The treatment of osteonecrosis of the femoral head (FHN) is controversial. It mainly occurs in young patients in whom total hip replacement is best avoided because of an increased risk of revision. The objective of this long-term
The mucopolysaccharidoses (MPS) are a group of
inherited lysosomal storage disorders with clinical manifestations relevant
to the orthopaedic surgeon. Our aim was to review the recent advances
in their management and the implications for surgical practice. The current literature about MPSs is summarised, emphasising
orthopaedic complications and their management. Recent advances in the diagnosis and management of MPSs include
the recognition of slowly progressive, late presenting subtypes,
developments in life-prolonging systemic treatment and potentially
new indications for surgical treatment. The outcomes of surgery
in these patients are not yet validated and some procedures have
a high rate of complications which differ from those in patients
who do not have a MPS. The diagnosis of a MPS should be considered in adolescents or
young adults with a previously unrecognised dysplasia of the hip.
Surgeons treating patients with a MPS should report their experience
and studies should include the assessment of function and quality
of life to guide treatment. Cite this article:
In a series of seventeen patients with unilateral osteoarthritis of the hip a scintiscanning
1. Stainless steel mould arthroplasty of the knee is described and a ten-year
This study assessed the association of classes of body mass index
in kg/m2 (classified as normal weight 18.5 kg/m2 to
24.9 kg/m2, overweight 25.0 kg/m2 to 29.9
kg/m2, and obese ≥ 30.0 kg/m2) with short-term
complications and functional outcomes three to six years post-operatively
for closed ankle fractures. We performed a historical cohort study with chart review of 1011
patients who were treated for ankle fractures by open reduction
and internal fixation in two hospitals, with a follow-up postal
survey of 959 of the patients using three functional outcome scores.Aims
Patients and Methods
We reviewed the records of 1257 patients having 1625 total knee arthroplasties; all had pre-operative and postoperative perfusion lung scans and postoperative venograms which were classified as showing no thrombi, calf thrombi or proximal thrombi. Patients with calf thrombi were found to have a significantly greater risk for both symptomatic and asymptomatic pulmonary embolism compared with patients with no venographic thrombi. There were positive lung scans in 6.9% of patients with calf thrombi compared with 2.0% of patients with negative venograms (p <
0.001). Symptomatic pulmonary embolism occurred in 1.6% of patients with calf thrombi compared with 0.2% of patients with negative venograms (p = 0.034). The risk of pulmonary embolism was not significantly different between patients with treated proximal thrombi, and those with calf thrombi. Patients who develop deep-vein thrombosis despite prophylaxis are at increased risk for pulmonary embolism; these patients should receive treatment, or undergo
The aim of this prospective randomised study was to compare the
time course of clinical improvement during the first two years following
a closing or opening wedge high tibial osteotomy (HTO). It was hypothesised
that there would be no differences in clinical outcome between the
two techniques. Between 2007 and 2013, 70 consecutive patients were randomly
allocated to undergo either a closing or opening wedge HTO. All
patients had medial compartment osteoarthritis (OA), and were aged
between 30 years and 60 years. They were evaluated by independent
investigators pre-operatively and at three and six months, and one
and two years post-operatively using the Knee Injury and Osteoarthritis
Outcome Score (KOOS), the Oxford Knee Score (OKS), the Lysholm score,
the Tegner activity score, the University of California, Los Angeles
(UCLA) activity scale and range of movement (ROM).Aims
Patients and Methods
A
1. Experimental evidence suggests that the autogenous graft exhibits some advantage over refrigerated homogenous grafts in that healing takes place more rapidly but that in the end the results are the same. 2. Histological study of fragments of healing grafts, both autogenous and refrigerated, that have been removed from human hosts shows no significant difference in the rate or method of repair. 3. Study of the clinical results of the use of homogenous transplants in 307 operations shows the bone to be well tolerated. The rate of infection in clean cases was 2·6 per cent; loss of bone occurred in only two cases. 4.
The aims of this study were to determine the cumulative ten-year
survivorship of hips treated for acetabular fractures using surgical
hip dislocation and to identify factors predictive of an unfavourable
outcome. We followed up 60 consecutive patients (61 hips; mean age 36.3
years, standard deviation (Aims
Patients and Methods
We assessed the outcome of patients who were
lost to follow-up after arthroplasty by a single surgeon. The aim was
to validate the surgeon’s data set with the Australian Orthopaedic
Association National Joint Replacement Registry and determine the
outcome of those patients lost to follow-up. Prospective data on patient demographics, operative details and
outcomes of the surgeon’s 1192 primary unicompartmental knee arthroplasty
(UKA) procedures were analysed. There were 69 knees in patients
who were lost to follow-up, among whom the Registry identified 31
deaths and eight revisions. The cumulative percentage revision (CPR) at seven years using
the additional Registry data was 8.8% (95% confidence interval (CI)
7 to 11). Using the surgeon’s data, the CPR at seven years was 8%
(95% CI 6.3 to 10.1) for the best-case scenario where loss to follow-up
was excluded, and 16% (95% CI 13.8 to 19.4) for the worst-case scenario, where
all patients lost to follow-up were deemed to have been revised.
There was a significantly higher mortality rate in those patients
lost to
We report on the outcome of the Synergy cementless femoral stem
with a minimum follow-up of 15 years (15 to 17). A retrospective review was undertaken of a consecutive series
of 112 routine primary cementless total hip arthroplasties (THAs)
in 102 patients (112 hips). There were 60 female and 42 male patients
with a mean age of 61 years (18 to 82) at the time of surgery. A
total of 78 hips in the 69 patients remain Aims
Patients and Methods
The PROximal Fracture of the Humerus Evaluation by Randomisation
(PROFHER) randomised clinical trial compared the operative and non-operative
treatment of adults with a displaced fracture of the proximal humerus
involving the surgical neck. The aim of this study was to determine
the long-term treatment effects beyond the two-year follow-up. Of the original 250 trial participants, 176 consented to extended
follow-up and were sent postal questionnaires at three, four and
five years after recruitment to the trial. The Oxford Shoulder Score
(OSS; the primary outcome), EuroQol 5D-3L (EQ-5D-3L), and any recent
shoulder operations and fracture data were collected. Statistical
and economic analyses, consistent with those of the main trial were
applied.Aims
Patients and Methods
To evaluate the hypothesis that failed osteosynthesis of periprosthetic
Vancouver type B1 fractures can be treated successfully with stem
revision using a transfemoral approach and a cementless, modular,
tapered revision stem with reproducible rates of fracture healing,
stability of the revision stem, and clinically good results. A total of 14 patients (11 women, three men) with a mean age
of 72.4 years (65 to 90) undergoing revision hip arthroplasty after
failed osteosynthesis of periprosthetic fractures of Vancouver type
B1 were treated using a transfemoral approach to remove the well-fixed
stem before insertion of a modular, fluted titanium stem which obtained
distal fixation. These patients were clinically and radiologically
followed up for a mean 52.2 months (24 to 144).Aims
Patients and Methods
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