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:
Fractures of the tibial shaft are common injuries,
but there are no long-term outcome data in the era of increased surgical
management. The aim of this prospective study was to assess the
clinical and functional outcome of this injury at 12 to 22 years.
Secondary aims were to determine the short- and long-term mortality,
and if there were any predictors of clinical or functional outcome
or mortality. From a prospective trauma database of 1502 tibial
shaft fractures in 1474 consecutive adult patients, we identified
a cohort of 1431 tibial diaphyseal fractures in 1403 patients, who
fitted our inclusion criteria. There were 1024 men, and mean age
at injury was 40.6 years. Fractures were classified according to
the AO system, and open fractures graded after Gustilo and Anderson.
Requirement of fasciotomy, time to fracture union, complications,
incidence of knee and ankle pain at long-term follow-up, changes in
employment and the patients’ social deprivation status were recorded.
Function was assessed at 12 to 22 years post-injury using the Short
Musculoskeletal Function Assessment and short form-12 questionnaires.
Long-term functional outcome data was available for 568 of the surviving
patients, 389 were deceased and 346 were lost to follow-up. Most
fractures (90.7%, n = 1363) united without further intervention.
Fasciotomies were performed in 11.5% of patients; this did not correlate
with poorer functional outcome in the long term. Social deprivation
was associated with a higher incidence of injury but had no impact
on long-term function. The one-year mortality in those over 75 years
of age was 29 (42%). At long-term follow-up, pain and function scores
were good. However, 147 (26%) reported ongoing knee pain, 62 (10%)
reported ankle pain and 97 (17%) reported both. Such joint pain correlated
with poorer functional outcome. Cite this article:
Knee joint distraction (KJD) is a relatively new, knee-joint
preserving procedure with the goal of delaying total knee arthroplasty
(TKA) in young and middle-aged patients. We present a randomised
controlled trial comparing the two. The 60 patients ≤ 65 years with end-stage knee osteoarthritis
were randomised to either KJD (n = 20) or TKA (n = 40). Outcomes
were assessed at baseline, three, six, nine, and 12 months. In the
KJD group, the joint space width (JSW) was radiologically assessed,
representing a surrogate marker of cartilage thickness.Aims
Patients and Methods
Periacetabular osteotomy is an effective way of treating symptomatic
hip dysplasia. We describe a new minimally invasive technique using
a modification of the Smith-Peterson approach. We performed a prospective, longitudinal cohort study to assess
for any compromise in acetabular correction when using this approach,
and to see if the procedure would have a higher complication rate
than that quoted in the literature for other approaches. We also
assessed for any improvement in functional outcome. From 168 consecutive patients (189 hips) who underwent acetabular
correction between March 2010 and March 2013 we excluded those who
had undergone previous pelvic surgery for DDH and those being treated
for acetabular retroversion. The remaining 151 patients (15 men,
136 women) (166 hips) had a mean age of 32 years (15 to 56) and the
mean duration of follow-up was 2.8 years (1.2 to 4.5). In all 90%
of cases were Tönnis grade 0 or 1. Functional outcomes were assessed
using the Non Arthritic Hip Score (NAHS), University of California,
Los Angeles (UCLA) and Tegner activity scores.Aims
Patients and Methods
The aim of this study was to systematically review the literature on measurement of muscle strength in patients with femoroacetabular impingement (FAI) and other pathologies and to suggest guidelines to standardise protocols for future research in the field. The Cochrane and PubMed libraries were searched for any publications using the terms ‘hip’, ‘muscle’, ‘strength’, and ‘measurement’ in the ‘Title, Abstract, Keywords’ field. A further search was performed using the terms ‘femoroacetabular’ or ‘impingement’. The search was limited to recent literature only.Objectives
Methods
Patellar instability most frequently presents
during adolescence. Congenital and infantile dislocation of the
patella is a distinct entity from adolescent instability and measurable
abnormalities may be present at birth. In the normal patellofemoral
joint an increase in quadriceps angle and patellar height are matched
by an increase in trochlear depth as the joint matures. Adolescent
instability may herald a lifelong condition leading to chronic disability
and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer
or medial patellofemoral ligament (MPFL) reconstruction in the young
adult prevents further instability. Although these techniques are
proven in the young adult, they may cause growth arrest and deformity
where the physis is open. A vigorous non-operative strategy may
permit delay of surgery until growth is complete. Where non-operative
treatment has failed a modified MPFL reconstruction may be performed
to maintain stability until physeal closure permits anatomical reconstruction.
If significant growth remains an extraosseous reconstruction of
the MPFL may impart the lowest risk to the physis. If minor growth
remains image intensifier guided placement of femoral intraosseous
fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to
adolescent instability and provides a framework for management of
these patients. 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:
The ideal treatment for traumatic anterior dislocation
of the shoulder in the skeletally immature patient is controversial.
The aim of this study is to evaluate the outcomes after either conservative
and/or surgical treatment using the Latarjet technique. A retrospective
series of 49 out of 80 patients were reviewed. We found no significant differences
between either treatment method regarding functional scores and
pain levels. Although not statistically significant, post-surgical
patients showed better signs of shoulder stability than others who
have a higher rate of recurrence. Further, 92% of the post-surgical
group had returned to the same level of activity Cite this article:
The fundamental concept of open reduction and internal fixation
(ORIF) of ankle fractures has not changed appreciably since the
1960s and, whilst widely used, is associated with complications
including wound dehiscence and infection, prominent hardware and
failure. Closed reduction and intramedullary fixation (CRIF) using
a fibular nail, wires or screws is biomechanically stronger, requires
minimal incisions, and has low-profile hardware. We hypothesised
that fibular nailing in the elderly would have similar functional
outcomes to standard fixation, with a reduced rate of wound and
hardware problems. A total of 100 patients (25 men, 75 women) over the age of 65
years with unstable ankle fractures were randomised to undergo standard
ORIF or fibular nailing (11 men and 39 women in the ORIF group,
14 men and 36 women in the fibular nail group). The mean age was
74 years (65 to 93) and all patients had at least one medical comorbidity. Complications,
patient related outcome measures and cost-effectiveness were assessed
over 12 months.Aims
Patients and Methods
The purpose of this study was to determine patient-reported
outcomes of patients with mild to moderate developmental dysplasia
of the hip (DDH) and femoroacetabular impingement (FAI) undergoing
arthroscopy of the hip in the treatment of chondrolabral pathology.
A total of 28 patients with a centre-edge angle between 15° and
19° were identified from an institutional database. Their mean age
was 34 years (18 to 53), with 12 female and 16 male patients. All
underwent labral treatment and concomitant correction of FAI. There
were nine reoperations, with two patients requiring revision arthroscopy,
two requiring periacetabular osteotomy and five needing total hip arthroplasty. Patients who required further major surgery were more likely
to be older, male, and to have more severe DDH with a larger alpha
angle and decreased joint space. At a mean follow-up of 42 months (24 to 89), the mean modified
Harris hip score improved from 59 (20 to 98) to 82 (45 to 100; p
<
0.001). The mean Western Ontario and McMaster Universities
Osteoarthritis Index score improved from 30 (1 to 61) to 16 (0 to
43; p <
0.001). Median patient satisfaction was 9.0/10 (1 to
10). Patients reported excellent improvement in function following
arthroscopy of the hip. This study shows that with proper patient selection, arthroscopy
of the hip can be successful in the young patient with mild to moderate
DDH and FAI. Cite this article:
The aim of the current study was to assess whether calcaneal broadband ultrasound attenuation (BUA) can predict whole body and regional dual-energy x-ray absorptiometry (DXA)-derived bone mass in healthy, Australian children and adolescents at different stages of maturity. A total of 389 boys and girls across a wide age range (four to 18 years) volunteered to participate. The estimated age of peak height velocity (APHV) was used to classify children into pre-, peri-, and post-APHV groups. BUA was measured at the non-dominant heel with quantitative ultrasonometry (QUS) (Lunar Achilles Insight, GE), while bone mineral density (BMD) and bone mineral content (BMC) were examined at the femoral neck, lumbar spine and whole body (DXA, XR-800, Norland). Associations between BUA and DXA-derived measures were examined with Pearson correlations and linear regression. Participants were additionally ranked in quartiles for QUS and DXA measures in order to determine agreement in rankings.Objectives
Methods
The routine use of patient reported outcome measures
(PROMs) in evaluating the outcome after arthroplasty by healthcare
organisations reflects a growing recognition of the importance of
patients’ perspectives in improving treatment. Although widely embraced
in the NHS, there are concerns that PROMs are being used beyond
their means due to a poor understanding of their limitations. This paper reviews some of the current challenges in using PROMs
to evaluate total knee arthroplasty. It highlights alternative methods
that have been used to improve the assessment of outcome. Cite this article:
We performed a retrospective, comparative study of elderly patients
with an increased risk from anaesthesia who had undergone either
anterior screw fixation (ASF) or halo vest immobilisation (HVI)
for a type II odontoid fracture. A total of 80 patients aged 65 years or more who had undergone
either ASF or HVI for a type II odontoid fracture between 1988 and
2013 were reviewed. There were 47 women and 33 men with a mean age
of 73 (65 to 96; standard deviation 7). All had an American Society
of Anesthesiologists score of 2 or more.Aims
Patients and Methods
The Advance Medial-Pivot total knee arthroplasty (TKA) was designed
to reflect contemporary data regarding the kinematics of the knee.
We wished to examine the long-term results obtained with this prosthesis
by extending a previous evaluation. We retrospectively evaluated prospectively collected data from
225 consecutive patients (41 men and 184 women; mean age at surgery
71 years, 52 to 84) who underwent 284 TKAs with a mean follow-up
of 13.4 years (11 to 15). Implant failure, complication rate, clinical (both
subjective and objective) and radiological outcome were assessed.
Pre- and post-operative clinical and radiographic data were available
at regular intervals for all patients. A total of ten patients (4.4%;
ten TKAs) were lost to follow-up.Aims
Patients and Methods
The December 2014 Spine Roundup360 looks at: surgeon outcomes; complications and scoliosis surgery; is sequestrectomy enough in lumbar disc prolapse?; predicting outcomes in lumbar disc herniation; sympathectomy has a direct effect on the dorsal root ganglion; and distal extensions of fusion in adolescent idiopathic scoliosis.
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:
