Heterotopic ossification (HO) occurs after arthroplasty, especially
total hip arthroplasty. In this study we describe the incidence,
evolution, morphology and clinical consequences of HO following
reverse shoulder arthroplasty. This is a single-centre retrospective study of 132 consecutive
patients who received a Delta III or Delta Xtend reverse total shoulder
arthroplasty between 2006 and 2013 for the treatment of cuff tear
arthropathy. There were 96 women and 36 men. Their mean age at the
time of surgery was 69 years (49 to 89) and the mean follow-up was
36 months (12 to 84). The incidence, evolution, morphology and clinical
consequences of HO using the Constant-Murley score (CS) were analysed.
A modified Brooker classification of HO of the hip was used.Aims
Patients and Methods
T-cells are considered to play an important role in the inflammatory response causing arthroplasty failure. The study objectives were to investigate the composition and distribution of CD4+ T-cell phenotypes in the peripheral blood (PB) and synovial fluid (SF) of patients undergoing revision surgery for failed metal-on-metal (MoM) and metal-on-polyethylene (MoP) hip arthroplasties, and in patients awaiting total hip arthroplasty. In this prospective case-control study, PB and SF were obtained from 22 patients (23 hips) undergoing revision of MoM (n = 14) and MoP (n = 9) hip arthroplasties, with eight controls provided from primary hip osteoarthritis cases awaiting arthroplasty. Lymphocyte subtypes in samples were analysed using flow cytometry.Objectives
Methods
The primary purpose of this meta-analysis was to determine whether statin usage could reduce the risk of glucocorticoid-related osteonecrosis in animal models. A systematic literature search up to May 2015 was carried out using the PubMed, Ovid, EBM reviews, ISI Web of Science, EBSCO, CBM, CNKI databases with the term and boolean operators: statins and osteonecrosis in all fields. Risk ratio (RR), as the risk estimate of specific outcome, was calculated along with 95% confidence intervals (CI). The methodological quality of individual studies was assessed using a quantitative tool based on the updated Stroke Therapy Academic Industry Roundtable (STAIR) recommendations.Objectives
Methods
As adverse events related to metal on metal hip
arthroplasty have been better understood, there has been increased
interest in toxicity related to the high circulating levels of cobalt ions.
However, distinguishing true toxicity from benign elevations in
cobalt levels can be challenging. The purpose of this review is
to examine the use of cobalt alloys in total hip arthroplasty, to
review the methods of measuring circulating cobalt levels, to define
a level of cobalt which is considered pathological and to review
the pathophysiology, risk factors and treatment of cobalt toxicity.
To the best of our knowledge, there are 18 published cases where
cobalt metal ion toxicity has been attributed to the use of cobalt-chromium
alloys in hip arthroplasty. Of these cases, the great majority reported
systemic toxic reactions at serum cobalt levels more than 100 μg/L.
This review highlights some of the clinical features of cobalt toxicity,
with the goal that early awareness may decrease the risk factors
for the development of cobalt toxicity and/or reduce its severity. Take home message: Severe adverse events can arise from the release
of cobalt from metal-on-metal arthroplasties, and as such, orthopaedic
surgeons should not only be aware of the presenting problems, but
also have the knowledge to treat appropriately. Cite this article:
Injuries to the foot in athletes are often subtle
and can lead to a substantial loss of function if not diagnosed
and treated appropriately. For these injuries in general, even after
a diagnosis is made, treatment options are controversial and become
even more so in high level athletes where limiting the time away
from training and competition is a significant consideration. In this review, we cover some of the common and important sporting
injuries affecting the foot including updates on their management
and outcomes. Cite this article:
The June 2015 Children’s orthopaedics Roundup360 looks at: ACL reconstruction in paediatric knees; Hips, slips and cams; The adolescent clavicle; 3D fluoroscopy in DDH?; The psychiatric aspects of hip pain in adolescents; Adolescent bunions: dealer’s choice?; Medial epicondylar fractures revisited
The ideal treatment for traumatic anterior dislocation
of the shoulder in the skeletally immature patient is controversial.
The aim of this study is to evaluate the outcomes after either conservative
and/or surgical treatment using the Latarjet technique. A retrospective
series of 49 out of 80 patients were reviewed. We found no significant differences
between either treatment method regarding functional scores and
pain levels. Although not statistically significant, post-surgical
patients showed better signs of shoulder stability than others who
have a higher rate of recurrence. Further, 92% of the post-surgical
group had returned to the same level of activity Cite this article:
The purpose of this study was to clarify the appearance of the reparative tissue on the articular surface and to analyse the properties of the reparative tissue after hemicallotasis osteotomy (HCO) using MRI T1ρ and T2 mapping. Coronal T1ρ and T2 mapping and three-dimensional gradient-echo images were obtained from 20 subjects with medial knee osteoarthritis. We set the regions of interest (ROIs) on the full-thickness cartilage of the medial femoral condyle (MFC) and medial tibial plateau (MTP) of the knee and measured the cartilage thickness (mm) and T1ρ and T2 relaxation times (ms). Statistical analysis of time-dependent changes in the cartilage thickness and the T1ρ and T2 relaxation times was performed using one-way analysis of variance, and Scheffe’s test was employed for Objectives
Methods
The August 2014 Foot &
Ankle Roundup360 looks at: calcaneotibial nail in ankle fractures; reamer irrigator aspirator for ankle fusion; periprosthetic bone infection; infection in ankle fixation; cheap and cheerful OK in MTP fusion plates; sliding fibular graft for peroneal tendon pathology and fusion for failed ankle replacement.
The aim of this study was to determine whether
an osteoplasty of the femoral neck performed at the same time as an
intertrochanteric Imhäuser osteotomy led to an improved functional
outcome or increased morbidity. A total of 20 hips in 19 patients
(12 left, 8 right, 13 male, 6 female), who underwent an Imhäuser
intertrochanteric osteotomy following a slipped capital femoral
epiphysis were assessed over an eight-year period. A total of 13
hips in 13 patients had an osteoplasty of the femoral neck at the
same time. The remaining six patients (seven hips) had intertrochanteric
osteotomy alone. The mean age was 15.3 years (13 to 20) with a mean
follow-up of 57.8 months (15 to 117); 19 of the slips were severe
(Southwick grade III) and one was moderate (grade II), with a mean
slip angle of 65.3° (50° to 80°); 17 of the slips were stable and
three unstable at initial presentation. The mean Non-Arthritic Hip Scores
(NAHS) in patients who underwent osteoplasty was 91.7 (76.3 to 100)
and the mean NAHS in patients who did not undergo osteoplasty was
76.6 (41.3 to 100) (p = 0.056). Two patients required a subsequent
arthroplasty and neither of these patients had an osteoplasty. No
hips developed osteonecrosis or chondrolysis, and there was no increase
in complications related to the osteoplasty. We recommend that for
patients with a slipped upper femoral epiphysis undergoing an intertrochanteric
osteotomy, the addition of an osteoplasty of the femoral neck should
be considered. Cite this article:
A total of 22 patients with a tibial avulsion
fracture involving the insertion of the posterior cruciate ligament
(PCL) with grade II or III posterior laxity were reduced and fixed
arthroscopically using routine anterior and double posteromedial
portals. A double-strand Ethibond suture was inserted into the joint
and wrapped around the PCL from anterior to posterior to secure
the ligament above the avulsed bony fragment. Two tibial bone tunnels
were created using the PCL reconstruction guide, aiming at the medial
and lateral borders of the tibial bed. The ends of the suture were
pulled out through the bone tunnels and tied over the tibial cortex
between the openings of the tunnels to reduce and secure the bony
fragment. Satisfactory reduction of the fracture was checked arthroscopically and
radiographically. The patients were followed-up for a mean of 24.5 months (19 to
28). Bone union occurred six weeks post-operatively. At final follow-up,
all patients had a negative posterior drawer test and a full range
of movement. KT-1000 arthrometer examination showed that the mean
post-operative side-to-side difference improved from 10.9 mm (standard
deviation ( We conclude that this technique is convenient, reliable and minimally
invasive and successfully restores the stability and function of
the knee. Cite this article:
We have reviewed the current literature to compare
the results of surgery aimed to repair or debride a damaged acetabular
labrum. We identified 28 studies to be included in the review containing
a total of 1631 hips in 1609 patients. Of these studies 12 reported
a mean rate of good results of 82% (from 67% to 100%) for labral debridement.
Of the 16 studies that reported a combination of debridement and
re-attachment, five reported a comparative outcome for the two methods,
four reported better results with re-attachment and one study did
not find any significant difference in outcomes. Due to the heterogeneity
of the studies it was not possible to perform a meta-analysis or
draw accurate conclusions. Confounding factors in the studies include
selection bias, use of historical controls and high rates of loss
of follow-up. It seems logical to repair an unstable tear in a good quality
labrum with good potential to heal in order potentially to preserve
its physiological function. A degenerative labrum on the other hand
may be the source of discomfort and its preservation may result
in persistent pain and the added risk of failure of re-attachment.
The results of the present study do not support routine refixation
for all labral tears. Cite this article:
There is increasing global awareness of adverse
reactions to metal debris and elevated serum metal ion concentrations
following the use of second generation metal-on-metal total hip
arthroplasties. The high incidence of these complications can be
largely attributed to corrosion at the head-neck interface. Severe
corrosion of the taper is identified most commonly in association
with larger diameter femoral heads. However, there is emerging evidence
of varying levels of corrosion observed in retrieved components
with smaller diameter femoral heads. This same mechanism of galvanic
and mechanically-assisted crevice corrosion has been observed in
metal-on-polyethylene and ceramic components, suggesting an inherent
biomechanical problem with current designs of the head-neck interface. We provide a review of the fundamental questions and answers
clinicians and researchers must understand regarding corrosion of
the taper, and its relevance to current orthopaedic practice. Cite this article:
The August 2014 Spine Roundup360 looks at: rhBMP complicates cervical spine surgery; posterior longitudinal ligament revisited; thoracolumbar posterior instrumentation without fusion in burst fractures; risk modelling for VTE events in spinal surgery; the consequences of dural tears in microdiscectomy; trends in revision spinal surgery; radiofrequency denervation likely effective in facet joint pain and hooks optimally biomechanically transition posterior instrumentation.
To clarify the asymmetrical ossification of the epiphyseal ring
between the convex and concave sides in patients with adolescent
idiopathic scoliosis (AIS). A total of 29 female patients (mean age, 14.4 years; 11 to 18)
who underwent corrective surgery for AIS (Lenke type 1 or 2) were
included in our study. In all, 349 vertebrae including 68 apical
vertebrae and 87 end vertebrae in the main thoracic (MT) curve and
thoracolumbar/lumbar (TL/L) curve were analysed. Coronal sections
(anterior, middle and posterior) of the vertebral bodies were reconstructed
from pre-operative CT scans (320-row detector; slice thickness,
0.5 mm) and the appearances of the ossification centre in the epiphyseal
ring at four corners were evaluated in three groups; all vertebrae
excluding end vertebrae, apical vertebrae and end vertebrae. The appearance
rates of the ossification centre at the concave and convex sides
were calculated and compared.Aims
Patients and Methods
In this study we evaluated whether the Instability
Severity Index Score (ISIS) and the Western Ontario Shoulder Instability
Index (WOSI) could detect those patients at risk of failure following
arthroscopic Bankart repair. Between April 2008 and June 2010, the
ISIS and WOSI were recorded pre-operatively in 110 patients (87
male, 79%) with a mean age of 25.1 years (16 to 61) who underwent
this procedure for recurrent anterior glenohumeral instability. A telephone interview was performed two-years post-operatively
to determine whether patients had experienced a recurrent dislocation
and whether they had returned to pre-injury activity levels. In
all, six (5%) patients had an ISIS >
6 points (0 to 9). Of 100 (91%)
patients available two years post-operatively, six (6%) had a recurrent dislocation,
and 28 (28%) did not return to pre-injury activity. No patient who
dislocated had an ISIS >
6 (p = 1.0). There was no difference in
the mean pre-operative WOSI in those who had a re-dislocation and
those who did not (p = 0.99). The pre-operative WOSI was significantly
lower (p = 0.02) in those who did not return to pre-injury activity, whereas
the ISIS was not associated with return to pre-injury activity (p
= 0.13). In conclusion, neither the pre-operative ISIS nor WOSI predicted
recurrent dislocation within two years of arthroscopic Bankart repair.
Patients with a lower pre-operative WOSI were less likely to return
to pre-injury activity. Cite this article:
To examine the rates of hamstring graft salvage with arthroscopic
debridement of infected anterior cruciate ligament (ACL) reconstruction
as reported in the literature and discuss functional outcomes. A search was performed without language restriction on PubMed,
EMBASE, Ovid, CINAHL and Cochrane Register of Controlled Trials
(CENTRAL) databases from their inception to April 2015. We identified
147 infected hamstring grafts across 16 included studies. Meta-analysis
was performed using a random-effects model to estimate the overall
graft salvage rate, incorporating two different definitions of graft
salvage.Aims
Materials and Methods
The outcome of 219 revision total hip arthroplasties
(THAs) in 98 male and 121 female patients, using 137 long length
and 82 standard length cemented collarless double-taper femoral
stems in 211 patients, with a mean age of 72 years (30 to 90) and
mean follow-up of six years (two to 18) have been described previously.
We have extended the follow-up to a mean of 13 years (8 to 20) in
this cohort of patients in which the pre-operative bone deficiency Paprosky
grading was IIIA or worse in 79% and 73% of femurs with long and
standard stems, respectively. For the long stem revision group, survival to re-revision for
aseptic loosening at 14 years was 97% (95% confidence interval (CI)
91 to 100) and in patients aged >
70 years, survival was 100%. Two
patients (two revisions) were lost to follow-up and 86 patients
with 88 revisions had died. Worst-case analysis for survival to
re-revision for aseptic loosening at 14 years was 95% (95% CI 89
to 100) and 99% (95% CI 96 to 100) for patients aged >
70 years. One
additional long stem was classified as loose radiographically but
not revised. For the standard stem revision group, survival to re-revision
for aseptic loosening at 14 years was 91% (95% CI 83 to 99). No
patients were lost to follow-up and 49 patients with 51 hips had
died. No additional stems were classified as loose radiographically. Femoral revision using a cemented collarless double-taper stem,
particularly with a long length stem, and in patients aged >
70
years, continues to yield excellent results up to 20 years post-operatively,
including in hips with considerable femoral metaphyseal bone loss. Cite this article: