We evaluated the outcome of 41 consecutive Charnley
low-friction arthroplasties (LFAs) performed by a single surgeon
in 28 patients aged ≤ 35 years at operation between 23 and 36 years
previously. There were 20 women and eight men with a mean age of
32 years (23 to 35) at surgery. Two patients (three hips) were lost
to follow-up at 12 and 17 years post-operatively, respectively,
and one patient (one hip) died at 13 years post-operatively. These patients
were excluded from the final evaluation. The survival rate of the
acetabular components was 92.7% (95% confidence interval (CI) 88.7
to 96.7) at ten years, 67.1% (95% CI 59.75 to 74.45) at 20 years
and 53.2% (95% CI 45.3 to 61.1) at 25 years. For the femoral component
the survival was 95.1% (95% CI 91.8 to 98.5) at ten years, 77.1%
(95% CI 73.9 to 80.3) at 20 years and 68.2% (95% CI 60.7 to 75.8)
at 25 years. The results indicate that the Charnley LFA remains
a reasonable choice in the treatment of young patients and can serve
for comparison with newer techniques and implants. Cite this article:
This cohort study investigated the influence
of psychological factors, including perception of illness, anxiety
and depression on recovery and functional outcome after total knee
replacement surgery. A total of 100 patients (55 male; 45 female) with a mean age
of 71 (42 to 92) who underwent a primary total knee replacement
for osteoarthritis were recruited into this study. In all 97 participants
completed the six week and 87 the one year follow-up questionnaires. Pre-operatively patients completed the revised Illness Perception
Questionnaire, Hospital Anxiety and Depression Scale and Recovery
Locus of Control Scale. Function was assessed pre-operatively, at
six weeks and one year using Oxford Knee Score (OKS) and the goniometer-measured
range of movement (ROM). The results showed that pre-operative function had the biggest
impact on post-operative outcome for ROM and OKS. In addition questionnaire
variables and depression had an impact on the OKS at six weeks.
Depression and anxiety were also associated with a higher (worse)
knee score at one year but did not influence the ROM at either six weeks
or one year. Recovery from total knee replacement can be difficult to predict.
This study has identified psychological factors that play an important
role in recovery from surgery and functional outcome. These should
be taken into account when considering patients for total knee replacement. Cite this article:
The February 2014 Research Roundup360 looks at: blood supply to the femoral head after dislocation; diabetes and hip replacement; bone remodelling over two decades following hip replacement; sham surgery as good as arthroscopic meniscectomy; distraction in knee osteoarthritis; whether joint replacement prevent cardiac events; tranexamic acid and knee replacement haemostasis; cartilage colonisation in bipolar ankle grafts; CTs and proof of fusion; atorvastatin for muscle re-innervation after sciatic nerve transection; microfracture and short-term pain in cuff repair; promising early results from L-PRF augmented cuff repairs; and fatty degeneration in a rodent model.
The April 2015 Knee Roundup360 looks at: Genetic determinants of ACL strength; TKA outcomes influenced by prosthesis; Single- or two-stage revision for infected TKA?; Arthroscopic meniscectomy: a problem that just won’t go away!; Failure in arthroscopic ACL reconstruction; ACL reconstruction in the over 50s?; Knee arthroplasty for early osteoarthritis; All inside meniscal repair; Steroids, thrombogenic markers and TKA
Back pain is a common symptom in children and
adolescents. Here we review the important causes, of which defects
and stress reactions of the pars interarticularis are the most common
identifiable problems. More serious pathology, including malignancy
and infection, needs to be excluded when there is associated systemic
illness. Clinical evaluation and management may be difficult and
always requires a thorough history and physical examination. Diagnostic
imaging is obtained when symptoms are persistent or severe. Imaging
is used to reassure the patient, relatives and carers, and to guide
management. Cite this article:
The June 2013 Knee Roundup360 looks at: knee arthroplasty in diabetic patients; whether TKR is a timebomb; the use of antidepressants for knee OA; trochleoplasty; articulated spacers; mental health and joint replacement; and the use of physiotherapy for meniscal tear.
Osteoarthritis results in changes in the dimensions
of the glenoid. This study aimed to assess the size and radius of curvature
of arthritic glenoids. A total of 145 CT scans were analysed, performed
as part of routine pre-operative assessment before total shoulder
replacement in 91 women and 54 men. Only patients with primary osteoarthritis and
a concentric glenoid were included in the study. The CT scans underwent
three-dimensional (3D) reconstruction and were analysed using dedicated
computer software. The measurements consisted of maximum superoinferior height,
anteroposterior width and a best-fit sphere radius of curvature
of the glenoid. The mean height was 40.2 mm ( With current shoulder replacement systems using a unique backside
radius of curvature for the glenoid component, there is a risk of
undertaking excessive reaming to adapt the bone to the component
resulting in sacrifice of subchondral bone or under-reaming and
instability of the component due to a ’rocking horse‘ phenomenon. Cite this article:
In this study we used subject-specific finite
element analysis to investigate the mechanical effects of rotational acetabular
osteotomy (RAO) on the hip joint and analysed the correlation between
various radiological measurements and mechanical stress in the hip
joint. We evaluated 13 hips in 12 patients (two men and ten women, mean
age at surgery 32.0 years; 19 to 46) with developmental dysplasia
of the hip (DDH) who were treated by RAO. Subject-specific finite element models were constructed from
CT data. The centre–edge (CE) angle, acetabular head index (AHI),
acetabular angle and acetabular roof angle (ARA) were measured on
anteroposterior pelvic radiographs taken before and after RAO. The
relationship between equivalent stress in the hip joint and radiological measurements
was analysed. The equivalent stress in the acetabulum decreased from 4.1 MPa
(2.7 to 6.5) pre-operatively to 2.8 MPa (1.8 to 3.6) post-operatively
(p <
0.01). There was a moderate correlation between equivalent
stress in the acetabulum and the radiological measurements: CE angle
(R = –0.645, p <
0.01); AHI (R = –0.603, p <
0.01); acetabular
angle (R = 0.484, p = 0.02); and ARA (R = 0.572, p <
0.01). The equivalent stress in the acetabulum of patients with DDH
decreased after RAO. Correction of the CE angle, AHI and ARA was
considered to be important in reducing the mechanical stress in
the hip joint. Cite this article:
We performed a retrospective review of a consecutive
series of 178 Mobility total ankle replacements (TARs) performed
by three surgeons between January 2004 and June 2009, and analysed
radiological parameters and clinical outcomes in a subgroup of 129
patients. The mean follow-up was 4 years (2 to 6.3). A total of
ten revision procedures (5.6%) were undertaken. The mean Ankle Osteoarthritis
Scale (AOS) pain score was 17 (0 to 88) and 86% of patients were
clinically improved at follow-up. However, 18 patients (18 TARs,
14%) had a poor outcome with an AOS pain score of >
30. A worse
outcome was associated with a pre-operative diagnosis of post-traumatic degenerative
arthritis. However, no pre- or post-operative radiological parameters
were significantly associated with a poor outcome. Of the patients
with persistent pain, eight had predominantly medial-sided pain.
Thirty TARs (29%) had a radiolucency in at least one zone. The outcome of the Mobility TAR at a mean of four years is satisfactory
in >
85% of patients. However, there is a significant incidence
of persistent pain, particularly on the medial side, for which we
were unable to establish a cause. Cite this article:
In this study we evaluated the results of midtarsal
release and open reduction for the treatment of children with convex
congenital foot (CCF) (vertical talus) and compared them with the
published results of peritalar release. Between 1977 and 2009, a
total of 22 children (31 feet) underwent this procedure. In 15 children
(48%) the CCF was isolated and in the remainder it was not (seven
with arthrogryposis, two with spinal dysraphism, one with a polymalformative
syndrome and six with an undefined neurological disorder). Pre-operatively, the mean tibiotalar angle was 150.2° (106° to
175°) and the mean calcaneal pitch angle was -19.3° (-72° to 4°).
The procedure included talonavicular and calcaneocuboid joint capsulotomies,
lengthening of tendons of tibialis anterior and the extensors of
the toes, allowing reduction of the midtarsal joints. Lengthening
of the Achilles tendon was necessary in 23 feet (74%). The mean follow-up was 11 years (2 to 21). The results, as assessed
by the Adelaar score, were good in 24 feet (77.4%), fair in six
(19.3%) and poor in one foot (3.3%), with no difference between
those with isolated CCF and those without. The mean American Orthopaedic
Foot and Ankle Society midfoot score was 89.9 (54 to 100) and 77.8
(36 to 93) for those with isolated CCF and those without, respectively.
At the final follow-up, the mean tibiotalar (120°; 90 to 152) and
calcaneal pitch angles (4°; -13 to 22) had improved significantly
(p <
0.0001). Dislocation of the talonavicular and calcaneocuboid
joints was completely reduced in 22 (70.9%) and 29 (93.6%) of feet,
respectively. Three children (five feet) underwent further surgery
at a mean of 8.5 years post-operatively, three with pes planovalgus
and two in whom the deformity had been undercorrected. No child
developed avascular necrosis of the talus. Midtarsal joint release and open reduction is a satisfactory
procedure, which may provide better results than peritalar release.
Complications include the development of pes planovalgus and persistent
dorsal subluxation of the talonavicular joint. Cite this article:
Our objective in this article is to test the hypothesis that
type 2 diabetes mellitus (T2DM) is a factor in the onset and progression
of osteoarthritis, and to characterise the quality of the articular
cartilage in an appropriate rat model. T2DM rats were obtained from the UC Davis group and compared
with control Lewis rats. The diabetic rats were sacrificed at ages
from six to 12 months, while control rats were sacrificed at six
months only. Osteoarthritis severity was determined via histology
in four knee quadrants using the OARSI scoring guide. Immunohistochemical
staining was also performed as a secondary form of osteoarthritic
analysis.Objectives
Methods
Salubrinal is a synthetic agent that elevates phosphorylation
of eukaryotic translation initiation factor 2 alpha (eIF2α) and
alleviates stress to the endoplasmic reticulum. Previously, we reported
that in chondrocytes, Salubrinal attenuates expression and activity
of matrix metalloproteinase 13 (MMP13) through downregulating nuclear
factor kappa B (NFκB) signalling. We herein examine whether Salubrinal
prevents the degradation of articular cartilage in a mouse model
of osteoarthritis (OA). OA was surgically induced in the left knee of female mice. Animal
groups included age-matched sham control, OA placebo, and OA treated
with Salubrinal or Guanabenz. Three weeks after the induction of
OA, immunoblotting was performed for NFκB p65 and p-NFκB p65. At
three and six weeks, the femora and tibiae were isolated and the sagittal
sections were stained with Safranin O.Objectives
Methods
Whether to use total or unicompartmental knee
replacement (TKA/UKA) for end-stage knee osteoarthritis remains controversial.
Although UKA results in a faster recovery, lower rates of morbidity
and mortality and fewer complications, the long-term revision rate
is substantially higher than that for TKA. The effect of each intervention on
patient-reported outcome remains unclear. The aim of this study
was to determine whether six-month patient-reported outcome measures
(PROMs) are better in patients after TKA or UKA, using data from
a large national joint registry (NJR). We carried out a propensity score-matched cohort study which
compared six-month PROMs after TKA and UKA in patients enrolled
in the NJR for England and Wales, and the English national PROM
collection programme. A total of 3519 UKA patients were matched
to 10 557 TKAs. The mean six-month PROMs favoured UKA: the Oxford Knee Score
was 37.7 (95% confidence interval (CI) 37.4 to 38.0) for UKA and
36.1 (95% CI 35.9 to 36.3) for TKA; the mean EuroQol EQ-5D index
was 0.772 (95% CI 0.764 to 0.780) for UKA and 0.751 (95% CI 0.747
to 0.756) for TKA. UKA patients were more likely to achieve excellent
results (odds ratio (OR) 1.59, 95% CI 1.47 to 1.72, p <
0.001)
and to be highly satisfied (OR 1.27, 95% CI 1.17 to 1.39, p <
0.001), and
were less likely to report complications than those who had undergone
TKA. UKA gives better early patient-reported outcomes than TKA; these
differences are most marked for the very best outcomes. Complications
and readmission are more likely after TKA. Although the data presented
reflect the short-term outcome, they suggest that the high revision
rate for UKA may not be because of poorer clinical outcomes. These
factors should inform decision-making in patients eligible for either
procedure. Cite this article:
The treatment of peri-prosthetic joint infection
(PJI) of the ankle is not standardised. It is not clear whether
an algorithm developed for hip and knee PJI can be used in the management
of PJI of the ankle. We evaluated the outcome, at two or more years
post-operatively, in 34 patients with PJI of the ankle, identified
from a cohort of 511 patients who had undergone total ankle replacement.
Their median age was 62.1 years (53.3 to 68.2), and 20 patients
were women. Infection was exogenous in 28 (82.4%) and haematogenous
in six (17.6%); 19 (55.9%) were acute infections and 15 (44.1%)
chronic. Staphylococci were the cause of 24 infections (70.6%).
Surgery with retention of one or both components was undertaken
in 21 patients (61.8%), both components were replaced in ten (29.4%),
and arthrodesis was undertaken in three (8.8%). An infection-free
outcome with satisfactory function of the ankle was obtained in
23 patients (67.6%). The best rate of cure followed the exchange
of both components (9/10, 90%). In the 21 patients in whom one or
both components were retained, four had a relapse of the same infecting organism
and three had an infection with another organism. Hence the rate
of cure was 66.7% (14 of 21). In these 21 patients, we compared
the treatment given to an algorithm developed for the treatment
of PJI of the knee and hip. In 17 (80.9%) patients, treatment was
not according to the algorithm. Most (11 of 17) had only one criterion against
retention of one or both components. In all, ten of 11 patients
with severe soft-tissue compromise as a single criterion had a relapse-free
survival. We propose that the treatment concept for PJI of the ankle
requires adaptation of the grading of quality of the soft tissues. Cite this article
We compared the length of hospitalisation, rate
of infection, dislocation of the hip and revision, and mortality following
primary hip and knee arthroplasty for osteoarthritis in patients
with Alzheimer’s disease (n = 1064) and a matched control group
(n = 3192). The data were collected from nationwide Finnish health
registers. Patients with Alzheimer’s disease had a longer peri-operative
hospitalisation (median 13 days Cite this article:
The aim of this study was to assess the role
of synovial C-reactive protein (CRP) in the diagnosis of chronic periprosthetic
hip infection. We prospectively collected synovial fluid from 89
patients undergoing revision hip arthroplasty and measured synovial
CRP, serum CRP, erythrocyte sedimentation rate (ESR), synovial white
blood cell (WBC) count and synovial percentages of polymorphonuclear
neutrophils (PMN). Patients were classified as septic or aseptic
by means of clinical, microbiological, serum and synovial fluid
findings. The high viscosity of the synovial fluid precluded the
analyses in nine patients permitting the results in 80 patients
to be studied. There was a significant difference in synovial CRP
levels between the septic (n = 21) and the aseptic (n = 59) cohort.
According to the receiver operating characteristic curve, a synovial
CRP threshold of 2.5 mg/l had a sensitivity of 95.5% and specificity
of 93.3%. The area under the curve was 0.96. Compared with serum
CRP and ESR, synovial CRP showed a high diagnostic value. According
to these preliminary results, synovial CRP may be a useful parameter
in diagnosing chronic periprosthetic hip infection. Cite this article:
The February 2015 Children’s orthopaedics Roundup360 looks at: Hip dislocation in children with CTEV: two decades of experience; Population-based prevention of DDH in cerebral palsy: 20 years’ experience; Shoulder derotation in congenital plexus palsy; Back pain in the paediatric population: could MRI be the answer?; Intercondylar fracture of the humerus in children; The Dunn osteotomy in SUFE; Radiocapitellar line a myth!; Do ‘flatfooted’ children suffer?
Femoral stem version has a major influence on
impingement and early post-operative stability after total hip arthroplasty
(THA). The main objective of this study was to evaluate the validity
of a novel radiological method for measuring stem version. Anteroposterior
(AP) radiographs and three-dimensional CT scans were obtained for
115 patients (female/male 63/72, mean age 62.5 years (50 to 75))
who had undergone minimally invasive, cementless THA. Stem version was
calculated from the AP hip radiograph by rotation-based change in
the projected prosthetic neck–shaft (NSA*) angle using the mathematical
formula ST = arcos [tan (NSA*) / tan (135)]. We used two independent
observers who repeated the analysis after a six-week interval. Radiological
measurements were compared with 3D-CT measurements by an independent,
blinded external institute. We found a mean difference of 1.2° ( We found that femoral tilt was associated with the mean radiological
measurement error (r = 0.22, p = 0.02). The projected neck–shaft angle is a reliable method for measuring
stem version on AP radiographs of the hip after a THA. However,
a highly standardised radiological technique is required for its
precise measurement. Cite this article:
The number of surgical procedures performed each year to treat
femoroacetabular impingement (FAI) continues to rise. Although there
is evidence that surgery can improve symptoms in the short-term,
there is no evidence that it slows the development of osteoarthritis
(OA). We performed a feasibility study to determine whether patient
and surgeon opinion was permissive for a Randomised Controlled Trial
(RCT) comparing operative with non-operative treatment for FAI. Surgeon opinion was obtained using validated questionnaires at
a Specialist Hip Meeting (n = 61, 30 of whom stated that they routinely
performed FAI surgery) and patient opinion was obtained from clinical
patients with a new diagnosis of FAI (n = 31).Objectives
Methods
This study demonstrates a significant correlation
between the American Knee Society (AKS) Clinical Rating System and
the Oxford Knee Score (OKS) and provides a validated prediction
tool to estimate score conversion. A total of 1022 patients were prospectively clinically assessed
five years after TKR and completed AKS assessments and an OKS questionnaire.
Multivariate regression analysis demonstrated significant correlations between
OKS and the AKS knee and function scores but a stronger correlation
(r = 0.68, p <
0.001) when using the sum of the AKS knee and
function scores. Addition of body mass index and age (other statistically
significant predictors of OKS) to the algorithm did not significantly
increase the predictive value. The simple regression model was used to predict the OKS in a
group of 236 patients who were clinically assessed nine to ten years
after TKR using the AKS system. The predicted OKS was compared with
actual OKS in the second group. Intra-class correlation demonstrated
excellent reliability (r = 0.81, 95% confidence intervals 0.75 to
0.85) for the combined knee and function score when used to predict
OKS. Our findings will facilitate comparison of outcome data from
studies and registries using either the OKS or the AKS scores and
may also be of value for those undertaking meta-analyses and systematic
reviews. Cite this article: