Advertisement for orthosearch.org.uk
Results 501 - 520 of 4029
Results per page:
The Journal of Bone & Joint Surgery British Volume
Vol. 67-B, Issue 1 | Pages 44 - 46
1 Jan 1985
Langenskiold A

A patient with typical congenital contractural arachnodactyly followed up from the age of 12 years to the age of 48 is reported. He had spiderlike fingers and toes and marked contractures of the knees, ankles, toes, shoulders, elbows and fingers; the mobility of the hips and wrists was almost normal. Persistent knee contractures prevented him from walking. In his twenties he had an osteotomy of both femora and shortening of the patellar tendons which enabled him to walk for the first time in an upright position without external support. When seen at the age of 48 the range of movement of his knees was 0 to 90 degrees. He was working as a turner and had been doing so for almost 20 years


The Journal of Bone & Joint Surgery British Volume
Vol. 66-B, Issue 2 | Pages 196 - 200
1 Mar 1984
Leyshon R Channon G Jenkins D Ralis Z

Sixty-three knees with chronic ligamentous instability treated with flexible carbon fibre are reviewed. Assessment was by pre-operative and postoperative grading of function in work and sport, together with a subjective evaluation of the result based on stability. Fifteen knees had collateral repairs, seven had cruciate repairs and 41 had combined collateral and cruciate repairs. Overall, 71% of knees showed improvement in function and 67% had good or excellent results subjectively. Clinical examination did not correlate well with the patient's evaluation of the result. Nineteen unselected cases with intra-articular (cruciate) carbon fibre had arthroscopies. Infiltration of collagen tissues into the cruciate replacement was a slower process than at the extra-articular (collateral) site. There was no clinical or macroscopic evidence of synovitis but microscopically there was evidence of synovial irritation


The Journal of Bone & Joint Surgery British Volume
Vol. 71-B, Issue 3 | Pages 498 - 500
1 May 1989
Coolican M Dandy D

We report the results of arthroscopic removal of loose bodies and abnormal synovium from 18 knees with primary synovial chondromatosis. After a mean of three years, six months (range one to 10 years), 14 knees were either symptom-free or had only minor symptoms. Three of these had required two arthroscopic operations. Three patients were improved but not cured and there was one failure. The results were better than the published results of open operation for this condition. Three patterns of macroscopic appearances were noted: four knees had large lesions covered by normal synovium, 10 had small fragments of cartilage lying in or on the synovium and four had only free fragments of cartilage in the joint cavity but none in, on, or under, the synovium. These three appearances may represent three different disease processes


The Journal of Bone & Joint Surgery British Volume
Vol. 74-B, Issue 1 | Pages 105 - 110
1 Jan 1992
Beaver R Mahomed M Backstein D Davis A Zukor D Gross A

Fresh osteochondral allografts were used to repair post-traumatic osteoarticular defects in 92 knees. At the time of grafting, varus or valgus deformities were corrected by upper tibial or supracondylar femoral osteotomies. A survivorship analysis was performed in which failure was defined as the need for a revision operation or the persistence of the pre-operative symptoms. There was a 75% success rate at five years, 64% at ten years and 63% at 14 years. The failure rate was higher for bipolar grafts than for unipolar and the results in patients over the age of 60 years were poor. The outcome did not depend on the sex of the patient and the results of allografts in the medial and lateral compartments of the knee were similar. Careful patient selection, correction of joint malalignment by osteotomy, and rigid fixation of the graft are all mandatory requirements for success. We recommend this method for the treatment of post-traumatic osteochondral defects in the knees of relatively young and active patients


The Bone & Joint Journal
Vol. 95-B, Issue 2 | Pages 188 - 191
1 Feb 2013
Arockiaraj J Korula RJ Oommen AT Devasahayam S Wankhar S Velkumar S Poonnoose PM

Loss of proprioception following an anterior cruciate ligament (ACL) injury has been well documented. We evaluated proprioception in both the injured and the uninjured limb in 25 patients with ACL injury and in 25 healthy controls, as assessed by joint position sense (JPS), the threshold for the detection of passive movement (TDPM) and postural sway during single-limb stance on a force plate. There were significant proprioceptive deficits in both ACL-deficient and uninjured knees compared with control knees, as assessed by the angle reproduction test (on JPS) and postural sway on single limb stance. The degree of loss of proprioception in the ACL-deficient knee and the unaffected contralateral knee joint in the same patient was similar. The TDPM in the injured knee was significantly higher than that of controls at 30° and 70° of flexion. The TDPM of the contralateral knee joint was not significantly different from that in controls. Based on these findings, the effect of proprioceptive training of the contralateral uninjured knee should be explored. Cite this article: Bone Joint J 2013;95-B:188–91


The Journal of Bone & Joint Surgery British Volume
Vol. 80-B, Issue 2 | Pages 298 - 301
1 Mar 1998
Kloen P Keel SB Chandler HP Geiger RH Zarins BE Rosenberg AE

Lipoma arborescens is a rare intra-articular lesion, characterised by diffuse replacement of the subsynovial tissue by mature fat cells, producing prominent villous transformation of the synovium. The aetiology of this benign condition is unknown. We describe six cases involving the knee discussing the symptoms, diagnosis and treatment


The Journal of Bone & Joint Surgery British Volume
Vol. 54-B, Issue 3 | Pages 520 - 521
1 Aug 1972
Muckle DS Monahan P

Two cases of ganglion arising in the alar folds of the infrapatellar fat pad are reported. Both patients had symptoms of internal derangement of the knee, sufficient to justify operation


The Journal of Bone & Joint Surgery British Volume
Vol. 48-B, Issue 1 | Pages 134 - 137
1 Feb 1966
Caughey DE Highton TC

1. A case of glomus tumour of the subcutaneous tissues of the knee which presented with extreme pain is described. Successful removal of the tumour led to complete relief of pain and return to normal function. 2. The histological features are given. 3. The literature is briefly reviewed


The Bone & Joint Journal
Vol. 95-B, Issue 6 | Pages 782 - 787
1 Jun 2013
Niki Y Takeda Y Udagawa K Enomoto H Toyama Y Suda Y

We investigated the characteristics of patients who achieved Japanese-style deep flexion (seiza-sitting) after total knee replacement (TKR) and measured three-dimensional positioning and the contact positions of the femoral and tibial components. Seiza-sitting was achieved after surgery by 23 patients (29 knees) of a series of 463 TKRs in 341 patients. Pre-operatively most of these patients were capable of seiza-sitting, had a lower body mass index and a favourable attitude towards the Japanese lifestyle (27 of 29 knees). According to two-/three-dimensional image registration analysis in the seiza-sitting position, flexion, varus and internal rotation angles of the tibial component relative to the femoral component had means of 148° (. sd. 8.0), 1.9° (. sd. 3.2) and 13.4° (. sd. 5.9), respectively. Femoral surface contact positions tended to be close to the posterior edge of the tibial polyethylene insert, particularly in the lateral compartment, but only 8.3% (two of 24) of knees showed femoral subluxation over the posterior edge. The mean contact positions of the femoral cam on the tibial post were located 7.8 mm (. sd. 1.5) proximal to the lowest point of the polyethylene surface and 5.5 mm (. sd. 0.9) medial to the centre of the post, indicating that the post-cam contact position translated medially during seiza-sitting, but not proximally. Collectively, the seiza-sitting position seems safe against component dislocation, but the risks of posterior edge loading and breakage of the tibial polyethylene post remain. Cite this article: Bone Joint J 2013;95-B:782–7


The Journal of Bone & Joint Surgery British Volume
Vol. 81-B, Issue 1 | Pages 171 - 177
1 Jan 1999
Okamoto T Atsuta Y Shimazaki S

We studied the sensory afferent properties of normal, immobilised and inflamed rat knees by recording the activity of the medial articular nerve (MAN). When the knee was inflamed by kaolin-carrageenan or immobilised for six weeks, MAN activity significantly increased during rest and continuous passive motion (CPM). The maximal discharge rate tended to increase depending on the angular velocity of the CPM. When the knees were then rested for one hour before again starting CPM, activity was further increased at the initial CPM cycle, the ‘post-rest effect’. Analysis of the conduction velocity showed that 94% and 66% of spike units on the recorded discharge of the immobilised and inflamed knees, respectively, belonged to fine nerve fibres. Our findings show that the sensory receptors in the knee are sensitised in a similar manner by immobilisation and by inflammation, suggesting a relationship to pain. The post-rest effect may be related to a characteristic symptom of osteoarthritis called ‘starting pain’


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 3 | Pages 363 - 365
1 Apr 2003
Fleming P Lenehan B O’Rourke S McHugh P Kaar K McCabe JP

Injuries to the sciatic nerve are an occasional complication of surgery to the hip and acetabulum, and traction is frequently the causative mechanism. In vitro and animal experiments have shown that increased tensile strain on peripheral nerves, when applied for prolonged periods, impairs nerve function. We have used video-extensometry to measure strain on the human sciatic nerve during total hip replacement (THR). Ten consecutive patients with a mean age of 72 years undergoing primary THR by the posterior approach were recruited, and strains in the sciatic nerve were measured in different combinations of flexion and extension of the hip and knee, before dislocation of the hip. Significant increases (p = 0.02) in strain in the sciatic nerve were observed in flexion of the hip and extension of the knee. The mean increase was 26% (19% to 30%). In animal studies increases of this magnitude have been shown to impair electrophysiological function in peripheral nerves. Our results suggest that excessive flexion of the hip and extension of the knee should be avoided during THR


The Journal of Bone & Joint Surgery British Volume
Vol. 70-B, Issue 2 | Pages 217 - 223
1 Mar 1988
Mackinnon J Young S Baily R

Since 1974, we have made a prospective study in Bristol of the results of unicompartmental knee replacement using the St Georg sledge prosthesis. A total of 115 knees in 100 patients have been followed up for 2 to 12 years (mean, 4 years 9 months). Results have assessed both by the Bristol knee score and by survivorship studies on the total series of 138 knees. Results were excellent or good in 86% and fair or poor in 14%. The survivorship study (based on a definition of failure which included significant pain or a dissatisfied patient or the need for revision) showed a cumulative success rate of 76.4% at six years, with no further failures after that time. Seven knees have been revised, in most cases for deterioration of the contralateral compartment. The operation is recommended as a satisfactory and durable form of treatment for osteoarthritis affecting a single tibiofemoral compartment


The Journal of Bone & Joint Surgery British Volume
Vol. 65-B, Issue 2 | Pages 204 - 209
1 Mar 1983
Pournaras J Symeonides P Karkavelas G

The significance of the posterior cruciate ligament in the stability of the knee was investigated in dogs and it was compared with that of the anterior cruciate ligament by studying the changes produced in the knee after transection of either ligament. Osteophyte formation and changes in articular cartilage were less prominent after division of the posterior cruciate ligament. A complete longitudinal tear of the medial meniscus was found in eight out of the 10 dogs who had undergone section of the anterior cruciate but in none of the 10 with section of the posterior cruciate. It appears that, in dogs at least, the posterior cruciate ligament is less important than the anterior in the stability of the knee


Bone & Joint Research
Vol. 9, Issue 11 | Pages 778 - 788
1 Nov 2020
Xu H Yang J Xie J Huang Z Huang Q Cao G Pei F

Aims

The efficacy and safety of intrawound vancomycin for preventing surgical site infection in primary hip and knee arthroplasty is uncertain.

Methods

A systematic review of the literature was conducted, indexed from inception to March 2020 in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases. All studies evaluating the efficacy and/or safety of intrawound vancomycin in patients who underwent primary hip and knee arthroplasty were included. Incidence of periprosthetic joint infection (PJI), superficial infection, aseptic wound complications, acute kidney injury, anaphylactic reaction, and ototoxicity were meta-analyzed. Results were reported as odds ratios (ORs) and 95% confidence intervals (CIs). The quality of included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) assessment tool.


The Journal of Bone & Joint Surgery British Volume
Vol. 71-B, Issue 3 | Pages 501 - 504
1 May 1989
Kay P Freemont A Davies D

We report four patients who showed hundreds of brilliant white loose bodies at arthroscopy of the knee after a short history of pain and crepitus. Histological, historical and clinical evidence is presented which indicates that the aetiology of this condition is the culture of chondrocytes in synovial fluid. It is suggested that reversal of the usually accepted order of events in synovial osteochondromatosis could provide a better and unified explanation for both that condition and multiple loose bodies. The term 'snow storm knee' is proposed to describe the dramatic picture seen at arthroscopy


The Journal of Bone & Joint Surgery British Volume
Vol. 54-B, Issue 1 | Pages 96 - 102
1 Feb 1972
Taylor AR Arden GP Rainey HA

1. The results have been reviewed of forty-two traumatic dislocations of the knee in forty-one patients, twenty-six of which were treated conservatively. 2. Primary operative repair was carried out in only three cases, although a further ten had operative intervention for various complications. 3. It was not possible to compare the results of operation with those of conservative treatment, because the operative procedures were so diverse in nature. 4. The conservative treatment of twenty-six dislocations yielded surprisingly good results with regard to stability, absence of pain, and range of flexion movement. 5. In general, immobilisation for long periods, like operative repair, led to reduced movement. 6. In the absence of complications, conservative treatment is the method of choice


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 2 | Pages 258 - 262
1 Mar 2002
O’Connor MA Palaniappan M Khan N Bruce CE

The treatment of osteochondritis dissecans (OCD) in children and adolescents is determined by the stability of the lesion and the state of the overlying cartilage. MRI has been advocated as an accurate way of assessing and staging such lesions. Our aim was to determine if MRI scans accurately predicted the subsequent arthroscopic findings in adolescents with OCD of the knee. Some authors have suggested that a high signal line behind a fragment on the T2-weighted image indicates the presence of synovial fluid and is a sign of an unstable lesion. More recent reports have suggested that this high signal line is due to the presence of vascular granulation tissue and may represent a healing reaction. We were able to improve the accuracy of MRI for staging the OCD lesion from 45% to 85% by interpreting the high signal T2 line as a predictor of instability only when it was accompanied by a breach in the cartilage on the T1-weighted image. We conclude that MRI can be used to stage OCD lesions accurately and that a high signal line behind the OCD fragment does not always indicate instability. We recommend the use of an MRI classification system which correlates with the arthroscopic findings


The Journal of Bone & Joint Surgery British Volume
Vol. 73-B, Issue 4 | Pages 582 - 586
1 Jul 1991
White S Ludkowski P Goodfellow J

Medial tibial plateaux excised during 46 unicompartmental arthroplasties for osteoarthritis were collected and photographed. The anterior cruciate ligament was intact in all joints. In every case the cartilage and bone erosion was centred anteriorly on the plateau and the posterior cartilage was intact. The site of the lesion and the intact state of the cruciate ligaments taken together explain why varus deformity was observed only in the extended knee, and why the deformity was correctable and had not become fixed. Failure of the anterior cruciate ligament may allow the erosion to extend posteriorly, producing fixed varus deformity and leading to degeneration of the lateral compartment. Anteromedial osteoarthritis is a distinct clinicopathological entity; its radiographic features enable it to be diagnosed from lateral radiographs; its anatomical features render it suitable for treatment by unicompartmental arthroplasty


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 2 | Pages 223 - 230
1 Mar 2003
Bentley G Biant LC Carrington RWJ Akmal M Goldberg A Williams AM Skinner JA Pringle J

Autologous chondrocyte implantation (ACI) and mosaicplasty are both claimed to be successful for the repair of defects of the articular cartilage of the knee but there has been no comparative study of the two methods. A total of 100 patients with a mean age of 31.3 years (16 to 49) and with a symptomatic lesion of the articular cartilage in the knee which was suitable for cartilage repair was randomised to undergo either ACI or mosaicplasty; 58 patients had ACI and 42 mosaicplasty. Most lesions were post-traumatic and the mean size of the defect was 4.66 cm. 2. The mean duration of symptoms was 7.2 years and the mean number of previous operations, excluding arthroscopy, was 1.5. The mean follow-up was 19 months (12 to 26). Functional assessment using the modified Cincinatti and Stanmore scores and objective clinical assessment showed that 88% had excellent or good results after ACI compared with 69% after mosaicplasty. Arthroscopy at one year demonstrated excellent or good repairs in 82% after ACI and in 34% after mosaicplasty. All five patellar mosaicplasties failed. Our prospective, randomised, clinical trial has shown significant superiority of ACI over mosaicplasty for the repair of articular defects in the knee. The results for ACI are comparable with those in other studies, but those for mosaicplasty suggest that its continued use is of dubious value


The Bone & Joint Journal
Vol. 99-B, Issue 10 | Pages 1313 - 1318
1 Oct 2017
Nakamura R Komatsu N Fujita K Kuroda K Takahashi M Omi R Katsuki Y Tsuchiya H

Aims. Open wedge high tibial osteotomy (OWHTO) for medial-compartment osteoarthritis of the knee can be complicated by intra-operative lateral hinge fracture (LHF). We aimed to establish the relationship between hinge position and fracture types, and suggest an appropriate hinge position to reduce the risk of this complication. Patients and Methods. Consecutive patients undergoing OWHTO were evaluated on coronal multiplanar reconstruction CT images. Hinge positions were divided into five zones in our new classification, by their relationship to the proximal tibiofibular joint (PTFJ). Fractures were classified into types I, II, and III according to the Takeuchi classification. Results. Among 111 patients undergoing OWHTOs, 22 sustained lateral hinge fractures. Of the 89 patients without fractures, 70 had hinges in the zone within the PTFJ and lateral to the medial margin of the PTFJ (zone WL), just above the PTFJ. Among the five zones, the relative risk of unstable fracture was significantly lower in zone WL (relative risk 0.24, confidence interval 0.17 to 0.34). Conclusion. Zone WL appears to offer the safest position for the placement of the osteotomy hinge when trying to avoid a fracture at the osteotomy site. Cite this article: Bone Joint J 2017;99B10:1313–18