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
The primary purpose of this meta-analysis was to determine whether statin usage could reduce the risk of glucocorticoid-related osteonecrosis in animal models. A systematic literature search up to May 2015 was carried out using the PubMed, Ovid, EBM reviews, ISI Web of Science, EBSCO, CBM, CNKI databases with the term and boolean operators: statins and osteonecrosis in all fields. Risk ratio (RR), as the risk estimate of specific outcome, was calculated along with 95% confidence intervals (CI). The methodological quality of individual studies was assessed using a quantitative tool based on the updated Stroke Therapy Academic Industry Roundtable (STAIR) recommendations.Objectives
Methods
Surgeons face a substantial risk of infection because of the occupational exposure to blood-borne pathogens (BBPs) from patients undergoing high-risk orthopaedic procedures. This study aimed to determine the seroprevalence of four BBPs among patients undergoing joint arthroplasty in Shanghai, China. In addition, we evaluated the significance of pre-operative screening by calculating a cost-to-benefit ratio. A retrospective observational study of pre-operative screening for BBPs, including hepatitis B and C viruses (HBV and HCV), human immunodeficiency virus (HIV) and Treponema pallidum (TP), was conducted for sequential patients in the orthopaedic department of a large urban teaching hospital between 01 January 2009 and 30 May 2016. Medical records were analysed to verify the seroprevalence of these BBPs among the patients stratified by age, gender, local origin, type of surgery, history of previous transfusion and marital status.Objectives
Methods
Mesenchymal stem cells have the ability to differentiate into various cell types, and thus have emerged as promising alternatives to chondrocytes in cell-based cartilage repair methods. The aim of this experimental study was to investigate the effect of bone marrow derived mesenchymal stem cells combined with platelet rich fibrin on osteochondral defect repair and articular cartilage regeneration in a canine model. Osteochondral defects were created on the medial femoral condyles of 12 adult male mixed breed dogs. They were either treated with stem cells seeded on platelet rich fibrin or left empty. Macroscopic and histological evaluation of the repair tissue was conducted after four, 16 and 24 weeks using the International Cartilage Repair Society macroscopic and the O’Driscoll histological grading systems. Results were reported as mean and standard deviation (Objectives
Methods
To evaluate the outcomes of cemented total hip arthroplasty (THA)
following a fracture of the acetabulum, with evaluation of risk
factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of
57 years (25 to 87) underwent cemented THA at a mean of 6.5 years
(0.1 to 25) following acetabular fracture. A total of 38 had undergone
surgical fixation and 11 had been treated non-operatively; 13 patients
died at a mean of 10.2 years after THA (0.6 to 19). Patients were
assessed pre-operatively, at one year and at final follow-up (mean
9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant
survivorship was assessed. An age and gender-matched cohort of THAs
performed for non-traumatic osteoarthritis (OA) or avascular necrosis
(AVN) (n = 98) were used to compare complications and patient-reported outcome
measures (PROMs).Aims
Patients and Methods
Using a systematic review, we investigated whether there is an
increased risk of post-operative infection in patients who have
received an intra-articular corticosteroid injection to the hip
for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection
to the hip and infection following subsequent THA were identified
from databases for the period between 1990 to 2013. Retrieved articles
were independently assessed for their methodological quality.Aims
Methods
The injured anterior cruciate ligament (ACL) is thought to exhibit an impaired healing response, and attempts at surgical repair have not been successful. Connective tissue growth factor (CTGF) is reported to be associated with wound healing, probably through transforming growth factor beta 1 (TGF-β1). A rabbit ACL injury model was used to study the effect of CTGF on ligament recovery. Quantitative real-time PCR (qRT-PCR) was performed for detection of changes in RNA levels of TGF-β1, type 1 collagen (COL1), type 2 collagen (COL2), SRY-related high mobility group-box gene9 (SOX9), tissue inhibitor of metalloproteinase-1 (TIMP-1) and matrix metallopeptidase 13 (MMP-13). Expression of related proteins was detected by Western blotting.Objectives
Methods
The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures. Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared.Objectives
Methods
Hip hemiarthroplasty is a standard treatment for intracapsular
proximal femoral fractures in the frail elderly. In this study we
have explored the implications of early return to theatre, within
30 days, on patient outcome following hip hemiarthroplasty. We retrospectively reviewed the hospital records of all hip hemiarthroplasties
performed in our unit between January 2010 and January 2015. Demographic
details, medical backround, details of the primary procedure, complications,
subsequent procedures requiring return to theatre, re-admissions,
discharge destination and death were collected.Aims
Patients and Methods
This study investigated whether the use of tranexamic acid (TXA)
decreased blood loss and transfusion related cost following surface
replacement arthroplasty (SRA). A retrospective review of patients treated with TXA during a
SRA, who did not receive autologous blood (TXA group) was performed.
Two comparison groups were established; the first group comprised
of patients who donated their own blood pre-operatively (auto group)
and the second of patients who did not donate blood pre-operatively
(control). Outcomes included transfusions, post-operative haemoglobin
(Hgb), complications, and length of post-operative stay. Aims
Methods
To compare the structural durability of hydroxyapatite-tricalcium
phosphate (HATCP) to autologous iliac crest bone graft in calcaneal
lengthening osteotomy (CLO) for pes planovalgus in childhood. We present the interim results of ten patients (HATCP, n = 6
and autograft, n = 5) with a mean age of 11.5 years (8.2 to 14.2)
from a randomised controlled non-inferiority trial with six months
follow-up. The primary outcome was the stability of the osteotomy
as measured by radiostereometric analysis. A non-inferiority margin
of ≤ 2 mm osteotomy compression was set.Aims
Patients and Methods
Osteoporosis has become an increasing concern for older people as it may potentially lead to osteoporotic fractures. This study is designed to assess the efficacy and safety of ten therapies for post-menopausal women using network meta-analysis. We conducted a systematic search in several databases, including PubMed and Embase. A random-effects model was employed and results were assessed by the odds ratio (OR) and corresponding 95% confidence intervals (CI). Furthermore, with respect to each outcome, each intervention was ranked according to the surface under the cumulative ranking curve (SUCRA) value.Objectives
Methods
Pelvic reconstruction after the resection of a tumour around
the acetabulum is a challenging procedure due to the complex anatomy
and biomechanics. Several pelvic endoprostheses have been introduced,
but the rates of complication remain high. Our aim was to review
the use of a stemmed acetabular pedestal cup in the management of
these patients. The study involved 48 patients who underwent periacetabular reconstruction
using a stemmed pedestal cup (Schoellner cup; Zimmer Biomet Inc.,
Warsaw, Indiana) between 2000 and 2013. The indications for treatment included
a primary bone tumour in 27 patients and metastatic disease in 21
patients. The mean age of the patients at the time of surgery was
52 years (16 to 83).Aims
Patients and Methods
Cellular movement and relocalisation are important for many physiologic properties. Local mesenchymal stem cells (MSCs) from injured tissues and circulating MSCs aid in fracture healing. Cytokines and chemokines such as Stromal cell-derived factor 1(SDF-1) and its receptor chemokine receptor type 4 (CXCR4) play important roles in maintaining mobilisation, trafficking and homing of stem cells from bone marrow to the site of injury. We investigated the differences in migration of MSCs from the femurs of young, adult and ovariectomised (OVX) rats and the effect of CXCR4 over-expression on their migration. MSCs from young, adult and OVX rats were put in a Boyden chamber to establish their migration towards SDF-1. This was compared with MSCs transfected with CXCR4, as well as MSCs differentiated to osteoblasts.Objectives
Methods
The most effective surgical approach for total hip arthroplasty
(THA) remains controversial. The direct anterior approach may be
associated with a reduced risk of dislocation, faster recovery,
reduced pain and fewer surgical complications. This systematic review
aims to evaluate the current evidence for the use of this approach
in THA. Following the Cochrane collaboration, an extensive literature
search of PubMed, Medline, Embase and OvidSP was conducted. Randomised
controlled trials, comparative studies, and cohort studies were
included. Outcomes included the length of the incision, blood loss,
operating time, length of stay, complications, and gait analysis.Aims
Materials and Methods
Tissue responses to debris formed by abrasion of polymethylmethacrylate
(PMMA) spacers at two-stage revision arthroplasty for prosthetic
joint infection are not well described. We hypothesised that PMMA
debris induces immunomodulation in periprosthetic tissues. Samples of tissue were taken during 35 two-stage revision arthroplasties
(nine total hip and 26 total knee arthroplasties) in patients whose
mean age was 67 years (44 to 85). Fourier transform infrared microscopy
was used to confirm the presence of PMMA particles. Histomorphometry
was performed using Sudan Red and Haematoxylin-Eosin staining.
CD-68, CD-20, CD-11(c), CD-3 and IL-17 antibodies were used to immunophenotype
the inflammatory cells. All slides were scored semi-quantitatively
using the modified Willert scoring system.Aims
Patients and Methods
Advocates of debridement, antibiotics and implant retention (DAIR)
in hip periprosthetic joint infection (PJI) argue that a procedure
not disturbing a sound prosthesis-bone interface is likely to lead
to better survival and functional outcome compared with revision.
This case-control study aims were to compare outcome of DAIRs for
infected primary total hip arthroplasty (THA) with outcomes following
primary THA and two-stage revision of infected primary THAs. We retrospectively reviewed all DAIRs, performed for confirmed
infected primary hip arthropasty (n = 82) at out institution, between
1997 and 2013. Data recorded included full patient information and
type of surgery. Outcome measures included complications, mortality,
implant survivorship and functional outcome. Outcome was compared with
two control groups matched for gender and age; a cohort of primary
THAs (n = 120) and a cohort of two-stage revisions for infection
(n = 66).Aims
Patients and Methods
The aim of this study was to compare early functional and health
related quality of life outcomes (HRQoL) in patients who have undergone
total hip arthroplasty (THA) using a bone conserving short stem
femoral component and those in whom a conventional length uncemented
component was used. Outcome was assessed using a validated performance
based outcome instrument as well as patient reported outcome measures
(PROMs). We prospectively analysed 33 patients whose THA involved a contemporary
proximally porous coated tapered short stem femoral component and
53 patients with a standard conventional femoral component, at a
minimum follow-up of two years. The mean follow-up was 31.4 months
(24 to 39). Patients with poor proximal femoral bone quality were
excluded. The mean age of the patients was 66.6 years (59 to 77)
and the mean body mass index was 30.2 kg/m2 (24.1 to
41.0). Outcome was assessed using the Oxford Hip Score (OHS) and
the University College Hospital (UCH) hip score which is a validated
performance based instrument. HRQoL was assessed using the EuroQol
5D (EQ-5D).Aims
Patients and Methods
Thermal stability is a key property in determining the suitability of an antibiotic agent for local application in the treatment of orthopaedic infections. Despite the fact that long-term therapy is a stated goal of novel local delivery carriers, data describing thermal stability over a long period are scarce, and studies that avoid interference from specific carrier materials are absent from the orthopaedic literature. In this study, a total of 38 frequently used antibiotic agents were maintained at 37°C in saline solution, and degradation and antibacterial activity assessed over six weeks. The impact of an initial supplementary heat exposure mimicking exothermically curing bone cement was also tested as this material is commonly used as a local delivery vehicle. Antibiotic degradation was assessed by liquid chromatography coupled to mass spectrometry, or by immunoassays, as appropriate. Antibacterial activity over time was determined by the Kirby-Bauer disk diffusion assay.Objectives
Methods
