In order to evaluate the effectiveness of the Mobi-C implant
in cervical disc degeneration, a randomised study was conducted,
comparing the Mobi-C prosthesis arthroplasty with anterior cervical
disc fusion (ACDF) in patients with single level cervical spondylosis. From January 2008 to July 2009, 99 patients were enrolled and
randomly divided into two groups, those having a Mobi-C implant
(n = 51; 30 men, 21 women) and those undergoing ACDF (n = 48; 28
men, 20 women).The patients were followed up for five years, with
the primary outcomes being the Japanese Orthopaedic Association
score, visual analogue scale for pain and the incidence of further
surgery. The secondary outcomes were the Neck Disability Index and
range of movement (ROM) of the treated segment.Aims
Patients and Methods
Bisphosphonates are widely used as first-line treatment for primary and secondary prevention of fragility fractures. Whilst they have proved effective in this role, there is growing concern over their long-term use, with much evidence linking bisphosphonate-related suppression of bone remodelling to an increased risk of atypical subtrochanteric fractures of the femur (AFFs). The objective of this article is to review this evidence, while presenting the current available strategies for the management of AFFs. We present an evaluation of current literature relating to the pathogenesis and treatment of AFFs in the context of bisphosphonate use.Objectives
Methods
To explore the therapeutic potential of combining bone marrow-derived mesenchymal stem cells (BM-MSCs) and hydroxyapatite (HA) granules to treat nonunion of the long bone. Ten patients with an atrophic nonunion of a long bone fracture were selectively divided into two groups. Five subjects in the treatment group were treated with the combination of 15 million autologous BM-MSCs, 5g/cm3 (HA) granules and internal fixation. Control subjects were treated with iliac crest autograft, 5g/cm3 HA granules and internal fixation. The outcomes measured were post-operative pain (visual analogue scale), level of functionality (LEFS and DASH), and radiograph assessment.Objectives
Methods
Recent studies have shown that systemic injection of rapamycin can prevent the development of osteoarthritis (OA)-like changes in human chondrocytes and reduce the severity of experimental OA. However, the systemic injection of rapamycin leads to many side effects. The purpose of this study was to determine the effects of intra-articular injection of Torin 1, which as a specific inhibitor of mTOR which can cause induction of autophagy, is similar to rapamycin, on articular cartilage degeneration in a rabbit osteoarthritis model and to investigate the mechanism of Torin 1’s effects on experimental OA. Collagenase (type II) was injected twice into both knees of three-month-old rabbits to induce OA, combined with two intra–articular injections of Torin 1 (400 nM). Degeneration of articular cartilage was evaluated by histology using the Mankin scoring system at eight weeks after injection. Chondrocyte degeneration and autophagosomes were observed by transmission electron microscopy. Matrix metallopeptidase-13 (MMP-13) and vascular endothelial growth factor (VEGF) expression were analysed by quantitative RT-PCR (qPCR).Beclin-1 and light chain 3 (LC3) expression were examined by Western blotting.Objectives
Methods
Osteochondritis Dissecans (OCD) is a condition
for which the aetiology remains unknown. It affects subchondral bone
and secondarily its overlying cartilage and is mostly found in the
knee. It can occur in adults, but is generally identified when growth
remains, when it is referred to as juvenile OCD. As the condition
progresses, the affected subchondral bone separates from adjacent
healthy bone, and can lead to demarcation and separation of its associated
articular cartilage. Any symptoms which arise relate to the stage
of the disease. Early disease without separation of the lesion results
in pain. Separation of the lesion leads to mechanical symptoms and
swelling and, in advanced cases, the formation of loose bodies. Early identification of OCD is essential as untreated OCD can
lead to the premature degeneration of the joint, whereas appropriate
treatment can halt the disease process and lead to healing. Establishing
the stability of the lesion is a key part of providing the correct
treatment. Stable lesions, particularly in juvenile patients, have
greater propensity to heal with non-surgical treatment, whereas
unstable or displaced lesions usually require surgical management. This article discusses the aetiology, clinical presentation and
prognosis of OCD in the knee. It presents an algorithm for treatment,
which aims to promote healing of native hyaline cartilage and to
ensure joint congruity. Take home message: Although there is no clear consensus as to
the best treatment of OCD, every attempt should be made to retain
the osteochondral fragment when possible as, with a careful surgical
technique, there is potential for healing even in chronic lesions Cite this article:
We investigated the effects on fracture healing of two up-regulators of inducible nitric oxide synthase (iNOS) in a rat model of an open femoral osteotomy: tadalafil, a phosphodiesterase inhibitor, and the recently reported nutraceutical, COMB-4 (consisting of L-citrulline, Paullinia cupana, ginger and muira puama), given orally for either 14 or 42 days. Unilateral femoral osteotomies were created in 58 male rats and fixed with an intramedullary compression nail. Rats were treated daily either with vehicle, tadalafil or COMB-4. Biomechanical testing of the healed fracture was performed on day 42. The volume, mineral content and bone density of the callus were measured by quantitative CT on days 14 and 42. Expression of iNOS was measured by immunohistochemistry.Objectives
Materials and Methods
Free vascularised fibular grafting has been used for the treatment
of large bony defects for more than 40 years. However, there is
little information about the risk factors for failure and whether
newer locking techniques of fixation improve the rates of union.
The purpose of this study was to compare the rates of union of free
fibular grafts fixed with locking and traditional techniques, and
to quantify the risk factors for nonunion and failure. A retrospective review involved 134 consecutive procedures over
a period of 20 years. Of these, 25 were excluded leaving 109 patients
in the study. There were 66 men and 43 women, with a mean age of
33 years (5 to 78). Most (62) were performed for oncological indications,
and the most common site (52) was the lower limb. Rate of union
was estimated using the Kaplan-Meier method and risk factors for
nonunion were assessed using Cox regression. All patients were followed
up for at least one year.Aims
Patients and Methods
The purpose of our study is to summarise the current scientific
findings regarding the impact of obesity on total hip arthroplasty
(THA); specifically the influence of obesity on the timing of THA,
incidence of complications, and effect on clinical and functional
outcomes. We performed a systematic review that was compliant with the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines to identify prospective studies from the PubMed/Medline,
Embase, and Cochrane Library databases that evaluated primary THA
in obese (body mass index (BMI) ≥ 30 kg/m2) patients.Aims
Materials and Methods
To assess the effect of high tibial and distal femoral osteotomies
(HTO and DFO) on the pressure characteristics of the ankle joint. Varus and valgus malalignment of the knee was simulated in human
cadaver full-length legs. Testing included four measurements: baseline
malalignment, 5° and 10° re-aligning osteotomy, and control baseline
malalignment. For HTO, testing was rerun with the subtalar joint
fixed. In order to represent half body weight, a 300 N force was applied
onto the femoral head. Intra-articular sensors captured ankle pressure.Aims
Materials and Methods
This investigation sought to advance the work published in our prior biomechanical study ( A total of 33 adult humeri were used from a previous study where we quantified bone mineral density of the proximal humerus using radiographs and dual-energy x-ray absorptiometry (DEXA), and regional mean cortical thickness and cortical index using radiographs. The bones were fractured in a simulated backwards fall with the humeral head loaded at 2 mm/second via a frustum angled at 30° from the long axis of the bone. Correlations were assessed with ultimate fracture load and these new parameters: cortical index expressed in areas (“areal cortical index”) of larger regions of the diaphysis; the canal-to-calcar ratio used analogous to its application in proximal femurs; and the recently described medial cortical ratio.Objectives
Materials and Methods
The role of high tibial osteotomy (HTO) is being questioned by
the use of unicompartmental knee arthroplasty (UKA) in the treatment
of medial compartment femorotibial osteoarthritis. Our aim was to
compare the outcomes of revision HTO or UKA to a total knee arthroplasty
(TKA) using computer-assisted surgery in matched groups of patients. We conducted a retrospective study to compare the clinical and
radiological outcome of patients who underwent revision of a HTO
to a TKA (group 1) with those who underwent revision of a medial
UKA to a TKA (group 2). All revision procedures were performed using
computer-assisted surgery. We extracted these groups of patients
from our database. They were matched by age, gender, body mass index,
follow-up and pre-operative functional score. The outcomes included
the Knee Society Scores (KSS), radiological outcomes and the rate
of further revision.Aims
Patients and Methods
Our aim was to describe the atypical pattern of increased fatty
degeneration in the infraspinatus muscle compared with the supraspinatus
in patients with a massive rotator cuff tear. We also wished to
describe the nerve conduction and electromyography findings in these
patients. A cohort of patients undergoing surgery for a massive rotator
cuff tear was identified and their clinical records obtained. Their
MRI images were reviewed to ascertain the degree of retraction of
the torn infraspinatus and supraspinatus muscles, and the degree
of fatty degeneration in both muscles was recorded. Nerve conduction studies
were also performed in those patients who showed more degeneration
in the infraspinatus than in the supraspinatus.Aims
Patients and Methods
The accurate assessment of skeletal maturity
is essential in the management of orthopaedic conditions in the growing
child. In order to identify the time of peak height velocity (PHV)
in adolescents, two systems for assessing skeletal maturity have
been described recently; the calcaneal apophyseal ossification method
and the Sanders hand scores. The purpose of this study was to compare these methods in assessing
skeletal maturity relative to PHV. We studied the radiographs of
a historical group of 94 healthy children (49 females and 45 males),
who had been followed longitudinally between the ages of three and
18 years with serial radiographs and physical examination. Radiographs
of the foot and hand were undertaken in these children at least
annually between the ages of ten and 15 years. We reviewed 738 radiographs
of the foot and 694 radiographs of the hand. PHV was calculated
from measurements of height taken at the time of the radiographs. Prior to PHV we observed four of six stages of calcaneal apophyseal
ossification and two of eight Sanders stages. Calcaneal stage 3
and Sanders stage 2 was seen to occur about 0.9 years before PHV,
while calcaneal stage 4 and Sanders stage 3 occurred approximately
0.5 years after PHV. The stages of the calcaneal and Sanders systems can be used in
combination, offering better assessment of skeletal maturity with
respect to PHV than either system alone. Cite this article:
Acute angulation at the thoracolumbar junction
with segmental subluxation of the spine occurring at the level above
an anteriorly hypoplastic vertebra in otherwise normal children
is a rare condition described as infantile developmental thoracolumbar
kyphosis. Three patient series with total of 18 children have been
reported in the literature. We report five children who presented
with thoracolumbar kyphosis and discuss the treatment algorithm. We
reviewed the medical records and spinal imaging at initial clinical
presentation and at minimum two-year follow-up. The mean age at
presentation was eight months (two to 12). All five children had
L2 anterior vertebral body hypoplasia. The kyphosis improved spontaneously
in three children kept under monitoring. In contrast, the deformity
was progressive in two patients who were treated with bracing. The
kyphosis and segmental subluxation corrected at latest follow-up
(mean age 52 months; 48 to 60) in all patients with near complete
reconstitution of the anomalous vertebra. The deformity and radiological
imaging on a young child can cause anxiety to both parents and treating
physicians. Diagnostic workup and treatment algorithm in the management
of infantile developmental thoracolumbar kyphosis is proposed. Observation
is indicated for non-progressive kyphosis and bracing if there is evidence
of kyphosis and segmental subluxation deterioration beyond walking
age. Surgical stabilisation of the spine can be reserved for severe
progressive deformities unresponsive to conservative treatment. Cite this article:
During open orthopaedic surgery, joints may be exposed to air, potentially leading to cartilage drying and chondrocyte death, however, the long-term effects of joint drying The patellar groove of anaesthetised rats was exposed (sham-operated), or exposed and then subjected to laminar airflow (0.25m/s; 60 minutes) before wounds were sutured and animals recovered. Animals were monitored for up to eight weeks and then sacrificed. Cartilage and chondrocyte properties were studied by histology and confocal microscopy, respectively.Objectives
Methods
