filled most of
the defect sufficiently. We found subchondral laminar changes in all
patients. Intralesional osteophytes were found in two patients (5.3%).
We conclude that this one-step scaffold-based technique can be used
for osteochondral repair. The surgical technique is straightforward,
and the clinical results are promising. The MRI aspects of the repair
tissue continue to evolve during the first two years after surgery.
However, the subchondral laminar and bone changes are a concern. Cite this article:
We investigated the relationship between spinopelvic
parameters and disc degeneration in young adult patients with spondylolytic
spondylolisthesis. A total of 229 men with a mean age of 21 years
(18 to 26) with spondylolytic spondylolisthesis were identified.
All radiological measurements, including pelvic incidence, sacral
slope, pelvic tilt, lumbar lordosis, sacral inclination, lumbosacral
angle (LSA), and sacrofemoral distance, were calculated from standing
lateral lumbosacral radiographs. The degree of intervertebral disc
degeneration was classified using a modified Pfirrmann scale. We
analysed the spinopelvic parameters according to disc level, degree
of slip and disc degeneration. There were significant positive correlations between the degree
of slip and pelvic incidence (p = 0.009), sacral slope (p = 0.003)
and lumbar lordosis (p = 0.010). The degree of slip and the LSA
were correlated with disc degeneration (p <
0.001 and p = 0.003,
respectively). There was also a significant difference between the
degree of slip (p <
0.001) and LSA (p = 0.006) according to the
segmental level of disc degeneration. Cite this article: