Few studies have assessed outcomes following non-metal-on-metal hip arthroplasty (non-MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD). We assessed outcomes following non-MoMHA revision surgery performed for ARMD, and identified predictors of re-revision. We performed a retrospective observational study using data from the National Joint Registry for England and Wales. All non-MoMHAs undergoing revision surgery for ARMD between 2008 and 2014 were included (185 hips in 185 patients). Outcome measures following ARMD revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using Cox regression.Objectives
Methods
The classical longitudinal incision used for the direct anterior
approach (DAA) to the hip does not follow the tension lines of the
skin and can lead to impaired wound healing and poor cosmesis. The
purpose of this retrospective study was to determine the satisfaction
with the scar, and functional and radiographic outcomes comparing
the classic longitudinal incision with a modified skin crease ‘bikini’
when the DAA is used for total hip arthroplasty (THA). A total of 964 patients (51% female; 59% longitudinal, 41% ‘bikini’)
completed a follow-up questionnaire between two and four years postoperatively,
including the Oxford Hip Score (OHS), the University of North Carolina
‘4P’ scar scale (UNC4P) and two items for assessing the aesthetic
appearance of the scar and symptoms of numbness. The positioning
of the components, rates of heterotopic ossification (HO) and rates
of revision were assessed.Aims
Patients and Methods
Fretting and corrosion at the modular head/neck junction, known
as trunnionosis, in total hip arthroplasty (THA) is a cause of adverse
reaction to metal debris (ARMD). We describe the outcome of revision
of metal-on-polyethylene (MoP) THA for ARMD due to trunnionosis
with emphasis on the risk of major complications. A total of 36 patients with a MoP THA who underwent revision
for ARMD due to trunnionosis were identified. Three were excluded
as their revision had been to another metal head. The remaining
33 were revised to a ceramic head with a titanium sleeve. We describe
the presentation, revision findings, and risk of complications in
these patients.Aims
Patients and Methods
The aims of this study were to compare the efficacy and safety
of intra-articular and intravenous (IV) tranexamic acid (TXA) in
controlling perioperative blood loss in total knee arthroplasty
(TKA) using a randomized, double-blinded equivalence trial. A total of 182 patients aged between 45 and 75 years undergoing
unilateral TKA at a tertiary centre were randomized to receive TXA,
either 1.5 g intra-articularly after closure of the wound (n = 91)
or two doses of 10 mg/kg IV (n = 91). The primary outcome measure
was the reduction in the level of haemoglobin (Hb) in the blood
on the fifth postoperative day. Secondary outcome measures were
the total, visible, and hidden blood losses (TBL, VBL, HBL). We
assumed equivalence of the primary outcome in both routes with a
margin of ± 0.35gm/dl. Block randomization using computer-generated
random numbers was used. The patients and the assessor of outcome were
blinded.Aims
Patients and Methods
Surgical site infection can be a devastating complication of
hemiarthroplasty of the hip, when performed in elderly patients
with a displaced fracture of the femoral neck. It results in a prolonged
stay in hospital, a poor outcome and increased costs. Many studies
have identified risk and prognostic factors for deep infection.
However, most have combined the rates of infection following total
hip arthroplasty and internal fixation as well as hemiarthroplasty, despite
the fact that they are different entities. The aim of this study
was to clarify the risk and prognostic factors causing deep infection
after hemiarthroplasty alone. Data were extracted from a prospective hip fracture database
and completed by retrospective review of the hospital records. A
total of 916 patients undergoing a hemiarthroplasty in two level
II trauma teaching hospitals between 01 January 2011 and
01 May 2016 were included. We analysed the potential peri-operative
risk factors with univariable and multivariable logistic regression
analysis.Aims
Patients and Methods
Minimally invasive transforaminal lumbar interbody fusion (MITLIF)
has been well validated in overweight and obese patients who are
consequently subject to a higher radiation exposure. This prospective
multicentre study aimed to investigate the efficacy of a novel lumbar
localisation system for MITLIF in overweight patients. The initial study group consisted of 175 patients. After excluding
49 patients for various reasons, 126 patients were divided into
two groups. Those in Group A were treated using the localisation
system while those in Group B were treated by conventional means.
The primary outcomes were the effective radiation dosage to the
surgeon and the exposure time.Aims
Patients and Methods
Little is known about employment following total knee arthroplasty
(TKA). This study aims to identify factors which predict return
to work following TKA in patients of working age in the United Kingdom. We prospectively assessed 289 patients (289 TKAs) aged ≤ 65 years
who underwent TKA between 2010 and 2013. There were 148 women. The
following were recorded pre-operatively: age, gender, body mass
index, social deprivation, comorbidities, indication for surgery,
work status and nature of employment, activity level as assessed by
the University of California, Los Angeles (UCLA) activity score
and Oxford Knee Score (OKS). The intention of patients to return
to work or to retire was not assessed pre-operatively. At a mean
of 3.4 years (2 to 4) post-operatively, the return to work status,
OKS, the EuroQol-5 dimensions (EQ-5D) score, UCLA activity score
and Work, Osteoarthritis and joint-Replacement (WORQ) score were
obtained. Univariate and multivariate analyses were performed.Aims
Patients &
Methods
The aim of this study was to compare the efficacy of a corticosteroid injection for the
treatment of carpal tunnel syndrome (CTS) in patients with and without Raynaud’s
phenomenon. In a prospective study, 139 patients with CTS were treated with a corticosteroid
injection (10 mg triamcinolone acetonide); 34 had Raynaud’s phenomenon and 105
did not (control group). Grip strength, perception of touch with a Semmes-Weinstein
monofilament and the Boston Carpal Tunnel Questionnaires (BCTQ) were assessed at
baseline and at six, 12 and 24 weeks after the injection. The Cold Intolerance Severity
Score (CISS) questionnaire was also assessed at baseline and 24 weeks after the
injection.Aims
Patients and 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
To investigate whether pre-operative functional mobility is a
determinant of delayed inpatient recovery of activities (IRoA) after
total knee arthroplasty (TKA) in three periods that coincided with
changes in the clinical pathway. All patients (n = 682, 73% women, mean age 70 years, standard
deviation 9) scheduled for TKA between 2009 and 2015 were pre-operatively
screened for functional mobility by the Timed-up-and-Go test (TUG)
and De Morton mobility index (DEMMI). The cut-off point for delayed
IRoA was set on the day that 70% of the patients were recovered,
according to the Modified Iowa Levels of Assistance Scale (mILAS)
(a 5-item activity scale). In a multivariable logistic regression
analysis, we added either the TUG or the DEMMI to a reference model
including established determinants.Aims
Patients and Methods
The purpose of this study was to assess early physical function
after total hip or knee arthroplasty (THA/TKA), and the correlation
between patient-reported outcome measures, physical performance
and actual physical activity (measured by actigraphy). A total of 80 patients aged 55 to 80 years undergoing THA or
TKA for osteoarthritis were included in this prospective cohort
study. The main outcome measure was change in patient reported hip
or knee injury and osteoarthritis outcome score (HOOS/KOOS) from
pre-operatively until post-operative day 13 (THA) or 20 (TKA). Secondary measures
were correlations to objectively assessed change in physical performance
(paced-walk, chair-stand, stair-climb tests) at day 14 (THA) or
21 (TKA) and actual physical activity (actigraphy) measured at day
12 and 13 (THA) or 19 and 20 (TKA). 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
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
Whilst gait speed is variable between healthy and injured adults, the extent to which speed alone alters the 3D A total of 26 men and 25 women (18 to 35 years old) participated in this study. Participants walked on a treadmill with the KneeKG system at a slow imposed speed (2 km/hr) for three trials, then at a self-selected comfortable walking speed for another three trials. Paired Objectives
Methods
The optimal method of tibial component fixation remains uncertain
in total knee arthroplasty (TKA). Hydroxyapatite coatings have been
applied to improve bone ingrowth in uncemented designs, but may
only coat the directly accessible surface. As peri-apatite (PA)
is solution deposited, this may increase the coverage of the implant
surface and thereby fixation. We assessed the tibial component fixation
of uncemented PA-coated TKAs Patients were randomised to PA-coated or cemented TKAs. In 60
patients (30 in each group), radiostereometric analysis of tibial
component migration was evaluated as the primary outcome at baseline,
three months post-operatively and at one, two and five years. A
linear mixed-effects model was used to analyse the repeated measurements.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
Patients with an acute Achilles tendon rupture (ATR) take a long
time to heal, have a high incidence of deep vein thrombosis (DVT)
and widely variable functional outcomes. This variation in outcome
may be explained by a lack of knowledge of adverse factors, and
a subsequent shortage of appropriate interventions. A total of 111 patients (95 men, 16 women; mean age 40.3, standard
deviation 8.4) with an acute total ATR were prospectively assessed.
At one year post-operatively a uniform outcome score, Achilles Combined
Outcome Score (ACOS), was obtained by combining three validated,
independent, outcome measures: Achilles tendon Total Rupture Score,
heel-rise height test, and limb symmetry heel-rise height. Predictors
of ACOS included treatment; gender; age; smoking; body mass index;
time to surgery; physical activity level pre- and post-injury; symptoms; quality
of life and incidence of DVT. Aims
Patients and Methods
We compared the clinical and radiological outcomes of using a
polyetheretherketone cage with (TiPEEK) and without a titanium coating
(PEEK) for instrumented transforaminal lumbar interbody fusion (TLIF). We conducted a randomised clinical pilot trial of 40 patients
who were scheduled to undergo a TLIF procedure at one or two levels
between L2 and L5. The Oswestry disability index (ODI), EuroQoL-5D,
and back and leg pain were determined pre-operatively, and at three,
six, and 12 months post-operatively. Fusion rates were assessed
by thin slice CT at three months and by functional radiography at
12 months.Aims
Materials and Methods