We
Five cases are presented of bilateral simultaneous rupture of the quadriceps tendon and the English literature of six isolated case reports is
From 1986 to 1993, we repaired 278 torn menisci in 264 patients using an arthroscopically assisted inside-out technique. A total of 132 meniscal repairs in 122 patients were evaluated by second-look arthroscopy. At
We conducted a meta-analysis, including randomised
controlled trials (RCTs) and cohort studies, to examine the effect
of patient-specific instruments (PSI) on radiological outcomes after
total knee replacement (TKR) including: mechanical axis alignment
and malalignment of the femoral and tibial components in the coronal,
sagittal and axial planes, at a threshold of >
3º from neutral.
Relative risks (RR) for malalignment were determined for all studies
and for RCTs and cohort studies separately. Of 325 studies initially identified, 16 met the eligibility criteria,
including eight RCTs and eight cohort studies. There was no significant
difference in the likelihood of mechanical axis malalignment with
PSI We conclude that PSI does not improve the accuracy of alignment
of the components in TKR compared with conventional instrumentation. Cite this article:
We report a rare case of Albright's syndrome associated with both a soft-tissue myxoma and hypophosphataemic osteomalacia. Renal tubular function was preserved, except for glycosuria. Serum levels of 1,25(OH)2 vitamin D3 were normal. Excision of the myxoma did not influence the biochemical abnormalities, nor did standard doses of vitamin D3 or 1 alpha-OH vitamin D3. The previously reported cases of hypophosphataemic osteomalacia associated with fibrous dysplasia and mesenchymal tumours are
Elastofibroma dorsi is an uncommon, benign, slow-growing soft-tissue tumour of uncertain aetiology. It classically presents as an ill-defined mass at the inferior pole of the scapula with symptoms which include swelling, discomfort, snapping, stiffness and occasionally pain. We report the symptoms, function and outcome after treatment of 21 elastofibromas in 15 patients. All were diagnosed by MRI and early in the series four also underwent CT-guided biopsy to confirm the diagnosis. In all, 18 tumours were excised and three were observed. After excision, the mean visual analogue score for pain decreased from 4.6 (0 to 10) pre-operatively to 2.4 (0 to 8) post-operatively (p = 0.04). The mean shoulder function, at a mean follow-up of 4.2 years (3 months to 16 years), was 78.1% (30 to 100) using the Stanmore percentage of normal shoulder assessment scoring system. The mean range of forward flexion improved from 135° (70° to 180°) to 166° (100° to 180°) after excision (p = 0.005). In four patients a post-operative haematoma formed; one required evacuation. Three patients developed a post-operative seroma requiring needle aspiration and one developed a superficial infection which was treated with antibiotics. Our findings support previous reports suggesting that a pre-operative tissue diagnosis is not necessary in most cases since the lesion can be confidently diagnosed by MRI, when interpreted in the light of appropriate clinical findings. Surgical excision in symptomatic patients, is helpful. It has been suggested that elastofibroma is caused by a local tissue reaction and is not a true neoplastic process. A strong association has been noted between elastofibroma and repetitive use of the shoulder, which is supported by our findings.
There are differences of opinion about the pathogenesis of Perthes' disease. All are agreed that it is due to ischaemia, but the cause of this and the size and number of infarctions are in dispute. Through the generosity of the contributors six whole femoral heads and core biopsies of five other cases have been studied radiographically and histologically. The findings ranged from an ischaemic arrest of ossification in the capital articular cartilage without infarction to multiple complete infarctions of the epiphysial bone. The ensuing reparative process contributes to the pathology, which is of a range to warrant grading or grouping.
As part of the national initiative to reduce
waiting times for joint replacement surgery in Wales, the Cardiff
and Vale NHS Trust referred 224 patients to the NHS Treatment Centre
in Weston-Super-Mare for total knee replacement (TKR). A total of
258 Kinemax TKRs were performed between November 2004 and August
2006. Of these, a total of 199 patients (232 TKRs, 90%) have been
followed up for five years. This cohort was compared with 258 consecutive
TKRs in 250 patients, performed at Cardiff and Vale Orthopaedic
Centre (CAVOC) over a similar time period. The five year cumulative
survival rate was 80.6% (95% confidence interval (CI) 74.0 to 86.0)
in the Weston-Super-Mare cohort and 95.0% (95% CI 90.2 to 98.2)
in the CAVOC cohort with revision for any reason as the endpoint.
The relative risk for revision at Weston-Super-Mare compared with
CAVOC was 3.88 (p <
0.001). For implants surviving five years,
the mean Oxford knee scores (OKS) and mean EuroQol (EQ-5D) scores
were similar (OKS: Weston-Super-Mare 29 (2 to 47) The results show a higher revision rate for patients operated
at Weston-Super-Mare Treatment Centre, with a reduction in functional
outcome and quality of life after revision. This further confirms
that patients moved from one area to another for joint replacement
surgery fare poorly.
It is not uncommon to observe bone cement in the pelvis on radiographs after total hip replacement, a finding which is generally considered to be benign. This paper
Mobile-bearing (MB) total knee replacement (TKR)
was introduced to reduce the risk of aseptic loosening and wear of
polyethylene inserts. However, no consistent clinical advantages
of mobile- over fixed-bearing (FB) TKR have been found. In this
study we evaluated whether mobile bearings have an advantage over
fixed bearings with regard to revision rates and clinical outcome
scores. Furthermore, we determined which modifying variables affected
the outcome. A systematic search of the literature was conducted to collect
clinical trials comparing MB and FB in primary TKR. The primary
outcomes were revision rates for any reason, aseptic loosening and
wear. Secondary outcomes included range of movement, Knee Society
score (KSS), Oxford knee score (OKS), Short-Form 12 (SF-12) score
and radiological parameters. Meta-regression techniques were used
to explore factors modifying the observed effect. Our search yielded 1827 publications, of which 41 studies met
our inclusion criteria, comprising over 6000 TKRs. Meta-analyses
showed no clinically relevant differences in terms of revision rates,
clinical outcome scores or patient-reported outcome measures between
MB and FB TKRs. It appears that theoretical assumptions of superiority
of MB over FB TKR are not borne out in clinical practice. Cite this article: