Introduction: The purpose of this study is to evaluate the clinical and radiogra phic outcome of patients with secondary osteoarthritis of the hip, who underwent custom-made cementless THA. Methods: Between January 1994 and June 1997, 98 prim ary cementless custom-made THA’s were performed in 76 patients with secondary osteoarthritis and reviewed at mean 6 years follow-up (range: 4 – 7.5 years). Nine patients had a previous femoral osteotomy. There were 69 females and seven males. The mean age at operation was 54 years (40 – 73 years). Custom-made, 125 mm-long, titanium femoral components with blasted surface were fabricated based on the computerized tomography. Results: The mean Harris Hip Score improved from 43 to 95 points. 97 patients (99%) had more than 80 points for total score, and 2 patients (2%) had thigh pain at the latest follow-up. Radiographically, 86 hips (87%) showed obviously extensive bone ongrowth onto the middle part of the stem while 8 hips (9%) showed stable fibrous fixation. Four hips (4%) were unstable: more than 2 mm subsidence in 2 hips and more than 2 degrees varus migration in 2 hips. Of these 4 hips, 2 had intraoperative cracks of the poximal femur and 2 had varus positioning of the stem. Discussion and conclusion: Cementless THA has been advocated to enhance fit and fill of variable hip geometry. However, some clinical studies failed to show that custom implants significantly improve clinical success or implant longevity because their surface finish was not optimal. Custom-made titanium femoral components with blasted surface showed good clinical results. The reasons for radiolographical failures were because of intraoperative technical errors and these might be derived from 125 mm-long stem with maximum canal fill. A shorter stem may be an option because it may improve the feasibility of stem insertion and the distal fill

Summary

PCA-III, a phosphocitrate analog, acts not only as a potent calcification inhibitor but also as a protective agent for extracellular matrices. PCA-III has potential as a disease-modifying drug in the treatment of primary osteoarthritis and posttraumatic osteoarthritis in humans.

We report the medium term outcome of a 15 degrees face-changing acetabular cup in THA due to secondary OA in DDH.

We analysed 28 Hips in 26 patients who underwent THA between May 2007and September 2009. There were 20 females and 6 males with a mean age of 52 yrs (range 33–68yrs).

All patients received a cementless Exceed Advanced Bearing Technology 15° Face-changing cup (Biomet) with a ceramic liner through a posterior approach. A cementless or a cemented femoral stem, with 28 or 32mm Biolox Delta ceramic head, was used in all cases. All patients started full weight-bearing the next day. The average clinical and radiological follow-up was for 50 months (range 36–76 months). The mean Harris Hip Score improved to 94 and the Oxford Hip Score improved to 44. There was 100% survivorship of the hip joint for both components.

Post-operative radiographs revealed integration of the cup with no signs of loosening or osteolysis. The mean covered acetabular lip inclination angle was 51 degrees (range 43–61)and the true inclination angle of the bearing was 36 degrees (range 28–46).

The clinical results support the use of the cementless 15 degrees face-changing acetabular cup in the dysplastic acetabulum.

Dysfunction of acetabular dysplasia is a complex problem which includes excessive stresses on the cartilage, dynamic instability and muscular fatigue eventually leading to degenerative osteoarthrosis if left uncorrected. The most physiologic solution for a young adult with this problem is to redirect the acetabulum into a normal position. Rotational acetabular osteotomy developed in Japan aims to transfer the position of the acetabulum en bloc by circumacetabular osteotomy using the curved osteotome. Because of same curvatures of osteotomy surfaces, this osteotomy produces the greater contact among bony surfaces, stable fixation and early solid union. However, this osteotomy requires abductors splitting, leaves acetabular teardrop in its original position, and has the risk of postoperative avascular necrosis of the transferred acetabulum. Bernese periacetabular osteotomy developed by Ganz also provides good coverage of the femoral head by redirecting the acetabulum. This osteotomy preserves the vascular supply of the transferred acetabulum and allows medialization of the hip joint. On the other hand, it poses the risk of considerable morbidities due to extensive exposure, and major and/or moderate complications, such as bleeding complications, reflex sympathetic dystrophy, motor nerve palsy and heterotopic ossification are reported. In order to reduce these disadvantages, we developed a curved periacetabular osteotomy (CPO), for the treatment of hip dysplasias and have performed CPO on more than 400 hips since 1995. Both an imaging of the margin of the hip presumed to be on the quadrilateral surface and a sophisticated operative technique are needed for CPO. However, the extent of soft tissue dissection is limited with abductors left intact, and the osteotomy surfaces retain their original curvature. There have been no major or moderate complications. These advantages seem to reduce postoperative complications and promote early postoperative rehabilitation.

Recently, we compared surgical invasion and complications in patients aged over 40 years who underwent CPO (n=30) or total hip arthroplasty (THA; n=30) using postoperative levels of interleukin (IL)-6 and C-reactive protein (CRP). The mean IL-6 levels were 55.4 pg/ml and 89.5 in the CPO and THA groups, respectively (p< 0.001). The mean CRP levels were 4.5 mg/dl and 5.8 in the CPO and THA groups, respectively (p< 0.01). No major or moderate complications were encountered in either group. CPO appears to be a less invasive and safer surgical procedure for middle-aged patients than THA.

Purpose: Implantation of a single-compartment lateral prosthesis can be proposed to patients with primary or secondary osteoarthritis uniquely involving the lateral femorotibial compartment. Many surgeons hesitate to use this procedure which does not have a particularly good reputation. We report a series analysed retrospectively to determine the impact of aetiology, operative findings, and pre- and post-operative radiographic findings on final outcome. We searched for the ‘ideal’ indication and specific technical difficulties encountered. Material and methods: The review included 81 single-compartment medial implants (complete pre- and postoperative radiological and clinical data were available for 87% of the files, all were reviewed). Minimum follow-up was two years (mean 6.5 years). Clinical assessment was based on the IKS score and radiological analysis included a complete series (AP, lateral, axial, full knee, preoperative stress views). Results: Mean IKS score was clearly improved from 49/100 preoperatively to 90.2/100 postoperatively. Severe pain was noted in 12% of the patients preoperatively versus 1.2% postoperatively. Sixty-three percent of the patients had completely forgotten their knee. Mean amplitude was 0.5–123°. Clinical lateral laxity was less than 5° in 93% of the patients and the knee was stable in the sagittal plane in 96.5%. Mean function score improved from 59/100 preoperatively to 73.3/100 postoperatively, limited basically by going up and down stairs (normal values in 36% of the patients). Walking distance was greater than 1 km in 68% of the patients (29% preoperatively). In the frontal plane, the mean mechanical femorotibial angle was 183.31 ± 3.01° (189.9 ± 5° preoperatively) with a mean mechanical femoral angle of 91.06 ± 3.01 (and a mean mechanical tibial angle of 90.6 ± 1°. Implant survival at five years was 97.15% and 93.33% at ten years (three loosenings and one metallosis). Discussion: At last follow-up, the final result was significantly affected by diverse factors: osteoarthritis status at surgery (p < 0.02), patient age (p < 0.01), raising the anterior tibial tuberosity (p < 0.01), initial aetiology. The results were compared with data in the literature and discussed by type of indication and therapeutic options for lateral femoral osteoarthritis. The problem of indications in case of tibial plateau fractures and lateral meniscectomy is discussed. Conclusion: These clinical and radiological results show that the lateral single-compartment prosthesis is a safe and reliable procedure for the treatment of primary or secondary osteoarthritis of the lateral femorotibial compartment

Psoas tendinopathy is a potential cause of groin pain after primary total hip arthroplasty (THA). The direct anterior approach (DAA) is becoming increasingly popular as the standard approach for primary THA due to being a muscle preserving technique. It is unclear what the prevalence is for the development of psoas-related pain after DAA THA, how this can influence patient reported outcome, and which risk factors can be identified. This retrospective case control study of prospectively recorded data evaluated 1784 patients who underwent 2087 primary DAA THA procedures between January 2017 and September 2019. Psoas tendinopathy was defined as (1) persistence of groin pain after DAA THA and was triggered by active hip flexion, (2) exclusion of other causes such as dislocation, infection, implant loosening or (occult) fractures, and (3) a positive response to an image-guided injection with xylocaine and steroid into the psoas tendon sheath. Complication-, re-operation rates, and patient-reported outcome measures (PROMs) were measured. Forty-three patients (45 hips; 2.2%) were diagnosed with psoas tendinopathy according to the above-described criteria. The mean age of patients who developed psoas tendinopathy was 50.8±11.7 years, which was significantly lower than the mean age of patients without psoas pain (62.4±12.7y; p<0.001). Patients with primary hip osteoarthritis were significantly less likely to develop psoas tendinopathy (14/1207; 1.2%) in comparison to patients with secondary hip osteoarthritis to dysplasia (18/501; 3.6%) (p<0.001) or FAI (12/305; 3.9%) (p<0.001). Patients with psoas tendinopathy had significantly lower PROM scores at 6 weeks and 1 year follow-up. Psoas tendinopathy was present in 2.2% after DAA THA. Younger age and secondary osteoarthritis due to dysplasia or FAI were risk factors for the development of psoas tendinopathy. Post-operatively, patients with psoas tendinopathy often also presented with low back pain and lateral trochanteric pain. Psoas tendinopathy had an important influence on the evolution of PROM scores

The treatment of acetabular dysplasia in adolescents (age> 12) is difþcult and various complex pelvic osteotomies have been described. The aim of surgery being improvement in pain and to delay the onset of secondary osteoarthrosis. Methods: We present our experience of using the Tonnis triple pelvic osteotomy for treatment of acetabular dysplasia in the adolescent and adult age groups (range 13–27 years). This retrospective analysis includes 25 patients operated on over a nine year period (1991–2000) with an average followup of four years (range 2–8 years). More than 50% of the patients had had a previous open reduction or femoral osteotomy for CDH. Results: Radiographic analysis (pre & post op) included CE angle of Wiberg, Sharp-Ullmann index and the acetabular angle of the weight bearing zone. All parameters showed an improvement in the post operative analysis with an improvement in pain and range of movement in all patients. Discussion: The Tonnis triple pelvic osteotomy has the advantage of allowing the operator a direct þeld of view at all times and achieving a great deal of lateral rotation and medial displacement of the acetabulum due to the proximity of the osteotomy to the acetabulum. The ischial ramus and its ligaments to the sacrum are left intact, leading to greater stability of the pelvis and spine. Conclusion: Though technically difþcult and needing a long learning curve, it does improve acetabular alignment and symptoms in the early postoperative years. However long term studies are required to document its effect on the rate of secondary osteoarthrosis

The present study sought to assess the clinical and radiological results and long-term joint impact of different techniques of lateral ankle ligament reconstruction. Material and methods. A multicenter retrospective review was performed on 310 lateral ankle reconstructions, with a mean 13 years’ follow-up (minimum FU of 5 years with a maximum of 30). Male subjects (53%) and sports trauma (78%) predominated. Mean duration of instability was 92 months; mean age at surgery was 28 years. 28% of cases showed subtalar joint involvement. Four classes of surgical technique were distinguished: C1, direct capsulo-ligamentary repair; C2, augmented repair; C3, ligamentoplasty using part of the peroneus brevis tendon; and C4, ligamentoplasty using the whole peroneus brevis tendon. Clinical and functional assessment used Karlsson and Good-Jones-Livingstone scores; radiologic assessment combined centered AP and lateral views, hindfoot weight-bearing Méary views and dynamic views (manual technique, TelosR or self-imposed varus). Results. The majority of results (92%) were satisfactory. The mean Karlsson score of 90 [19–100] (i.e., 87% good and very good results) correlated with the subjective assessment, and did not evolve over time. Postoperative complications (20%), particularly when neurologic, were associated with poorer results. Control X-ray confirmed the very minor progression in osteoarthritis (2 %), with improved stability (88%); there was, however, no correlation between functional result and residual laxity on X-ray. Unstable and painful ankles showed poorer clinical results and more secondary osteoarthritis. Analysis by class of technique found poorer results in C4-type plasties and poorer control of laxity on X-ray in C1-type tension restoration. Discussion. The present series is the largest to be reported with so long a follow-up. We applied the same study criteria as in the present series to each article reviewed in the literature, in order to expose the compared results. The occurence of complex instability is noted. Conclusion. The present results confirm the interest 1) of lateral ankle ligamentoplasty in the management of instability and protection against secondary osteoarthritis, and 2) of precise lesion assessment (CT-scan/MRI) to adapt surgery to the ligamentary and associated lesions

Osteoarthritis is a slowly progressive disease which includes the intervention of several cytokines and macrophage metalleinoproteinases reaction, leading to the degradation of the local cartilage but also having an impact on the serum acute phase proteins (APPs). Subsequently, biomarkers seem to be essential to estimate its progression and the need for any surgical intervention such as total arthroplasty, but also can be used as therapeutic agents. Recently, among APPs, fetuin-A drew attention regarding its possible anti-inflammatory role in animal models but also as a therapeutic agent in the inflammatory joint disease in clinical trials. The purpose of this study is to investigate the possible attenuating role of the intra-articular administration of Fetuin-A in post-traumatic induced secondary osteoarthritis in rats, and also its effect on the systematic levels of IL-2,4,7, BMPs 2,4,7, CRP and Fetuin-A. 30 male Sprague Dawley rats were separated in two groups where post-traumatic osteoarthritis was induced surgically by Anterior Cruciate Ligament Transection and the transection of the Medial Collateral Ligament of the right knee. In the Control Group, only surgical intervention took place. In Fetuin Group, along with the induction of osteoarthritis, a single dose of bovine fetuin was administrated intra-articularly intra-operatively in 5 and 8 weeks of the experimental protocol. Both groups were examined for 8 weeks. The levels of interleukins, bone morphogenetic proteins, Fetuin-A and C-Reactive Protein were evaluated by ELISA of peripheral blood in three time periods: preoperatively, 5 and 8 weeks post-operatively. Knee osteoarthritic lesions were classified according to Osteoarthritis Research Society International Grading System and Modified Mankin Score, by histologic examination. IL-2 levels were significantly decreased in the Fetuin Group. No statistical difference was signed on the levels of IL-7, BMP-2,4,7 and Fetuin-A between the two groups. CRP levels were significantly increased in the Fetuin Group in 5 weeks of the experiment. Fetuin Group signed better scores according to the OARSI classification system and Modified Mankin Score, without any statistical significance. Intra-articular administration of Fetuin-A restrictively affected the progression of post-traumatic arthritis in rats, as only the levels of IL-2 were decreased as well as limited osteoarthritic lesions were observed on the Fetuin Group

Protrusio acetabuli (arthrokatadysis or Otto pelvis) is a relatively rare condition associated with secondary osteoarthritis of the hip. Radiographically, protrusio acetabuli is present when the medial aspect of the femoral head projects medial to Kohler's (ilioischial) line. This results in medialization of the center of rotation (COR) of the hip. Protrusio acetabuli is typically associated with metabolic bone disease (osteoporosis, osteomalacia, Paget's disease) or inflammatory arthritis (RA or ankylosing spondylitis). Idiopathic acetabular protrusio can occur without the above associated factors however. Patients with protrusio acetabuli typically present with significant restriction of range of motion (ROM) of the hip due to femoral neck and trochanteric impingement in the deep acetabular socket and pain associated with secondary osteoarthritis (OA). Total hip arthroplasty (THA) in patients with protrusion acetabuli is more challenging than THA in patients with a normal hip COR. ROM is typically quite restricted which can compromise surgical exposure. Dislocation of the hip in the patient with a deep socket and medialised COR can be extremely difficult and associated with fracture of the femur if not carefully performed. Restoration of the hip COR to the normal more lateralised position is a principle goal of surgery. This restores more normal mechanics of the hip and has been associated with improved durability. A variety of techniques to accomplish this have been described including medial acetabular bone grafting with cemented cups, protrusio rings or porous coated cementless cups fixed with multiple screws. The latter technique has been shown to be more durable and associated with better outcomes. THA in protrusio acetabuli starts with templating of the preoperative x-rays to determine the optimal acetabular implant size and final position of the acetabular component that restores the hip COR to the normal position. Patients with protrusio acetabuli often have varus oriented femoral necks and the femur needs to be carefully templated as well to insure that an appropriate femoral component is available that will allow for restoration of the patient's anatomy. Cartilage covering the thinned medial wall needs to be carefully removed without disruption of the medial acetabular wall. The acetabulum is then carefully reamed with the goal of obtaining stable peripheral rim support of a cementless socket and at least 50% contact of the implant on good quality host bone. Unlike acetabular preparation in the normal hip, preventing the reamer from “bottoming out” is essential in order to obtain desired rim support and return of the hip COR to the normal lateralised position. When good rim support of the reamer is obtained, a trial component is placed and intraoperative x-ray obtained to confirm fit, position and restoration of hip COR. Limited addition reaming can be performed to obtain desired degree of press fit (1‐2mm) and contact with host bone. Morselised autograft from the femoral head and neck is then packed into the medial defect and reverse reamed. The cementless acetabular component is then impacted into position and fixed with screws. Weight bearing is determined by bone quality, size and containment of the medial defect, amount of contact of the cementless cup with host bone and stability of the acetabular construct. Incorporation of autograft bone in the acetabulum and stable long term fixation occurs reliably if stable initial press-fit fixation of the cementless cup is obtained. Restoration of hip COR to within 7mm of its normal location is associated with better implant survival

Introduction: Between 1985 and 1995 an uncemented Osteonics hip prosthesis with bipolar Universal Head was the implant of choice in young patients with osteonecrosis of the femoral head and with posttraumatic secondary osteoarthritis of the hip. Materials and Methods: 30 bipolar hemiarthroplasties were performed in 24 patients with an average age of 34 years. Twenty-six hips had osteonecrosis of the femoral head and 4 hips had secondary osteoarthritis. All prostheses were Osteonics Omnifit collarless stems with an UHR universal head. 11 were non-HA-coated prostheses (NG) and 19 proximal HA-coated prostheses (HA). The mean duration of follow-up was 10.4 years. Results: Clinically, at final follow-up, the Harris Hip Score increased from a preoperative average of 41 points to 76 points (NG 70 and HA 80 points). Thigh or groin pain was present in 16 of 30 hips (NG 3/11 and HA 10/19). Radiographically, a subsidence of 5 mm or more was the major problem in the non-coated prostheses, 11 of 30 hips (NG 10/11, HA 1/19), but osteolysis was mainly seen in the HA-coated group, 20 of 30 hips (HA 17/19, NG 3/11). Total proximal migration of 5 mm or more of the bipolar head was found in 18 prostheses (NG 5/11 and HA 13/19). The revision rate for aseptic loosening was 8 of the 30 hips (NG 3/11 and HA 5/19). During the revisions, major destruction of the polyethylene (PE) inserts were found. Discussion: The revision rate of the Osteonics Omnifit Prosthesis with bipolar UHR is too high to use this implant in young patients with ON. Bone destruction due to third body wear is probably the main cause. Extensive proximal femoral bone loss is seen predominately in the HA group. The loosening rate in the HA-coated group showed no difference with the non-coated group although the reason for this is different

Introduction The consequence of discongrency of the hip joint may be early, secondary osteoarthritis of the hip joint, that leads to important limits in movement abilities of an individual. The deficit of the femoral head coverage can be rather easily corrected, but only until the growth and maturation of the pelvis is completed. Redirection of the acetabular fragment can be performed by use of the periacetabular osteotomy according to Ganz. This type of the osteotomy is mainly used in the treatment of the acetabular displasia in patients with closed Y cartilage, but also in the treatment of the osteoarthritis of the hip joint. The Aim of the study was to present our early results of treatment of the patients with the secondary osteoarthritis of the hip joint by use of the periacetabular osteotomy according to Ganz. Material and Methods. Our material consisted of 64 patients, 72 hip joints, operated on between 1998–2004. 20 patients (24 hip joints) were selected from this group. In these 20 patients the indication for the treatment was not only the acetabular displasia, but also osteoarthritis of the hip joint. Our group consisted of 17 female and 3 male. In 4 cases the both hip joints were affected. The age of the patients was 26–44 years, average 34 years. The observation period was from 4 months to 6 years, average 2,5 years. The most important clinical symptom was the groin pain on the rest or while flexing the hip joint with internal rotation and adduction. The radiological symptoms in patients before the operation were: decentration, narrowing of the articular space, cysts beyond the sclerotic zone, fatigue fractures of the acetabular edge. Results. In all the patients, except of one, the pain disappeared. Abduction and internal rotation in the hip joint increased, but flexion decreased. The Wiberg’s angle increased from 10–15° to 25–40°, and the interior Wiberg’s angle from 10–0° to 15–20°. During follow up we observed remodeling of the cysts. The treatment was subjectively assessed by the patients as very good. Conclusion. The use of the periacetabular osteotomy occording to Ganz is the operation that corrects the hip joint. But in some cases of the osteoarthritis of the hip joint it allows to improve the quality of life and we hope may also delay the arthroplasty in the young age

To compare the long-term outcomes of fibular nailing and plate fixation for unstable ankle fractures in a cohort of patients under the age of 65 years. Patients from a previously conducted randomized control trial comparing fibular nailing and plate fixation were contacted at a minimum of 10 years post intervention at a single study centre. Short term data were collected prospectively and long-term data were collected retrospectively using an electronic patient record software. Ninety-nine patients from one trauma centre were included (48 fibular nails and 51 plate fixations). Groups were matched for gender (p = 0.579), age (p = 0.811), body mass index (BMI)(p = 0.925), smoking status (p = 0.209), alcohol status (p = 0.679) and injury type (p = 0.674). Radiographically at an average of 2 years post-injury, there was no statistically significant difference between groups for development of osteoarthritis (p = 0.851). Both groups had 1 tibio-talar fusion (2% of both groups) secondary to osteoarthritis with no statistically significant difference in overall re-operation rate between groups identified (p = 0.518,). Forty-five percent (n=42) of patients had so far returned patient reported outcome measures at a minimum of 10 years (Fibular nail n=19, plate fixation n=23). No significant difference was found between groups at 10 years for the Olerud and Molander Ankle Score (p = 0.990), the Manchester-Oxford Foot Questionnaire (p = 0.288), Euroqol-5D Index (p = 0.828) and Euroqol-5D Visual Analogue Score (p = 0.769). The current study illustrates no difference between fibular nail fixation and plate fixation at a long-term follow up of 10 years in patients under 65 years old, although the study is currently under powered

Background. Studies have compared open reduction internal fixation (ORIF) with fibular nail fixation (FNF) and shown reduced wound complications with minimal difference to PROMS in the short term. Our aim is to compare long-term outcomes for unstable ankle fractures at 10 year follow up. Methods. Patients from a previously conducted RCT were contacted at a minimum of 10 years post intervention at a single study centre. Case notes were reviewed, and patient reported outcome measures acquired at 10 years. Results. Ninety-nine patients were included (48 FNF and 51 ORIF). After 10 years 75% (33/44) of patients in the FNF group required no further follow up versus 81% (39/48) in the ORIF group. Radiographically at 2 years post-injury, there was no statistically significant difference between groups for development of osteoarthritis (p=0.851). There was one tibio-talar fusion in each group secondary to osteoarthritis, but no statistically significant difference in overall re-operation rate (p=0.518). Fifty-one percent (n=50) of patients have so far returned patient reported outcome measures at a minimum of 10 years (Fibular nail n=23, plate fixation n=27). No significant difference was found between groups for the mean scores of Olerud and Molander Ankle Score (FNF 84.78 vs ORIF 84.07; p=0.883), the Manchester-Oxford Foot Questionnaire (MOXFQ) (FNF 89.54 vs ORIF 96.47; p=0.112), Euroqol-5D Index (FNF 0.88 vs ORIF 0.87; p=0.701) and Euroqol-5D Visual Analogue Score (FNF 77.30 vs ORIF 77.52; p=0.859). Conclusion. The current study illustrates that both methods of treatment result in a satisfactory long-term outcome with no difference in late complications or PROM scores at up to 10 years in patients under 65 years old, although the study is currently under powered

Purpose: To analyze the long-term functional outcome of vertical shear fractures to other forms of severe pelvic injuries: APC-III, LC-III, and complex acetabular fractures. Patients and Methods: Out of 561 patients with pelvic ring injuries we identified 31 vertical shear fractures in 29 consecutive patients (4 female). A retrospective chart analysis was performed and the following data was recorded: age, sex, mechanism of injury, associated injuries, Injury Severity Score (ISS), resuscitation requirements, method of stabilization, intensive care unit (ICU) or high dependency unit (HDU) stay, duration of hospital stay, urogenital injuries, neurological injury, systemic complications, time to union and mortality. The same parameters were assessed and analyzed in a control group comprising of 98 patients: 34 patients with APC–III, 32 patients with LC-III and 32 patients with complex (at least bicolumnar) ace-tabular fractures. All patients in the control group were matched for age and sex with the vertical shear fracture group. The mean follow up was 62 months. At final follow up, functional outcome was assessed in all patients using the following generic outcome measurement tools: Euro-Qol 5D (EQ), SF36 v2 (Short form), VAS (Visual analogue score), SMFA (Short musculoskeletal functional assessment) and Majeed score. In addition Merle d’ Aubignæ and Postel scores (Matta modification – 1986) and radiologic degenerative hip scores (Matta 994) were used to assess patients with acetabular fractures. Results: The mean age of all the patients in the study was 43.5 years (16–71) and the median injury severity score was 22 (12–32). Motor vehicle accidents accounted for 79% of the injuries. All patients had their pelvic ring stabilized at least temporarily within 24 hours and all acetabular fractures were reduced and stabilized by 7 days. The mean hospital stay was 26 (9–176) days. Functional outcome was assessed in all patients of the control group and in 28/29 patients of the vertical shear fracture group (1 patient died as a result of a cerebral vascular accident 11 months after injury). In the vertical shear fracture group, 35% of the patients have returned to their previous jobs (49% in control group), 30% have changed their professions (30% in control group) and 25% (14% in control group) have retired from regular work. In the acetabular group, 10 (31%) patients had neurologic injury (6 sciatic, 3 common peroneal, 1 femoral). Of these, 4 were iatrogenic. 6 patients had complete neurologic recovery. Heterotopic ossification was seen in 19 (59%) patients (12 had Brooker Grade 1, four had Grade 2, three had Grade 3). Three patients (9%) with acetabular fractures (all had associated posterior wall fracture) had total hip replacements at 29,40,51months (2 secondary osteoarthritis and 1 osteonecrosis). The clinical outcome (Matta modification-1986 of Merle d’ Aubignæ and Postel scores) of patients in the acetabular fracture group was: 5 excellent (3 THA), 4 good, 13 fair and 10 poor. The radiologic score of degenerative hip disease (Matta 1994) for the acetabular fracture group was: 4 excellent, 8 good, 14 fair and 3 poor. Conclusion: Patients with vertical shear fractures represent the spectrum of high-energy pelvic disruption. The functional outcome is significantly better in patients with APC III and LC III fractures when compared to vertical shear and complex acetabular fractures thus reflecting the severity of the injury. Secondary osteoarthritis and neurologic injury appear to contribute to the poor outcome of acetabular fractures. Sound reconstruction of the pelvic ring is not always associated with good results probably due to the extensive pelvic floor trauma as seen in this series of patients. Younger individuals seem to have a relatively better outcome when compared to the older age group

Developmental dysplasia of the hip (DDH) represents a heterogeneous group of deformities that are commonly associated with secondary osteoarthritis. Affected hips may require total hip arthroplasty (THA) for endstage disease and these cases can present unique challenges for the reconstructive surgeon. While the severity of deformity varies greatly, optimizing THA can be challenging even in the “mildly” dysplastic hip. These disorders are commonly characterised by acetabular deficiency with inadequate coverage of the anterolateral femoral head and proximal femoral abnormalities including excessive femoral antetorsion, coxa valga and femoral stenosis. In more severe cases, major femoral head subluxation or dislocation can add additional complexity to the procedure. In addition to the primary deformities of DDH, secondary deformities from previous acetabular or proximal femoral osteotomies may also impact the primary THA. Primary THA in the DDH hip can be optimised by detailed understanding of the bony anatomy, careful pre-operative planning, and an appropriate spectrum of techniques and implants for the given case. This presentation will review the abnormal hip morphologies encountered in the dysplastic hip and will focus on the more challenging aspects of THA. These include acetabular reconstruction of the severely deficient socket and in the setting of total dislocation, femoral implant procedures combined with corrective osteotomy or shortening, and issues related to arthroplasty in the setting of previous pelvic osteotomy. Despite the complexity of reconstruction for various dysplastic variants the clinical outcomes and survivorship of these procedures are good to excellent for most patients. Nevertheless, more complex procedures are associated with an increased complication rate and this should be considered in the surgical decision-making process

Abstract. Cranial cruciate ligament (CrCL) disease/rupture is a highly prevalent orthopaedic disease in dogs and common cause of pain, lameness, and secondary joint osteoarthritis (OA). Previous experiments investigating the role of glutamate receptors (GluR) in arthritic degeneration and pain revealed that OA biomarkers assessing early bone turnover and inflammation, including osteoprotegerin (OPG) and the receptor activator of nuclear factor kappa-B ligand (RANKL) are more likely to be influenced by glutamate signalling. Moreover, interleukin-6 (IL-6) has a complex and potentially bi directional (beneficial and detrimental) effect, and it is a critical mediator of arthritic pain, OA progression and joint destruction. Objectives. 1) to recruit dogs undergoing CrCL disease/rupture surgery and obtain discarded synovial fluid (SF) and serum/plasma (ethics approval, RCVS:2017/14/Alves); 2) to quantify the biomarkers listed above in the SF and serum/plasma by enzyme linked immunosorbent assay (ELISA); 3) to assess radiographic OA at the time of surgery and correlate it with the biomarkers and clinical findings. Methods. Abnova, Abcam and AMSBIO ELISA kits were tested using a validation protocol relating the standard curve to a dilution series of SF and serum/plasma (1× to 1/50×), with and without SF hyaluronidase treatment to evaluate linearity, specificity and optimal dilutions. Validated ELISA kits were used to measure [IL-6], glutamate [glu], [RANKL] and [OPG] in SF and serum/plasma. For each dog, CrCL disease pre-operative lameness scores were graded as: (1) mild, (2) moderate (easily visible), (3) marked (encumbered), (4) non-weightbearing lameness. Blinded OA scoring was performed on radiographs [15–60, normal-severe OA]. Results. canine population (n=14) was of various breeds, aged between 2–10 years and weighing 17.1–45.5Kg; 42.86% male; 57.14% female; 83.33% males and 62.5% females were neutered. Lameness scores varied from 1 and 4 (average 2.07±1.12) and radiographic OA scores from 18 and 36 (average 27.86±5.11). Individual correlations in concentrations with respect to age, weight, lameness score (1–4) and OA scores (15–60) were tested. SF [glu] and lameness score were inversely correlated with higher levels of lameness corresponding to lower SF [glu] (P=0.0141). SF [RANKL] inversely correlated with weight (P=0.0045) and lameness score (P=0.0135), and serum [RANKL] inversely correlated with weight (P=0.0437). There was also a negative correlation between SF and serum [OPG] and weight (P=0.0165 and P=0.0208, respectively). No other significant correlations were detected. Overall, [glu] and [IL-6] are increased in SF compared to serum/plasma, by 12.84 and 1.28, respectively, whereas all the remaining biomarkers are higher (2–3 times) in the serum/plasma compared to SF. Principal component analysis (PCA) and Pearson correlation coefficient matrix [IL-6/glu/RANKL/OPG] (n=7) showed SF [IL-6] correlates with SF [glu] (rs=0.64) and strong positive correlations between SF/serum [RANKL] and SF/serum [OPG] (rs 0.68–0.96). Conclusions. Dogs with CrCL disease show an association between the bone remodelling markers RANKL and OPG, and the inflammatory cytokine IL-6, and to a lesser extent SF [glu]. Therapeutics targeting bone remodelling, IL-6 or GluR/[glu] may be of interest for the management of OA in dogs. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

INTRODUCTION. The direct anterior approach to THR has become an increasingly popular minimally-invasive technique in an effort to minimize dislocation risk, facility early recovery, and diminish soft tissue injury. However, it has been associated with unique complications including intraoperative femur fracture, cutaneous nerve palsy, stem subsidence, and wound healing complications. These risk of these complications have been documented to be more likely in the surgeon's early experience with the approach. The minimally-invasive Supercapsular Percutaneous-Assisted (SuperPATH) technique was developed to minimize capsular and short-external rotator injury, minimize dislocation risk, and provide an easier transition from the standard posterior approach. METHODS. Fifty (50) consecutive elective total hip replacements in 48 patients were performed using the SuperPATH technique. These also represented the first fifty elective THRs the surgeon performed in practice. Indications were primary or secondary osteoarthritis (92%), avascular necrosis (6%), and impending pathologic fracture (2%). Patients were evaluated retrospectively for dislocation, major, and minor complications. RESULTS. At average follow-up of 10.9 months (Range 1–27 months), there were no dislocation events. There was one periprosthetic fracture identified at 14-day follow-up that required femoral revision surgery in an elderly female patient with osteoporosis. Otherwise, there were no reoperations for any reason. There were no wound complications or deep infections. There was one stem subsidence (2%) of 4 mm. There were no neurovascular injuries. CONCLUSION. The SuperPATH technique can likely be performed at an early experience level with low early complication risk and lower early dislocation risk. This minimally-invasive technique deserves further interest and evaluation as it may present a gentle learning-curve to surgeons

A 51 years old female who experienced difficulty in gait ambulation due to secondary osteoarthritis of knee showed knee instability caused by paralysis associated with poliomyelitis and scoliosis. At the first medical examination, right knee range of motion was 0° to 90°, and spino malleolar distance (SMD) showed 72cm for the right leg, 78cm for the left leg, and the bilateral comparison of SMD indicated the leg length discrepancy of 6cm. The patient has a history of surgeries with an anterior – posterior instrument for the treatment of scoliosis, and with Langenskiöld method for the paralyzed right knee at the age of seventeen. The patient also experienced varus degeneration at the age of twenty seven, which was surgically treated with high tibial osteotomy. In this case, a reoperation of her right knee was performed due to the reoccurrence of the knee pain. Preoperative planning was performed using Patient-matched instrument (Signature; Biomet) which was created based on computed tomography data. Each part of osteotomy followed the resection guide by Signature, and a total knee arthroplasty was carried out using the Rotating Hinge Knee System (Zimmer, warsaw. Inc). Two week after the operation, the patient showed the ability to walk without any assistance, and has been in a good condition

BACKGROUND. We conducted this study to determine if the pre-surgical patient specific instrumented planning based on Computed tomography scans can accurately predict each of the femoral and tibial resections. The technique helps in optimization of component positioning and hence overall alignment thereby reducing errors. This makes it less invasive, more efficient and cost effective. The surgical plan in combination with the cutting guides determine the resection thickness, component size, femoral rotation and femoral and tibial component alignment. Several clinical studies have shown that PSI is safe, accurate and reproducible in primary TKA. Accurate preparation of the femoral and tibial surfaces will determine alignment and component positioning and this in turn reflects on function and longevity. METHODS. The study was conducted prospectively between May 2016 and December 2017 in our institution. Patients admitted over a period of these twenty months were included in the study. Patients with primary or secondary osteoarthritis (OA) and inflammatory arthritis who were suitable to undergo patient-specific TKA were included in the study. Patients with conventional instrumented TKR and those with significant deformities requiring constrain including valgus or varus of greater than 20 degrees with incompetent lateral or medial collateral ligaments were excluded from the study along with revisions of partial knee to TKA using PSI blocks. Prophecy® Preoperative Navigation 3D printed Guides were used for the Evolution Medial Pivot knee replacement system (. Microport Orthopaedics (Arlington, TN 38002, USA)). in all cases. The operating surgeon measured all the resections made (4 femoral and 2 tibial) using vernier calipers intraoperatively. These measurements were then compared with the preoperative CT predicted bone resection surgical planning. The senior author (IN) also designed markings on the tibial cutting blocks to improve accurate placement on the tibia and further markings on the femoral cutting blocks to ensure accurate positioning and rotational alignment improving accuracy of the cuts and femoral rotation. Further markings by senior surgeon (IN) on the pre-operative plans included tibial rotational plans in relation to the tibial tubercle. RESULTS. A total of 3618 readings were calculated from 201 knees (105 right and 96 left). There were 112 females and 76 males, and the average age was 67.72 years (44 to 90 years) and average BMI 32.3 (25.1 to 42.3). The surgical time ranged from 46 to 102 minutes with a mean operating time of 62 minutes. All Femoral and Tibial blocks sat accurately on the bony surfaces before being pinned. 94% of all collected resection readings were below the error margin of ≤1.5 mm of which 90% showed resection error of ≤1mm. Mean error of different resections were ≤0.60 mm (P ≤ 0.0001). In 24% of measurements there were no errors or deviations from the templated resection (0.0 mm). CONCLUSION. The 3D printed cutting blocks with slots for jigs accurately predict bone resections in PSI total knee arthroplasty which would directly affect component positioning and hence longevity and function