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The Journal of Bone & Joint Surgery British Volume
Vol. 66-B, Issue 5 | Pages 656 - 659
1 Nov 1984
Stillwell A Menelaus M

Of 47 patients with spina bifida who had had transplantation of the iliopsoas more than 10 years previously, 32 (68%) were community walkers, 3 were household walkers and 12 were non-walkers. Comparison with other published reports showed that, at the very least, the patients reviewed had not had their walking ability jeopardized by the inevitable loss of hip flexor power. Furthermore, all but three of the community walkers were able to climb and descend stairs. There was a high proportion of non-walkers in those patients whose operation had been performed in the first year of life and such early surgery is no longer recommended. We also found that the pre-operative assessment of muscle power had, in some patients, been inaccurate. Finally, we found that, at review, the power of the transferred muscles was poor, suggesting that transplantation is beneficial because it achieves permanent and major reduction in hip flexor power; this usually prevents recurrent hip flexion deformity and dislocation


The Journal of Bone & Joint Surgery British Volume
Vol. 57-B, Issue 2 | Pages 160 - 166
1 May 1975
Sharrard WJW Allen JMH Heaney SH

The clinical and radiological state of the hips of a group of children with cerebral palsy treated without operation is compared with that in a group treated by operation to correct adduction and flexion deformity and to obtain balanced action in the hip muscles. In the first group, 11 per cent of hips were dislocated, 28 per cent subluxated, 46 per cent dysplastic and 15 per cent normal. In the second group no hip was dislocated, 13 per cent were subluxated, 35 per cent dysplastic and 52 per cent normal. Surgical intervention is indicated clinically for a range of abduction diminishing to less than 45 degrees and–on radiological criteria–for early dysplastic changes, especially a break in Shenton's line, irrespective of the patient's age, severity of involvement or neurological maturity. Prevention of subluxation or dislocation improves function and diminishes the liability to develop a painful hip in adolescence or early adult life


The Journal of Bone & Joint Surgery British Volume
Vol. 41-B, Issue 2 | Pages 337 - 341
1 May 1959
Robins RHC

1. Sixty feet operated upon either by triple or pantalar tarsal fusion for instability after poliomyelitis were re-examined ten to twenty-four years later. 2. After triple fusion with preservation of the ankle joint there was a striking absence of late osteoarthritis of the ankle, and only a low incidence of troublesome lateral instability of the ankle. The results were generally good provided the patient had reasonable power of extension of the knee. 3. Triple arthrodesis for completely flail foot in patients without active muscle control of the knee was often disappointing, so far as the limb as a whole was concerned, because of a persistent flexion deformity of the knee which usually necessitated the wearing of an appliance. 4. The results of pantalar arthrodesis for the flail foot were satisfactory. When this operation was performed (with the foot in slight equinus) in patients who lacked active extension of the knee it helped to stabilise the knee in walking by encouraging hyperextension


The Journal of Bone & Joint Surgery British Volume
Vol. 66-B, Issue 3 | Pages 355 - 361
1 May 1984
Lettin A Kavanagh T Craig D Scales J

We review 210 Stanmore knee replacements in 163 patients to assess the survival of the prostheses and the long-term results. The annual rate of failure reached a maximum of 4.6% in the fourth year after operation; thereafter it declined to reach zero by the eighth year. Between two and eight years after operation, 66.3% of the surviving knees were completely free of pain and 30.2% had mild retropatellar pain. Fixed flexion deformities present before operation were completely corrected in 73% of the knees, and varus or valgus deformities were invariably corrected. Stability was always restored to unstable knees and 80.8% of knees flexed to 90 degrees or more after replacement. Aseptic loosening (8.1%), prosthetic infection (4.3%) and femoral fracture (2.9%) led to 8.5% of the prostheses being revised or removed over eight years. Modifications in prosthetic design and operative techniques have been introduced to minimise such complications in the future


The Journal of Bone & Joint Surgery British Volume
Vol. 64-B, Issue 4 | Pages 486 - 488
1 Aug 1982
Tasker T Waugh W

A prospective study was made of 100 knees which had been operated on for various kinds of internal derangement. An observer, who did not know the clinical condition of the knee, recorded whether or not there were articular lesions of the femoral condyles. Lesions were found to be localised to a triangular area on the medial condyle and to a strip on the lateral condyle. Similar lesions have been described in association with flexion deformities in rheumatoid and osteoarthritic knees. Lesions were found in 49 out of 50 knees which had been locked for more than three days. They were also found in 29 knees in which there appeared to be full extension before operation, but where there was either a torn meniscus with a history of intermittent locking or serious anterolateral instability. In these cases it was considered that the final "screw-home" mechanism of full extension had been lost. Lesions were not present in 10 knees which appeared locked, but in nine of these the interval between injury and operation was less than three days. Lesions were not found in eight knees where there was full extension and no history of locking or instability. In four knees with a plica syndrome similar lesions were present


The Journal of Bone & Joint Surgery British Volume
Vol. 49-B, Issue 1 | Pages 80 - 86
1 Feb 1967
Pollock GA English TA

1 . A ten-year study of fifty-four operations for transplantation of the hamstring muscles in thirty-one spastic patients has been made. 2. Twenty-one patients were improved after operation, six were not improved, and in four the duration of follow-up was too short for proper assessment. One patient died from other causes. 3. Greatest benefit was not obtained until one year after operation. 4. The results varied considerably in different grades of spastic patient. Important factors affecting the results were age, sex, personality, balance and function of arm and hip. Hand and major hip operations should be carried out before hamstring transplantation. 5. The objectives of operation are discussed. These were most consistently achieved in older, more ambitious or more responsible males with good balance and with good arm and hip function. 6. Factors which were of less direct importance were mental capacity, minor degrees of limb length inequality, and foot deformities. 7. Operative correction of foot deformities should not be done before hamstring transplantation. 8. Serial plaster correction of the knee flexion deformity before operation is preferred to division of the patellar retinacula. 9. Transplantation of the hamstrings to the patella in spastics is under trial


The Bone & Joint Journal
Vol. 103-B, Issue 2 | Pages 286 - 293
1 Feb 2021
Park CH Yan H Park J

Aims

No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA.

Methods

Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of motion (ROM), Böhler’s angle and calcaneal width, and posterior facet reduction.


Bone & Joint Research
Vol. 9, Issue 7 | Pages 341 - 350
1 Jul 2020
Marwan Y Cohen D Alotaibi M Addar A Bernstein M Hamdy R

Aims

To systematically review the outcomes and complications of cosmetic stature lengthening.

Methods

PubMed and Embase were searched on 10 November 2019 by three reviewers independently, and all relevant studies in English published up to that date were considered based on predetermined inclusion/exclusion criteria. The search was done using “cosmetic lengthening” and “stature lengthening” as key terms. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 6 | Pages 914 - 917
1 Nov 1997
Pope RO Corcoran S McCaul K Howie DW

We report a prospective randomly controlled trial to examine the effectiveness of continuous passive motion (CPM) in improving postoperative function and range of movement after total knee arthroplasty (TKA). We allocated 53 patients (57 knees) to one of three postoperative regimes: no CPM (n = 19); CPM at 0 to 40° (0 to 40 CPM; n = 18); and CPM at 0 to 70° (0 to 70 CPM; n = 20). Those in the CPM groups had CPM for 48 hours and all patients had an identical regime of physiotherapy. There was an even distribution of various cemented and cementless TKAs in each group. Patients were assessed preoperatively and at one week and at one year postoperatively. At one week, there was a statistically significant increase in the range of flexion and total range of movement in the 0 to 70 CPM group compared with the no-CPM group. At one year we found no significant differences in mean flexion, overall range of movement, fixed flexion deformity or functional results in the three groups. Those who had CPM had a significant increase in analgesic requirement (p = 0.04). There was an increased mean blood drainage postoperatively in those who had 0 to 70 CPM (1558 ml) compared with those with no CPM (956 ml) (t = 2.96, p = 0.005) and with 0 to 40 CPM (1017 ml) (t = 2.62, p = 0.01). Our findings show that CPM had no significant advantage in terms of improving function or range of movement, and that its use increased blood loss and analgesic requirements


The Bone & Joint Journal
Vol. 103-B, Issue 1 | Pages 105 - 112
1 Jan 2021
Lynch JT Perriman DM Scarvell JM Pickering MR Galvin CR Neeman T Smith PN

Aims

Modern total knee arthroplasty (TKA) prostheses are designed to restore near normal kinematics including high flexion. Kneeling is a high flexion, kinematically demanding activity after TKA. The debate about design choice has not yet been informed by six-degrees-of-freedom in vivo kinematics. This prospective randomized clinical trial compared kneeling kinematics in three TKA designs.

Methods

In total, 68 patients were randomized to either a posterior stabilized (PS-FB), cruciate-retaining (CR-FB), or rotating platform (CR-RP) design. Of these patients, 64 completed a minimum one year follow-up. Patients completed full-flexion kneeling while being imaged using single-plane fluoroscopy. Kinematics were calculated by registering the 3D implant models onto 2D-dynamic fluoroscopic images and exported for analysis.


Bone & Joint 360
Vol. 9, Issue 5 | Pages 19 - 22
1 Oct 2020


The Bone & Joint Journal
Vol. 102-B, Issue 10 | Pages 1354 - 1358
3 Oct 2020
Noureddine H Vejsbjerg K Harrop JE White MJ Chakravarthy J Harrison JWK

Aims

In the UK, fasciectomy for Dupuytren’s contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients.

Methods

Prospective data were collected for 30 patients undergoing open fasciectomy on 36 digits (six having two digits affected), over a one-year period and under the care of two surgeons. In total, 10 ml to 20 ml volume of 1% lidocaine with 1:100,000 adrenaline was used. A standard postoperative rehabilitation regime was used. Preoperative health scores, goniometer measurements of metacarpophalangeal (MCP), proximal interphalangeal (PIP) contractures, and Unité Rheumatologique des Affections de la Main (URAM) scores were measured pre- and postoperatively at six and 12 weeks.


Bone & Joint 360
Vol. 10, Issue 1 | Pages 38 - 41
1 Feb 2021


Bone & Joint 360
Vol. 9, Issue 1 | Pages 21 - 24
1 Feb 2020


The Bone & Joint Journal
Vol. 102-B, Issue 7 Supple B | Pages 47 - 51
1 Jul 2020
Kazarian GS Schloemann DT Barrack TN Lawrie CM Barrack RL

Aims

The aims of this study were to determine the change in the sagittal alignment of the pelvis and the associated impact on acetabular component position at one-year follow-up after total hip arthroplasty (THA).

Methods

This study represents the one-year follow-up of a previous short-term study at our institution. Using the patient population from our prior study, the radiological pelvic ratio was assessed in 91 patients undergoing THA, of whom 50 were available for follow-up of at least one year (median 1.5; interquartile range (IQR) 1.1 to 2.0). Anteroposterior radiographs of the pelvis were obtained in the standing position preoperatively and at one year postoperatively. Pelvic ratio was defined as the ratio between the vertical distance from the inferior sacroiliac (SI) joints to the superior pubic symphysis and the horizontal distance between the inferior SI joints. Apparent acetabular component position changes were determined from the change in pelvic ratio. A change of at least 5° was considered clinically meaningful.


Bone & Joint Open
Vol. 1, Issue 7 | Pages 339 - 345
3 Jul 2020
MacDessi SJ Griffiths-Jones W Harris IA Bellemans J Chen DB

Aims

An algorithm to determine the constitutional alignment of the lower limb once arthritic deformity has occurred would be of value when undertaking kinematically aligned total knee arthroplasty (TKA). The purpose of this study was to determine if the arithmetic hip-knee-ankle angle (aHKA) algorithm could estimate the constitutional alignment of the lower limb following development of significant arthritis.

Methods

A matched-pairs radiological study was undertaken comparing the aHKA of an osteoarthritic knee (aHKA-OA) with the mechanical HKA of the contralateral normal knee (mHKA-N). Patients with Grade 3 or 4 Kellgren-Lawrence tibiofemoral osteoarthritis in an arthritic knee undergoing TKA and Grade 0 or 1 osteoarthritis in the contralateral normal knee were included. The aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA) measured on standing long leg radiographs. The primary outcome was the mean of the paired differences in the aHKA-OA and mHKA-N. Secondary outcomes included comparison of sex-based differences and capacity of the aHKA to determine the constitutional alignment based on degree of deformity.


The Bone & Joint Journal
Vol. 102-B, Issue 7 | Pages 852 - 860
1 Jul 2020
Zamora T Garbuz DS Greidanus NV Masri BA

Aims

Our objective is to describe our early and mid-term results with the use of a new simple primary knee prosthesis as an articulating spacer in planned two-stage management for infected knee arthroplasty. As a second objective, we compared outcomes between the group with a retained first stage and those with a complete two-stage revision.

Methods

We included 47 patients (48 knees) with positive criteria for infection, with a minimum two-year follow-up, in which a two-stage approach with an articulating spacer with new implants was used. Patients with infection control, and a stable and functional knee were allowed to retain the initial first-stage components. Outcomes recorded included: infection control rate, reoperations, final range of motion (ROM), and quality of life assessment (QoL) including Western Ontario and McMaster Universities osteoarthritis index, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, 12-Item Short-Form Health Survey questionnaire, and University of California Los Angeles (UCLA) activity score and satisfaction score. These outcomes were evaluated and compared to additional cohorts of patients with retained first-stage interventions and those with a complete two-stage revision. Mean follow-up was 3.7 years (2.0 to 6.5).


The Bone & Joint Journal
Vol. 102-B, Issue 1 | Pages 64 - 71
1 Jan 2020
Tsuda Y Fujiwara T Stevenson JD Parry MC Tillman R Abudu A

Aims

The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma.

Methods

A total of 35 consecutive patients treated with extendable endoprosthetic replacement of the humerus in children were included. There were 17 boys and 18 girls in the series with a median age at the time of initial surgery of nine years (interquartile range (IQR) 7 to 11).


The Bone & Joint Journal
Vol. 102-B, Issue 6 | Pages 727 - 735
1 Jun 2020
Burger JA Dooley MS Kleeblad LJ Zuiderbaan HA Pearle AD

Aims

It remains controversial whether patellofemoral joint pathology is a contraindication to lateral unicompartmental knee arthroplasty (UKA). This study aimed to evaluate the effect of preoperative radiological degenerative changes and alignment on patient-reported outcome scores (PROMs) after lateral UKA. Secondarily, the influence of lateral UKA on the alignment of the patellofemoral joint was studied.

Methods

A consecutive series of patients who underwent robotic arm-assisted fixed-bearing lateral UKA with at least two-year follow-up were retrospectively reviewed. Radiological evaluation was conducted to obtain a Kellgren Lawrence (KL) grade, an Altman score, and alignment measurements for each knee. Postoperative PROMs were assessed using the Kujala (Anterior Knee Pain Scale) score, Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), and satisfaction levels.


The Bone & Joint Journal
Vol. 102-B, Issue 6 Supple A | Pages 49 - 58
1 Jun 2020
Mullaji A

Aims

The aims of this study were to determine the effect of osteophyte excision on deformity correction and soft tissue gap balance in varus knees undergoing computer-assisted total knee arthroplasty (TKA).

Methods

A total of 492 consecutive, cemented, cruciate-substituting TKAs performed for varus osteoarthritis were studied. After exposure and excision of both cruciates and menisci, it was noted from operative records the corrective interventions performed in each case. Knees in which no releases after the initial exposure, those which had only osteophyte excision, and those in which further interventions were performed were identified. From recorded navigation data, coronal and sagittal limb alignment, knee flexion range, and medial and lateral gap distances in maximum knee extension and 90° knee flexion with maximal varus and valgus stresses, were established, initially after exposure and excision of both cruciate ligaments, and then also at trialling. Knees were defined as ‘aligned’ if the hip-knee-ankle axis was between 177° and 180°, (0° to 3° varus) and ‘balanced’ if medial and lateral gaps in extension and at 90° flexion were within 2 mm of each other.