Patient-specific (PS) implantation surgical technology has been introduced in recent years and a gradual increase in the associated number of surgical cases has been observed. PS technology uses a patient’s own geometry in designing a medical device to provide minimal bone resection with improvement in the prosthetic bone coverage. However, whether PS unicompartmental knee arthroplasty (UKA) provides a better biomechanical effect than standard off-the-shelf prostheses for UKA has not yet been determined, and still remains controversial in both biomechanical and clinical fields. Therefore, the aim of this study was to compare the biomechanical effect between PS and standard off-the-shelf prostheses for UKA. The contact stresses on the polyethylene (PE) insert, articular cartilage and lateral meniscus were evaluated in PS and standard off-the-shelf prostheses for UKA using a validated finite element model. Gait cycle loading was applied to evaluate the biomechanical effect in the PS and standard UKAs.Objectives
Methods
The primary aim of this study was to determine the morbidity
of a tibial strut autograft and characterize the rate of bony union
following its use. We retrospectively assessed a series of 104 patients from a single
centre who were treated with a tibial strut autograft of > 5 cm
in length. A total of 30 had a segmental reconstruction with continuity
of bone, 27 had a segmental reconstruction without continuity of
bone, 29 had an arthrodesis and 18 had a nonunion. Donor-site morbidity
was defined as any event that required a modification of the postoperative
management. Union was assessed clinically and radiologically at
a median of 36 months (IQR, 14 to 74).Aims
Patients and Methods
The success of anterior cruciate ligament reconstruction (ACLR)
depends on osseointegration at the graft-tunnel interface and intra-articular
ligamentization. Our aim was to conduct a systematic review of clinical
and preclinical studies that evaluated biological augmentation of
graft healing in ACLR. In all, 1879 studies were identified across three databases.
Following assessment against strict criteria, 112 studies were included
(20 clinical studies; 92 animal studies). Aims
Materials and Methods
The aim of this study was to evaluate the effects of using a
portable, accelerometer-based surgical navigation system (KneeAlign2)
in total knee arthroplasty (TKA) on the alignment of the femoral
component, and blood loss. A total of 241 consecutive patients with primary osteoarthritis
of the knee were enrolled in this prospective, randomised controlled
study. There were 207 women and 34 men. The mean age of the patients
was 74.0 years (57 to 89). The KneeAlign2 system was used for distal
femoral resection in 121 patients (KA2 group) and a conventional intramedullary
femoral guide was used in 120 patients (IM group).Aims
Patients and Methods
Following the resection of an extensive amount of bone in the
treatment of a tumour, the residual segment may be insufficient
to accept a standard length intramedullary cemented stem. Short-stemmed
endoprostheses conceivably have an increased risk of aseptic loosening.
Extra-cortical plates have been added to minimise this risk by supplementing
fixation. The aim of this study was to investigate the survivorship
of short-stemmed endoprostheses and extra-cortical plates. The study involved 37 patients who underwent limb salvage surgery
for a primary neoplasm of bone between 1998 and 2013. Endoprosthetic
replacement involved the proximal humerus in nine, the proximal
femur in nine, the distal femur in 13 and the proximal tibia in
six patients. There were 12 primary (32%) and 25 revision procedures (68%).
Implant survivorship was compared with matched controls. The amount
of bone that was resected was >
70% of its length and statistically
greater than the standard control group at each anatomical site.Aims
Patients and Methods
The aim of this study was to evaluate the long-term clinical
and radiographic outcomes of the Birmingham Interlocking Pelvic
Osteotomy (BIPO). In this prospective study, we report the mid- to long-term clinical
outcomes of the first 100 consecutive patients (116 hips; 88 in
women, 28 in men) undergoing BIPO, reflecting the surgeon’s learning
curve. Failure was defined as conversion to hip arthroplasty. The
mean age at operation was 31 years (7 to 57). Three patients (three
hips) were lost to follow-up.Aims
Patients and Methods
The aims of this study were to investigate any possible relationship
between a preoperative sensitivity to pain and the degree of pain
at rest and on exertion with postoperative function in patients
who underwent stemless total shoulder arthroplasty (TSA). In this prospective study, we included 63 patients who underwent
stemless TSA and were available for evaluation one year postoperatively.
There were 31 women and 32 men; their mean age was 71 years (53
to 89). The pain threshold, which was measured using a Pain Matcher
(PM) unit, the degree of pain (visual analogue scale at rest and
on exertion, and function using the short version of the Disabilities
of the Arm, Shoulder and Hand questionnaire (QuickDASH), were recorded
preoperatively, as well as three and 12 months postoperatively.Aims
Patients and Methods
To evaluate the incidence of primary venous thromboembolism (VTE),
epidural haematoma, surgical site infection (SSI), and 90-day mortality
after elective spinal surgery, and the effect of two protocols for
prophylaxis. A total of 2181 adults underwent 2366 elective spinal procedures
between January 2007 and January 2012. All patients wore anti-embolic
stockings, mobilised early and were kept adequately hydrated. In
addition, 29% (689) of these were given low molecular weight heparin
(LMWH) while in hospital. SSI surveillance was undertaken using the
Centers for Disease Control and Prevention criteria.Aims
Patients and Methods
The aim of this retrospective study was to compare the functional
and radiological outcomes of bridge plating, screw fixation, and
a combination of both methods for the treatment of Lisfranc fracture
dislocations. A total of 108 patients were treated for a Lisfranc fracture
dislocation over a period of nine years. Of these, 38 underwent
transarticular screw fixation, 45 dorsal bridge plating, and 25
a combination technique. Injuries were assessed preoperatively according
to the Myerson classification system. The outcome measures included
the American Orthopaedic Foot and Ankle Society (AOFAS) score, the
validated Manchester Oxford Foot Questionnaire (MOXFQ) functional
tool, and the radiological Wilppula classification of anatomical
reduction.Aims
Patients and Methods
The aim of this study was to compare the cost-effectiveness of
intramedullary nail fixation and ‘locking’ plate fixation in the
treatment of extra-articular fractures of the distal tibia. An economic evaluation was conducted from the perspective of
the United Kingdom National Health Service (NHS) and personal social
services (PSS), based on evidence from the Fixation of Distal Tibia
Fractures (UK FixDT) multicentre parallel trial. Data from 321 patients
were available for analysis. Costs were collected prospectively
over the 12-month follow-up period using trial case report forms
and participant-completed questionnaires. Cost-effectiveness was
reported in terms of incremental cost per quality adjusted life
year (QALY) gained, and net monetary benefit. Sensitivity analyses
were conducted to test the robustness of cost-effectiveness estimates.Aim
Patients and Methods
The purpose of this study was to evaluate whether an innovative
templating technique could predict the need for acetabular augmentation
during primary total hip arthroplasty for patients with dysplastic
hips. We developed a simple templating technique to estimate acetabular
component coverage at total hip arthroplasty, the True Cup: False
Cup (TC:FC) ratio. We reviewed all patients with dysplastic hips
who underwent primary total hip arthroplasty between 2005 and 2012.
Traditional radiological methods of assessing the degree of acetabular dysplasia
(Sharp’s angle, Tönnis angle, centre-edge angle) as well as the
TC:FC ratio were measured from the pre-operative radiographs. A
comparison of augmented and non-augmented hips was undertaken to
determine any difference in pre-operative radiological indices between
the two cohorts. The intra- and inter-observer reliability for all
radiological indices used in the study were also calculated.Aims
Patients and Methods
This study aimed to assess the effect of age and osteoporosis on the proliferative and differentiating capacity of bone-marrow-derived mesenchymal stem cells (MSCs) in female rats. We also discuss the role of these factors on expression and migration of cells along the C-X-C chemokine receptor type 4 (CXCR-4) / stromal derived factor 1 (SDF-1) axis. Mesenchymal stem cells were harvested from the femora of young, adult, and osteopenic Wistar rats. Cluster of differentiation (CD) marker and CXCR-4 expression was measured using flow cytometry. Cellular proliferation was measured using Alamar Blue, osteogenic differentiation was measured using alkaline phosphatase expression and alizarin red production, and adipogenic differentiation was measured using Oil red O. Cells were incubated in Boyden chambers to quantify their migration towards SDF-1. Data was analyzed using a Student’s Objectives
Methods
Adolescent idiopathic scoliosis (AIS) is a complex
3D deformity of the spine. Its prevalence is between 2% and 3% in the
general population, with almost 10% of patients requiring some form
of treatment and up to 0.1% undergoing surgery. The cosmetic aspect
of the deformity is the biggest concern to the patient and is often
accompanied by psychosocial distress. In addition, severe curves
can cause cardiopulmonary distress. With proven benefits from surgery,
the aims of treatment are to improve the cosmetic and functional
outcomes. Obtaining correction in the coronal plane is not the only
important endpoint anymore. With better understanding of spinal
biomechanics and the long-term effects of multiplanar imbalance,
we now know that sagittal balance is equally, if not more, important.
Better correction of deformities has also been facilitated by an
improvement in the design of implants and a better understanding
of metallurgy. Understanding the unique character of each deformity
is important. In addition, using the most appropriate implant and
applying all the principles of correction in a bespoke manner is important
to achieve optimum correction. In this article, we review the current concepts in AIS surgery. Cite this article:
