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The Bone & Joint Journal
Vol. 100-B, Issue 4 | Pages 507 - 515
1 Apr 2018
Nnadi C Thakar C Wilson-MacDonald J Milner P Rao A Mayers D Fairbank J Subramanian T

Aims

The primary aim of this study was to evaluate the performance and safety of magnetically controlled growth rods in the treatment of early onset scoliosis. Secondary aims were to evaluate the clinical outcome, the rate of further surgery, the rate of complications, and the durability of correction.

Patients and Methods

We undertook an observational prospective cohort study of children with early onset scoliosis, who were recruited over a one-year period and followed up for a minimum of two years. Magnetically controlled rods were introduced in a standardized manner with distractions performed three-monthly thereafter. Adverse events which were both related and unrelated to the device were recorded. Ten children, for whom relevant key data points (such as demographic information, growth parameters, Cobb angles, and functional outcomes) were available, were recruited and followed up over the period of the study. There were five boys and five girls. Their mean age was 6.2 years (2.5 to 10).


The Bone & Joint Journal
Vol. 99-B, Issue 10 | Pages 1265 - 1266
1 Oct 2017
Jacofsky DJ Haddad FS


Bone & Joint 360
Vol. 6, Issue 6 | Pages 31 - 33
1 Dec 2017


The Bone & Joint Journal
Vol. 100-B, Issue 1_Supple_A | Pages 62 - 67
1 Jan 2018
Bedard NA DeMik DE Dowdle SB Callaghan JJ

Aims

The purpose of this study was to evaluate trends in opioid use after unicompartmental knee arthroplasty (UKA), to identify predictors of prolonged use and to compare the rates of opioid use after UKA, total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Materials and Methods

We identified 4205 patients who had undergone UKA between 2007 and 2015 from the Humana Inc. administrative claims database. Post-operative opioid use for one year post-operatively was assessed using the rates of monthly repeat prescription. These were then compared between patients with and without a specific variable of interest and with those of patients who had undergone TKA and THA.


The Bone & Joint Journal
Vol. 99-B, Issue 9 | Pages 1216 - 1222
1 Sep 2017
Fu MC Boddapati V Gausden EB Samuel AM Russell LA Lane JM

Aims

We aimed to characterise the effect of expeditious hip fracture surgery in elderly patients within 24 hours of admission on short-term post-operative outcomes.

Patients and Methods

Patients age 65 or older that underwent surgery for closed femoral neck and intertrochanteric hip fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program between 2011 and 2014. Multivariable propensity-adjusted logistic regressions were performed to determine associations between early surgery within 24 hours and post-operative complications, controlling for selection bias in patients undergoing early surgery based on observable characteristics.


The Bone & Joint Journal
Vol. 97-B, Issue 3 | Pages 383 - 390
1 Mar 2015
Mariconda M Costa GG Cerbasi S Recano P Aitanti E Gambacorta M Misasi M

Several studies have reported the rate of post-operative mortality after the surgical treatment of a fracture of the hip, but few data are available regarding the delayed morbidity. In this prospective study, we identified 568 patients who underwent surgery for a fracture of the hip and who were followed for one year. Multivariate analysis was carried out to identify possible predictors of mortality and morbidity. The 30-day, four-month and one-year rates of mortality were 4.3%, 11.4%, and 18.8%, respectively. General complications and pre-operative comorbidities represented the basic predictors of mortality at any time interval (p < 0.01). In-hospital, four-month and one-year general complications occurred in 29.4%, 18.6% and 6.7% of patients, respectively. After adjusting for confounding variables, comorbidities and poor cognitive status determined the likelihood of early and delayed general complications, respectively (p < 0.001). Operative delay was the main predictor of the length of hospital stay (p < 0.001) and was directly related to in-hospital (p = 0.017) and four-month complications (p = 0.008).

Cite this article: Bone Joint J 2015;97-B:383–90


The Bone & Joint Journal
Vol. 99-B, Issue 5 | Pages 566 - 576
1 May 2017
van der Velden CA Tolk JJ Janssen RPA Reijman M

Aims

The aim of this study was to assess the current available evidence about when patients might resume driving after elective, primary total hip (THA) or total knee arthroplasty (TKA) undertaken for osteoarthritis (OA).

Materials and Methods

In February 2016, EMBASE, MEDLINE, Web of Science, Scopus, Cochrane, PubMed Publisher, CINAHL, EBSCO and Google Scholar were searched for clinical studies reporting on ‘THA’, ‘TKA’, ‘car driving’, ‘reaction time’ and ‘brake response time’. Two researchers (CAV and JJT) independently screened the titles and abstracts for eligibility and assessed the risk of bias. Both fixed and random effects were used to pool data and calculate mean differences (MD) and 95% confidence intervals (CI) between pre- and post-operative total brake response time (TBRT).


Bone & Joint Research
Vol. 6, Issue 5 | Pages 259 - 269
1 May 2017
McKirdy A Imbuldeniya AM

Objectives

To assess the clinical and cost-effectiveness of a virtual fracture clinic (VFC) model, and supplement the literature regarding this service as recommended by The National Institute for Health and Care Excellence (NICE) and the British Orthopaedic Association (BOA).

Methods

This was a retrospective study including all patients (17 116) referred to fracture clinics in a London District General Hospital from May 2013 to April 2016, using hospital-level data. We used interrupted time series analysis with segmented regression, and direct before-and-after comparison, to study the impact of VFCs introduced in December 2014 on six clinical parameters and on local Clinical Commissioning Group (CCG) spend. Student’s t-tests were used for direct comparison, whilst segmented regression was employed for projection analysis.


Bone & Joint 360
Vol. 3, Issue 4 | Pages 5 - 8
1 Aug 2014
Budd H Ollivere B Norrish A

While the demand for orthopaedic surgical expertise in the developing world is in critically short supply, short-term remedy from visiting doctors cannot solve this long-term healthcare problem. Capacity building by senior and training orthopaedic surgeons from established Western training programmes can offer a significant contribution to the orthopaedic patient in the developing world and the gains for those visiting are extremely valuable. We report on several visits by a UK orthopaedic team to a hospital in Kabul, Afghanistan and discuss the operative and non-operative case mix and the benefits in terms of local capacity building and the unique experience of those visiting.


The Bone & Joint Journal
Vol. 99-B, Issue 4 | Pages 432 - 439
1 Apr 2017
Weinberg DS Williamson DFK Millis MB Liu RW

Aims

Recently, there has been considerable interest in quantifying the associations between bony abnormalities around and in the hip joint and osteoarthritis (OA). Our aim was to investigate the relationships between acetabular undercoverage, acetabular overcoverage, and femoroacetabular impingement (FAI) with OA of the hip, which currently remain controversial.

Materials and Methods

A total of 545 cadaveric skeletons (1090 hips) from the Hamann-Todd osteological collection were obtained. Femoral head volume (FHV), acetabular volume (AV), the FHV/AV ratio, acetabular version, alpha angle and anterior femoral neck offset (AFNO) were measured. A validated grading system was used to quantify OA of the hip as minimal, moderate, or severe. Multiple linear and multinomial logistic regression were used to determine the factors that correlated independently with the FHV, AV, and the FHV/AV ratio.


Bone & Joint 360
Vol. 4, Issue 2 | Pages 30 - 32
1 Apr 2015

The April 2015 Children’s orthopaedics Roundup360 looks at: Reducing the incidence of DDH – is ‘back carrying’ the answer?; Surgical approach and AVN may not be linked in DDH; First year routine radiographic follow up for scoliosis not necessary; Diagnosis of osteochondritis dessicans; Telemedicine in paediatrics; Regional anesthesia in supracondylar fractures?


The Bone & Joint Journal
Vol. 99-B, Issue 2 | Pages 211 - 217
1 Feb 2017
Sluis GVD Goldbohm RA Elings JE Sanden MWND Akkermans RP Bimmel R Hoogeboom TJ Meeteren NLV

Aims

To investigate whether pre-operative functional mobility is a determinant of delayed inpatient recovery of activities (IRoA) after total knee arthroplasty (TKA) in three periods that coincided with changes in the clinical pathway.

Patients and Methods

All patients (n = 682, 73% women, mean age 70 years, standard deviation 9) scheduled for TKA between 2009 and 2015 were pre-operatively screened for functional mobility by the Timed-up-and-Go test (TUG) and De Morton mobility index (DEMMI). The cut-off point for delayed IRoA was set on the day that 70% of the patients were recovered, according to the Modified Iowa Levels of Assistance Scale (mILAS) (a 5-item activity scale). In a multivariable logistic regression analysis, we added either the TUG or the DEMMI to a reference model including established determinants.


The Bone & Joint Journal
Vol. 99-B, Issue 2 | Pages 237 - 244
1 Feb 2017
Vegt AEVD Grond R Grüschke JS Boomsma MF Emmelot CH Dijkstra PU Sluis CKVD

Aims

The aim of this study was to compare the Push Ortho Thumb Brace CMC and a custom-made orthosis in the treatment of patients with primary osteoarthritis of the carpometacarpal joint of the thumb. Our outcome measures were pain scores, tests of hand function, patient satisfaction and patient preference.

Patients and Methods

A multicentre crossover randomised controlled trial was conducted which included 63 patients (44 women) with primary osteoarthritis of the carpometacarpal joint of the thumb. Of these, 59 patients with a mean age of 60.1 years (standard deviation 8.2), completed the study. Patients used both orthoses for two weeks with a two-week washout period in-between. Pain was measured on a 10-cm visual analogue scale. Hand function was assessed using the Jebsen Taylor Hand Function test, Nine Hole Peg Test, key grip, pinch grip and Functional Index for Hand Osteoarthritis. Patient preference was assessed using the Dutch version of the Quebec User Evaluation of Satisfaction with Assistive Technology score.


The Bone & Joint Journal
Vol. 99-B, Issue 1 | Pages 107 - 115
1 Jan 2017
Carr A Cooper C Campbell MK Rees J Moser J Beard DJ Fitzpatrick R Gray A Dawson J Murphy J Bruhn H Cooper D Ramsay C

Aims

The appropriate management for patients with a degenerative tear of the rotator cuff remains controversial, but operative treatment, particularly arthroscopic surgery, is increasingly being used. Our aim in this paper was to compare the effectiveness of arthroscopic with open repair of the rotator cuff.

Patients and Methods

A total of 273 patients were recruited to a randomised comparison trial (136 to arthroscopic surgery and 137 to open surgery) from 19 teaching and general hospitals in the United Kingdom. The surgeons used their usual preferred method of repair. The Oxford Shoulder Score (OSS), two years post-operatively, was the primary outcome measure. Imaging of the shoulder was performed at one year after surgery. The trial is registered with Current Controlled Trials, ISRCTN97804283.


The Bone & Joint Journal
Vol. 98-B, Issue 8 | Pages 1093 - 1098
1 Aug 2016
Park S Kim HJ Ko BG Chung JW Kim SH Park SH Lee MH Yeom JS

Aims

The purpose of this study was to investigate the prevalence of sarcopenia and to examine its impact on patients with degenerative lumbar spinal stenosis (DLSS).

Patients and Methods

This case-control study included two groups: one group consisting of patients with DLSS and a second group of control subjects without low back or neck pain and related leg pain. Five control cases were randomly selected and matched by age and gender (n = 77 cases and n = 385 controls) for each DLSS case. Appendicular muscle mass, hand-grip strength, sit-to-stand test, timed up and go (TUG) test, and clinical outcomes, including the Oswestry Disability Index (ODI) scores and the EuroQol EQ-5D were compared between the two groups.


The Bone & Joint Journal
Vol. 98-B, Issue 8 | Pages 1112 - 1118
1 Aug 2016
Pedersen AB Christiansen CF Gammelager H Kahlert J Sørensen HT

Aims

We examined risk of developing acute renal failure and the associated mortality among patients aged > 65 years undergoing surgery for a fracture of the hip.

Patients and Methods

We used medical databases to identify patients who underwent surgical treatment for a fracture of the hip in Northern Denmark between 2005 and 2011. Acute renal failure was classified as stage 1, 2 and 3 according to the Kidney Disease Improving Global Outcome criteria. We computed the risk of developing acute renal failure within five days after surgery with death as a competing risk, and the short-term (six to 30 days post-operatively) and long-term mortality (31 days to 365 days post-operatively). We calculated adjusted hazard ratios (HRs) for death with 95% confidence intervals (CIs).


Bone & Joint 360
Vol. 5, Issue 1 | Pages 12 - 14
1 Feb 2016


The Bone & Joint Journal
Vol. 98-B, Issue 2 | Pages 224 - 228
1 Feb 2016
Padegimas EM Clyde CT Zmistowski BM Restrepo C Williams GR Namdari S

Aims

Currently, there is little information about the need for peri-operative blood transfusion in patients undergoing shoulder arthroplasty.

The purpose of this study was to identify the rate of transfusion and its predisposing factors, and to establish a blood conservation strategy.

Methods

We identified all patients who had undergone shoulder arthroplasty at our hospital between 1 January 2011 and 31 December 2013. The rate of transfusion was determined from the patient’s records. While there were exceptions, patients typically underwent transfusion if they had a level of haemoglobin of < 7.5 g/dl if asymptomatic, < 9.0 g/dl if they had a significant cardiac history or symptoms of dizziness or light headedness.

Multivariable regression analysis was undertaken to identify predictors of transfusion. High- and low-risk cohorts for transfusion were identified from a receiver operating characteristic (ROC) curve.


Bone & Joint 360
Vol. 4, Issue 5 | Pages 18 - 20
1 Oct 2015

The October 2015 Shoulder & Elbow Roundup360 looks at: Culture time important in propionibacterium acnes; Microvascularisation of the cuff footprint; Degenerative cuff tears: evidence for repair; Middle ground in distal humeral fractures?; Haste needed in elbow heterotopic ossification; Iatrogenic frozen shoulder; Salvage of failed humeral fixation


The Bone & Joint Journal
Vol. 98-B, Issue 2 | Pages 249 - 259
1 Feb 2016
Sabharwal S Carter AW Rashid A Darzi A Reilly P Gupte CM

Aims

The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost.

Methods

A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of cost