We have examined the
The aims of this study were to establish the incidence of acute
Achilles tendon rupture (AATR) in a North American population, to
select demographic subgroups and to examine trends in the management
of this injury in the province of Ontario, Canada. Patients ≥ 18 years of age who presented with an AATR to an emergency
department in Ontario, Canada between 1 January 2003 and 31 December
2013 were identified using administrative databases. The overall
and annual incidence density rate (IDR) of AATR were calculated
for all demographic subgroups. The annual rate of surgical repair
was also calculated and compared between demographic subgroups.Aims
Patients and Methods
We evaluated the construct validity of the Musculoskeletal Tumour Society rating scale (Enneking score) as a functional measure for patients with sarcoma involving the upper limb. We compared the Enneking score by examining the correlation between two patient-derived
We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice.Objectives
Methods
The aim of this study was to compare the design of the generic
OptiStem XTR femoral stem with the established Exeter femoral stem. We obtained five boxed, as manufactured, implants of both designs
at random (ten in total). Two examiners were blinded to the implant
design and independently measured the mass, volume, trunnion surface
topography, trunnion roughness, trunnion cone angle, Caput-Collum-Diaphyseal
(CCD) angle, femoral offset, stem length, neck length, and the width
and roughness of the polished stem shaft using peer-reviewed methods.
We then compared the stems using these parameters.Aims
Materials and Methods
Nerve palsy is a well-described complication
following total hip arthroplasty, but is highly distressing and
disabling. A nerve palsy may cause difficulty with the post-operative
rehabilitation, and overall mobility of the patient. Nerve palsy
may result from compression and tension to the affected nerve(s)
during the course of the operation via surgical manipulation and
retractor placement, tension from limb lengthening or compression
from post-operative hematoma. In the literature, hip dysplasia,
lengthening of the leg, the use of an uncemented femoral component, and
female gender are associated with a greater risk of nerve palsy.
We examined our experience at a high-volume, tertiary care referral
centre, and found an overall incidence of 0.3% out of 39 056 primary
hip arthroplasties. Risk factors found to be associated with the
incidence of nerve palsy at our institution included the presence
of spinal stenosis or lumbar disc disease, age younger than 50,
and smoking. If a nerve palsy is diagnosed, imaging is mandatory
and surgical evacuation or compressive haematomas may be beneficial.
As palsies are slow to recover, supportive care such as bracing,
therapy, and reassurance are the mainstays of treatment. Cite this article:
Valgus knee deformity can present a number of
unique surgical challenges for the total knee arthroplasty (TKA)
surgeon. Understanding the typical patterns of bone and soft-tissue pathology
in the valgus arthritic knee is critical for appropriate surgical
planning. This review aims to provide the knee arthroplasty surgeon
with an understanding of surgical management strategies for the
treatment of valgus knee arthritis. Lateral femoral and tibial deficiencies, contracted lateral soft
tissues, attenuated medial soft tissues, and multiplanar deformities
may all be present in the valgus arthritic knee. A number of classifications
have been reported in order to guide surgical management, and a variety
of surgical strategies have been described with satisfactory clinical
results. Depending on the severity of the deformity, a variety of
TKA implant designs may be appropriate for use. Regardless of an operating surgeon’s preferred surgical strategy,
adherence to a step-wise approach to deformity correction is advised. Cite this article:
We report our experience of the use of callus distraction with a monolateral fixator for the treatment of acquired radial club-hand deformity after osteomyelitis. Between 1994 and 2004, 13 patients with a mean age of eight years (4 to 15) were treated by callus distraction with a monolateral fixator after a preliminary period of at least four weeks in a corrective short-arm cast. All patients achieved bony union and were satisfied with the functional and cosmetic
Joint-preserving surgery of the hip (JPSH) has evolved considerably
and now includes a number of procedures, including arthroscopy,
surgical dislocation, and redirectional osteotomies of the femur
and acetabulum. There are a number of different factors which lead
to failure of JPSH. Consequently, it is of interest to assess the
various modes of failure in order to continue to identify best practice
and the indications for these procedures. Using a retrospective observational study design, we reviewed
1013 patients who had undergone JPSH by a single surgeon between
2005 and 2015. There were 509 men and 504 women with a mean age
of 39 years (16 to 78). Of the 1013 operations, 783 were arthroscopies,
122 surgical dislocations, and 108 peri-acetabular osteotomies (PAO).
We analysed the overall failure rates and modes of failure. Re-operations
were categorised into four groups: Mode 1 was arthritis progression
or organ failure leading to total hip arthroplasty (THA); Mode 2
was an Incorrect diagnosis/procedure; Mode 3 resulted from malcorrection
of femur (type A), acetabulum (type B), or labrum (type C) and Mode 4
resulted from an unintended consequence of the initial surgical
intervention.Aims
Patients and Methods
The aim of this study was to investigate the effect of granulocyte-colony stimulating factor (G-CSF) on mesenchymal stem cell (MSC) proliferation MSCs from rabbits were cultured in a control medium and medium with G-CSF (low-dose: 4 μg, high-dose: 40 μg). At one, three, and five days after culturing, cells were counted. Differential potential of cultured cells were examined by stimulating them with a osteogenic, adipogenic and chondrogenic medium. A total of 30 rabbits were divided into three groups. The low-dose group (n = 10) received 10 μg/kg of G-CSF daily, the high-dose group (n = 10) received 50 μg/kg daily by subcutaneous injection for three days prior to creating cartilage defects. The control group (n = 10) was administered saline for three days. At 48 hours after the first injection, a 5.2 mm diameter cylindrical osteochondral defect was created in the femoral trochlea. At four and 12 weeks post-operatively, repaired tissue was evaluated macroscopically and microscopically.Objectives
Methods
The Intraosseous Transcutaneous Amputation Prosthesis (ITAP)
may improve quality of life for amputees by avoiding soft-tissue
complications associated with socket prostheses and by improving
sensory feedback and function. It relies on the formation of a seal
between the soft tissues and the implant and currently has a flange
with drilled holes to promote dermal attachment. Despite this, infection
remains a significant risk. This study explored alternative strategies
to enhance soft-tissue integration. The effect of ITAP pins with a fully porous titanium alloy flange
with interconnected pores on soft-tissue integration was investigated.
The flanges were coated with fibronectin-functionalised hydroxyapatite
and silver coatings, which have been shown to have an antibacterial
effect, while also promoting viable fibroblast growth Aims
Materials and Methods
The best time for definitive orthopaedic care is often unclear
in patients with multiple injuries. The objective of this study
was make a prospective assessment of the safety of our early appropriate
care (EAC) strategy and to evaluate the potential benefit of additional
laboratory data to determine readiness for surgery. A cohort of 335 patients with fractures of the pelvis, acetabulum,
femur, or spine were included. Patients underwent definitive fixation
within 36 hours if one of the following three parameters were met:
lactate <
4.0 mmol/L; pH ≥ 7.25; or base excess (BE) ≥ -5.5 mmol/L.
If all three parameters were met, resuscitation was designated full
protocol resuscitation (FPR). If less than all three parameters
were met, it was designated an incomplete protocol resuscitation
(IPR). Complications were assessed by an independent adjudication
committee and included infection; sepsis; PE/DVT; organ failure;
pneumonia, and acute respiratory distress syndrome (ARDS). Aims
Patients and Methods
This review summarises the technique of impaction
grafting with mesh augmentation for the treatment of uncontained
acetabular defects in revision hip arthroplasty. The ideal acetabular revision should restore bone stock, use
a small socket in the near-anatomic position, and provide durable
fixation. Impaction bone grafting, which has been in use for over
40 years, offers the ability to achieve these goals in uncontained
defects. The precepts of modern, revision impaction grafting are
that the segmental or cavitary defects must be supported with a
mesh; the contained cavity is filled with vigorously impacted morselised
fresh-frozen allograft; and finally, acrylic cement is used to stabilise
the graft and provide rigid, long-lasting fixation of the revised
acetabular component. Favourable results have been published with this technique. While
having its limitations, it is a viable option to address large acetabular
defects in revision arthroplasty. Cite this article:
We have reviewed the data from our regional Bone Tumour Registry on patients with osteosarcoma diagnosed between 1933 and 2004 in order to investigate the relationship between survival and changes in treatment. There were 184 patients with non-metastatic appendicular osteosarcoma diagnosed at the age of 18 or under. Survival was calculated using Kaplan-Meier curves, and multivariate analysis was performed using the Cox regression proportional hazards model. The five-year survival improved from 21% between 1933 and 1959, to 62% between 1990 and 1999. During this time, a multi-disciplinary organisation was gradually developed to manage treatment. The most significant variable affecting
We describe the survivorship of the Medial Rotation total knee replacement (TKR) at ten years in 228 cemented primary replacements implanted between October 1994 and October 2006, with their clinical and radiological
The last decade has seen a considerable increase
in the use of in total ankle arthroplasty (TAA) to treat patients
with end-stage arthritis of the ankle. However, the longevity of
the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment
algorithm for the painful TAA to be used when considering revision
surgery. Cite this article:
When the Bernese periacetabular osteotomy is performed through an anterior approach, the ischial and retroacetabular osteotomies and manual fracture of the incompletely osteotomised ischium are conducted with an incomplete view resulting in increased risk and morbidity. We have assessed the dual anteroposterior approach which appears to address this deficiency. We compared the results of the Bernese periacetabular osteotomy performed in 11 patients (13 osteotomies) through a single anterior approach with those in 12 patients (13 osteotomies) in whom the procedure was carried out through a dual anteroposterior approach. The estimated blood loss, the length of anaesthesia, duration of surgery and radiological parameters were measured. The mean operative time and length of anaesthesia were not significantly different in the two groups (p = 0.781 and p = 0.698, respectively). The radiological parameters improved to a similar extent in both groups after the operation but there was significantly less blood loss in the dual osteotomy group (p = 0.034). The dual anteroposterior approach provides a direct view of the retroacetabular and ischial parts of the osteotomy, within a reasonable operating time and with minimal blood loss and gives a satisfactory
This study reports our experience with total elbow replacement for fused elbows. Between 1982 and 2004, 13 patients with spontaneously ankylosed elbows were treated with a linked semi-constrained non-custom total elbow implant. The mean age at operation was 54 years (24 to 80). The stiffness was a result of trauma in ten elbows, juvenile rheumatoid arthritis in one, and rheumatoid arthritis in two. The patients were followed for a mean of 12 years (2 to 26) and were evaluated clinically using the Mayo Elbow Performance Score, as well as radiologically. A mean arc from 37° of extension to 118° of flexion was achieved. Outcomes were good or excellent for seven elbows at final review. Ten patients felt better or much better after total elbow replacement. However, there was a high complication rate and re-operation was required in over half of patients. Two developed peri-operative soft-tissue breakdown requiring debridement. A muscle flap with skin grafting was used for soft-tissue cover in one. Revision was undertaken in one elbow following fracture of the ulnar component. Three patients developed a deep infection. Three elbows were manipulated under anaesthesia for post-operative stiffness. Prophylactic measures for heterotopic ossification were unsuccessful. Total elbow replacement for the ankylosed elbow should be performed with caution. However, the
The type II Monteggia (posterior) lesion is a rare injury which is sometimes associated with ulnohumeral instability. We have reviewed 23 of 28 patients with this injury. A clinical and radiographic assessment was undertaken at follow-up. Functional outcome scores, including the Broberg and Morrey Index and the Disabilities of the Arm, Shoulder or Hand (DASH), were used. The results from the six patients with associated posterior ulnohumeral dislocation were compared with 17 without ulnohumeral injury. Those with dislocation had reduced movement of the elbow and had