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The Bone & Joint Journal
Vol. 100-B, Issue 1_Supple_A | Pages 62 - 67
1 Jan 2018
Bedard NA DeMik DE Dowdle SB Callaghan JJ

Aims

The purpose of this study was to evaluate trends in opioid use after unicompartmental knee arthroplasty (UKA), to identify predictors of prolonged use and to compare the rates of opioid use after UKA, total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Materials and Methods

We identified 4205 patients who had undergone UKA between 2007 and 2015 from the Humana Inc. administrative claims database. Post-operative opioid use for one year post-operatively was assessed using the rates of monthly repeat prescription. These were then compared between patients with and without a specific variable of interest and with those of patients who had undergone TKA and THA.


The Bone & Joint Journal
Vol. 98-B, Issue 3 | Pages 301 - 306
1 Mar 2016
Reidy MJ Faulkner A Shitole B Clift B

Aims

The long-term functional outcome of total hip arthroplasty (THA) performed by trainees is not known. A multicentre retrospective study of 879 THAs was undertaken to investigate any differences in outcome between those performed by trainee surgeons and consultants.

Patients and Methods

A total of 879 patients with a mean age of 69.5 years (37 to 94) were included in the study; 584 THAs (66.4%) were undertaken by consultants, 138 (15.7%) by junior trainees and 148 (16.8%) by senior trainees. Patients were scored using the Harris Hip Score (HHS) pre-operatively and at one, three, five, seven and ten years post-operatively. Surgical outcome, complications and survival were compared between groups. The effect of supervision was determined by comparing supervised and unsupervised trainees. A primary univariate analysis was used to select variables for inclusion in multivariate analysis.


The Bone & Joint Journal
Vol. 99-B, Issue 11 | Pages 1515 - 1519
1 Nov 2017
Saltzman BM Mayo BC Bohl DD Frank RM Cole BJ Verma NN Nicholson GP Romeo AA

Aims

To determine the incidence and timing of post-operative fevers following shoulder arthroplasty and the resulting investigations performed.

Patients and Methods

A retrospective review was conducted of all patients undergoing shoulder arthroplasty over a nine-year period. The charts of all patients with a post-operative fever (≥ 38.6°C) were reviewed and the results of all investigations were analysed.


Bone & Joint 360
Vol. 5, Issue 6 | Pages 27 - 29
1 Dec 2016


The Bone & Joint Journal
Vol. 98-B, Issue 3 | Pages 334 - 340
1 Mar 2016
Tayton ER Frampton C Hooper GJ Young SW

Aims

The aim of this study was to identify risk factors for prosthetic joint infection (PJI) following total knee arthroplasty (TKA).

Patients and Methods

The New Zealand Joint Registry database was analysed, using revision surgery for PJI at six and 12 months after surgery as primary outcome measures. Statistical associations between revision for infection, with common and definable surgical and patient factors were tested.


The Bone & Joint Journal
Vol. 99-B, Issue 2 | Pages 175 - 183
1 Feb 2017
Morita D Hasegawa Y Okura T Osawa Y Ishiguro N

Aims

Transtrochanteric rotational osteotomy (TRO) is performed for young patients with non-traumatic osteonecrosis of the femoral head (ONFH) to preserve the hip. We aimed to investigate the long-term outcomes and the risk factors for failure 15 years after this procedure.

Patients and Methods

This study included 95 patients (111 hips) with a mean age of 40 years (21 to 64) who underwent TRO for ONFH. The mean follow-up was 18.2 years (3 to 26). Kaplan–Meier survivorship analyses were performed with conversion to total hip arthroplasty (THA) and radiological failure due to secondary collapse of the femoral head or osteoarthritic changes as the endpoint. Multivariate analyses were performed to assess risk factors for each outcome.


Bone & Joint 360
Vol. 6, Issue 2 | Pages 10 - 13
1 Apr 2017


The Bone & Joint Journal
Vol. 99-B, Issue 9 | Pages 1190 - 1196
1 Sep 2017
Swarup I Henn CM Nguyen JT Dines DM Craig EV Warren RF Gulotta LV Henn III RF

Aims

Few studies have evaluated the relationship between patients’ pre-operative expectations and the outcome of orthopaedic procedures. Our aim was to determine the effect of expectations on the outcome after primary anatomical total shoulder arthroplasty (TSA). We hypothesised that patients with greater expectations would have better outcomes.

Patients and Methods

Patients undergoing primary anatomical TSA completed the Hospital for Special Surgery’s Shoulder Expectations Survey pre-operatively. The American Shoulder and Elbow Surgeons (ASES), Shoulder Activity Scale (SAS), Short-Form-36 (SF-36), and visual analogue scale (VAS) for pain, fatigue, and general health scores were also collected pre-operatively and two years post-operatively. Pearson correlations were used to assess the relationship between the number of expectations and the outcomes. Differences in outcomes between those with higher and lower levels of expectations for each expectation were assessed by independent samples t-test. Multivariable linear regression analysis was used to control for potential confounding factors.


The Bone & Joint Journal
Vol. 99-B, Issue 5 | Pages 702 - 704
1 May 2017
Haddad FS

Su EP Post-operative neuropathy after total hip arthroplasty. Bone Joint J 2017;99-B:(1 Supple A):46-49.


The Bone & Joint Journal
Vol. 98-B, Issue 11 | Pages 1526 - 1533
1 Nov 2016
van Tilburg CWJ Stronks DL Groeneweg JG Huygen FJPM

Aims

The aim of this study was to compare the effect of a percutaneous radiofrequency heat lesion at the medial branch of the primary dorsal ramus with a sham procedure, for the treatment of lumbar facet joint pain.

Patients and Methods

A randomised sham-controlled double blind multicentre trial was carried out at the multidisciplinary pain centres of two hospitals. A total of 60 patients aged > 18 years with a history and physical examination suggestive of facet joint pain and a decrease of ≥ 2 on a numerical rating scale (NRS 0 to 10) after a diagnostic facet joint test block were included. In the treatment group, a percutaneous radiofrequency heat lesion (80oC during 60 seconds per level) was applied to the medial branch of the primary dorsal ramus. In the sham group, the same procedure was undertaken without for the radiofrequency lesion. Both groups also received a graded activity physiotherapy programme. The primary outcome measure was decrease in pain. A secondary outcome measure was the Global Perceived Effect scale (GPE).


The Bone & Joint Journal
Vol. 99-B, Issue 8 | Pages 1012 - 1019
1 Aug 2017
Howard DP Wall PDH Fernandez MA Parsons H Howard PW

Aims

Ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA) are commonly used, but concerns exist regarding ceramic fracture. This study aims to report the risk of revision for fracture of modern CoC bearings and identify factors that might influence this risk, using data from the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man.

Patients and Methods

We analysed data on 223 362 bearings from 111 681 primary CoC THAs and 182 linked revisions for bearing fracture recorded in the NJR. We used implant codes to identify ceramic bearing composition and generated Kaplan-Meier estimates for implant survivorship. Logistic regression analyses were performed for implant size and patient specific variables to determine any associated risks for revision.


Bone & Joint 360
Vol. 6, Issue 3 | Pages 21 - 24
1 Jun 2017


The Bone & Joint Journal
Vol. 99-B, Issue 7 | Pages 865 - 871
1 Jul 2017
Amstutz HC Le Duff MJ Bhaurla SK

Aims

A contact patch to rim (CPR) distance of < 10 mm has been associated with edge-loading and excessive wear. However, not all arthroplasties with a low CPR distance show problems with wear. Therefore, CPR distance may not be the only variable affecting the post-operative metal ion concentrations.

Patients and Methods

We used multiple logistic regression to determine what variables differed between the patients who had high and low cobalt (CoS) and chromium (CrS) serum ion concentrations within a cohort of patients with low (< 10 mm) CPR distances. A total of 56 patients treated with unilateral hip resurfacing arthroplasty (HRA) had CoS and CrS ion studies performed more than one year after surgery. The mean age of the patients at the time of surgery was 51.7 years (29 to 70), with 38 women (68%) and 18 men (32%).


Bone & Joint 360
Vol. 6, Issue 6 | Pages 38 - 40
1 Dec 2017


The Bone & Joint Journal
Vol. 98-B, Issue 12 | Pages 1682 - 1688
1 Dec 2016
Ghazala CG Agni NR Ragbir M Dildey P Lee D Rankin KS Beckingsale TB Gerrand CH

Aims

Myxofibrosarcomas (MFSs) are malignant soft-tissue sarcomas characteristically presenting as painless slowly growing masses in the extremities. Locally infiltrative growth means that the risk of local recurrence is high. We reviewed our experience to make recommendations about resection strategies and the role of the multidisciplinary team in the management of these tumours.

Patients and Methods

Patients with a primary or recurrent MFS who were treated surgically in our unit between 1997 and 2012 were included in the study. Clinical records and imaging were reviewed. A total of 50 patients with a median age of 68.4 years (interquartile range 61.6 to 81.8) were included. There were 35 men; 49 underwent surgery in our unit.


Bone & Joint Research
Vol. 6, Issue 5 | Pages 337 - 344
1 May 2017
Kim J Hwang JY Oh JK Park MS Kim SW Chang H Kim T

Objectives

The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls.

Methods

Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups.


The Bone & Joint Journal
Vol. 97-B, Issue 5 | Pages 689 - 695
1 May 2015
Basques BA Bohl DD Golinvaux NS Samuel AM Grauer JG

The aim of this study was to compare the operating time, length of stay (LOS), adverse events and rate of re-admission for elderly patients with a fracture of the hip treated using either general or spinal anaesthesia. Patients aged ≥ 70 years who underwent surgery for a fracture of the hip between 2010 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Of the 9842 patients who met the inclusion criteria, 7253 (73.7%) were treated with general anaesthesia and 2589 (26.3%) with spinal anaesthesia. On propensity-adjusted multivariate analysis, general anaesthesia was associated with slightly increased operating time (+5 minutes, 95% confidence interval (CI) +4 to +6, p < 0.001) and post-operative time in the operating room (+5 minutes, 95% CI +2 to +8, p < 0.001) compared with spinal anaesthesia. General anaesthesia was associated with a shorter LOS (hazard ratio (HR) 1.28, 95% CI 1.22 to 1.34, p < 0.001). Any adverse event (odds ratio (OR) 1.21, 95% CI 1.10 to 1.32, p < 0.001), thromboembolic events (OR 1.90, 95% CI 1.24 to 2.89, p = 0.003), any minor adverse event (OR 1.19, 95% CI 1.09 to 1.32, p < 0.001), and blood transfusion (OR 1.34, 95% CI 1.22 to 1.49, p < 0.001) were associated with general anaesthesia. General anaesthesia was associated with decreased rates of urinary tract infection (OR 0.73, 95% CI 0.62 to 0.87, p < 0.001). There was no clear overall advantage of one type of anaesthesia over the other, and surgeons should be aware of the specific risks and benefits associated with each type.

Cite this article: Bone Joint J 2015; 97-B:689–95.


Bone & Joint 360
Vol. 6, Issue 6 | Pages 25 - 28
1 Dec 2017


The Bone & Joint Journal
Vol. 99-B, Issue 4 | Pages 538 - 543
1 Apr 2017
Laitinen MK Parry MC Albergo JI umathi VS Jeys LM Grimer RJ

Aims

The aim of the study was to investigate the controversial issue of whether the pelvic ring should be reconstructed following resection of the sarcomas of the ilium.

Patients and Methods

From our database, we identified 64 patients who underwent excision of a tumour involving the ilium between 1976 and 2015. A total of 35 underwent complete resection, of whom 24 were reconstructed with a non-vascularised fibula graft, and four with extracorporeal irradiation and reimplantation. A total of 29 patients had a partial resection. The mean follow-up was 9.2 years (1.1 to 25.6). Functional outcomes were assessed using the Toronto Extremity Salvation Score (TESS) at final follow-up.

In all, 32 patients (50%) had a chondrosarcoma.


Bone & Joint 360
Vol. 6, Issue 1 | Pages 19 - 21
1 Feb 2017