We performed a systematic review of the current literature regarding
the outcomes of unconstrained metacarpophalangeal joint (MCPJ) arthroplasty. We initially identified 1305 studies, and 406 were found to be
duplicates. After exclusion criteria were applied, seven studies
were included. Outcomes extracted included pre- and post-operative
pain visual analogue scores, range of movement (ROM), strength of
pinch and grip, satisfaction and patient reported outcome measures
(PROMs). Clinical and radiological complications were recorded.
The results are presented in three groups based on the design of
the arthroplasty and the aetiology (pyrocarbon-osteoarthritis (pyro-OA),
pyrocarbon-inflammatory arthritis (pyro-IA), metal-on-polyethylene
(MoP)).Aims
Materials and Methods
To employ a simple and fast method to evaluate those patients with neurological deficits and misplaced screws in relatively safe lumbosacral spine, and to determine if it is necessary to undertake revision surgery. A total of 316 patients were treated by fixation of lumbar and lumbosacral transpedicle screws at our institution from January 2011 to December 2012. We designed the criteria for post-operative revision scores of pedicle screw malpositioning (PRSPSM) in the lumbosacral canal. We recommend the revision of the misplaced pedicle screw in patients with PRSPSM = 5′ as early as possible. However, patients with PRSPSM < 5′ need to follow the next consecutive assessment procedures. A total of 15 patients were included according to at least three-stage follow-up.Objectives
Methods
Improvements in the evaluation of outcome after nerve transfers
are required. The assessment of force using the Medical Research
Council (MRC) grades (0 to 5) is not suitable for this purpose.
A ceiling effect is encountered within MRC grade 4/5 rendering this
tool insensitive. Our aim was to show how the strength of flexion
of the elbow could be assessed in patients who have undergone a
re-innervation procedure using a continuous measurement scale. A total of 26 patients, 23 men and three women, with a mean age
of 37.3 years (16 to 66), at the time of presentation, attended
for review from a cohort of 52 patients who had undergone surgery
to restore flexion of the elbow after a brachial plexus injury and
were included in this retrospective study. The mean follow-up after
nerve transfer was 56 months (28 to 101, standard deviation (Aims
Methods
Total hip arthroplasty (THA) has well known subjective benefits,
but little is known objectively about the recovery of mobility in
the early post-operative period. A total of 33 patients aged >
60 years who underwent elective
primary THA had their activity monitored for 30 days post-operatively
using an at-home (Fitbit) ankle accelerometer. Their mean age was
70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance
and the mean level of activity were determined. Comparisons between subgroups
based on age, body mass index (BMI), surgical approach, and the
destination of the patients when discharged were also performed.Aims
Patients and Methods
The purpose of this study was to determine the lifetime risk
of revision surgery for patients undergoing Charnley cemented total
hip arthroplasty (THA), with 40-year follow up, using death as a
competing risk. We retrospectively reviewed 2000 cemented Charnley THAs, with
51 living hips available at 40 years. Aims
Materials and Methods
The purpose of this study was to compare clinical
outcomes of total knee arthroplasty (TKA) after manipulation under
anaesthesia (MUA) for post-operative stiffness with a matched cohort
of TKA patients who did not requre MUA. In total 72 patients (mean age 59.8 years, 42 to 83) who underwent
MUA following TKA were identified from our prospective database
and compared with a matched cohort of patients who had undergone
TKA without subsequent MUA. Patients were evaluated for range of
movement (ROM) and clinical outcome scores (Western Ontario and
McMaster Universities Arthritis Index, Short-Form Health Survey,
and Knee Society Clinical Rating System) at a mean follow-up of
36.4 months (12 to 120). MUA took place at a mean of nine weeks
(5 to 18) after TKA. In patients who required MUA, mean flexion
deformity improved from 10° (0° to 25°) to 4.4° (0° to 15°) (p <
0.001),
and mean range of flexion improved from 79.8° (65° to 95°) to 116°
(80° to 130°) (p <
0.001). There were no statistically significant
differences in ROM or functional outcome scores at three months,
one year, or two years between those who required MUA and those
who did not. There were no complications associated with manipulation At most recent follow-up, patients requiring MUA achieved equivalent
ROM and clinical outcome scores when compared with a matched control
group. While other studies have focused on ROM after manipulation,
the current study adds to current literature by supplementing this
with functional outcome scores. Cite this article:
The mainstay of surgical correction of hallux valgus is first
metatarsal osteotomy, either proximally or distally. We present
a technique of combining a distal chevron osteotomy with a proximal
opening wedge osteotomy, for the correction of moderate to severe
hallux valgus. We reviewed 45 patients (49 feet) who had undergone double osteotomy.
Outcome was assessed using the American Orthopaedic Foot and Ankle
Society (AOFAS) and the Short Form (SF) -36 Health Survey scores.
Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The
mean follow-up was 35.4 months (24 to 51).Aims
Patients and Methods
The widespread use of MRI has revolutionised
the diagnostic process for spinal disorders. A typical protocol
for spinal MRI includes T1 and T2 weighted sequences in both axial
and sagittal planes. While such an imaging protocol is appropriate
to detect pathological processes in the vast majority of patients,
a number of additional sequences and advanced techniques are emerging.
The purpose of the article is to discuss both established techniques
that are gaining popularity in the field of spinal imaging and to
introduce some of the more novel ‘advanced’ MRI sequences with examples
to highlight their potential uses. Cite this article:
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:
Pain catastrophising is an adverse coping mechanism,
involving an exaggerated response to anticipated or actual pain. The purpose of this study was to investigate the influence of
pain ‘catastrophising’, as measured using the pain catastrophising
scale (PCS), on treatment outcomes after surgery for lumbar spinal
stenosis (LSS). A total of 138 patients (47 men and 91 women, mean age 65.9;
45 to 78) were assigned to low (PCS score <
25, n = 68) and high
(PCS score ≥ 25, n = 70) PCS groups. The primary outcome measure
was the Oswestry Disability Index (ODI) 12 months after surgery.
Secondary outcome measures included the ODI and visual analogue
scale (VAS) for back and leg pain, which were recorded at each assessment
conducted during the 12-month follow-up period The overall changes in the ODI and VAS for back and leg pain
over a 12-month period were significantly different between the
groups (ODI, p <
0.001; VAS for back pain, p <
0.001; VAS
for leg pain, p = 0.040). The ODI and VAS for back and leg pain
significantly decreased over time after surgery in both groups (p
<
0.001 for all three variables). The patterns of change in the
ODI and VAS for back pain during the follow-up period significantly
differed between the two groups, suggesting that the PCS group is
a potential treatment moderator. However, there was no difference
in the ODI and VAS for back and leg pain between the low and high
PCS groups 12 months after surgery. In terms of minimum clinically important differences in ODI scores
(12.8), 22 patients (40.7%) had an unsatisfactory surgical outcome
in the low PCS group and 16 (32.6%) in the high PCS group. There
was no statistically significant difference between the two groups
(p = 0.539). Pre-operative catastrophising did not always result in a poor
outcome 12 months after surgery, which indicates that this could
moderate the efficacy of surgery for LSS. Cite this article:
Partial knee arthroplasty (PKA), either medial
or lateral unicompartmental knee artroplasty (UKA) or patellofemoral arthroplasty
(PFA) are a good option in suitable patients and have the advantages
of reduced operative trauma, preservation of both cruciate ligaments
and bone stock, and restoration of normal kinematics within the
knee joint. However, questions remain concerning long-term survival.
The goal of this review article was to present the long-term results
of medial and lateral UKA, PFA and combined compartmental arthroplasty
for multicompartmental disease. Medium- and long-term studies suggest
reasonable outcomes at ten years with survival greater than 95% in
UKA performed for medial osteoarthritis or osteonecrosis, and similarly
for lateral Cite this article:
Our aim was to compare kinematic with mechanical alignment in
total knee arthroplasty (TKA). We performed a prospective blinded randomised controlled trial
to compare the functional outcome of patients undergoing TKA in
mechanical alignment (MA) with those in kinematic alignment (KA).
A total of 71 patients undergoing TKA were randomised to either
kinematic (n = 36) or mechanical alignment (n = 35). Pre- and post-operative
hip-knee-ankle radiographs were analysed. The knee injury and osteoarthritis
outcome score (KOOS), American Knee Society Score, Short Form-36,
Euro-Qol (EQ-5D), range of movement (ROM), two minute walk, and timed
up and go tests were assessed pre-operatively and at six weeks,
three and six months and one year post-operatively.Aims
Patients and Methods
Although infrequent, a fracture of the cuboid can lead to significant
disruption of the integrity of the midfoot and its function. The
purpose of this study was to classify the pattern of fractures of
the cuboid, relate them to the mechanism of injury and suggest methods
of managing them. We performed a retrospective review of patients with radiologically
reported cuboid fractures. Fractures were grouped according to commonly
occurring patterns of injury. A total of 192 fractures in 188 patients
were included. They were classified into five patterns of injury.Aims
Patients and Methods
The aim of this study was to determine whether
obesity affects pain, surgical and functional outcomes following lumbar
spinal fusion for low back pain (LBP). A systematic literature review and meta-analysis was made of
those studies that compared the outcome of lumbar spinal fusion
for LBP in obese and non-obese patients. A total of 17 studies were
included in the meta-analysis. There was no difference in the pain
and functional outcomes. Lumbar spinal fusion in the obese patient resulted
in a statistically significantly greater intra-operative blood loss
(weighted mean difference: 54.04 ml; 95% confidence interval (CI)
15.08 to 93.00; n = 112; p = 0.007) more complications (odds ratio:
1.91; 95% CI 1.68 to 2.18; n = 43858; p <
0.001) and longer duration
of surgery (25.75 mins; 95% CI 15.61 to 35.90; n = 258; p <
0.001). Obese
patients have greater intra-operative blood loss, more complications
and longer duration of surgery but pain and functional outcome are
similar to non-obese patients. Based on these results, obesity is
not a contraindication to lumbar spinal fusion. Cite this article:
The October 2013 Research Roundup360 looks at: Orthopaedics: a dangerous profession?; Freezing and biomarkers for bone turnover; Herniation or degeneration first?; MARS MRI and metallosis; Programmed cell death in partial thickness cuff tears; Lead glasses for trauma surgery?; Smoking inhibits bone healing; Optimising polyethylene microstructure.
