Abstract. Background. Aim of this study is to determine the difference between re-operation rates after conventional Methods of fixation of patella fractures using Metallic implants and novel technique of all suture fixation using Ethibond or fiber tape. Methods. This is a retrospective comparative analysis involving 62 patients who had a transverse patellar fracture and underwent surgery between January 2013 to December 2021. Selected patients were divided, based on different fixation methods used, into four groups - TBW group, CC screw group, Encirclage group and Suture Fixation Group. Patients were followed till bone union was evident on radiographs. Number of patients in Metallic implant group undergoing repeat operation were compared with the patients who underwent patella fracture fixation using all suture technique. Mean and standard deviation (SD) were calculated for all continuous variables. Mean of the two groups was compared using unpaired t-test. Results. TBW was the most common method of fixation used in 41(66.1%) patients. 7 patients each underwent surgery using CC screw, Encirclage +/− TBW, and suture fixation respectively. Bone union was seen in about 85% of patients in all the groups suggesting all treatment modalities lead to good fracture healing. 15 patients(36.6%) of patients in TBW group and 3 patients(42.9%) in encirclage group had implant removal because of hardware-related complications (p<0.001). None of the patient who underwent All suture Fixation underwent re-operation. Conclusion. The results suggest that Suture fixation of patellar fractures is a valid treatment modality giving excellent results with similar bone union rates without any complications

Aims

Classifying trochlear dysplasia (TD) is useful to determine the treatment options for patients suffering from patellofemoral instability (PFI). There is no consensus on which classification system is more reliable and reproducible for the purpose of guiding clinicians’ management of PFI. There are also concerns about the validity of the Dejour Classification (DJC), which is the most widely used classification for TD, having only a fair reliability score. The Oswestry-Bristol Classification (OBC) is a recently proposed system of classification of TD, and the authors report a fair-to-good interobserver agreement and good-to-excellent intraobserver agreement in the assessment of TD. The aim of this study was to compare the reliability and reproducibility of these two classifications.

Aim

The rise of multidrug-resistant bacteria and the decreasing efficacy of antibiotic therapy in successfully treating biofilm-associated infections are prompting the exploration of alternative treatment options. This study investigates the efficacy of different bioactive glass (BAG) formulations - alone or combined with vancomycin - to eradicate biofilm. Further, we study the influence of BAG on pH and osmotic pressure as important factors limiting bacterial growth.

Aims. The metabolic variations between the cartilage of osteoarthritis (OA) and Kashin-Beck disease (KBD) remain largely unknown. Our study aimed to address this by conducting a comparative analysis of the metabolic profiles present in the cartilage of KBD and OA. Methods. Cartilage samples from patients with KBD (n = 10) and patients with OA (n = 10) were collected during total knee arthroplasty surgery. An untargeted metabolomics approach using liquid chromatography coupled with mass spectrometry (LC-MS) was conducted to investigate the metabolomics profiles of KBD and OA. LC-MS raw data files were converted into mzXML format and then processed by the XCMS, CAMERA, and metaX toolbox implemented with R software. The online Kyoto Encyclopedia of Genes and Genomes (KEGG) database was used to annotate the metabolites by matching the exact molecular mass data of samples with those from the database. Results. A total of 807 ion features were identified for KBD and OA, including 577 positive (240 for upregulated and 337 for downregulated) and 230 negative (107 for upregulated and 123 for downregulated) ions. After annotation, LC-MS identified significant expressions of ten upregulated and eight downregulated second-level metabolites, and 183 upregulated and 162 downregulated first-level metabolites between KBD and OA. We identified differentially expressed second-level metabolites that are highly associated with cartilage damage, including dimethyl sulfoxide, uric acid, and betaine. These metabolites exist in sulphur metabolism, purine metabolism, and glycine, serine, and threonine metabolism. Conclusion. This comprehensive comparative analysis of metabolism in OA and KBD cartilage provides new evidence of differences in the pathogenetic mechanisms underlying cartilage damage in these two conditions. Cite this article: Bone Joint Res 2024;13(7):362–371

As patient data continues to grow, the importance of efficient and precise analysis cannot be overstated. The employment of Generative Artificial Intelligence (AI), specifically Chat GPT-4, in the realm of medical data interpretation has been on the rise. However, its effectiveness in comparison to manual data analysis has been insufficiently investigated.

This quality improvement project aimed to evaluate the accuracy and time-efficiency of Generative AI (GPT-4) against manual data interpretation within extensive datasets pertaining to patients with orthopaedic injuries.

A dataset, containing details of 6,562 orthopaedic trauma patients admitted to a district general hospital over a span of two years, was reviewed. Two researchers operated independently: one utilised GPT-4 for insights via prompts, while the other manually examined the identical dataset employing Microsoft Excel and IBM® SPSS® software. Both were blinded on each other's procedures and outcomes. Each researcher answered 20 questions based on the dataset including injury details, age groups, injury specifics, activity trends and the duration taken to assess the data.

Upon comparison, both GPT-4 and the manual researcher achieved consistent results for 19 out of the 20 questions (95% accuracy). After a subsequent review and refined prompts (prompt engineering) to GPT-4, the answer to the final question aligned with the manual researcher's findings. GPT-4 required just 30 minutes, a stark contrast to the manual researcher's 9-hour analytical duration.

This quality improvement project emphasises the transformative potential of Generative AI in the domain of medical data analysis. GPT-4 not only paralleled the accuracy of manual analysis but also achieved this in significantly less time. For optimal accurate results, data analysis by AI can be enhanced through human oversight. Adopting AI-driven approaches, particularly in orthopaedic data interpretation, can enhance efficiency and ultimately improve patient care. We recommend future investigations on large and more varied datasets to reaffirm these outcomes.

Classifying trochlear dysplasia (TD) is useful to determine the treatment options for patients suffering from patellofemoral instability (PFI). There is no consensus on which classification system is more reliable and reproducible for this purpose to guide clinicians in order to treat PFI. There are also concerns about validity of the Dejour classification (DJC), which is the most widely used classification for TD, having only a fair reliability score.

The Oswestry-Bristol classification (OBC) is a recently proposed system of classification of TD and the authors report a fair-to-good interobserver agreement and good-to-excellent intra-observer agreement in the assessment of TD. The aim of this study was to compare the reliability and reproducibility of these two classifications.

6 assessors (4 consultants and 2 registrars) independently evaluated 100 magnetic resonance axial images of the patella-femoral joint for TD and classified them according to OBC and DJC. These assessments were again repeated by all raters after 4 weeks. The inter and intra-observer reliability scores were calculated using Cohen's kappa and Cronbach's alpha.

Both classifications showed good to excellent interobserver reliability with high alpha scores. The OBC classification showed a substantial intra-observer agreement (mean kappa 0.628)[p<0.005] whereas the DJC showed a moderate agreement (mean kappa 0.572) [p<0.005]. There was no significant difference in the kappa values when comparing the assessments by consultants to those by registrars, in either classification systems.

This large study from a non-founding institute shows both classification systems to be reliable for classifying TD based on magnetic resonance axial images of the patella-femoral joint, with the simple to use OBC having a higher intra-observer reliability score compared to the DJC.

Two-stage exchange arthroplasty is traditionally used to treat periprosthetic hip infection. Nevertheless, particularly in high-risk patients, there has been increased attention towards alternatives such as 1.5-stage exchange arthroplasty which takes place in one surgery. Therefore, we sought to compare (1) operative time, length-of-stay (LOS), transfusions, (2) causative organism identification and polymicrobial infection rates, (3) re-revision rates and re-revision reasons, (4) mortality, and determine (5) independent predictors of re-revision.

Retrospective chart review of 71 patients who underwent either 1.5- (n=38) or 2-stage (n=33) exchange hip arthroplasty at a single institution (03/2019-05/2023). Demographics, surgical, inpatient, and infection characteristics were noted. Main outcomes evaluated were re-revision rates, re-revision reasons, mortality, and cause of death. Independent predictors of re-revision were assessed utilizing logistic regression. Mean follow: 675 days (range, 23–1,715).

Demographics were not significantly different except for a higher proportion of 1.5-stage patients classified as American-Society-of-Anesthesiologists (ASA) status 3 or 4 (84.2 vs. 48.5%, p=0.002). Length of follow-up was significantly longer in the 2-stage group (924.4 vs. 458 days, p<0.001) as well as operative time (506 vs. 271 minutes, p<0.001). In the 1.5-stage group, there was a higher proportion of polymicrobial infections (23.7 vs. 3.0%, p=0.016), re-revision rates (28.9 vs. 9.1%, p=0.042) and periprosthetic infections as a cause of revision (90.9 vs. 0%, p=0.007). Mortality rates were not significantly different, and no patient died for causes related to infection. Type of surgery (1.5-stage vs. 2-stage) was the only independent predictor of re-revision (odds-ratio 4.0, 95% confidence-interval 1.02–16.16, p=0.046).

Our data suggests that patients who undergo 1.5-stage exchange arthroplasty have a significantly higher re-revision rate (mostly due to infection) when compared to 2-stage patients. We acknowledge potential benefits of the 1.5-stage strategy, especially in high-risk patients since it involves single surgery. However, higher re-revision rates must be considered when counseling patients.

Study purpose and background

Kinematic variables have been identified as potential biomarkers for low back pain patients; however, an in-depth comparison between chronic (n=22), acute (n=15), and healthy controls (n=136) has not been done. This retrospective data analysis compared intervertebral lumbar motion parameters, angular range of motion, translation, maximum disc height, motion share inequality (MSI) and variability (MSV), and laxity, between these groups.

Aims

Highly polished stems with force-closed design have shown satisfactory clinical results despite being related to relatively high early migration. It has been suggested that the minimal thickness of cement mantles surrounding the femoral stem should be 2 mm to 4 mm to avoid aseptic loosening. The line-to-line cementing technique of the femoral stem, designed to achieve stem press-fit, challenges this opinion. We compared the migration of a highly polished stem with force-closed design by standard and line-to-line cementing to investigate whether differences in early migration of the stems occur in a clinical study.

Introduction

The American Joint Replacement Registry (AJRR) is the largest registry of total hip and knee arthroplasty (THA and TKA) procedures performed in the U.S. The National (Nationwide) Inpatient Sample (NIS) is a public database containing demographic estimates based on more than seven million hospitalizations annually. The purpose of this study was to analyze whether AJRR data is representative of the national experience with TJA as represented in NIS

Unicameral bone cyst is a frequent benign lesion of the child’s skeleton of unclear ethopathology and scarce symptoms.Possible complications and limits in the child’s activities necessitate an active approach to management. Intracystic injection of corticosteroid depot, curettage of the cyst and bone grafting and osteoinduction procedures are three frequently used therapeutic procedures.Having in mind that attitudes regarding initial treatment are still heterogeneous, in period 1992–2001, we have conducted a study aimed at making a comparative analysis of those commonly applied methods of treatment. The prospective randomised study included 37 patients treated with corticosteroid injections, 32 patients treated with curettage and bone grafting and 31 patients treated with osteoinduction procedure.As osteoinductive material we used mixture of demineralised bone matrix powder and autologous bone marrow. Results evaluation was based on criteria designed by Neer,Campannaci and Capanna.Mean follow up period was 6,5 years. In our patients results of initial treatment were good, regardless of the applied method and they do not significantly differ from the results of other authors.No significant difference in treatment outcome was statistically revealed and frequency of recurrence does not vary in relation to applied method. Mean failure rate was 18%,mean recurrence rate 10% and mean rate of usual complications 17%. Under conditions of similar efficiacy, it is justified to apply a less invasive method in the initial treatment. Methods of corticosteroid injection and osteoinduction are advantageous in cysts with physeal and epiphyseal propagation especially in the upper limb. Besides, those methods are characterised by simplicity, safety and short duration of intervention and hospitalisation and short limitation of the child’s activity.In exceptionally large cysts, as well as in cysts localised in the femoral neck and complicated with displaced fracture which requires reposition and osteosynthesis, the advantage is given to curetage and bone grafting

BACKGROUND

This scientific work is a non-interventional, experimental and prospective comparative study of two very high-viscosity PMMA bone cements: DePuy CMW 2G and Palacos® fast R+G. Reference product: Palacos® R+G.

Fast-setting PMMA bone cements are used in the endoprothetics of the patella and knee (in Australia) and are also used to cement an artificial acetabulum (in the UK). Are there any differences regarding the characteristics of the two fast-setting PMMA bone cements?

Arthrodesis of the first metatarsophalangeal joint (MTPJ) is the most reliable surgical option, for hallux rigidus from end-stage osteoarthritis. The aim of the study was to compare the functional outcomes of memory nickel-titanium staples versus a compression plate with a cross screw construct for first MTPJ arthrodesis using the Manchester–Oxford Foot Questionnaire (MOXFQ).

Patients who underwent MTPJ arthrodesis using either memory nickel-titanium staples or a compression plate with a cross screw construct were identified from the surgical lists of two orthopaedic consultants. Pre and post-operative MOXFQ questionnaire, a validated patient-reported outcome measure, was administered, and responses were analysed to derive the MOXFQ summary index.

The study included 38 patients (staple group N=12 and plate and cross screw group N=26). 23 patients were female and 15 were male. Mean age was 64.8 years (SD 9.02; 40 to 82). Initial analysis showed no significant difference in preoperative MOXFQ scores between the groups (p = 0.04). Postoperatively, the staple group exhibited a mean improvement of 36.17, surpassing the plate group's mean improvement of 23. Paired t-test analysis revealed a statistically significant difference (t-score= 2.5, p = 0.008), favouring the use of staples.

The findings indicate that the use of staples in MTPJ arthrodesis resulted in a significantly greater improvement in MOXFQ scores compared to plates. Further research is needed to explore the underlying factors contributing to this difference and to evaluate long-term effects on patient outcomes.

Objective: To evaluate the long term radiological and clinical outcome after posterior correction of adolescent right thoracic idiopathic scoliosis with Cotrel-Dubousset instrumentation (CDI) and Harrington rod instrumentation (HRI). Design: Retrospective comparative analysis. Subjects: Out of preoperative standing radiographs of 229 patients 30 pairs of female patients, one patient with Harrington rod instrumentation (HRI) and the other with Cotrel-Dubousset instrumentation (CDI), could be identified. Curves within pairs were comparable with regard to curve magnitude (thoracic and lumbar) and level of stable and neutral vertebrae. Follow up examination included a clinical review, long cassette upright PA and lateral radiographs of the spine and two patient outcome questionnaires. Mean follow up time for CDI patients was 128 months and for HRI patients 198 months respectively. Outcome measures: The pain questionnaire according to Moskowitz [. 1. ] was used to assess back pain. A customized questionnaire was used to assess whether patients were satisfied with their postoperative cosmetic appearance. Results: In 92 per cent of the patients L2 was the lowest instrumented vertebra. The thoracic Cobb angle in the HRI group was corrected from 64° to 42° (34%) and in the CDI group from 66° to 24° (58%). Group differences were significant (p=0.004). The lumbar Cobb angle in the HRI group was corrected from 41° to 24° (41%) and in the CDI group from 44° to 21° (52%) respectively. Group differences were significant (p=0.03). The lumbar lordosis below the fusion could be improved postoperatively in CDI patients (L2–L5: 31° to 37°), whereas it remained unchanged in HRI patients (L2–L5: 32°). Group differences were significant (p=0.005). The overall cosmetic appearance was better in the CDI group (CDI 76% excellent and good, HRI 71%, p=0.04). 15% of the CDI patients and 24% of the HRI patients reported frequent low back pain episodes. Group differences were significant (p=0.008). A high correlation between incidence of low back pain and low degrees of lumbar lordosis below the fusion was revealed in HRI patients (p=0.02). Conclusion: With Cotrel-Dubousset instrumentation better correction of the thoracic and lumbar curves in the frontal plane and better restoration of the lumbar lordosis distal the fusion is achievable. The lack of restoration of lumbar lordosis below the fusion in HRI patients may have some impact on the higher incidence of low back pain episodes found in this group. The postoperative cosmetic result was better in patients with Cotrel-Dubousset instrumentation

Background: context: In Adolescent Idiopathic Scoliosis (AIS), the correction of thoracic hypokyphosis with hooks instrumentation and also with pedicle screws system is moderate. Purpose: To compare radiographic results between two instrumentations with thoracic screws using two different. Methods: of reduction: cantilever reduction (CR group– MOSS-MIAMI system) versus simultaneous translation on two rods (ST group – PASSMED system). Study design: Retrospective comparative analysis of two consecutive cohorts of patients treated by the same surgeon at a single hospital. Patient sample: Forty-two adolescent idiopathic thoracic scoliosis (Lenke type 1, 2 and 3) underwent a posterior spinal fusion and instrumentation: 20 patients in CR group and 22 patients in the ST group. The minimum follow-up was two years (Mean follow-up: 71 months and 47 months). Outcomes measures: Thoracic sagittal kyphosis between T4 and T12 and Cobb angle measurements of major and minor curves evaluated preoperatively, postoperatively and the final visit, by an independent observer. Methods: In CR group, we have used polyaxial pedicle screws and one or two monoaxial thoracic hooks. In ST group, we have used polyaxial pedicle screws and poly-axial claws which provide same stability than screws. Three groups of preoperative kyphosis were generated: 11 patients with severe hypokyphosis (T4–T12 < 10°) (5 in CR group and 6 in ST group); 11 patients with mild hypokyphosis (between 10 and 20°) (respectively 4° vs 7°) and 20 with normokyphosis (> 20°) (respectively 11 vs 9). Results: At the final follow-up, for patients with a severe preoperative hypokyphosis, the mean gain was 14 degrees in the CR group (8° preop to 22° postop) and 25° in the ST group (6° preop to 31 postop) (p< 0.05). For patients xith mild hypokyphosis, te mean gains were respectively 7 degrees (16° preop to 23° postop) and 18° (16° preop to 34° postop) (p< 0.05). After surgery, 3 patients of CR group had hypokyphosis alors que all patients had normal kyphosis (> 20°) in the ST group. In the coronal plane, the mean correction of scoliosis are similar in the two groups (75% vs 69% p=NS). Discussion and Conclusion: In posterior instrumentation for AIS, simultaneous reduction on two rods provides a better correction of the thoracic kyphosis than the cantilever reduction in patient with preoperative hypokyphosis. This surgical technique seems to restore thoracic normal kyphosis

The aim of this study was to compare the results of Matti-Russe (MR) procedure and interpositional techniques (IT) in the management of scaphoid non-union.

50 scaphoid non-unions were included in this retrospective study. Demographics, initial management of fracture, location of non-union, time to surgery, procedure done and immobilisation time were recorded. Radiographs were analysed for union and deformity correction. Functional outcome was analysed using the Herbert's grading system.

The mean age and time to surgery were 26.7 years and 15.9 months. Twenty-one patients had the MR procedure and twenty-nine patients had interpositional procedures with internal fixation. DISI was present in 17 patients. The mean postoperative change in the scapholunate angle with the MR procedure was 7.9° compared to 8.0° (p>0.05) for the IT procedures. Union rate was 76% for both procedures. The mean follow-up was 9.9 months. Functional results were Herbert 0 or 1 in 42 cases.

The only significant prognostic variables were location of non-union and time to surgery. Similar deformity correction was achieved using both IT and MP procedures. MP procedure can be used in the management of scaphoid non-union even in the presence of deformity with good functional results.

Introduction: Different grafting materials for the filling of large bony defects are used in clinic. Aim of the present study was the comparative analyses of different bony grafting materials concerning their growth factor composition and osteoinductivity in vitro.

Materials & Methods: Different allograft preparations from the tissue bank of the Charité and two commercial demineralized bone matrices (DBM; DBX putty and Allomatrix) were analyzed. Using ELISA-kits following growth factors were quantified: VEGF, IGF-I, FGFa/b, TGF-β1, BMP-2/4, PDGF. Osteoinductivity was investigated by the induction of alkaline phosphatase activity in C2C12-cells.

Results: BMP-2 had the highest quantity within the different materials without differences between the materials. Differences in the quantity of the other growth factors were found between the investigated materials but also a high variability between the different batches was observable. The investigated materials showed individual differences which are donor related concerning their osteoinductive potential. A significant enhancement of osteogenic differentiation (AP) was seen for the two commercial DBM-products. For PES processed spongiosa from the tissue bank, 2 of the 5 materials had a negative effect on the AP-activity in the first incubation period but no effect in the second incubation period.

Discussion: The results of the present study revealed, that the different investigated grafting materials contain growth factors important for bone regeneration and an osteoinductive potential of the DBMs. A high batch/donor related variability, however, was detectable in both analysis. Important for the use in vivo is beside the osteoinductivity also the osteoconductivity and further comparative studies are necessary.

Purpose

Comparison between Aprotinin and Tranexamic acid on blood conservation in scoliosis surgery.

Background

Proper femoral component placement plays a key role in the success of a total knee replacement (TKR). Controversy exists on which technique should be used to ensure proper femoral component placement. This two-part study compares gap balancing (GB) and measured resection (MR) techniques used in TKR, investigating femoral component position and early clinical outcomes.

Search for optimal shape of hip implant have gone on from 70th’s. Different shapes of hip cups and methods of their implantation, which were created within those years, indicate, that long term results of cementless arthroplasty are still not satisfactory.

The clinical and radiological results of cementless hip arthroplasty, which were performed with two types of shape cups (threaded spherical and threaded conical), were analyzed after at least 7 years follow up. Analysis was based on results 106 of cementless hip arthroplasties among 141, which were done during 1993 – 1996. The study concerned 58 threaded spherical cups (group A) and 48 conical (group B). Application of cups was randomized with respect to both sex and etiology of hip dysfunction and their implantation conditioned to possession of this type of implant on this moment.

The mean age of 63 women and 35 men ( in 8 both side) in the moment of implantation were 48,9 years ( 10,6)and ranged from 28 to 76 years. Mean time of follow up was 8,2 years( 1,4) and ranged from 7 to 10 years.

Pre- and postoperative clinical evaluation of hip function was carried out by means of Harris Hip Scale. Radiological evaluation was based on measurements of angle of inclination, horizontal and vertical migration of cup and radiolucent lines in DeLee-Charnley zones. Those measurements of last x-ray examination were compared with those, which were done immediately after arthroplasty.

There were 80% of excellent and good results and 17% poor results in clinical evaluation of group A. In radiological evaluation of this group mean horizontal migration was 1mm, and vertical was 2,5mm. Clinical and radiological symptoms of cup loosening were confirmed in 10 hips. The revision procedures were performed in 9 hips. In group B excellent and good clinical results were in 98% and poor results only in 2 % of treated hips. Radiological evaluation also showed less migration of cups. Mean horizontal migration was 0,3mm, and vertical was 0,7mm. Clinical and radiological symptoms of loosening were in 1 hip, which were treated by revision procedure.

Conclusion of our study is statement, that application of cementless threaded conical cup in hip arthroplasty give better clinical and radiological midterm results, than apllication of cementless threaded spherical cups.