This multicentre, retrospective study aimed to improve our knowledge
of primary pyogenic spinal infections in children by analyzing a
large consecutive case series. The medical records of children with such an infection, treated
at four tertiary institutions between 2004 and 2014, were analyzed
retrospectively. Epidemiological, clinical, paraclinical, radiological,
and microbiological data were evaluated. There were 103 children,
of whom 79 (76.7%) were aged between six months and four years.Aims
Patients and Methods
Metabolic syndrome and low-grade systemic inflammation are associated with knee osteoarthritis (OA), but the relationships between these factors and OA in other synovial joints are unclear. The aim of this study was to determine if a high-fat/high-sucrose (HFS) diet results in OA-like joint damage in the shoulders, knees, and hips of rats after induction of obesity, and to identify potential joint-specific risks for OA-like changes. A total of 16 male Sprague-Dawley rats were allocated to either the diet-induced obesity group (DIO, 40% fat, 45% sucrose, n = 9) or a chow control diet (n = 7) for 12 weeks. At sacrifice, histological assessments of the shoulder, hip, and knee joints were performed. Serum inflammatory mediators and body composition were also evaluated. The total Mankin score for each animal was assessed by adding together the individual Modified Mankin scores across all three joints. Linear regression modelling was conducted to evaluate predictive relationships between serum mediators and total joint damage.Objectives
Methods
To evaluate the effect of a single early high-dose vitamin D
supplement on fracture union in patients with hypovitaminosis D
and a long bone fracture. Between July 2011 and August 2013, 113 adults with a long bone
fracture were enrolled in a prospective randomised double-blind
placebo-controlled trial. Their serum vitamin D levels were measured
and a total of 100 patients were found to be vitamin D deficient
(<
20 ng/ml) or insufficient (<
30 ng/mL). These were then
randomised to receive a single dose of vitamin D3 orally
(100 000 IU) within two weeks of injury (treatment group, n = 50)
or a placebo (control group, n = 50). We recorded patient demographics,
fracture location and treatment, vitamin D level, time to fracture
union and complications, including vitamin D toxicity. Outcomes included union, nonunion or complication requiring an
early, unplanned secondary procedure. Patients without an outcome
at 15 months and no scheduled follow-up were considered lost to
follow-up. The Aims
Patients and Methods
The aim of this study was to identify the incidence of positive
cultures during the second stage of a two-stage revision arthroplasty
and to analyse the association between positive cultures and an
infection-free outcome. This single-centre retrospective review of prospectively collected
data included patients with a periprosthetic joint infection (PJI)
of either the hip or the knee between 2013 and 2015, who were treated
using a standardised diagnostic and therapeutic algorithm with two-stage
exchange. Failure of treatment was assessed according to a definition
determined by a Delphi-based consensus. Logistic regression analysis
was performed to assess the predictors of positive culture and risk
factors for failure. The mean follow-up was 33 months (24 to 48).Aims
Patients and Methods
The length of the tourniquet time during total knee arthroplasty (TKA) is related to the incidence of post-operative deep vein thrombosis (DVT). Our aim in this study was to investigate the effect of the early release of the tourniquet on the incidence of DVT in patients undergoing TKA. A total of 200 patients who underwent TKA between November 2015 and November 2016 were prospectively enrolled. The tourniquet was inflated before surgery and released immediately after the introduction of the components (early release group). This group was compared with a retrospective cohort of 200 primary TKAs, in which the tourniquet was released after the dressings had been applied (late release group). The presence of a DVT was detected using bilateral lower limb ultrasonography. Peri-operative clinical and follow-up data were collected for analysis.Objectives
Methods
Our aim was to evaluate the radiographic characteristics of patients
undergoing total hip arthroplasty (THA) for the potential of posterior
bony impingement using CT simulations. Virtual CT data from 112 patients who underwent THA were analysed.
There were 40 men and 72 women. Their mean age was 59.1 years (41
to 76). Associations between radiographic characteristics and posterior
bony impingement and the range of external rotation of the hip were
evaluated. In addition, we investigated the effects of pelvic tilt
and the neck/shaft angle and femoral offset on posterior bony impingement.Aims
Patients and 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
The primary aim of this study was to evaluate the performance
and safety of magnetically controlled growth rods in the treatment
of early onset scoliosis. Secondary aims were to evaluate the clinical
outcome, the rate of further surgery, the rate of complications,
and the durability of correction. We undertook an observational prospective cohort study of children
with early onset scoliosis, who were recruited over a one-year period
and followed up for a minimum of two years. Magnetically controlled
rods were introduced in a standardized manner with distractions
performed three-monthly thereafter. Adverse events which were both related
and unrelated to the device were recorded. Ten children, for whom
relevant key data points (such as demographic information, growth
parameters, Cobb angles, and functional outcomes) were available,
were recruited and followed up over the period of the study. There
were five boys and five girls. Their mean age was 6.2 years (2.5
to 10).Aims
Patients and Methods
To determine ten-year failure rates following 36 mm metal-on-metal
(MoM) Pinnacle total hip arthroplasty (THA), and identify predictors
of failure. We retrospectively assessed a single-centre cohort of 569 primary
36 mm MoM Pinnacle THAs (all Corail stems) followed up since 2012
according to Medicines and Healthcare Products Regulation Agency
recommendations. All-cause failure rates (all-cause revision, and
non-revised cross-sectional imaging failures) were calculated, with predictors
for failure identified using multivariable Cox regression.Aims
Patients and Methods
The use of ceramic femoral heads in total hip arthroplasty (THA) has increased due to their proven low bearing wear characteristics. Ceramic femoral heads are also thought to reduce wear and corrosion at the head-stem junction with titanium (Ti) stems when compared with metal heads. We sought to evaluate taper damage of ceramic compared with metal heads when paired with cobalt chromium (CoCr) alloy stems in a single stem design. This retrieval study involved 48 total hip arthroplasties (THAs) with CoCr V40 trunnions paired with either CoCr (n = 21) or ceramic (n = 27) heads. The taper junction of all hips was evaluated for fretting/corrosion damage and volumetric material loss using a roundness-measuring machine. We used linear regression analysis to investigate taper damage differences after adjusting for potential confounding variables.Objectives
Methods
Femoral stems with exchangeable (modular) necks were introduced
to offer surgeons an increased choice when determining the version,
offset and length of the femoral neck during total hip arthroplasty
(THA). It was hoped that this would improve outcomes and reduce
complications, particularly dislocation. In 2010, the Australian Orthopaedic
Association National Joint Replacement Registry (AOANJRR) first
reported an increased rate of revision after primary THA using femoral
stems with an exchangeable neck. The aim of this study was to provide
a more comprehensive up-to-date analysis of primary THA using femoral
stems with exchangeable and fixed necks. The data included all primary THA procedures performed for osteoarthritis
(OA), reported to the AOANJRR between 01 September 1999 and 31 December
2014. There were 9289 femoral stems with an exchangeable neck and
253 165 femoral stems with a fixed neck. The characteristics of
the patients and prostheses including the bearing surface and stem/neck
metal combinations were examined using Cox proportional hazard ratios
(HRs) and Kaplan-Meier estimates of survivorship. Aims
Materials and Methods
Recently, there has been considerable interest in quantifying
the associations between bony abnormalities around and in the hip
joint and osteoarthritis (OA). Our aim was to investigate the relationships
between acetabular undercoverage, acetabular overcoverage, and femoroacetabular
impingement (FAI) with OA of the hip, which currently remain controversial. A total of 545 cadaveric skeletons (1090 hips) from the Hamann-Todd
osteological collection were obtained. Femoral head volume (FHV),
acetabular volume (AV), the FHV/AV ratio, acetabular version, alpha
angle and anterior femoral neck offset (AFNO) were measured. A validated
grading system was used to quantify OA of the hip as minimal, moderate,
or severe. Multiple linear and multinomial logistic regression were
used to determine the factors that correlated independently with
the FHV, AV, and the FHV/AV ratio. Aims
Materials and Methods
The aim of this prospective randomised controlled trial was to
compare non-operative and operative management for acute isolated
displaced fractures of the olecranon in patients aged ≥ 75 years. Patients were randomised to either non-operative management or
operative management with either tension-band wiring or fixation
with a plate. They were reviewed at six weeks, three and six months
and one year after the injury. The primary outcome measure was the
Disabilities of the Arm, Shoulder and Hand (DASH) score at one year.Aims
Patients and Methods
The aim of this study was to compare the effectiveness of a femoral
nerve block and a periarticular infiltration in the management of
early post-operative pain after total knee arthroplasty (TKA). A pragmatic, single centre, two arm parallel group, patient blinded,
randomised controlled trial was undertaken. All patients due for
TKA were eligible. Exclusion criteria included contraindications
to the medications involved in the study and patients with a neurological
abnormality of the lower limb. Patients received either a femoral
nerve block with 75 mg of 0.25% levobupivacaine hydrochloride around
the nerve, or periarticular infiltration with 150 mg of 0.25% levobupivacaine
hydrochloride, 10 mg morphine sulphate, 30 mg ketorolac trometamol
and 0.25 mg of adrenaline all diluted with 0.9% saline to make a
volume of 150 ml.Aims
Patients and Methods
The aim of this study was to identify patient- and surgery-related
risk factors for sustaining an early periprosthetic fracture following
primary total hip arthroplasty (THA) performed using a double-tapered
cementless femoral component (Bi-Metric femoral stem; Biomet Inc.,
Warsaw, Indiana). A total of 1598 consecutive hips, in 1441 patients receiving
primary THA between January 2010 and June 2015, were retrospectively
identified. Level of pre-operative osteoarthritis, femoral Dorr
type and cortical index were recorded. Varus/valgus placement of
the stem and canal fill ratio were recorded post-operatively. Periprosthetic
fractures were identified and classified according to the Vancouver
classification. Regression analysis was performed to identify risk
factors for early periprosthetic fracture.Aims
Patients and Methods
The use of a noninvasive growing endoprosthesis in the management
of primary bone tumours in children is well established. However,
the efficacy of such a prosthesis in those requiring a revision
procedure has yet to be established. The aim of this series was
to present our results using extendable prostheses for the revision
of previous endoprostheses. All patients who had a noninvasive growing endoprosthesis inserted
at the time of a revision procedure were identified from our database.
A total of 21 patients (seven female patients, 14 male) with a mean
age of 20.4 years (10 to 41) at the time of revision were included.
The indications for revision were mechanical failure, trauma or infection
with a residual leg-length discrepancy. The mean follow-up was 70
months (17 to 128). The mean shortening prior to revision was 44 mm
(10 to 100). Lengthening was performed in all but one patient with
a mean lengthening of 51 mm (5 to 140).Aims
Patients and Methods
The aim of this study was to examine the efficacy and safety
of multiple boluses of intravenous (IV) tranexamic acid (TXA) on
the hidden blood loss (HBL) and inflammatory response following
primary total hip arthroplasty (THA). A total of 150 patients were allocated randomly to receive a
single bolus of 20 mg/kg IV TXA before the incision (group A), a
single bolus followed by a second bolus of 1 g IV-TXA three hours
later (group B) or a single bolus followed by two boluses of 1 g
IV-TXA three and six hours later (group C). All patients were treated
using a standard peri-operative enhanced recovery protocol. Primary
outcomes were HBL and the level of haemoglobin (Hb) as well as the
levels of C-reactive protein (CRP) and interleukin-6 (IL-6) as markers
of inflammation. Secondary outcomes included the length of stay
in hospital and the incidence of venous thromboembolism (VTE).Aims
Patients and Methods