Until now, there has been no consensus as to whether stemmed
acetabular components are appropriate for use in patients undergoing
revision total hip arthroplasty (THA) who have major acetabular
defects or pelvic discontinuity. We wished to address this deficiency
in the literature. We carried out a retrospective study of 35 patients (six men
and 29 women) with a mean age of 68 years (37 to 87), with major
acetabular defects who underwent revision THA between 2000 and 2012.Aim
Patients and Methods
The aim of this randomised controlled study was
to compare functional and radiological outcomes between modern cemented
and uncemented hydroxyapatite coated stems after one year in patients
treated surgically for a fracture of the femoral neck. A total of
141 patients aged >
65 years were included. Patients were randomised
to be treated with a cemented Exeter stem or an uncemented Bimetric
stem. The patients were reviewed at four and 12 months. The cemented group performed better than the uncemented group
for the Harris hip score (78 In conclusion, our data do not support the use of an uncemented
hydroxyapatite coated stem for the treatment of displaced fractures
of the femoral neck in the elderly. Cite this article:
Total hip arthroplasty (THA) has well known subjective benefits,
but little is known objectively about the recovery of mobility in
the early post-operative period. A total of 33 patients aged >
60 years who underwent elective
primary THA had their activity monitored for 30 days post-operatively
using an at-home (Fitbit) ankle accelerometer. Their mean age was
70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance
and the mean level of activity were determined. Comparisons between subgroups
based on age, body mass index (BMI), surgical approach, and the
destination of the patients when discharged were also performed.Aims
Patients and Methods
The best method of managing a fracture of the
distal humerus in a frail low-demand patient with osteoporotic bone remains
controversial. Total elbow arthroplasty (TEA) has been recommended
for patients in whom open reduction and internal fixation (ORIF)
is not possible. Conservative methods of treatment, including the
‘bag of bones’ technique (acceptance of displacement of the bony
fragments and early mobilisation), are now rarely considered as
they are believed to give a poor functional result. We reviewed 40 elderly and low-demand patients (aged 50 to 93
years, 72% women) with a fracture of the distal humerus who had
been treated conservatively at our hospital between March 2008 and
December 2013, and assessed their short- and medium-term functional
outcome. In the short-term, the mean Broberg and Morrey score improved
from 42 points (poor; 23 to 80) at six weeks after injury to 67
points (fair; 40 to 88) by three months. In the medium-term, surviving patients (n = 20) had a mean Oxford
elbow score of 30 points (7 to 48) at four years and a mean Disabilities
of the Arm, Shoulder and Hand score of 38 points (0 to 75): 95%
reported a functional range of elbow flexion. The cumulative rate
of fracture union at one year was 53%. The mortality at five years approached
40%. Conservative management of a fracture of the distal humerus in
a low-demand patient only gives a modest functional result, but
avoids the substantial surgical risks associated with primary ORIF
or TEA. Cite this article:
This study identifies early risk factors for symptomatic nonunion
of displaced midshaft fractures of the clavicle that aid identification
of an at risk group who may benefit from surgery. We performed a retrospective study of 88 patients aged between
16 and 60 years that were managed non-operatively. Aims
Methods
High failure rates of metal-on-metal hip arthroplasty implants have highlighted the need for more careful introduction and monitoring of new implants and for the evaluation of the safety of medical devices. The National Joint Registry and other regulatory services are unable to detect failing implants at an early enough stage. We aimed to identify validated surrogate markers of long-term outcome in patients undergoing primary total hip arthroplasty (THA). We conducted a systematic review of studies evaluating surrogate markers for predicting long-term outcome in primary THA. Long-term outcome was defined as revision rate of an implant at ten years according to National Institute of Health and Care Excellence guidelines. We conducted a search of Medline and Embase (OVID) databases. Separate search strategies were devised for the Cochrane database and Google Scholar. Each search was performed to include articles from the date of their inception to June 8, 2015.Objectives
Methods
The results of the DRAFFT (distal radius acute
fracture fixation trial) study, which compared volar plating with
Kirschner (K-) wire fixation for dorsally displaced fractures of
the distal radius, were published in August 2014. The use of K-wires
to treat these fractures is now increasing, with a concomitant decline
in the use of volar locking plates. We provide a critical appraisal of the DRAFFT study and question
whether surgeons have been unduly influenced by its headline conclusions. Cite this article:
Our aim, using English Hospital Episode Statistics data before
during and after the Distal Radius Acute Fracture Fixation Trial
(DRAFFT), was to assess whether the results of the trial affected
clinical practice. Data were grouped into six month intervals from July 2005 to
December 2014. All patient episodes in the National Health Service
involving emergency surgery for an isolated distal radial fracture
were included.Aims
Patients and Methods
Risk of revision following total knee arthroplasty (TKA) is higher
in patients under 55 years, but little data are reported regarding
non-revision outcomes. This study aims to identify predictors of
dissatisfaction in these patients. We prospectively assessed 177 TKAs (157 consecutive patients,
99 women, mean age 50 years; 17 to 54) from 2008 to 2013. Age, gender,
implant, indication, body mass index (BMI), social deprivation,
range of movement, Kellgren-Lawrence (KL) grade of osteoarthritis
(OA) and prior knee surgery were recorded. Pre- and post-operative
Oxford Knee Score (OKS) as well as Short Form-12 physical (PCS)
and mental component scores were obtained. Post-operative range
of movement, complications and satisfaction were measured at one
year.Aims
Patients and Methods
This review summarises the evidence for the treatment
of displaced fractures of the femoral neck in elderly patients.
Results from randomised clinical trials and national register studies are
presented when available. The advantages of arthroplasty compared with internal fixation
are supported by several studies. A number of studies contribute
to the discussions of total hip arthroplasty (THA) The direct lateral approach reduces the risk of dislocation compared
with the posterior approach. Cemented implants lower the risk of
periprosthetic fracture and its subsequent morbidity and mortality.
As the risk of peri-operative death related to bone cement can be reduced
by adequate measures, cemented implants are recommended in fracture
cases. Take home message: There remains a great variation in the surgical
management of patients with a hip fracture, and an evidence-based
approach should improve the outcomes for this vulnerable patient
group. Cite this article:
We reviewed 34 consecutive patients (18 female-16 male) with
isthmic spondylolysis and grade I to II lumbosacral spondylolisthesis
who underwent in situ posterolateral arthodesis between the L5 transverse
processes and the sacral ala with the use of iliac crest autograft.
Ten patients had an associated scoliosis which required surgical correction
at a later stage only in two patients with idiopathic curves unrelated
to the spondylolisthesis. No patient underwent spinal decompression or instrumentation
placement. Mean surgical time was 1.5 hours (1 to 1.8) and intra-operative
blood loss 200 ml (150 to 340). There was one wound infection treated
with antibiotics but no other complication. Radiological assessment
included standing posteroanterior and lateral, Ferguson and lateral flexion/extension
views, as well as CT scans. Aims
Methods
The surgical management of ankle arthritis with tibiotalar arthrodesis
is known to alter gait, as compared with normal ankles. The purpose
of this study was to assess post-operative gait function with gait
before arthrodesis. We prospectively studied 20 patients who underwent three-dimensional
gait analysis before and after tibiotalar arthrodesis. Cadence,
step length, walking velocity and total support time were assessed.
Kinetic parameters, including the moment and power of the ankle
in the sagittal plane and hip power were also recorded.Aims
Patients and Methods
Patients with multiple myeloma (MM) develop deposits in the spine
which may lead to vertebral compression fractures (VCFs). Our aim
was to establish which spinopelvic parameters are associated with
the greatest disability in patients with spinal myeloma and VCFs. We performed a retrospective cross-sectional review of 148 consecutive
patients (87 male, 61 female) with spinal myeloma and analysed correlations
between spinopelvic parameters and patient-reported outcome scores.
The mean age of the patients was 65.5 years (37 to 91) and the mean
number of vertebrae involved was 3.7 (1 to 15).Aims
Patients and Methods
Patients undergoing femoral lengthening by external fixation
tolerate treatment less well when compared to tibial lengthening.
Lengthening of the femur with an intramedullary device may have
advantages. We reviewed all cases of simple femoral lengthening performed
at our unit from 2009 to 2014. Cases of nonunions, concurrent deformities,
congenital limb deficiencies and lengthening with an unstable hip
were excluded, leaving 33 cases (in 22 patients; 11 patients had
bilateral procedures) for review. Healing index, implant tolerance
and complications were compared.Aims
Patients and Methods
The eccentric glenosphere was principally introduced into reverse
shoulder arthroplasty to reduce the incidence of scapular notching.
There is only limited information about the influence of its design
on deltoid power and joint reaction forces. The aim of our study was to investigate how the diameter and
eccentricity of the glenosphere affect the biomechanics of the deltoid
and the resultant joint reaction forces. Different sizes of glenosphere and eccentricity were serially
tested in ten cadaveric shoulders using a custom shoulder movement
simulator.Aims
Methods
The degree of displacement of a fracture of the distal radius
is an important factor which can be assessed using simple radiographic
measurements. Our aim was to investigate the reliability and reproducibility
of these measurements and to determine if they should be used clinically. A 10% sample was randomly generated from 3670 consecutive adult
patients who had presented to University Hospitals of Leicester
NHS Trust between 2007 and 2010 with a fracture of the distal radius.
Radiographs of the 367 patients were assessed by two independent
reviewers. Four measurements of displacement of the fracture were recorded
and the inter-observer correlation assessed using the intra-class
correlation coefficient.Aims
Patients and Methods
