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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_8 | Pages 86 - 86
1 May 2016
Kasparek M Lazar M Weber M Ringl H Herold C Kasparek M Kubista B Windhager R Toepker M
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Introduction

Computer Tomography (CT) imaging has been limited to beam hardening artefacts until now. Literature has failed to describe sensitivity and specifity for loosening of endoprothesis in CTs, as metal artefacts have always influenced the diagnostic value of CTs.

In recent years a new technology has been developed, the Dual Energy CT. Dual Energy CT scanners simultaneously scan with two tubes at different energy levels, most commonly 100kVp and 140kVp. Furthermore pictures gained from Dual Energy CTs are post-processed with monoenergetic reconstruction, which increases picture quality while further reducing metal artefacts.

This promising technology has increased the diagnostic value preventing more radiation for the patients, for example in detection of kidney stones or to map lung perfusion. In the musculoskeletal imaging it has not been established yet and further clinical investigations are necessary.

Thus the aim of this study is to describe sensitivity and sensibility for endoprothesis loosening of this novel technology.

Material and Methods

53 prospective patients (31 total hip- and 22 total knee-arthoplasties) who were planned for revision surgery underwent preoperative Dual Energy CT examination. All scans were performed with a second-generation, dual-energy multi-detector CT scanner. And all pictures were post-processed with monoenergetic reconstruction.

Radiologists were blinded for patient´s history. Senior consultants, who are specialized in arthroplasty of the hip and the knee, performed surgery. Intraoperative information was used as gold standard.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVI | Pages 35 - 35
1 Aug 2012
Smith T Drew B Toms A Jerosch-Herold C Chojnowski A
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Background and Objectives

Triangular fibrocartilaginous complex (TFCC) tears are common sources of ulna sided wrist pain and resultant functional disability. Diagnosis is based on history, clinical examination and radiological evidence of a TFCC central perforation or radial/ulna tear. The purpose of this study is therefore to evaluate the diagnostic accuracy of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Arthrography (MRA) in the detection of TFCC injury in the adult population.

Methods

Published and unpublished literature databases were systematically review independently by two researchers. Two-by-two tables were constructed to calculate the sensitivity and specificity of MRI or MRA investigations against arthroscopic outcomes. Pooled sensitivity and specificity values and summary Receiver Operating Characteristic curve (sROC) evaluations were performed. Methodological quality of each study was assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 235 - 235
1 Mar 2010
Candy E Stephenson R Jerosch-Herold C Shepstone L Farewell D
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Background and Purpose: There is a high prevalence of self reported back pain in the adolescent population. A randomised controlled trial (RCT) was undertaken to determine the effects of a high density foam seating wedge on back pain intensity.

Methods: The study took part in a large predominantly rural county in Eastern England. 185 students with back pain were recruited from 12 schools. Randomisation was stratified by school, and resulted in 92 students in the control and 93 in the intervention groups, respectively. The primary outcome measure was pain intensity (numerical rating 0–10 scale) recorded in pain diaries over 4 weeks. Following a one week baseline at the beginning of week 2, the intervention group were given a wedge to use on their school chairs. Linear effects models were used to analyse the pain intensity data.

Results: 97 students (46 control, 51 intervention) completed the RCT. For the intervention group, pain intensity was significantly reduced during the 3 weeks when the wedge was used (0.013 point reduction per half day, 95%CI −0.025 to −0.001, p=0.04). Evening pain was significantly less for the intervention group (0.324 reduction, 95%CI −0.543 to −0.104, p≤0.01).

Conclusion: The introduction of the wedge significantly reduced back pain intensity especially in the evenings. Despite its benefits some students found carrying the wedge a nuisance. It is therefore only suitable to relieve back pain in the short term. The results suggest that further research into the longer-term effect of alternative, permanent, seating on pain intensity in adolescents should be completed.