Total hip replacement for developmental hip dysplasia
is challenging. The anatomical deformities on the acetabular and
femoral sides are difficult to predict. The Crowe classification
is usually used to describe these cases – however, it is not a very
helpful tool for pre-operative planning. Small acetabular components,
acetabular augments, and modular femoral components should be available
for all cases. Regardless of the Crowe classification, the surgeon must
be prepared to perform a femoral osteotomy for shortening, or to
correct rotation, and/or angulation. Cite this article:
Inherent disadvantages of reverse shoulder arthroplasty
designs based on the Grammont concept have raised a renewed interest
in less-medialised designs and techniques. The aim of this study
was to evaluate the outcome of reverse shoulder arthroplasty (RSA)
with the fully-constrained, less-medialised, Bayley–Walker prosthesis performed
for the treatment of rotator-cuff-deficient shoulders with glenohumeral
arthritis. A total of 97 arthroplasties in 92 patients (53 women
and 44 men, mean age 67 years (standard deviation ( The Bayley–Walker prosthesis provides reliable pain relief and
reasonable functional improvement for patients with symptomatic
cuff-deficient shoulders. Compared with other designs of RSA, it
offers a modest improvement in forward elevation, but restores external
rotation to some extent and prevents scapular notching. A longer
follow-up is required to assess the survival of the prosthesis and
the clinical performance over time. Cite this article:
Peri-acetabular osteotomy is an established surgical
treatment for symptomatic acetabular dysplasia in young adults.
An anteroposterior radiograph of the pelvis is commonly used to
assess the extent of dysplasia as well as to assess post-operative
correction. Radiological prognostic factors include the lateral
centre-edge angle, acetabular index, extrusion index and the acetabular
version. Standing causes a change in the pelvis tilt which can alter
certain radiological measurements relative to the supine position.
This article discusses the radiological indices used to assess dysplasia
and reviews the effects of patient positioning on these indices
with a focus on assessment for a peri-acetabular osteotomy. Intra-operatively,
fluoroscopy is commonly used and the implications of using fluoroscopy
as a modality to assess the various radiological indices along with
the effects of using an anteroposterior or posteroanterior fluoroscopic
view are examined. Each of these techniques gives rise to a slightly different
image of the pelvis as the final image is sensitive to the position
of the pelvis and the projection of the x-ray beam. Cite this article:
Revision knee arthroplasty presents a number
of challenges, not least of which is obtaining solid primary fixation
of implants into host bone. Three anatomical zones exist within
both femur and tibia which can be used to support revision implants.
These consist of the joint surface or epiphysis, the metaphysis
and the diaphysis. The methods by which fixation in each zone can
be obtained are discussed. The authors suggest that solid fixation
should be obtained in at least two of the three zones and emphasise
the importance of pre-operative planning and implant selection. Cite this article:
The results of the DRAFFT (distal radius acute
fracture fixation trial) study, which compared volar plating with
Kirschner (K-) wire fixation for dorsally displaced fractures of
the distal radius, were published in August 2014. The use of K-wires
to treat these fractures is now increasing, with a concomitant decline
in the use of volar locking plates. We provide a critical appraisal of the DRAFFT study and question
whether surgeons have been unduly influenced by its headline conclusions. Cite this article:
Because posterior cruciate ligament (PCL) resection makes flexion
gaps wider in total knee replacement (TKR), preserving or sacrificing
a PCL affects the gap equivalence; however, there are no criteria
for the PCL resection that consider gap situations of each knee.
This study aims to investigate gap characteristics of knees and
to consider the criteria for PCL resection. The extension and flexion gaps were measured, first with the
PCL preserved and subsequently with the PCL removed (in cases in
which posterior substitute components were selected). The PCL preservation
or sacrifice was solely determined by the gap measurement results,
without considering other functions of the PCL such as ‘roll back.’Objectives
Methods
Orthopaedic surgeons use stems in revision knee surgery to obtain
stability when metaphyseal bone is missing. No consensus exists
regarding stem size or method of fixation. This A custom test rig using differential variable reluctance transducers
(DVRTs) was developed to record all translational and rotational
motions at the bone–implant interface. Composite femurs were used.
These were secured to permit variation in flexion angle from 0°
to 90°. Cyclic loads were applied through a tibial component based
on three peaks corresponding to 0°, 10° and 20° flexion from a normal
walking cycle. Three different femoral components were investigated
in this study for cementless and cemented interface conditions.Objectives
Methods
Revision total hip arthroplasty (THA) is challenging
when there is severe loss of bone in the proximal femur. The purpose
of this study was to evaluate the clinical and radiographic outcomes
of revision THA in patients with severe proximal femoral bone loss
treated with a fluted, tapered, modular femoral component. Between
January 1998 and December 2004, 92 revision THAs were performed
in 92 patients using a single fluted, tapered, modular femoral stem
design. Pre-operative diagnoses included aseptic loosening, infection
and peri-prosthetic fracture. Bone loss was categorised pre-operatively
as Paprosky types III-IV, or Vancouver B3 in patients with a peri-prosthetic
fracture. The mean clinical follow-up was 6.4 years (2 to 12). A
total of 47 patients had peri-operative complications, 27 of whom
required further surgery. However, most of these further operations
involved retention of a well-fixed femoral stem, and 88/92 femoral
components (97%) remained Revision THA in patients with extensive proximal femoral bone
loss using the Link MP fluted, tapered, modular stem led to a high
rate of osseointegration of the stem at mid-term follow-up. Cite this article:
Patient specific instrumentation (PSI) uses advanced
imaging of the knee (CT or MRI) to generate individualised cutting
blocks aimed to make the procedure of total knee arthroplasty (TKA)
more accurate and efficient. However, in this era of healthcare
cost consciousness, the value of new technologies needs to be critically
evaluated. There have been several comparative studies looking at
PSI Cite this article:
Tapered fluted titanium stems are increasingly
used for femoral revision arthroplasty. They are available in modular and
non-modular forms. Modularity has advantages when the bone loss
is severe, the proximal femur is mis shapen or the surgeon is unfamiliar
with the implant, but it introduces the risk of fracture of the
stem at the junction between it and the proximal body segment. For
that reason, and while awaiting intermediate-term results of more recently
introduced designs of this junction, non-modularity has attracted
attention, at least for straightforward revision cases. We review the risks and causes of fracture of tapered titanium
modular revision stems and present an argument in favour of the
more selective use of modular designs. Cite this article:
The pre-operative level of haemoglobin is the strongest predictor
of the peri-operative requirement for blood transfusion after total
knee arthroplasty (TKA). There are, however, no studies reporting
a value that could be considered to be appropriate pre-operatively. This study aimed to identify threshold pre-operative levels of
haemoglobin that would predict the requirement for blood transfusion
in patients who undergo TKA. Analysis of receiver operator characteristic (ROC) curves of
2284 consecutive patients undergoing unilateral TKA was used to
determine gender specific thresholds predicting peri-operative transfusion
with the highest combined sensitivity and specificity (area under
ROC curve 0.79 for males; 0.78 for females).Aims
Patients and Methods
Throughout the 20th Century, it has been postulated that the knee moves on the basis of a four-bar link mechanism composed of the cruciate ligaments, the femur and the tibia. As a consequence, the femur has been thought to roll back with flexion, and total knee arthroplasty (TKA) prostheses have been designed on this basis. Recent work, however, has proposed that at a position of between 0° and 120° the medial femoral condyle does not move anteroposteriorly whereas the lateral femoral condyle tends, but is not obliged, to roll back – a combination of movements which equates to tibial internal/ femoral external rotation with flexion. The aim of this paper was to assess if the articular geometry of the GMK Sphere TKA could recreate the natural knee movements The pattern of knee movement was studied in 15 patients (six male: nine female; one male with bilateral TKAs) with 16 GMK Sphere implants, at a mean age of 66 years (53 to 76) with a mean BMI of 30 kg/m2 (20 to 35). The motions of all 16 knees were observed using pulsed fluoroscopy during a number of weight-bearing and non-weight-bearing static and dynamic activities.Objectives
Methods
We report a prospective cohort study of the midterm results of
surgical dislocation of the hip (according to Ganz) to perform resection
of osteochondromas involving the femoral neck in patients with multiple
hereditary exostoses (MHE). Hip range of movement (ROM) was assessed pre- and post-operatively.
Patients’ judgment of post-operative reduction of pain, symptoms,
the Rand 36-item Health Survey (RAND-36) and complications were
analysed. Aims
Methods
The primary aim of this study was to investigate the effect of
an enhanced recovery program (ERP) on the short-term functional
outcome after total hip arthroplasty (THA). Secondary outcomes included
its effect on rates of dislocation and mortality. Data were gathered on 1161 patients undergoing primary THA which
included 611 patients treated with traditional rehabilitation and
550 treated with an ERP. Aims
Patients and Methods
The purpose of this study was to compare the long-term results
of primary total hip arthroplasty (THA) in young patients using
either a conventional (CPE) or a highly cross-linked (HXLPE) polyethylene
liner in terms of functional outcome, incidence of osteolysis, radiological
wear and rate of revision. We included all patients between the ages of 45 and 65 years
who, between January 2000 and December 2001, had undergone a primary
THA for osteoarthritis at our hospital using a CPE or HXLPE acetabular
liner and a 28 mm cobalt-chrome femoral head. From a total of 160 patients, 158 (177 hips) were available for
review (CPE 89; XLPE 88). The mean age, body mass index (BMI) and
follow-up in each group were: CPE: 56.8 years (46 to 65); 30.7 kg/m2 (19
to 58); 13.2 years (2.1 to 14.7) and HXLPE: 55.6 years (45 to 65);
BMI: 30 kg/m2 (18 to 51); 13.1 years (5.7 to 14.4).Aims
Methods
The technical advances in arthroscopic surgery
of the hip, including the improved ability to manage the capsule
and gain extensile exposure, have been paralleled by a growth in
the number of conditions that can be addressed. This expanding list
includes symptomatic labral tears, chondral lesions, injuries of
the ligamentum teres, femoroacetabular impingement (FAI), capsular
laxity and instability, and various extra-articular disorders, including snapping
hip syndromes. With a careful diagnostic evaluation and technical
execution of well-indicated procedures, arthroscopic surgery of
the hip can achieve successful clinical outcomes, with predictable
improvements in function and pre-injury levels of physical activity
for many patients. This paper reviews the current position in relation to the use
of arthroscopy in the treatment of disorders of the hip. Cite this article:
The December 2014 Research Roundup360 looks at: demineralised bone matrix not as good as we thought?; trunk control following ACL reconstruction; subclinical thyroid dysfunction: not quite subclinical?; establishing musculoskeletal function in mucopolysaccharidosis; starting out: a first year in consultant practice under the spotlight; stroke and elective surgery; sepsis and clots; hip geometry and arthritis incidence; and theatre discipline and infection.