The bony shoulder stability ratio (BSSR) allows for quantification of the bony stabilisers Four polyethylene balls (radii: 19.1 mm to 38.1 mm) were used to mould four fitting sockets in four different depths (3.2 mm to 19.1mm). The SR was measured in biomechanical congruent and incongruent experimental series. The experimental SR of a congruent system was compared with the calculated SR based on the BSSR approach. Differences in SR between congruent and incongruent experimental conditions were quantified. Finally, the experimental SR was compared with either calculated SR based on the socket concavity or plastic ball radius.Objectives
Methods
There are several reports clarifying successful results following
open reduction using Ludloff’s medial approach for congenital (CDH)
or developmental dislocation of the hip (DDH). This study aimed
to reveal the long-term post-operative course until the period of
hip-joint maturity after the conventional surgical treatments. A long-term follow-up beyond the age of hip-joint maturity was
performed for 115 hips in 103 patients who underwent open reduction
using Ludloff’s medial approach in our hospital. The mean age at
surgery was 8.5 months (2 to 26) and the mean follow-up was 20.3
years (15 to 28). The radiological condition at full growth of the hip
joint was evaluated by Severin’s classification.Objectives
Methods
Progressive degenerative changes in the medial
compartment of the knee following lateral unicompartmental arthroplasty
(UKA) remains a leading indication for revision surgery. The purpose
of this study is to evaluate changes in the congruence and joint
space width (JSW) of the medial compartment following lateral UKA.
The congruence of the medial compartment of 53 knees (24 men, 23
women, mean age 13.1 years; Our data suggest that a well conducted lateral UKA may improve
the congruence and normalise the JSW of the medial compartment,
potentially preventing progression of degenerative change. Cite this article:
Patients undergoing femoral lengthening by external fixation
tolerate treatment less well when compared to tibial lengthening.
Lengthening of the femur with an intramedullary device may have
advantages. We reviewed all cases of simple femoral lengthening performed
at our unit from 2009 to 2014. Cases of nonunions, concurrent deformities,
congenital limb deficiencies and lengthening with an unstable hip
were excluded, leaving 33 cases (in 22 patients; 11 patients had
bilateral procedures) for review. Healing index, implant tolerance
and complications were compared.Aims
Patients and Methods
The purpose of this study was to compare the results and complications of tibial lengthening over an intramedullary nail with treatment using the traditional Ilizarov method. In this matched case study, 16 adult patients underwent 19 tibial lengthening over nails (LON) procedures. For the matched case group, 17 patients who underwent 19 Ilizarov tibial lengthenings were retrospectively matched to the LON group.Objectives
Methods
Our aim was to investigate the outcomes of patients with a displaced
fracture of the glenoid fossa who are treated conservatively. There
is little information in the literature about the treatment of these
rare injuries non-operatively. We reviewed 24 patients with a mean age of 52 years (19 to 81)
at a mean of 5.6 years (11 months to 18 years) after the injury.Aims
Patients and Methods
This study compared the long-term results following Salter osteotomy
and Pemberton acetabuloplasty in children with developmental dysplasia
of the hip (DDH). We assessed if there was a greater increase in
pelvic height following the Salter osteotomy, and if this had a
continued effect on pelvic tilt, lumbar curvature or functional outcomes. We reviewed 42 children at more than ten years post-operatively
following a unilateral Salter osteotomy or Pemberton acetabuloplasty.
We measured the increase in pelvic height and the iliac crest tilt
and sacral tilt at the most recent review and at an earlier review
point in the first decade of follow-up. We measured the lumbar Cobb angle
and the Short Form-36 (SF-36) and Harris hip scores were collected
at the most recent review.Aims
Patients and Methods
Revision total elbow arthroplasty (TEA) is often challenging.
The aim of this study was to report on the clinical and radiological
results of revision arthroplasty of the elbow with the Latitude
TEA. Between 2006 and 2010 we used the Latitude TEA for revision in
18 consecutive elbows (17 patients); mean age 53 years (28 to 80);
14 women. A Kudo TEA was revised in 15 elbows and a Souter-Strathclyde
TEA in three. Stability, range of movement (ROM), visual analogue score (VAS)
for pain and functional scores, Elbow Functional Assessment Scale
(EFAS), the Functional Rating Index of Broberg and Morrey (FRIBM)
and the Modified Andrews’ Elbow Scoring System (MAESS) were assessed
pre-operatively and at each post-operative follow-up visit (six,
12 months and biennially thereafter). Radiographs were analysed
for loosening, fractures and dislocation. The mean follow-up was
59 months (26 to 89).Aims
Patients and Methods
We present the ten- to 15-year follow-up of 31
patients (34 knees), who underwent an Elmslie-Trillat tibial tubercle osteotomy
for chronic, severe patellar instability, unresponsive to non-operative
treatment. The mean age of the patients at the time of surgery was
31 years (18 to 46) and they were reviewed post-operatively, at
four years (2 to 8) and then at 12 years (10 to 15). All patients
had pre-operative knee radiographs and Cox and Insall knee scores. Superolateral
portal arthroscopy was performed per-operatively to document chondral
damage and after the osteotomy to assess the stability of the patellofemoral
joint. A total of 28 knees (82%) had a varying degree of damage
to the articular surface. At final follow-up 25 patients (28 knees)
were available for review and underwent clinical examination, radiographs
of the knee, and Cox and Insall scoring. Six patients who had no
arthroscopic chondral abnormality showed no or only early signs
of osteoarthritis on final radiographs; while 12 patients with lower
grade chondral damage (grade 1 to 2) showed early to moderate signs
of osteoarthritis and six out of ten knees with higher grade chondral
damage (grade 3 to 4) showed marked evidence of osteoarthritis;
four of these had undergone a knee replacement. In the 22 patients
(24 knees) with complete follow-up, 19 knees (79.2%) were reported
to have a good or excellent outcome at four years, while 15 knees
(62.5%) were reported to have the same at long-term follow-up. The
functional and radiological results show that the extent of pre-operatively
sustained chondral damage is directly related to the subsequent
development of patellofemoral osteoarthritis. Cite this article:
We investigated the incidence of anomalies in
the vertebral arteries and Circle of Willis with three-dimensional
CT angiography in 55 consecutive patients who had undergone an instrumented
posterior fusion of the cervical spine. We recorded any peri-operative and post-operative complications.
The frequency of congenital anomalies was 30.9%, abnormal vertebral
artery blood flow was 58.2% and vertebral artery dominance 40%. The posterior communicating artery was occluded on one side in
41.8% of patients and bilaterally in 38.2%. Variations in the vertebral
arteries and Circle of Willis were not significantly related to
the presence or absence of posterior communicating arteries. Importantly,
18.2% of patients showed characteristic variations in the Circle
of Willis with unilateral vertebral artery stenosis or a dominant
vertebral artery, indicating that injury may cause lethal complications.
One patient had post-operative cerebellar symptoms due to intra-operative
injury of the vertebral artery, and one underwent a different surgical
procedure because of insufficient collateral circulation. Pre-operative assessment of the vertebral arteries and Circle
of Willis is essential if a posterior spinal fusion with instrumentation
is to be carried out safely. Cite this article:
Successful management of late presenting hip
dislocation in childhood is judged by the outcome not just at skeletal
maturity but well beyond into adulthood and late middle age. This
review considers different methods of treatment and looks critically
at the handful of studies reporting long-term follow-up after successful
reduction. Cite this article
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:
We conducted a retrospective study to assess
the prevalence of adverse reactions to metal debris (ARMD) in patients
operated on at our institution with metal-on-metal (MoM) total hip
replacements with 36 mm heads using a Pinnacle acetabular shell.
A total of 326 patients (150 males, 175 hips; 176 females, 203 hips)
with a mean age of 62.7 years (28 to 85) and mean follow-up of 7.5
years (0.1 to 10.8) participating in our in-depth modern MoM follow-up
programme were included in the study, which involved recording whole
blood cobalt and chromium ion measurements, Oxford hip scores (OHS)
and plain radiographs of the hip and targeted cross-sectional imaging. Elevated
blood metal ion levels (>
5 parts per billion) were seen in 32 (16.1%)
of the 199 patients who underwent unilateral replacement. At 23
months after the start of our modern MoM follow-up programme, 29
new cases of ARMD had been revealed. Hence, the nine-year survival
of this cohort declined from 96% (95% CI 95 to 98) with the old
surveillance routine to 86% (95% CI 82 to 90) following the new
protocol. Although ARMD may not be as common in 36 mm MoM THRs as
in those with larger heads, these results support the Medicines
and Healthcare Products Regulatory Agency guidelines on regular
reviews and further investigations, and emphasise the need for specific
a follow-up programme for patients with MoM THRs. Cite this article:
Sporting injuries around the ankle vary from
simple sprains that will resolve spontaneously within a few days
to severe injuries which may never fully recover and may threaten
the career of a professional athlete. Some of these injuries can
be easily overlooked altogether or misdiagnosed with potentially
devastating effects on future performance. In this review article,
we cover some of the common and important sporting injuries involving
the ankle including updates on their management and outcomes. Cite this article:
It is probable that both genetic and environmental
factors play some part in the aetiology of most cases of degenerative
hip disease. Geneticists have identified some single gene disorders
of the hip, but have had difficulty in identifying the genetics
of many of the common causes of degenerative hip disease. The heterogeneity
of the phenotypes studied is part of the problem. A detailed classification
of phenotypes is proposed. This study is based on careful documentation
of 2003 consecutive total hip replacements performed by a single
surgeon between 1972 and 2000. The concept that developmental problems
may initiate degenerative hip disease is supported. The influences
of gender, age and body mass index are outlined. Biomechanical explanations
for some of the radiological appearances encountered are suggested.
The body weight lever, which is larger than the abductor lever, causes
the abductor power to be more important than body weight. The possibility
that a deficiency in joint lubrication is a cause of degenerative
hip disease is discussed. Identifying the phenotypes may help geneticists
to identify genes responsible for degenerative hip disease, and
eventually lead to a definitive classification.
The purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty. The transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, Objectives
Methods
Until now, there has been no consensus as to whether stemmed
acetabular components are appropriate for use in patients undergoing
revision total hip arthroplasty (THA) who have major acetabular
defects or pelvic discontinuity. We wished to address this deficiency
in the literature. We carried out a retrospective study of 35 patients (six men
and 29 women) with a mean age of 68 years (37 to 87), with major
acetabular defects who underwent revision THA between 2000 and 2012.Aim
Patients and Methods
Over a 15-year prospective period, 201 infants
with a clinically unstable hip at neonatal screening were subsequently
reviewed in a ‘one stop’ clinic where they were assessed clinically
and sonographically. Their mean age was 1.62 weeks (95% confidence
interval (CI) 1.35 to 1.89). Clinical neonatal hip screening revealed
a sensitivity of 62% (mean, 62.6 95%CI 50.9 to 74.3), specificity
of 99.8% (mean, 99.8, 95% CI 99.7 to 99.8) and positive predictive value
(PPV) of 24% (mean, 26.2, 95% CI 19.3 to 33.0). Static and dynamic
sonography for Graf type IV dysplastic hips had a 15-year sensitivity
of 77% (mean, 75.8 95% CI 66.9 to 84.6), specificity of 99.8% (mean,
99.8, 95% CI 99.8 to 99.8) and a PPV of 49% (mean, 55.1, 95% CI
41.6 to 68.5). There were 36 infants with an irreducible dislocation
of the hip (0.57 per 1000 live births), including six that failed
to resolve with neonatal splintage. Most clinically unstable hips referred to a specialist clinic
are female and stabilise spontaneously. Most irreducible dislocations
are not identified from this neonatal instability group. There may
be a small subgroup of females with instability of the hip which
may be at risk of progression to irreducibility despite early treatment
in a Pavlik harness. A controlled study is required to assess the value of neonatal
clinical screening programmes. Cite this article:
