The World Health Organization (WHO) and the Centre
for Disease Control and Prevention (CDC) recently published guidelines
for the prevention of surgical site infection. The WHO guidelines,
if implemented worldwide, could have an immense impact on our practices
and those of the CDC have implications for healthcare policy in
the United States. Our aim was to review the strategies for prevention of periprosthetic
joint infection in light of these and other recent guidelines. Cite this article:
The aim of this study was to evaluate the outcomes of a salvage procedure using a 95° angled blade plate for failed osteosynthesis of atypical subtrochanteric femoral fractures associated with the long-term use of bisphosphonates. These were compared with those for failed osteosynthesis of subtrochanteric fractures not associated with bisphosphonate treatment. Between October 2008 and July 2016, 14 patients with failed osteosynthesis of an atypical subtrochanteric femoral fracture were treated with a blade plate (atypical group). Their mean age was 67.8 years (60 to 74); all were female. During the same period, 21 patients with failed osteosynthesis of a typical subtrochanteric fracture underwent restabilization using a blade plate (typical group). Outcome variables included the time of union, postoperative complications, Harris Hip Score, and Sanders functional rating scale.Aims
Patients and Methods
Our aim in this paper was to investigate the
guidelines and laws governing informed consent in the English-speaking
world. We noted a recent divergence from medical paternalism within
the United Kingdom, highlighted by the Montgomery v Lanarkshire Health
Board ruling of 2015. We investigated the situation in the United
Kingdom, Australia, New Zealand, Canada, and the United States of
America. We read the national guidance regarding obtaining consent
for surgical intervention for each country. We used the references
from this guidance to identify the laws that helped inform the guidance,
and reviewed the court documents for each case. There has been a trend towards a more patient-focused approach
in consent in each country. Surgeons should be aware of the guidance
and legal cases so that they can inform patients fully, and prevent
legal problems if outdated practices are followed. Cite this article:
The aim of this study was to establish the diagnostic accuracy
of culture of joint aspirate with and without saline injection-reaspiration. This is a retrospective analysis of 580 hip and knee aspirations
in patients who were deemed to have a moderate to high risk of infection,
and who subsequently proceeded to revision arthroplasty over a period
of 12 years. It was carried out at a large quaternary referral centre
where preoperative aspiration is routine.Aims
Patients and Methods
Magnetically controlled growing rod (MCGR) systems use non-invasive
spinal lengthening for the surgical treatment of early-onset scoliosis
(EOS). The primary aim of this study was to evaluate the performance
of these devices in the prevention of progression of the deformity.
A secondary aim was to record the rate of complications. An observational study of 31 consecutive children with EOS, of
whom 15 were male, who were treated between December 2011 and October
2017 was undertaken. Their mean age was 7.7 years (2 to 14). The
mean follow-up was 47 months (24 to 69). Distractions were completed
using the tailgating technique. The primary outcome measure was
correction of the radiographic deformity. Secondary outcomes were
growth, functional outcomes and complication rates.Aims
Patients and Methods
The aim of this study was to investigate the clinical and radiographic
outcomes of microendoscopic laminotomy in patients with lumbar stenosis
and concurrent degenerative spondylolisthesis (DS), and to determine
the effect of this procedure on spinal stability. A total of 304 consecutive patients with single-level lumbar
DS with concomitant stenosis underwent microendoscopic laminotomy
without fusion between January 2004 and December 2010. Patients
were divided into two groups, those with and without advanced DS
based on the degree of spondylolisthesis and dynamic instability. A
total of 242 patients met the inclusion criteria. There were 101
men and 141 women. Their mean age was 68.1 years (46 to 85). Outcome
was assessed using the Japanese Orthopaedic Association and Roland
Morris Disability Questionnaire scores, a visual analogue score
for pain and the Short Form Health-36 score. The radiographic outcome
was assessed by measuring the slip and the disc height. The clinical
and radiographic parameters were evaluated at a mean follow-up of
4.6 years (3 to 7.5).Aims
Patients and Methods
The aim of this study was to identify risk factors for prosthetic
joint infection (PJI) following total knee arthroplasty (TKA). The New Zealand Joint Registry database was analysed, using revision
surgery for PJI at six and 12 months after surgery as primary outcome
measures. Statistical associations between revision for infection,
with common and definable surgical and patient factors were tested.Aims
Patients and Methods
Large bone defects remain a tremendous clinical challenge. There is growing evidence in support of treatment strategies that direct defect repair through an endochondral route, involving a cartilage intermediate. While culture-expanded stem/progenitor cells are being evaluated for this purpose, these cells would compete with endogenous repair cells for limited oxygen and nutrients within ischaemic defects. Alternatively, it may be possible to employ extracellular vesicles (EVs) secreted by culture-expanded cells for overcoming key bottlenecks to endochondral repair, such as defect vascularization, chondrogenesis, and osseous remodelling. While mesenchymal stromal/stem cells are a promising source of therapeutic EVs, other donor cells should also be considered. The efficacy of an EV-based therapeutic will likely depend on the design of companion scaffolds for controlled delivery to specific target cells. Ultimately, the knowledge gained from studies of EVs could one day inform the long-term development of synthetic, engineered nanovesicles. In the meantime, EVs harnessed from
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
Periprosthetic joint infection (PJI) is a serious complication
of total hip arthroplasty (THA). Different bearing surface materials
have different surface properties and it has been suggested that
the choice of bearing surface may influence the risk of PJI after
THA. The objective of this meta-analysis was to compare the rate
of PJI between metal-on-polyethylene (MoP), ceramic-on-polyethylene
(CoP), and ceramic-on-ceramic (CoC) bearings. Electronic databases (Medline, Embase, Cochrane library, Web
of Science, and Cumulative Index of Nursing and Allied Health Literature)
were searched for comparative randomized and observational studies
that reported the incidence of PJI for different bearing surfaces.
Two investigators independently reviewed studies for eligibility, evaluated
risk of bias, and performed data extraction. Meta-analysis was performed
using the Mantel–Haenzel method and random-effects model in accordance
with methods of the Cochrane group.Aims
Patients and Methods
Despite its intrinsic ability to regenerate form and function after injury, bone tissue can be challenged by a multitude of pathological conditions. While innovative approaches have helped to unravel the cascades of bone healing, this knowledge has so far not improved the clinical outcomes of bone defect treatment. Recent findings have allowed us to gain in-depth knowledge about the physiological conditions and biological principles of bone regeneration. Now it is time to transfer the lessons learned from bone healing to the challenging scenarios in defects and employ innovative technologies to enable biomaterial-based strategies for bone defect healing. This review aims to provide an overview on endogenous cascades of bone material formation and how these are transferred to new perspectives in biomaterial-driven approaches in bone regeneration. Cite this article: T. Winkler, F. A. Sass, G. N. Duda, K. Schmidt-Bleek. A review of biomaterials in bone defect healing, remaining shortcomings and future opportunities for bone tissue engineering: The unsolved challenge.
The aims of this study were to characterize the frequency of
missing data in the National Surgical Quality Improvement Program
(NSQIP) database and to determine how missing data can influence
the results of studies dealing with elderly patients with a fracture
of the hip. Patients who underwent surgery for a fracture of the hip between
2005 and 2013 were identified from the NSQIP database and the percentage
of missing data was noted for demographics, comorbidities and laboratory
values. These variables were tested for association with ‘any adverse
event’ using multivariate regressions based on common ways of handling
missing data.Aims
Patients and Methods
Our aim in this study was to describe a continuing review of
11 total hip arthroplasties using 22.225 mm Alumina ceramic femoral
heads on a Charnley flanged femoral component, articulating against
a silane crosslinked polyethylene. Nine patients (11 THAs) were reviewed at a mean of 27.5 years
(26 to 28) post-operatively. Outcome was assessed using the d’Aubigne
and Postel, and Charnley scores and penetration was recorded on
radiographs. In addition, the oxidation of a 29-year-old shelf-aged
acetabular component was analysed.Aims
Patients and Methods
Several genome-wide association studies (GWAS) of bone mineral density (BMD) have successfully identified multiple susceptibility genes, yet isolated susceptibility genes are often difficult to interpret biologically. The aim of this study was to unravel the genetic background of BMD at pathway level, by integrating BMD GWAS data with genome-wide expression quantitative trait loci (eQTLs) and methylation quantitative trait loci (meQTLs) data We employed the GWAS datasets of BMD from the Genetic Factors for Osteoporosis Consortium (GEFOS), analysing patients’ BMD. The areas studied included 32 735 femoral necks, 28 498 lumbar spines, and 8143 forearms. Genome-wide eQTLs (containing 923 021 eQTLs) and meQTLs (containing 683 152 unique methylation sites with local meQTLs) data sets were collected from recently published studies. Gene scores were first calculated by summary data-based Mendelian randomisation (SMR) software and meQTL-aligned GWAS results. Gene set enrichment analysis (GSEA) was then applied to identify BMD-associated gene sets with a predefined significance level of 0.05.Objectives
Method
Open wedge high tibial osteotomy (OWHTO) for medial-compartment
osteoarthritis of the knee can be complicated by intra-operative
lateral hinge fracture (LHF). We aimed to establish the relationship
between hinge position and fracture types, and suggest an appropriate
hinge position to reduce the risk of this complication. Consecutive patients undergoing OWHTO were evaluated on coronal
multiplanar reconstruction CT images. Hinge positions were divided
into five zones in our new classification, by their relationship
to the proximal tibiofibular joint (PTFJ). Fractures were classified
into types I, II, and III according to the Takeuchi classification.Aims
Patients and Methods
Microindentation has the potential to measure the stiffness of an individual patient’s bone. Bone stiffness plays a crucial role in the press-fit stability of orthopaedic implants. Arming surgeons with accurate bone stiffness information may reduce surgical complications including periprosthetic fractures. The question addressed with this systematic review is whether microindentation can accurately measure cortical bone stiffness. A systematic review of all English language articles using a keyword search was undertaken using Medline, Embase, PubMed, Scopus and Cochrane databases. Studies that only used nanoindentation, cancellous bone or animal tissue were excluded.Objectives
Methods
