The optimal management of intracapsular fractures of the femoral
neck in independently mobile patients remains open to debate. Successful
fixation obviates the limitations of arthroplasty for this group
of patients. However, with fixation failure rates as high as 30%,
the outcome of revision surgery to salvage total hip arthroplasty
(THA) must be considered. We carried out a systematic review to
compare the outcomes of salvage THA and primary THA for intracapsular
fractures of the femoral neck. We performed a Preferred Reporting Items for Systematic Reviews
and Meta-Analysis (PRISMA) compliant systematic review, using the
PubMed, EMBASE and Cochrane libraries databases. A meta-analysis
was performed where possible, and a narrative synthesis when a meta-analysis
was not possible.Aims
Patients and Methods
In approximately 20% of patients with ankle fractures, there
is an concomitant injury to the syndesmosis which requires stabilisation,
usually with one or more syndesmotic screws. The aim of this review
is to evaluate whether removal of the syndesmotic screw is required
in order for the patient to obtain optimal functional recovery. A literature search was conducted in Medline, Embase and the
Cochrane Library for articles in which the syndesmotic screw was
retained. Articles describing both removal and retaining of syndesmotic
screws were included. Excluded were biomechanical studies, studies
not providing patient related outcome measures, case reports, studies
on skeletally immature patients and reviews. No restrictions regarding
year of publication and language were applied.Aims
Materials and Methods
Cite this article: A. A. Abubakar, M. M. Noordin, T. I. Azmi, U. Kaka, M. Y. Loqman. The use of rats and mice as animal models in
The purpose of this study was to evaluate the
effect of various non-operative modalities of treatment (transcutaneous
electrical nerve stimulation (TENS); neuromuscular electrical stimulation
(NMES); insoles and bracing) on the pain of osteoarthritis (OA)
of the knee. We conducted a systematic review according to the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines to identify
the therapeutic options which are commonly adopted for the management
of osteoarthritis (OA) of the knee. The outcome measurement tools used in the different studies were
the visual analogue scale and The Western Ontario and McMaster Universities
Arthritis Index pain index: all pain scores were converted to a
100-point scale. A total of 30 studies met our inclusion criteria: 13 on insoles,
seven on TENS, six on NMES, and four on bracing. The standardised
mean difference (SMD) in pain after treatment with TENS was 1.796,
which represented a significant reduction in pain. The significant
overall effect estimate for NMES on pain was similar to that of
TENS, with a SMD of 1.924. The overall effect estimate of insoles
on pain was a SMD of 0.992. The overall effect of bracing showed
a significant reduction in pain of 1.34. Overall, all four non-operative modalities of treatment were
found to have a significant effect on the reduction of pain in OA
of the knee. This study shows that non-operative physical modalities of treatment
are of benefit when treating OA of the knee. However, much of the
literature reviewed evaluates studies with follow-up of less than
six months: future work should aim to evaluate patients with longer
follow-up. Cite this article:
Since redesign of the Oxford phase III mobile-bearing unicompartmental
knee arthroplasty (UKA) femoral component to a twin-peg design,
there has not been a direct comparison to total knee arthroplasty
(TKA). Thus, we explored differences between the two cohorts. A total of 168 patients (201 knees) underwent medial UKA with
the Oxford Partial Knee Twin-Peg. These patients were compared with
a randomly selected group of 177 patients (189 knees) with primary
Vanguard TKA. Patient demographics, Knee Society (KS) scores and
range of movement (ROM) were compared between the two cohorts. Additionally,
revision, re-operation and manipulation under anaesthesia rates
were analysed.Aims
Patients and Methods
Patients with diabetes are at increased risk of wound complications
after open reduction and internal fixation of unstable ankle fractures.
A fibular nail avoids large surgical incisions and allows anatomical
reduction of the mortise. We retrospectively reviewed the results of fluoroscopy-guided
reduction and percutaneous fibular nail fixation for unstable Weber
type B or C fractures in 24 adult patients with type 1 or type 2
diabetes. The re-operation rate for wound dehiscence or other indications
such as amputation, mortality and functional outcomes was determined.Aims
Patients and Methods
To elucidate the effects of age on the expression levels of the receptor activator of the nuclear factor-κB ligand (RANKL) and osteoclasts in the periodontal ligament during orthodontic mechanical loading and post-orthodontic retention. The study included 20 male Sprague-Dawley rats, ten in the young group (aged four to five weeks) and ten in the adult group (aged 18 to 20 weeks). In each rat, the upper-left first molar was subjected to a seven-day orthodontic force loading followed by a seven-day retention period. The upper-right first molar served as a control. The amount of orthodontic tooth movement was measured after seven-day force application and seven-day post-orthodontic retention. The expression levels of RANKL and the tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts were evaluated on day 7 (end of mechanical force loading) and day 14 (after seven days of post-orthodontic retention). Statistical analysis was performed using the Objectives
Materials and Methods
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
In recent years, the plantaris tendon has been
implicated in the development of chronic painful mid-portion Achilles tendinopathy.
In some cases, a thickened plantaris tendon is closely associated
with the Achilles tendon, and surgical excision of the plantaris
tendon has been reported to be curative in patients who have not
derived benefit following conservative treatment and surgical interventions. The aim of this review is to outline the basic aspects of, and
the recent research findings, related to the plantaris tendon, covering
anatomical and clinical studies including those dealing with histology,
imaging and treatment. Cite this article
There is uncertainty regarding the optimal means of thromboprophylaxis
following total hip and knee arthroplasty (THA, TKA). This systematic
review presents the evidence for acetylsalicylic acid (aspirin)
as a thromboprophylactic agent in THA and TKA and compares it with
other chemoprophylactic agents. A search of literature published between 2004 and 2014 was performed
in accordance with Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines. A total of 13 studies were eligible
for inclusion.Aims
Materials and Methods
The purpose of this study was to review a large cohort of patients
and further assess the correlation between the histological response
to chemotherapy in patients with Ewing’s sarcoma with the overall
(OS) and event-free survival (EFS). All patients treated for Ewing’s sarcoma between 1980 and 2012
were reviewed. Of these, 293 patients without metastases at the
time of diagnosis and treated with chemotherapy and surgery were
included. Patients were grouped according to the percentage of necrosis
after chemotherapy: Group I: 0% to 50%, Group II: 51% to 99% and Group
III: 100%.Aims
Patients and Methods
A patient-centred approach, usually achieved through shared decision
making, has the potential to help improve decision making around
knee arthroplasty surgery. However, such an approach requires an
understanding of the factors involved in patient decision making.
This review’s objective is to systematically examine the qualitative literature
surrounding patients’ decision making in knee arthroplasty. A systematic literature review using Medline and Embase was conducted
to identify qualitative studies that examined patients’ decision
making around knee arthroplasty. An aggregated account of what is
known about patients’ decision making in knee arthroplasties is
provided.Objectives
Methods
To determine the pattern of mutations of the A total of 15 patients with clinical features of PPD were enrolled in this study. Genomic DNA was isolated and polymerase chain reaction performed to amplify the Objectives
Patients and Methods
We wished to compare the clinical outcome, as assessed by questionnaires
and the rate of complications, in total knee arthroplasty (TKA)
undertaken with patient-matched positioning guides (PMPGs) or conventional
instruments. A total of 180 patients (74 men, 106 women; mean age 67 years)
were included in a multicentre, adequately powered, double-blind,
randomised controlled trial. The mean follow-up was 44 months (24
to 57).Aims
Patients and Methods
Total hip replacement causes a short-term increase
in the risk of mortality. It is important to quantify this and to identify
modifiable risk factors so that the risk of post-operative mortality
can be minimised. We performed a systematic review and critical
evaluation of the current literature on the topic. We identified
32 studies published over the last 10 years which provide either
30-day or 90-day mortality data. We estimate the pooled incidence
of mortality during the first 30 and 90 days following hip replacement
to be 0.30% (95% CI 0.22 to 0.38) and 0.65% (95% CI 0.50 to 0.81),
respectively. We found strong evidence of a temporal trend towards
reducing mortality rates despite increasingly co-morbid patients.
The risk factors for early mortality most commonly identified are
increasing age, male gender and co-morbid conditions, particularly
cardiovascular disease. Cardiovascular complications appear to have
overtaken fatal pulmonary emboli as the leading cause of death after
hip replacement. Cite this article:
As the number of younger and more active patients
treated with total knee arthroplasty (TKA) continues to increase,
consideration of better fixation as a means of improving implant
longevity is required. Cemented TKA remains the reference standard
with the largest body of evidence and the longest follow-up to support
its use. However, cementless TKA, may offer the opportunity of a
more bone-sparing procedure with long lasting biological fixation
to the bone. We undertook a review of the literature examining advances
of cementless TKA and the reported results. Cite this article:
The acetabular labrum is a soft-tissue structure
which lines the acetabular rim of the hip joint. Its role in hip
joint biomechanics and joint health has been of particular interest
over the past decade. In normal hip joint biomechanics, the labrum
is crucial in retaining a layer of pressurised intra-articular fluid
for joint lubrication and load support/distribution. Its seal around
the femoral head is further regarded as a contributing to hip stability through
its suction effect. The labrum itself is also important in increasing
contact area thereby reducing contact stress. Given the labrum’s
role in normal hip joint biomechanics, surgical techniques for managing
labral damage are continuously evolving as our understanding of
its anatomy and function continue to progress. The current paper
aims to review the anatomy and biomechanical function of the labrum
and how they are affected by differing surgical techniques. Take home message: The acetabular labrum plays a critical role
in hip function and maintaining and restoring its function during
surgical intervention remain an essential goal. Cite this article:
This study investigated the influence of body mass index (BMI)
on the post-operative fall in the level of haemoglobin (Hb), length
of hospital stay (LOS), 30-day re-admission rate, functional outcome
and quality of life, two years after total knee arthroplasty (TKA). A total of 7733 patients who underwent unilateral primary TKA
between 2001 and 2010 were included. The mean age was 67 years (30
to 90). There were 1421 males and 6312 females. The patients were
categorised into three groups: BMI <
25.0 kg/m2 (normal);
BMI between 25.0 and 39.9 kg/m2 (obese); and BMI ≥ 40.0
kg/m2 (morbidly obese).Aims
Patients and Methods
Total joint arthroplasty (TJA) is commonly performed in elderly
patients. Frailty, an aggregate expression of vulnerability, becomes
increasingly common with advanced age, and independently predicts
adverse outcomes and the use of resources after a variety of non-cardiac
surgical procedures. Our aim was to assess the impact of frailty
on outcomes after TJA. We analysed the impact of pre-operative frailty on death and
the use of resources after elective TJA in a population-based cohort
study using linked administrative data from Ontario, Canada.Aims
Patients and Methods
