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Prophylactic antibiotics can decrease the risk
of wound infection and have been routinely employed in orthopaedic surgery
for decades. Despite their widespread use, questions still surround
the selection of antibiotics for prophylaxis, timing and duration
of administration. The health economic costs associated with wound
infections are significant, and the judicious but appropriate use
of antibiotics can reduce this risk. This review examines the evidence behind commonly debated topics
in antibiotic prophylaxis and highlights the uses and advantages
of some commonly used antibiotics. Cite this article:
Anterior cruciate ligament (ACL) reconstruction
is commonly performed and has been for many years. Despite this, the
technical details related to ACL anatomy, such as tunnel placement,
are still a topic for debate. In this paper, we introduce the flat
ribbon concept of the anatomy of the ACL, and its relevance to clinical
practice. Cite this article:
Using a systematic review, we investigated whether there is an
increased risk of post-operative infection in patients who have
received an intra-articular corticosteroid injection to the hip
for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection
to the hip and infection following subsequent THA were identified
from databases for the period between 1990 to 2013. Retrieved articles
were independently assessed for their methodological quality.Aims
Methods
We wished to quantify the extent of soft-tissue damage sustained
during minimally invasive total hip arthroplasty through the direct
anterior (DA) and direct superior (DS) approaches. In eight cadavers, the DA approach was performed on one side,
and the DS approach on the other, a single brand of uncemented hip
prosthesis was implanted by two surgeons, considered expert in their
surgical approaches. Subsequent reflection of the gluteus maximus
allowed the extent of muscle and tendon damage to be measured and
the percentage damage to each anatomical structure to be calculated.Aims
Materials and Methods
We conducted a randomised controlled trial to assess the accuracy
of positioning and alignment of the components in total knee arthroplasty
(TKA), comparing those undertaken using standard intramedullary
cutting jigs and those with patient-specific instruments (PSI). There were 64 TKAs in the standard group and 69 in the PSI group. The post-operative hip-knee-ankle (HKA) angle and positioning
was investigated using CT scans. Deviation of >
3° from the planned
position was regarded as an outlier. The operating time, Oxford
Knee Scores (OKS) and Short Form-12 (SF-12) scores were recorded.Aims
Patients and Methods
The Advance Medial-Pivot total knee arthroplasty (TKA) was designed
to reflect contemporary data regarding the kinematics of the knee.
We wished to examine the long-term results obtained with this prosthesis
by extending a previous evaluation. We retrospectively evaluated prospectively collected data from
225 consecutive patients (41 men and 184 women; mean age at surgery
71 years, 52 to 84) who underwent 284 TKAs with a mean follow-up
of 13.4 years (11 to 15). Implant failure, complication rate, clinical (both
subjective and objective) and radiological outcome were assessed.
Pre- and post-operative clinical and radiographic data were available
at regular intervals for all patients. A total of ten patients (4.4%;
ten TKAs) were lost to follow-up.Aims
Patients and Methods
There is uncertainty regarding the optimal means of thromboprophylaxis
following total hip and knee arthroplasty (THA, TKA). This systematic
review presents the evidence for acetylsalicylic acid (aspirin)
as a thromboprophylactic agent in THA and TKA and compares it with
other chemoprophylactic agents. A search of literature published between 2004 and 2014 was performed
in accordance with Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines. A total of 13 studies were eligible
for inclusion.Aims
Materials and Methods
Tissue responses to debris formed by abrasion of polymethylmethacrylate
(PMMA) spacers at two-stage revision arthroplasty for prosthetic
joint infection are not well described. We hypothesised that PMMA
debris induces immunomodulation in periprosthetic tissues. Samples of tissue were taken during 35 two-stage revision arthroplasties
(nine total hip and 26 total knee arthroplasties) in patients whose
mean age was 67 years (44 to 85). Fourier transform infrared microscopy
was used to confirm the presence of PMMA particles. Histomorphometry
was performed using Sudan Red and Haematoxylin-Eosin staining.
CD-68, CD-20, CD-11(c), CD-3 and IL-17 antibodies were used to immunophenotype
the inflammatory cells. All slides were scored semi-quantitatively
using the modified Willert scoring system.Aims
Patients and Methods
The degree of displacement of a fracture of the distal radius
is an important factor which can be assessed using simple radiographic
measurements. Our aim was to investigate the reliability and reproducibility
of these measurements and to determine if they should be used clinically. A 10% sample was randomly generated from 3670 consecutive adult
patients who had presented to University Hospitals of Leicester
NHS Trust between 2007 and 2010 with a fracture of the distal radius.
Radiographs of the 367 patients were assessed by two independent
reviewers. Four measurements of displacement of the fracture were recorded
and the inter-observer correlation assessed using the intra-class
correlation coefficient.Aims
Patients and Methods
Our aim was to investigate the outcomes of patients with a displaced
fracture of the glenoid fossa who are treated conservatively. There
is little information in the literature about the treatment of these
rare injuries non-operatively. We reviewed 24 patients with a mean age of 52 years (19 to 81)
at a mean of 5.6 years (11 months to 18 years) after the injury.Aims
Patients and Methods
Patient-specific glenoid guides (PSGs) claim an improvement in
accuracy and reproducibility of the positioning of components in
total shoulder arthroplasty (TSA). The results have not yet been
confirmed in a prospective clinical trial. Our aim was to assess
whether the use of PSGs in patients with osteoarthritis of the shoulder
would allow accurate and reliable implantation of the glenoid component. A total of 17 patients (three men and 14 women) with a mean age
of 71 years (53 to 81) awaiting TSA were enrolled in the study.
Pre- and post-operative version and inclination of the glenoid were
measured on CT scans, using 3D planning automatic software. During
surgery, a congruent 3D-printed PSG was applied onto the glenoid
surface, thus determining the entry point and orientation of the
central guide wire used for reaming the glenoid and the introduction
of the component. Manual segmentation was performed on post-operative
CT scans to compare the planned and the actual position of the entry
point (mm) and orientation of the component (°).Aims
Patients and Methods
Revision total elbow arthroplasty (TEA) is often challenging.
The aim of this study was to report on the clinical and radiological
results of revision arthroplasty of the elbow with the Latitude
TEA. Between 2006 and 2010 we used the Latitude TEA for revision in
18 consecutive elbows (17 patients); mean age 53 years (28 to 80);
14 women. A Kudo TEA was revised in 15 elbows and a Souter-Strathclyde
TEA in three. Stability, range of movement (ROM), visual analogue score (VAS)
for pain and functional scores, Elbow Functional Assessment Scale
(EFAS), the Functional Rating Index of Broberg and Morrey (FRIBM)
and the Modified Andrews’ Elbow Scoring System (MAESS) were assessed
pre-operatively and at each post-operative follow-up visit (six,
12 months and biennially thereafter). Radiographs were analysed
for loosening, fractures and dislocation. The mean follow-up was
59 months (26 to 89).Aims
Patients and Methods
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). 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.Aims
Patients and Methods
Loosening of pedicle screws is a major complication of posterior
spinal stabilisation, especially in the osteoporotic spine. Our
aim was to evaluate the effect of cement augmentation compared with
extended dorsal instrumentation on the stability of posterior spinal
fixation. A total of 12 osteoporotic human cadaveric spines (T11-L3) were
randomised by bone mineral density into two groups and instrumented
with pedicle screws: group I (SHORT) separated T12 or L2 and group
II (EXTENDED) specimen consisting of T11/12 to L2/3. Screws were
augmented with cement unilaterally in each vertebra. Fatigue testing
was performed using a cranial-caudal sinusoidal, cyclic (1.0 Hz)
load with stepwise increasing peak force.Aims
Materials and Methods
The aim of this study was to report the outcome following primary
fixation or a staged protocol for type C fractures of the tibial
plafond. We studied all patients who sustained a complex intra-articular
fracture (AO type C) of the distal tibia over an 11-year period.
The primary short-term outcome was infection. The primary long-term
outcome was the Foot and Ankle Outcome Score (FAOS).Aims
Patients and Methods
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. 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).Aims
Patients and Methods
Flail chest from a blunt injury to the thorax is associated with
significant morbidity and mortality. Its management globally is
predominantly non-operative; however, there are an increasing number
of centres which undertake surgical stabilisation. The aim of this
meta-analysis was to compare the efficacy of this approach with
that of non-operative management. A systematic search of the literature was carried out to identify
randomised controlled trials (RCTs) which compared the clinical
outcome of patients with a traumatic flail chest treated by surgical
stabilisation of any kind with that of non-operative management.Aims
Patients and Methods
Demineralised bone matrix (DBM) is rarely used for the local
delivery of prophylactic antibiotics. Our aim, in this study, was
to show that a graft with a bioactive glass and DBM combination,
which is currently available for clinical use, can be loaded with
tobramycin and release levels of antibiotic greater than the minimum
inhibitory concentration for Antibiotic was loaded into a graft and subsequently evaluated
for drug elution kinetics and the inhibition of bacterial growth.
A rat femoral condylar plug model was used to determine the effect
of the graft, loaded with antibiotic, on bone healing.Aims
Materials and Methods
Compartment syndrome results from increased intra-compartmental
pressure (ICP) causing local tissue ischaemia and cell death, but
the systemic effects are not well described. We hypothesised that
compartment syndrome would have a profound effect not only on the affected
limb, but also on remote organs. Using a rat model of compartment syndrome, its systemic effects
on the viability of hepatocytes and on inflammation and circulation
were directly visualised using intravital video microscopy.Aims
Methods
The purpose of this study was to review a large cohort of patients
and further assess the correlation between the histological response
to chemotherapy in patients with Ewing’s sarcoma with the overall
(OS) and event-free survival (EFS). All patients treated for Ewing’s sarcoma between 1980 and 2012
were reviewed. Of these, 293 patients without metastases at the
time of diagnosis and treated with chemotherapy and surgery were
included. Patients were grouped according to the percentage of necrosis
after chemotherapy: Group I: 0% to 50%, Group II: 51% to 99% and Group
III: 100%.Aims
Patients and Methods
This study compared the long-term results following Salter osteotomy
and Pemberton acetabuloplasty in children with developmental dysplasia
of the hip (DDH). We assessed if there was a greater increase in
pelvic height following the Salter osteotomy, and if this had a
continued effect on pelvic tilt, lumbar curvature or functional outcomes. We reviewed 42 children at more than ten years post-operatively
following a unilateral Salter osteotomy or Pemberton acetabuloplasty.
We measured the increase in pelvic height and the iliac crest tilt
and sacral tilt at the most recent review and at an earlier review
point in the first decade of follow-up. We measured the lumbar Cobb angle
and the Short Form-36 (SF-36) and Harris hip scores were collected
at the most recent review.Aims
Patients and Methods
