The accurate reconstruction of hip anatomy and
biomechanics is thought to be important in achieveing good clinical
outcomes following total hip arthroplasty (THA). To this end some
newer hip designs have introduced further modularity into the design
of the femoral component such that neckshaft angle and anteversion,
which can be adjusted intra-operatively. The
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
The incidence of horizontal cleavage lesions of the menisci was studied in 100 random necropsy examinations. Sixty per cent of subjects had at least one such tear, the incidence being 29 per cent out of the 400 menisci. Eighty-five per cent of the subjects showed changes of osteoarthritis in the patello-femoral or tibio-femoral joint compartments. The coincidence of horizontal cleavage lesion and osteoarthritis was frequent. Horizontal cleavage lesions were commoner in medial or larger menisci and in males. Eighteen per cent of the menisci were calcified and this was twice as common in those menisci with a degenerate tear. Because the horizontal cleavage lesion was so common in the older knee, it must usually remain unrecognised
We reviewed a single-surgeon series of 300 athletic patients who had undergone reconstruction of the anterior cruciate ligament in order to establish the relationship between the timing of the reconstruction and the incidence of meniscal and chondral
We report a series of 15 children, six male and nine female, of average age 20 months, seen at a paediatric orthopaedic clinic with torticollis. Orthopaedic examination revealed a normal range of neck movement in all cases but in seven there was palpable tightness in the absence of true shortening or contracture of the sternomastoid muscle. The patients were prospectively referred for ocular examination. In five of the 15 an ocular cause for the torticollis was detected with underaction of the superior oblique muscle in three, paresis of the lateral rectus muscle in one and nystagmus in one. Another two patients were found to have an abnormal ocular examination which was thought to be unrelated to their torticollis. Three of the patients with ocular torticollis required extra-ocular muscle surgery to abolish the head tilt and one of these had a tight sternomastoid muscle. Two of the non-ocular group had surgical release of the sternomastoid muscle; in the rest, the condition either resolved with physiotherapy or required no active treatment. We recommend that all patients with torticollis and no clear orthopaedic cause are referred for ocular assessment since it is not possible
Objectives. We aimed first to summarise minimal
We report the long-term
The aim of this study was to compare the post-operative radiographic
and clinical outcomes between kinematically and mechanically aligned
total knee arthroplasties (TKAs). A total of 60 TKAs (30 kinematically and 30 mechanically aligned)
were performed in 60 patients with varus osteoarthritis of the knee
using a navigation system. The angles of orientation of the joint
line in relation to the floor, the conventional and true mechanical
axis (tMA) (the line from the centre of the hip to the lowest point
of the calcaneus) were compared, one year post-operatively, on single-leg
and double-leg standing long leg radiographs between the groups.
The range of movement and 2011 Knee Society Scores were also compared
between the groups at that time.Aims
Patients and Methods
A total of 445 consecutive primary total knee
replacements (TKRs) were followed up prospectively at six and 18 months
and three, six and nine years. Patients were divided into two groups:
non-obese (body mass index (BMI) <
30 kg/m. 2. ) and obese
(BMI ≥ 30 kg/m. 2. ). The obese group was subdivided into
mildly obese (BMI 30 to 35 kg/m. 2. ) and highly obese (BMI ≥ 35
kg/m. 2. ) in order to determine the effects of increasing
obesity on outcome. The
1. Epiphysial tilt commonly precedes slipping. 2. This tilt is due to a diminished or arrested growth from compression of the back of the epiphysial plate. 3. The stresses on the upper end of the femur are such that the upper femoral epiphysial plate is peculiarly liable to compression. 4. A primary abnormality of the cartilage of the epiphysial plate renders it susceptible to the effect of compression. 5. Because this abnormality is diffuse, deformities due to a similar
We performed CT to investigate how treatment may modify the basic skeletal
Osteopoikilosis is a rare condition showing characteristic sclerotic lesions on radiographic examination, which are diagnostic for the trait. We report four patients presenting with various complaints and 49 members of their families who later were found to have osteopoikilosis. The mean age of all 53 was 27.5 years and the male:female ratio was 33:20. Most had lesions in the small tubular bones. We studied the epidemiological,
A new cosmetic weight-relieving brace which utilises stainless steel and light alloy in its structure is described. A
We present a review of litigation claims relating
to foot and ankle surgery in the NHS in England during the 17-year period
between 1995 and 2012. A freedom of information request was made to obtain data from
the NHS litigation authority (NHSLA) relating to orthopaedic claims,
and the foot and ankle claims were reviewed. During this period of time, a total of 10 273 orthopaedic claims
were made, of which 1294 (12.6%) were related to the foot and ankle.
1036 were closed, which comprised of 1104 specific complaints. Analysis
was performed using the complaints as the denominator. The cost
of settling these claims was more than £36 million. There were 372 complaints (33.7%) involving the ankle, of which
273 (73.4%) were related to trauma. Conditions affecting the first
ray accounted for 236 (21.4%), of which 232 (98.3%) concerned elective
practice. Overall, claims due to diagnostic errors accounted for
210 (19.0%) complaints, 208 (18.8%) from alleged incompetent surgery
and 149 (13.5%) from alleged mismanagement. Our findings show that the incorrect, delayed or missed diagnosis
of conditions affecting the foot and ankle is a key area for improvement,
especially in trauma practice. Cite this article:
Traumatic rupture of the tendon of the subscapularis muscle was documented as an isolated lesion in the shoulders of 16 men. The injury was caused either by forceful hyperextension or external rotation of the adducted arm. The patients complained of anterior shoulder pain and weakness of the arm when it was used above and below the shoulder level. They did not experience shoulder instability. The injured shoulders exhibited increased external rotation and decreased strength of internal rotation. A simple
Patient function after arthroplasty should ideally quickly improve.
It is not known which peri-operative function assessments predict
length of stay (LOS) and short-term functional recovery. The objective
of this study was to identify peri-operative functions assessments
predictive of hospital LOS and short-term function after hospital discharge
in hip or knee arthroplasty patients. In total, 108 patients were assessed peri-operatively with the
timed-up-and-go (TUG), Iowa level of assistance scale, post-operative
quality of recovery scale, readiness for hospital discharge scale,
and the Western Ontario and McMaster Osteoarthritis Index (WOMAC).
The older Americans resources and services activities of daily living
(ADL) questionnaire (OARS) was used to assess function two weeks
after discharge. Objectives
Methods
Although the outcome of fractures of the distal radius is traditionally assessed using objective
The purpose of this study was to evaluate treatment
results following arthroscopic triangular fibrocartilage complex (TFCC)
debridement for recalcitrant ulnar wrist pain. According to the
treatment algorithm, 66 patients (36 men and 30 women with a mean
age of 38.1 years (15 to 67)) with recalcitrant ulnar wrist pain
were allocated to undergo ulnar shortening osteotomy (USO; n = 24),
arthroscopic TFCC repair (n = 15), arthroscopic TFCC debridement
(n = 14) or prolonged conservative treatment (n = 13). The mean
follow-up was 36.0 months (15 to 54). Significant differences in
Hand20 score at 18 months were evident between the USO group and
TFCC debridement group (p = 0.003), and between the TFCC repair
group and TFCC debridement group (p = 0.029). Within-group comparisons showed
that Hand20 score at five months or later and pain score at two
months or later were significantly decreased in the USO/TFCC repair
groups. In contrast, scores in the TFCC debridement/conservative
groups did not decrease significantly. Grip strength at 18 months
was significantly improved in the USO/TFCC repair groups, but not
in the TFCC debridement/conservative groups. TFCC debridement shows
little benefit on the
Giant cell tumour is the most common aggressive
benign tumour of the musculoskeletal system and has a high rate of
local recurrence. When it occurs in proximity to the hip, reconstruction
of the joint is a challenge. Options for reconstruction after wide
resection include the use of a megaprosthesis or an allograft-prosthesis
composite. We performed a