In this systematic review, our aim was to explore
whether or not patients are able to return to athletic activity
following lower limb joint replacement. We also investigated any evidence
as to whether participation in athletic activity post-joint replacement
increases complications and reduces implant survival. A PubMed, Embase and Sports Discus search was performed using
the MeSH terms ‘Sport’, ‘Athletic’, ‘Athlete’, ‘Physical’, ‘Activity’,
‘Arthroplasty’, ‘Total Hip Replacement’, ‘Hip Resurfacing’, ‘Total
Knee Replacement’, ‘Unicompartmental Knee Replacement’ and ‘Unicondylar
Knee Replacement’. From this search, duplications were excluded,
the remaining abstracts were reviewed and any unrelated to the search
terms were excluded. The remaining abstracts had their full papers
reviewed. Following joint replacement, participation in sporting activity
is common principally determined by pre-operative patient activity
levels, BMI and patient age. The type of joint replaced is of less
significance. Total time spent performing activity does not change
but tends to be at a lower intensity. There is little evidence in
the literature of an association between high activity levels and
early implant failure. Cite this article:
There are many causes of paraspinal muscle weakness which give rise to the dropped-head syndrome. In the upper cervical spine the central portion of the spinal cord innervates the cervical paraspinal muscles. Dropped-head syndrome resulting from injury to the central spinal cord at this level has not previously been described. We report two patients who were treated acutely for this condition. Both presented with weakness in the upper limbs and paraspinal cervical musculature after a fracture of C2. Despite improvement in the strength of the upper limbs, the paraspinal muscle weakness persisted in both patients. One ultimately underwent cervicothoracic fusion to treat her dropped-head syndrome. While the cause of the dropped-head syndrome cannot be definitively ascribed to the injuries to the spinal cord, this pattern is consistent with the known patho-anatomical mechanisms of both injury to the central spinal cord and dropped-head syndrome.
We conducted a meta-analysis, including randomised
controlled trials (RCTs) and cohort studies, to examine the effect
of patient-specific instruments (PSI) on radiological outcomes after
total knee replacement (TKR) including: mechanical axis alignment
and malalignment of the femoral and tibial components in the coronal,
sagittal and axial planes, at a threshold of >
3º from neutral.
Relative risks (RR) for malalignment were determined for all studies
and for RCTs and cohort studies separately. Of 325 studies initially identified, 16 met the eligibility criteria,
including eight RCTs and eight cohort studies. There was no significant
difference in the likelihood of mechanical axis malalignment with
PSI We conclude that PSI does not improve the accuracy of alignment
of the components in TKR compared with conventional instrumentation. Cite this article:
Lengthening of the conjoined tendon of the gastrocnemius
aponeurosis and soleus fascia is frequently used in the treatment
of equinus deformities in children and adults. The Vulpius procedure
as described in most orthopaedic texts is a division of the conjoined
tendon in the shape of an inverted V. However, transverse division
was also described by Vulpius and Stoffel, and has been reported
in some clinical studies. We studied the anatomy and biomechanics of transverse division
of the conjoined tendon in 12 human cadavers (24 legs). Transverse
division of the conjoined tendon resulted in predictable, controlled
lengthening of the gastrocsoleus muscle-tendon unit. The lengthening
achieved was dependent both on the level of the cut in the conjoined
tendon and division of the midline raphé. Division at a proximal
level resulted in a mean lengthening of 15.2 mm ( Cite this article:
The use of allografts for the treatment of bone tumours in children is limited by nonunion and the difficulty of finding a suitable graft. Furthermore, appositional growth can’t be expected of an allograft. We used an overlapping allograft in 11 children, with a mean age of ten years (4 to 15), with a mean follow-up of 24.1 months (20 to 33). There were five intercalary and six intra-articular resections, and the tumours were in the femur in six cases and the humerus in five. Rates of union, times to union, remodelling patterns and allograft-associated complications were evaluated. No allograft was removed due to a complication. Of the 16 junctional sites, 15 (94%) showed union at a mean of 3.1 months (2 to 5). Remodelling between host and allograft was seen at 14 junctions at a mean of five months (4 to 7). The mean Musculoskeletal Tumor Society score was 26.5 of 30 (88.3%). One case of nonunion and another with screw protrusion required re-operation. Overlapping allografts have the potential to shorten time to union, decrease rates of nonunion and have positive appositional growth effect.
We report the functional and socioeconomic long-term
outcome of patients with pelvic ring injuries. We identified 109 patients treated at a Level I trauma centre
between 1973 and 1990 with multiple blunt orthopaedic injuries including
an injury to the pelvic ring, with an Injury Severity Score (ISS)
of ≥ 16. These patients were invited for clinical review at a minimum
of ten years after the initial injury, at which point functional
results, general health scores and socioeconomic factors were assessed. In all 33 isolated anterior (group A), 33 isolated posterior
(group P) and 43 combined anterior/posterior pelvic ring injuries
(group A/P) were included. The mean age of the patients at injury
was 28.8 years (5 to 55) and the mean ISS was 22.7 (16 to 44). At review the mean Short-Form 12 physical component score for
the A/P group was 38.71 (22.12 to 56.56) and the mean Hannover Score
for Polytrauma Outcome subjective score was 67.27 (12.48 to 147.42),
being significantly worse compared with the other two groups (p =
0.004 and p = 0.024, respectively). A total of 42 patients (39%)
had a limp and 12 (11%) required crutches. Car or public transport
usage was restricted in 16 patients (15%). Overall patients in groups
P and A/P had a worse outcome. The long-term outcome of patients
with posterior or combined anterior/posterior pelvic ring injuries
is poorer than of those with an isolated anterior injury. Cite this article:
We describe three patients with pre-ganglionic (avulsion) injuries of the brachial plexus which caused a partial Brown-Séquard syndrome.
We analysed the outcome of patients with primary
non-metastatic diaphyseal sarcomas who had Extracorporeal irradiation is an oncologically safe and inexpensive
technique for limb salvage in diaphyseal sarcomas and has good functional
results.
Many tumors metastasise to bone, therefore, pathologic
fracture and impending pathologic fractures are common reasons for
orthopedic consultation. Having effective treatment strategies is
important to avoid complications, and relieve pain and preserve
function. Thorough pre-operative evaluation is recommended for medical
optimization and to ensure that the lesion is in fact a metastasis
and not a primary bone malignancy. For impending fractures, various scoring
systems have been proposed to determine the risk of fracture, and
therefore the need for prophylactic stabilisation. Lower score lesions
can often be treated with radiation, while more problematic lesions
may require internal fixation. Intramedullary fixation is generally
preferred due to favorable biomechanics. Arthroplasty may be required
for lesions with massive bony destruction where internal fixation
attempts are likely to fail. Radiation may also be useful postoperatively
to minimise construct failure due to tumor progression.
The April 2014 Children’s orthopaedics Roundup360 looks at: urgent supracondylar fractures; rotational osteotomy for synostosis; predicting slip in paediatric forearm fractures; progressive lengthening of the digit is possible; treatment of SUFE with the Dunn osteotomy; and the best way to apply the eight-plate?.
We report the long-term outcome of 33 patients
(37 knees) who underwent proximal tibial open-wedge osteotomy with
hemicallotasis (HCO) for medial osteoarthritis of the knee between
1995 and 2000. Among these, 29 patients with unilateral HCO were
enrolled and 19 were available for review at a mean of 14.2 years
(10 to 15.7) post-operatively. For these 19 patients, the mean Hospital
for Special Surgery knee score was 60 (57 to 62) pre-operatively
and 85 (82 to 87) at final follow-up (p <
0.001; paired Cite this article:
Pseudotumours (abnormal peri-prosthetic soft-tissue reactions)
following metal-on-metal hip resurfacing arthroplasty (MoMHRA) have
been associated with elevated metal ion levels, suggesting that
excessive wear may occur due to edge-loading of these MoM implants.
This study aimed to quantify The duration and magnitude of edge-loading Objectives
Methods
We report on 397 consecutive revision total hip
replacements in 371 patients with a mean clinical and radiological follow-up
of 12.9 years (10 to 17.7). The mean age at surgery was 69 years
(37 to 93). A total of 28 patients (8%) underwent further revision,
including 16 (4%) femoral components. In all 223 patients (56%,
233 hips) died without further revision and 20 patients (5%, 20
hips) were lost to follow-up. Of the remaining patients, 209 (221
hips) were available for clinical assessment and 194 (205 hips)
for radiological review at mean follow-up of 12.9 years (10 to 17.7). The mean Harris Hip Score improved from 58.7 (11 to 92) points
to 80.7 (21 to 100) (p <
0.001) and the mean Merle d’Aubigné and
Postel hip scores at final follow-up were 4.9 (2 to 6), 4.5 (2 to
6) and 4.3 (2 to 6), respectively for pain, mobility and function.
Radiographs showed no lucencies around 186 (90.7%) femoral stems
with stable bony ingrowth seen in 199 stems (97%). The survival
of the S-ROM femoral stem at 15 years with revision for any reason as
the endpoint was 90.5% (95% confidence interval (CI) 85.7 to 93.8)
and with revision for aseptic loosening as the endpoint 99.3% (95%
CI 97.2 to 99.8). We have shown excellent long-term survivorship and good clinical
outcome of a cementless hydroxyapatite proximally-coated modular
femoral stem in revision hip surgery. Cite this article:
Neurogenic claudication is most frequently observed
in patients with degenerative lumbar spinal stenosis. We describe
a patient with lumbar epidural varices secondary to obstruction
of the inferior vena cava by pathological lymph nodes presenting
with this syndrome. Following a diagnosis of follicular lymphoma,
successful chemotherapy led to the resolution of the varices and
the symptoms of neurogenic claudication. The lumbar epidural venous plexus may have an important role
in the pathogenesis of spinal stenosis. Although rare, epidural
venous engorgement can induce neurogenic claudication without spinal
stenosis. Further investigations should be directed at identifying
an underlying cause.
We report the results of six trauma and orthopaedic
projects to Kenya in the last three years. The aims are to deliver both
a trauma service and teaching within two hospitals; one a district
hospital near Mount Kenya in Nanyuki, the other the largest public
hospital in Kenya in Mombasa. The Kenya Orthopaedic Project team
consists of a wide range of multidisciplinary professionals that
allows the experience to be shared across those specialties. A follow-up
clinic is held three months after each mission to review the patients.
To our knowledge there are no reported outcomes in the literature
for similar projects. A total of 211 operations have been performed and 400 patients
seen during the projects. Most cases were fractures of the lower
limb; we have been able to follow up 163 patients (77%) who underwent
surgical treatment. We reflect on the results so far and discuss
potential improvements for future missions.
Patient specific cutting guides generated by
preoperative Magnetic Resonance Imaging (MRI) of the patient’s extremity
have been proposed as a method of improving the consistency of Total
Knee Arthroplasty (TKA) alignment and adding efficiency to the operative
procedure. The cost of this option was evaluated by quantifying the
savings from decreased operative time and instrument processing
costs compared to the additional cost of the MRI and the guide.
Coronal plane alignment was measured in an unselected consecutive
series of 200 TKAs, 100 with standard instrumentation and 100 with
custom cutting guides. While the cutting guides had significantly lower
total operative time and instrument processing time, the estimated
$322 savings was overwhelmed by the $1,500 additional cost of the
MRI and the cutting guide. All measures of coronal plane alignment
were equivalent between the two groups. The data does not currently
support the proposition that patient specific guides add value to
TKA.
The aim of this study was to determine if a change
in antibiotic prophylaxis for routine hip and knee replacement was
associated with an increased risk of acute renal impairment. We identified 238 patients (128 knees and 110 hips) who had received
a single prophylactic dose of 1.5 g cefuroxime before joint replacement.
We compared them with prospectively collected data from 254 patients
(117 knees and 137 hips) who received a single prophylactic dose
of 2 g flucloxacillin and a height- and gender-determined dose of
gentamicin. The primary outcome measure was any new renal impairment
as graded by clinically validated criteria. We identified four patients (1.69%) in the cefuroxime group who
developed renal impairment. All four had mild impairment and all
renal function was normal by the third post-operative day. The incidence
of new-onset renal impairment was significantly higher in the flucloxacillin-and-gentamicin
group at 9.45% (24 patients) (p <
0.001). Three of these patients
remained with acute renal impairment after a week, although the
serum creatinine levels in all subsequently returned to normal. Cite this article:
Van Nes rotationplasty may be used for patients
with congenital proximal focal femoral deficiency (PFFD). The lower
limb is rotated to use the ankle and foot as a functional knee joint
within a prosthesis. A small series of cases was investigated to
determine the long-term outcome. At a mean of 21.5 years (11 to
45) after their rotationplasty, a total of 12 prosthetic patients
completed the Short-Form (SF)-36, Faces Pain Scale-Revised, Harris
hip score, Oswestry back pain score and Prosthetic Evaluation Questionnaires,
as did 12 age- and gender-matched normal control participants. A
physical examination and gait analysis, computerised dynamic posturography
(CDP), and timed ‘Up &
Go’ testing was also completed. Wilcoxon
Signed rank test was used to compare each PFFD patient with a matched
control participant with false discovery rate of 5%. There were no differences between the groups in overall health
and well-being on the SF-36. Significant differences were seen in
gait parameters in the PFFD group. Using CDP, the PFFD group had
reduced symmetry in stance, and reduced end point and maximum excursions. Patients who had undergone Van Nes rotationplasty had a high
level of function and quality of life at long-term follow-up, but
presented with significant differences in gait and posture compared
with the control group. Cite this article:
The April 2014 Trauma Roundup360 looks at: is it safe to primarily close dog bite wounds?; conservative transfusion evidence based in hip fracture surgery; tibial nonunion is devastating to quality of life; sexual dysfunction after traumatic pelvic fracture; hemiarthroplasty versus fixation in displaced femoral neck fractures; silver VAC dressings “Gold Standard” in massive wounds; dual plating for talar neck fracture; syndesmosis and fibular length easiest errors in ankle fracture surgery; and dual mobility: stable as a rock in fracture.
The lateral compartment is predominantly affected
in approximately 10% of patients with osteoarthritis of the knee. The
anatomy, kinematics and loading during movement differ considerably
between medial and lateral compartments of the knee. This in the
main explains the relative protection of the lateral compartment
compared with the medial compartment in the development of osteoarthritis.
The aetiology of lateral compartment osteoarthritis can be idiopathic,
usually affecting the femur, or secondary to trauma commonly affecting
the tibia. Surgical management of lateral compartment osteoarthritis
can include osteotomy, unicompartmental knee replacement and total
knee replacement. This review discusses the biomechanics, pathogenesis
and development of lateral compartment osteoarthritis and its management. Cite this article: