The Precice nail is the latest intramedullary lengthening nail with excellent early outcomes. Implant complications have led to modification of the nail design. The aim of this study was to perform a retrieval study of Precice nails following lower-limb lengthening and to assess macroscopical and microscopical changes to the implants and evaluate differences following design modification, with the aim of identifying potential surgical, implant, and patient risk factors. A total of 15 nails were retrieved from 13 patients following lower-limb lengthening. Macroscopical and microscopical surface damage to the nails were identified. Further analysis included radiology and micro-CT prior to sectioning. The internal mechanism was then analyzed with scanning electron microscopy and energy dispersive x-ray spectroscopy to identify corrosion.Objectives
Methods
The classical longitudinal incision used for the direct anterior
approach (DAA) to the hip does not follow the tension lines of the
skin and can lead to impaired wound healing and poor cosmesis. The
purpose of this retrospective study was to determine the satisfaction
with the scar, and functional and radiographic outcomes comparing
the classic longitudinal incision with a modified skin crease ‘bikini’
when the DAA is used for total hip arthroplasty (THA). A total of 964 patients (51% female; 59% longitudinal, 41% ‘bikini’)
completed a follow-up questionnaire between two and four years postoperatively,
including the Oxford Hip Score (OHS), the University of North Carolina
‘4P’ scar scale (UNC4P) and two items for assessing the aesthetic
appearance of the scar and symptoms of numbness. The positioning
of the components, rates of heterotopic ossification (HO) and rates
of revision were assessed.Aims
Patients and Methods
Increasing innovation in rapid prototyping (RP)
and additive manufacturing (AM), also known as 3D printing, is bringing
about major changes in translational surgical research. This review describes the current position in the use of additive
manufacturing in orthopaedic surgery. Cite this article:
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
Partial knee arthroplasty (PKA), either medial
or lateral unicompartmental knee artroplasty (UKA) or patellofemoral arthroplasty
(PFA) are a good option in suitable patients and have the advantages
of reduced operative trauma, preservation of both cruciate ligaments
and bone stock, and restoration of normal kinematics within the
knee joint. However, questions remain concerning long-term survival.
The goal of this review article was to present the long-term results
of medial and lateral UKA, PFA and combined compartmental arthroplasty
for multicompartmental disease. Medium- and long-term studies suggest
reasonable outcomes at ten years with survival greater than 95% in
UKA performed for medial osteoarthritis or osteonecrosis, and similarly
for lateral Cite this article:
Dislocation rates are reportedly lower in patients requiring
proximal femoral hemiarthroplasty than for patients undergoing hip
arthroplasty for neoplasia. Without acetabular replacement, pain
due to acetabular wear necessitating revision surgery has been described.
We aimed to determine whether wear of the native acetabulum following
hemiarthroplasty necessitates revision surgery with secondary replacement
of the acetabulum after proximal femoral replacement (PFR) for tumour
reconstruction. We reviewed 100 consecutive PFRs performed between January 2003
and January 2013 without acetabular resurfacing. The procedure was
undertaken in 74 patients with metastases, for a primary bone tumour
in 20 and for myeloma in six. There were 48 male and 52 female patients,
with a mean age of 61.4 years (19 to 85) and median follow-up of
two years (interquartile range (IQR) 0.5 to 3.7 years). In total,
52 patients presented with a pathological fracture and six presented
with failed fixation of a previously instrumented pathological fracture.Aims
Patients and Methods
The primary aim of this prognostic study was to identify baseline
factors associated with physical health-related quality of life
(HRQL) in patients after a femoral neck fracture. The secondary
aims were to identify baseline factors associated with mental HRQL,
hip function, and health utility. Patients who were enrolled in the Fixation using Alternative
Implants for the Treatment of Hip Fractures (FAITH) trial completed
the 12-item Short Form Health Survey (SF-12), Western Ontario and
McMaster Universities Arthritis Index, and EuroQol 5-Dimension at
regular intervals for 24 months. We conducted multilevel mixed models
to identify factors potentially associated with HRQL. 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 development and pre-clinical evaluation of
nano-texturised, biomimetic, surfaces of titanium (Ti) implants treated
with titanium dioxide (TiO2) nanotube arrays is reviewed. Cite this article:
We present a retrospective review of patients treated with extracorporeally
irradiated allografts for primary and secondary bone tumours with
the mid- and long-term survivorship and the functional and radiographic
outcomes. A total of 113 of 116 (97.4%) patients who were treated with
extracorporeally irradiated allografts between 1996 and 2014 were
followed up. Forms of treatment included reconstructions, prostheses
and composite reconstructions, both with and without vascularised
grafts. Survivorship was determined by the Kaplan-Meier method.
Clinical outcomes were assessed using the Musculoskeletal Tumor
Society (MSTS) scoring system, the Toronto Extremity Salvage Score
(TESS) and Quality of Life-C30 (QLQ-30) measures. Radiographic outcomes
were assessed using the International Society of Limb Salvage (ISOLS)
radiographic scoring system.Aims
Patients and Methods
A possible solution for the management of proximal femoral bone
loss is a modular femoral endoprosthesis (EPR). Although the outcome
of EPRs in tumour surgery has been well described, the outcome of
their use in revision hip surgery has received less attention. The
aim of this study was to describe the outcome of using EPR for non-neoplastic
indications. A retrospective review of 79 patients who underwent 80 EPRs for
non-neoplastic indications was performed, including the rates of
complication and survival and the mean Oxford Hip Scores (OHS),
at a mean of five years post-operatively. The mean age at the time
of surgery was 69 years (28 to 93) and the mean number of previous operations
on the hip was 2.4 (0 to 17). The most common indications for EPR
implantation were periprosthetic joint infection (PJI) (n = 40),
periprosthetic fracture (n = 12) and failed osteosynthesis of a
proximal femoral fracture or complex trauma (n = 11).Objectives
Methods
Rib fracture fixation by orthopaedic and cardiothoracic surgeons has become increasingly popular for the treatment of chest injuries in trauma. The literature, though mainly limited to Level II and III evidence, shows favourable results for operative fixation. In this paper we review the literature and discuss the indications for rib fracture fixation, surgical approaches, choice of implants and the future direction for management. With the advent of NICE guidance and new British Orthopaedic Association Standards for Trauma (BOAST) guidelines in production, the management of rib fractures is going to become more and more commonplace.
In the time since Letournel popularised the surgical
treatment of acetabular fractures, more than 25 years ago, there
have been many changes within the field, related to patients, surgical
technique, implants and post-operative care. However, the long-term
outcomes appear largely unchanged. Does this represent stasis or
have the advances been mitigated by other negative factors? In this
article we have attempted to document the recent changes within
the surgery of patients with a fracture involving the acetabulum,
outline contemporary management, and identify the major problem
areas where further research is most needed. Cite this article:
The aim of this study was to determine whether the sequential
application of povidone iodine-alcohol (PVI) followed by chlorhexidine
gluconate-alcohol (CHG) would reduce surgical wound contamination
to a greater extent than PVI applied twice in patients undergoing
spinal surgery. A single-centre, interventional, two arm, parallel group randomised
controlled trial was undertaken, involving 407 patients who underwent
elective spinal surgery. For 203 patients, the skin was disinfected before surgery using
PVI (10% [w/w (1% w/w available iodine)] in 95% industrial denatured
alcohol, povidone iodine; Videne Alcoholic Tincture) twice, and
for 204 patients using PVI once followed by CHG (2% [w/v] chlorhexidine
gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint).
The primary outcome measure was contamination of the wound determined
by aerobic and anaerobic bacterial growth from samples taken after
disinfection.Aims
Patients and Methods
To evaluate the outcomes of cemented total hip arthroplasty (THA)
following a fracture of the acetabulum, with evaluation of risk
factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of
57 years (25 to 87) underwent cemented THA at a mean of 6.5 years
(0.1 to 25) following acetabular fracture. A total of 38 had undergone
surgical fixation and 11 had been treated non-operatively; 13 patients
died at a mean of 10.2 years after THA (0.6 to 19). Patients were
assessed pre-operatively, at one year and at final follow-up (mean
9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant
survivorship was assessed. An age and gender-matched cohort of THAs
performed for non-traumatic osteoarthritis (OA) or avascular necrosis
(AVN) (n = 98) were used to compare complications and patient-reported outcome
measures (PROMs).Aims
Patients and Methods
The MAGnetic Expansion Control (MAGEC) system
is used increasingly in the management of early-onset scoliosis.
Good results have been published, but there have been recent reports
identifying implant failures that may be associated with significant
metallosis surrounding the implants. This article aims to present
the current knowledge regarding the performance of this implant,
and the potential implications and strategies that may be employed
to identify and limit any problems. We urge surgeons to apply caution to patient and construct selection;
engage in prospective patient registration using a spine registry;
ensure close clinical monitoring until growth has ceased; and send
all explanted MAGEC rods for independent analysis. The MAGEC system may be a good instrumentation system for the
treatment of early-onset scoliosis. However, it is innovative and
like all new technology, especially when deployed in a paediatric
population, robust systems to assess long-term outcome are required
to ensure that patient safety is maintained. Cite this article:
Total knee arthroplasty (TKA) is an established
and successful procedure. However, the design of prostheses continues
to be modified in an attempt to optimise the functional outcome
of the patient. The aim of this study was to determine if patient outcome after
TKA was influenced by the design of the prosthesis used. A total of 212 patients (mean age 69; 43 to 92; 131 female (62%),
81 male (32%)) were enrolled in a single centre double-blind trial
and randomised to receive either a Kinemax (group 1) or a Triathlon
(group 2) TKA. Patients were assessed pre-operatively, at six weeks, six months,
one year and three years after surgery. The outcome assessments
used were the Oxford Knee Score; range of movement; pain numerical
rating scales; lower limb power output; timed functional assessment
battery and a satisfaction survey. Data were assessed incorporating
change over all assessment time points, using repeated measures
analysis of variance longitudinal mixed models. Implant group 2
showed a significantly greater range of movement (p = 0.009), greater
lower limb power output (p = 0.026) and reduced report of ‘worst
daily pain’ (p = 0.003) over the three years of follow-up. Differences
in Oxford Knee Score (p = 0.09), report of ‘average daily pain’
(p = 0.57) and timed functional performance tasks (p = 0.23) did
not reach statistical significance. Satisfaction with outcome was
significantly better in group 2 (p = 0.001). These results suggest that patient outcome after TKA can be influenced
by the prosthesis used. Cite this article:
Pelvic reconstruction after the resection of a tumour around
the acetabulum is a challenging procedure due to the complex anatomy
and biomechanics. Several pelvic endoprostheses have been introduced,
but the rates of complication remain high. Our aim was to review
the use of a stemmed acetabular pedestal cup in the management of
these patients. The study involved 48 patients who underwent periacetabular reconstruction
using a stemmed pedestal cup (Schoellner cup; Zimmer Biomet Inc.,
Warsaw, Indiana) between 2000 and 2013. The indications for treatment included
a primary bone tumour in 27 patients and metastatic disease in 21
patients. The mean age of the patients at the time of surgery was
52 years (16 to 83).Aims
Patients and Methods
Instability of the hip is the most common mode of failure after
reconstruction with a proximal femoral arthroplasty (PFA) using
an endoprosthesis after excision of a tumour. Small studies report
improved stability with capsular repair of the hip and other techniques,
but these have not been investigated in a large series of patients.
The aim of this study was to evaluate variables associated with
the patient and the operation that affect post-operative stability.
We hypothesised an association between capsular repair and stability. In a retrospective cohort study, we identified 527 adult patients
who were treated with a PFA for tumours. Our data included demographics,
the pathological diagnosis, the amount of resection of the abductor
muscles, the techniques of reconstruction and the characteristics
of the implant. We used regression analysis to compare patients
with and without post-operative instability.Aims
Patients and Methods
