For many designs of total knee arthroplasty (TKA) it remains unclear whether cemented or uncemented fixation provides optimal long-term survival. The main limitation in most studies is a retrospective or non-comparative study design. The same is true for comparative trials looking only at the survival rate as extensive sample sizes are needed to detect true differences in fixation and durability. Studies using radiostereometric analysis (RSA) techniques have shown to be highly predictive in detecting late occurring aseptic loosening at an early stage. To investigate the difference in predicted long-term survival between cemented, uncemented, and hybrid fixation of TKA, we performed a randomized controlled trial using RSA. A total of 105 patients were randomized into three groups (cemented, uncemented, and hybrid fixation of the ACS Mobile Bearing (ACS MB) knee system, implantcast). RSA examinations were performed on the first day after surgery and at scheduled follow-up visits at three months, six months, one year, and two years postoperatively. Patient-reported outcome measures (PROMs) were obtained preoperatively and after two years follow-up. Patients and follow-up investigators were blinded for the result of randomization.Aims
Methods
We report our experience of performing an elbow
hemiarthroplasty in the treatment of comminuted distal humeral fractures
in the elderly patients. A cohort of 42 patients (three men and 39 women, mean age 72;
56 to 84) were reviewed at a mean of 34.3 months (24 to 61) after
surgery.
Aims. The long-term
We report the short-term follow-up, functional
outcome and incidence of early and late infection after total hip replacement
(THR) in a group of HIV-positive patients who do not suffer from
haemophilia or have a history of intravenous drug use. A total of
29 patients underwent 43 THRs, with a mean follow-up of three years
and six months (five months to eight years and two months). There
were ten women and 19 men, with a mean age of 47 years and seven
months (21 years to 59 years and five months). No early (<
6
weeks) or late (>
6 weeks) complications occurred following their
THR. The mean pre-operative Harris hip score (HHS) was 27 (6 to
56) and the mean post-operative HHS was 86 (73 to 91), giving a
mean improvement of 59 points (p = <
0.05, Student’s t-test). No
revision procedures had been undertaken in any of the patients,
and none had any symptoms consistent with aseptic loosening. This
study demonstrates that it is safe to perform THR in HIV-positive
patients, with good short-term
We define the long-term outcomes and rates of
further operative intervention following displaced Bennett’s fractures
treated with Kirschner (K-) wire fixation between 1996 and 2009.
We retrospectively identified 143 patients (127 men and 16 women)
with a mean age at the time of injury of 33.2 years (18 to 75).
Electronic records were examined and patients were invited to complete
the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire
in addition to a satisfaction questionnaire. The time since injury
was a mean of 11.5 years (3.4 to 18.5). In total 11 patients had
died, one had developed dementia and 12 patients were lost to follow-up.
This left 119 patients available for recruitment. Of these, 57 did
not respond, leaving a study group of 62 patients. Patients reported
excellent
There is little published information on the
health impact of frozen shoulder. The purpose of this study was
to assess the functional and health-related quality of life outcomes
following arthroscopic capsular release (ACR) for contracture of
the shoulder. Between January 2010 and January 2012 all patients
who had failed non-operative treatment including anti-inflammatory
medication, physiotherapy and glenohumeral joint injections for
contracture of the shoulder and who subsequently underwent an ACR
were enrolled in the study. A total of 100 patients were eligible;
68 underwent ACR alone and 32 had ACR with a subacromial decompression
(ASD). ACR resulted in a highly significant improvement in the range
of movement and
Aims. We evaluated the short-term
The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized contolled trial (RCT) and to study patterns of change between subspecialties and nationalities. Two questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of distal radial fractures (DRFs). Overall, 380 orthopaedic surgeons were invited to participate in the first questionnaire, of whom 115 replied. One hundred surgeons were invited to participate in the second questionnaire. The primary outcome was the proportion of surgeons for whom a treatment change was warranted, who then reported a change of treatment preference following the RCT. Secondary outcomes included the reasons for repair or non-repair, reasons for and against following the RCT results, and difference of preferred treatment of the PQ muscle between surgeons of different nationalities, qualifications, years of training, and number of procedures performed per year.Aims
Methods
The aim of this study was to evaluate the ten-year
clinical and
To analyze outcomes reported in trials of childhood fractures. OVID MEDLINE, Embase, and Cochrane CENTRAL databases were searched on the eighth August 2019. A manual search of trial registries, bibliographic review and internet search was used to identify additional studies. 11,476 studies were screened following PRISMA guidelines. 100 trials were included in the analysis. Data extraction was completed by two researchers for each trial. Study quality was not evaluated. Outcomes reported by trials were mapped onto domains in the World Health Organization (WHO) International Classification of Function framework.Aims
Methods
We aimed to determine hip-related quality of life and clinical findings following treatment for neonatal hip instability (NHI) compared with age- and sex-matched controls. We hypothesized that NHI would predispose to hip discomfort in long-term follow-up. We invited those born between 1995 and 2001 who were treated for NHI at our hospital to participate in this population-based study. We included those that had Von Rosen-like splinting treatment started before one month of age. A total of 96 patients treated for NHI (75.6 %) were enrolled. A further 94 age- and sex-matched controls were also recruited. The Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire was completed separately for both hips, and a physical examination was performed.Aims
Methods
Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°. A matched cohort of patients similar for demographics and components used but differing in preoperative coronal-plane tibiotalar valgus deformity ≥ 15° (valgus, n = 50; 52% male, mean age 65.8 years (SD 10.3), mean body mass index (BMI) 29.4 (SD 5.2)) or < 15° (control, n = 50; 58% male, mean age 65.6 years (SD 9.8), mean BMI 28.7 (SD 4.2)), underwent TAA by one surgeon. Preoperative and postoperative radiographs, Ankle Osteoarthritis Scale (AOS) pain and disability and 36-item Short Form Health Survey (SF-36) version 2 scores were collected prospectively. Ancillary procedures, secondary procedures, and complications were recorded.Aims
Methods
Perthes’ disease is a condition leading to necrosis of the femoral head. It is most common in children aged four to nine years, affecting around one per 1,200 children in the UK. Management typically includes non-surgical treatment options, such as physiotherapy with/without surgical intervention. However, there is significant variation in care with no consensus on the most effective treatment option. This systematic review aims to evaluate the effectiveness of non-surgical interventions for the treatment of Perthes’ disease. Comparative studies (experimental or observational) of any non-surgical intervention compared directly with any alternative intervention (surgical, non-surgical or no intervention) were identified from: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMcare, Allied and Complementary Medicine Database (AMED), and the Physiotherapy Evidence Database (PEDro). Data were extracted on interventions compared and methodological quality. For post-intervention primary outcome of radiological scores (Stulberg and/or Mose), event rates for poor scores were calculated with significance values. Secondary outcomes included functional measures, such as range of movement, and patient-reported outcomes such as health-related quality of life.Aims
Methods
Antibiotic impregnated articulating spacers are
used in two-stage revision total knee arthroplasty to deliver local antibiotic
therapy while preserving function. We have observed infection control
in greater than 95% of cases with
The aim of this study was to examine the functional
outcome at ten years following lateral closing wedge high tibial osteotomy
for medial compartment osteoarthritis of the knee and to define
pre-operative predictors of survival and determinants of functional
outcome. . 164 consecutive patients underwent high tibial osteotomy between
2000 and 2002. A total of 100 patients (100 knees) met the inclusion
criteria and 95 were available for review at ten years. Data were
collected prospectively and included patient demographics, surgical
details, long leg alignment radiographs, Western Ontario and McMaster Universities
osteoarthritis index (WOMAC) and Knee Society scores (KSS) pre-operatively
and at five and ten years follow-up. At ten years, 21 patients had been revised at a mean of five
years. Overall Kaplan–Meier survival was 87% (95% confidence interval
(CI) 81 to 94) and 79% (95% CI 71 to 87) at five and ten years,
respectively. When compared with unrevised patients, those who had
been revised had significantly lower mean pre-operative WOMAC Scores
(47 (21 to 85) vs 65 (32 to 99), p <
0.001),
higher mean age (54 yrs (42 to 61) vs 49 yrs (26
to 66), p = 0.006) and a higher mean BMI (30.2; 25 to 39 vs 27.9;
21 to 36, p = 0.005). Each were found to be risk factors for revision,
with hazard ratios of 10.7 (95% CI 4 to 28.6; pre-operative WOMAC
<
45), 6.5 (95% CI 2.4 to 17.7; age >
55) and 3.0 (95%CI 1.2
to 7.6; BMI >
30). Survival of patients with pre-operative WOMAC
>
45, age <
55 and BMI <
30 was 97% at five and ten years. WOMAC
and KSS in surviving patients improved significantly between pre-operative
(mean 61; 32 to 99) and five (mean 88; 35 to 100, p = 0.001) and
ten years (mean 84; 38 to 100, p = 0.001). Older patients had better
functional outcomes overall, despite their higher revision rate. This study has shown that improved survival is associated with
age <
55 years, pre-operative WOMAC scores >
45 and, a BMI <
30. In patients over 55 years of age with adequate pre-operative
functional scores, survival can be good and functional outcomes
can be significantly better than their younger counterparts. We
recommend the routine use of pre-operative
As our understanding of hip function and disease improves, it is evident that the acetabular fossa has received little attention, despite it comprising over half of the acetabulum’s surface area and showing the first signs of degeneration. The fossa’s function is expected to be more than augmenting static stability with the ligamentum teres and being a templating landmark in arthroplasty. Indeed, the fossa, which is almost mature at 16 weeks of intrauterine development, plays a key role in hip development, enabling its nutrition through vascularization and synovial fluid, as well as the influx of chondrogenic stem/progenitor cells that build articular cartilage. The pulvinar, a fibrofatty tissue in the fossa, has the same developmental origin as the synovium and articular cartilage and is a biologically active area. Its unique anatomy allows for homogeneous distribution of the axial loads into the joint. It is composed of intra-articular adipose tissue (IAAT), which has adipocytes, fibroblasts, leucocytes, and abundant mast cells, which participate in the inflammatory cascade after an insult to the joint. Hence, the fossa and pulvinar should be considered in decision-making and surgical outcomes in hip preservation surgery, not only for their size, shape, and extent, but also for their biological capacity as a source of cytokines, immune cells, and chondrogenic stem cells. Cite this article:
Aims. We report on the outcome of the Synergy cementless femoral stem
with a minimum follow-up of 15 years (15 to 17). Patients and Methods. A retrospective review was undertaken of a consecutive series
of 112 routine primary cementless total hip arthroplasties (THAs)
in 102 patients (112 hips). There were 60 female and 42 male patients
with a mean age of 61 years (18 to 82) at the time of surgery. A
total of 78 hips in the 69 patients remain in situ;
nine hips in eight patients died before 15 years, and 16 hips in
16 patients were revised. Clinical outcome scores and radiographs
were available for 94 hips in 85 patients. Results. In all, four stems were revised. One stem was revised for aseptic
loosening; two stems because of deep infection; and one because
of periprosthetic femoral fracture. There was a significant improvement
in all components of the Western Ontario and McMaster Universities
Osteoarthritis Index score at the final follow-up (total: p <
0.001, pain: p <
0.001, stiffness: p <
0.001, function: p
<
0.001). The mean Harris Hip Scores improved from 47 points
(27 to 59) pre-operatively to 89 points (65 to 100) at the latest
follow-up (p <
0.001). Kaplan-Meier survivorship, with stem revision for aseptic loosening
as the endpoint, was 98.9% at 15 years (95% confidence interval
(CI) 96.9 to 100, number at risk at 15 years: 90) and with stem
revision for any reason was 95.7% (95% CI 91.7 to 99.8, number at
risk at 15 years: 90). Conclusion. The Synergy cementless femoral stem demonstrates excellent survivorship
and
The outcome of an anatomical shoulder replacement
depends on an intact rotator cuff. In 1981 Grammont designed a novel
large-head reverse shoulder replacement for patients with cuff deficiency.
Such has been the success of this replacement that it has led to
a rapid expansion of the indications. We performed a systematic
review of the literature to evaluate the