Aims. Responsiveness and ceiling effects are key properties of an outcome score. No such data have been reported for the original English version of the International Hip Outcome Tool 12 (iHOT-12) at a follow-up of more than four months. The aim of this study was to identify the responsiveness and ceiling effects of the English version iHOT-12 in a series of patients undergoing hip arthroscopy for intra-articular hip pathology at a minimum of one year postoperatively. Methods. A total of 171 consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement (FAI) under the care of a single surgeon between January 2013 and March 2017 were included. iHOT-12 and EuroQol 5D-5L (EQ-5D-5L) scores were available pre- and postoperatively. Effect size and ceiling effects for the iHOT-12 were calculated with subgroup analysis. Results. A total of 122 patients (71.3%) completed postoperative PROMs scores with median follow-up of 24.3 months (interquartile range (IQR) 17.2 to 33.5). The median total cohort iHOT-12 score improved significantly from 31.0 (IQR 20 to 58) preoperatively to 72.5 (IQR 47 to 90) postoperatively (p < 0.001). The effect size (Cohen’s d) was 1.59. In all, 33 patients (27%) scored within ten points (10%) of the maximum score and 38 patients (31.1%) scored within the previously reported minimal clinically important difference (MCID) of the maximum score. Furthermore, nine (47%) male patients aged < 30 years scored within 10% of the maximum score and ten (53%) scored within the previously reported MCID of the maximum score. Conclusion. There is a previously unreported ceiling effect of the iHOT-12 at a minimum one-year follow-up which is particularly marked in young, male patients following hip arthroscopy for FAI. This tool may not have the maximum measurement required to capture the true outcome following this procedure. Cite this article: Bone Joint J 2020;102-B(8):1010–1015

Introduction. Knee osteoarthritis (OA) is a major contributor to disability in seniors and affecting millions of people around the world. Its main problem and the biggest factor in the disability of patients is pain. Pain renders patient inactive and develops lower extremity muscle wasting and worsens patient status adversely. However no radical solution existed until now. Recently I discovered a very valid manipulative technique (Squeeze-hold) for OA knee. This study presents the one-year follow-up data (three cases) by this treatment. Methods. Subjects. The subjects were three severe knee OA patients who had their data collected for 12 months after having a treatment. Treatment (squeeze-hold): The lower limb muscles (all muscles attached to the knee joint) were squeezed and held by hand. Each squeeze was performed in linear sequence all the way through the lower limbs. The squeezes were held for 20 seconds. This treatment was performed on a weekly basis. Evaluation: The conditions of the OA were evaluated using a Kellgren-Lawrence Grading Scale. Visual analogue scale as indicator of pain and Japanese Knee Osteoarthritis Measure as indicator of the activity restriction were recorded every month for a year. Results. In all three cases, OA knee pain and ADL were gradually improved by sustained once-a-week treatment. The daily activities were gradually increased. After a year, the pain passed approximately away. In case 1 and 2, a limitation in ROM did not show a marked improvement and joint contracture remained. Discussion. Squeeze-hold therapy that is approach to lower-limb muscles relieved OA knee pain. It is suggested by the fact that lower-limb muscles is responsible for the pain. And the physical activity of knee OA patient increases with decreasing pain effected by Squeeze-hold therapy. This increase in physical activity provides increase in joint movement and it lead to improve articular metabolism. Cyclical loading increases chondrocyte activity. Additionally, It inhibits the release of matrix metalloproteinase, pro-inflammatory mediators and shear stress-induced nitric oxide that induces chondrocyte apoptosis. And further, this increased physical activity improves muscle-strengthening of the lower extremity. It is plausible that these effects may continuously lead to decreased pain and improved ADL. A primary pain in knee OA can be attributed to inflammation of knee joint capsule or within knee joint capsule. And the pain leads to muscular hypertonicity thereby a bigger secondary pain develops in the muscles. Decreased physical activity due to the pain worsens pathological condition to induce greater pain. By this means, there might be formed pain-deterioration chain. Squeeze-hold therapy reduces the myogenic pain and cut the pain-deterioration chain. However, ROM could not improve though the pain and ADL activity imploved. This treatment ought to be performed before the formation of articular contracture. The results indicate Squeeze-hold treatment for lower-limb muscles might improves OA knee pain and limited ADL. However, this study had only three cases. Further research efforts are needed to identify the adaptation to diverse clinical symptoms knee OA

Introduction

Superficial pin site infection is a common problem associated with external fixation, which has been extensively reported. However, the incidence and risk factors with regards to deep infection is rarely reported in the literature. In this study, we investigate and explore the incidence and risk factors of deep infection following circular frame surgery. For the purpose of this study, deep infection was defined as: persistent discharge or collection for which surgical intervention was recommended.

Companies manufacturing total knee arthroplasty (TKA) prostheses produce a variety of tibial and femoral components of different dimensions denoted by numbers or letters. Surgeons frequently implant components that are compatible but not of the same size on the femur and tibia. Recent studies suggest that equally sized femoral and tibial components produce better outcomes compared to size-mismatched components. In our study, we aim to explore the relationship between component size and outcome measured by oxford knee score at six weeks and one year following TKA.

A cohort of twenty-four patients who underwent TKA and had well-functioning prosthesis were studied. Thirteen (54%) had equally sized TKA components implanted, seventy-four patients (42%) had components that were mismatched by one size, and one (4%) had components that were mismatched by more than one size. The Oxford Knee Score (OKS) obtained preoperatively, at six weeks and one year postoperatively were retrieved from an electronic database. All data were analysed using R software.

A significant improvement in pre-operative and one-year postoperative OKS was observed. Patients who received one-size mismatched tibial and femoral components demonstrated a less pronounced improvement in OKS as compared with patients who received equally sized components.

When possible, it may be best to utilise equally sized prosthetic tibial and femoral components when performing total knee arthroplasty. Manufacturers may be able to produce better patient outcomes by including prostheses that are between sizes as part of their production line.

The primary aim was to assess patient-reported outcomes following a humeral diaphyseal fracture. The secondary aim was to compare the outcomes of patients who achieved union after initial management (operative or non-operative) with those that achieved union after nonunion surgery.

From 2008–2017, 291 patients (mean age 55yrs [17–86], 58% [n=168/291] female) were retrospectively identified and available to complete a survey. Sixty-four (22%) were managed with primary surgery and 227 (78%) non-operatively. Outcomes (QuickDASH, EQ-5D, EQ-VAS, SF-12) were obtained at a mean of 5.5yrs (1.2–11.0).

After initial management, 229 patients (79%) united (n=62 operative, n=167 non-operative) and 62 (21%) developed a nonunion (n=2 operative, n=60 non-operative; p<0.001). Fifty-two of 56 patients (93%) achieved union after nonunion surgery. The overall mean QuickDASH was 20.8, EQ-5D 0.730, EQ-VAS 74, SF-12 PCS 44.8 and MCS 50.2. Patients who united after nonunion surgery reported a worse functional outcome (mean QuickDASH 27.9 vs. 17.6, p=0.003) and health-related quality of life (HRQoL; mean EQ-5D 0.639 vs. 0.766, p=0.008; EQ-VAS 66 vs. 76, p=0.036; SF-12 PCS 41.8 vs. 46.1, p=0.036) than those who united primarily. When adjusting for confounders, union after nonunion surgery was independently associated with poorer function (difference in QuickDASH 8.1, p=0.019) and HRQoL (difference in EQ-5D -0.102, p=0.028).

Humeral diaphyseal union after nonunion surgery was associated with poorer function and HRQoL compared to patients who united primarily. Targeting early operative intervention to patients at risk of nonunion may have an important role, given the potential impact of nonunion on longer-term outcome.

The management of patients with massive irreparable rotator cuff tears (RCT) has traditionally proved challenging. This prospective study was undertaken with the aim to assess the overall functional outcome following the use of human dermal allograft in the reconstruction of massive irreparable RCT.

15 patients were included in the study, having a median age of 63 years. All patients underwent open reconstruction of massive irreparable RCT. None of the selected patients had evidence of significant gleno-humeral arthritis. All patients were evaluated pre- and post- operatively by the treating surgeon, and followed up for 12 months. The same physiotherapy protocol was prescribed for all patients. Initial and follow-up assessments were done at regular intervals using the Oxford and quick-DASH scoring systems.

A very high patient satisfaction rate, with substantial improvement in pain and function was noted. There was substantial improvement in Oxford shoulder score from a mean of 23.3 to 8.7 (p<0.01), and a similar improvement in mean quick-DASH score from 50.3 to 23.0 (p<0.01)

Of the 15 patients, 11 had an improvement of >10 in Oxford score, with these reporting a score of <10 after 12 months. None of the patients had any significant complications because of the surgery, and none had a deterioration in Oxford score from their pre-operative status.

We found that Human dermal allograft is a very effective tool in the repair of massive irreparable RCT, with excellent follow-up results after one year.

Introduction Lumbar discectomy is now the operation of choice for lumbosacral radicular syndrome. Few studies of high quality have been performed on the post-surgical management of these cases (Ostelo RWJG, et al; Spine 2003). The studies that have been reported compared one exercise regime to another. This study compares an exercise group with a true control group involving no exercise or formal rehabilitation. This is a randomised controlled trial comparing post surgical lumbar discectomy management regimes. Methods Ninety-three lumbar discectomy patients were randomised to two groups. Group A; the control group followed usual surgical advice which was to resume normal activity as soon as pain allowed. Group B; undertook a six month supervised non- aggravating gym rehab programme. Both groups were followed for a one year period using validated outcome measures and questionnaires (Roland Morris, Oswestry Low-back Score). The results are based on an intention-to-treat analysis. Results Patients in both groups improved during the one-year follow-up period (P=0.001). However there was no statistical difference between groups at the clinical end point (Roland Morris P=0.83, Oswestry Low-back Index P=0.90). Group B patients returned to work seven days earlier than group A patients and had fewer days off work in the one year follow-up period but this difference was not statistically significant. Discussion There was no statistical advantage gained by the patients who performed the gym rehabilitation programme after one year follow-up. These are the preliminary one-year results of a three-year follow-up study

We report the short term follow up of nineteen consecutive PFC sigma unicompartmental knee replacements carried out in our institution with minimum one year follow up. The PFC Sigma medial unicompartmental knee replacement is a fixed bearing, cemented unicompartmenal knee replacement. There are currently no published reports of follow up for the PFC Sigma medial unicompartmental knee replacement.

Nineteen patients (nineteen knees) underwent PFC sigma medial unicompartmental knee arthroplasty. The pre-operative diagnosis was osteoarthritis in eighteen patients and osteonecrosis in one patient. There were ten males and nine females with a mean age of sixty four years. All patients had clinical and radiological review at one year. All operations were carried out by the two senior authors (BPR and BL).

The mean length of admission was 2.7 days (Range 2–5). There have been no infective or thromboembolic complications to date. The mean oxford scores improved from 41 (Range 26–52) pre-operatively to 18 (15–27) at one year follow-up. The mean range of motion improved from 115 degrees of flexion preoperatively to 125 degrees. All radiographs were satisfactory at one year follow up with no evidence of loosening.

We report the promising early results of a new medial unicompartmental knee replacement with at least one year follow up. No early complications or infections were identified in our cohort of patients.

Introduction

Functional stability is a new concept stating that lower tensions than expected are enough to achieve joint stability leading to proper function after TKA. To check this rationale clinically, a new electronic device (DLB bicon sensorplate) was used intraoperatively to measure ligament tension and allow the surgeon to proper balance the knee after TKA insertion. In this study a controlled clinical analysis at 1 YR follow-up is reported.

Introduction

Sensoric soft tissue balancing in performing TKA is an upcoming topic to improve the results in TKA. A well balanced knee is working more proper together with the muscular stabilizing structures.

Dynamic ligament balancing (DLB)R give us the opportunity to check the balance of the ligaments at the beginning and the end of the surgery before implanting the definitive prosthesis. It is a platform independent, single-use device, which can be combined with all common types of knee prosthesis.

Of 66 recruits who sustained stress fractures during basic training and returned to training after a period of rest, seven (10.6%) suffered recurrent fractures within one year. None of the recurrences was at the original anatomical site. All of the recruits with recurrent stress fractures had had at least one of their initial stress fractures in the femur. This suggests that a femoral stress fracture carries a high risk of recurrence at other sites.

Introduction

Recently various type of spinal instrumentation was applied, and they are essential in modern spinal fusion surgery. Whereas several authors reported increased possibility of complication and degeneration on adjacent segment. We tried PLIF without instrumentation with box type intervertebral cages.

Introduction:

Displaced and shortened clavicle shaft fractures can be treated operatively by intra- or extramedullary fixation. The aim of the study was to compare the effectiveness of these two treatment modalities.

Aims: The aim of this prospective study was to measure changes of bone mineral density (BMD) in the proximal tibia after cemented total knee arthroplasty (TKA) in osteoarthrotic knee joints. Methods: Sixty-nine patients were scanned by dual-energy x-ray absorptiometry (DXA) within a week postoperatively, at 3, 6 and 12 months follow-up. Results:Medial metaphyseal measurement region on interest (ROI) showed a signiþcant decrease in BMD values in preoperatively varus knees joints (p < 0.0005). In preoperatively valgus knees there was a slight non-signiþcant increase in BMD (p=0.184). At the baseline the medial ROI BMD differed from each other signiþcantly in these alignment groups (p= 0.023, independent samples T-test). Alignment correction in the both groups showed bone remodeling towards similar actual BMD values. Finally medial and lateral BMD values were also more similar suggesting that the bone became equally strong on both compartments of metaphysis. We could not trace the effect of increasing AKS score values to the bone remodeling. Conclusions: We suggest that loading effect on bone may be a major profound bone remodeling factor. Its clinical value can not be ignored nor determined by other changes in knee joint status and function. These results conþrm the clinical importance of recreating the proper valgus alignment of the knee joint in TKA operation, which offers possibly better proof for the longevity of the tibial component.

To evaluate the clinical outcome of three different local antibiotic delivery materials, used as bone defect fillers after excision of chronic osteomyelitis.

We reviewed all patients receiving Collagen Fleece with Gentamicin (Septocoll E)(n=74), Calcium Sulphate with Tobramycin pellets (Osteoset T)(n=166) or Calcium Sulphate/Hydroxyapatite biocomposite with Gentamicin (Cerament G)(n=73) for dead space filling after resection of C-M Stage III and IV chronic osteomyelitis. Data was collected on patient comorbidities, operation details, microbiology, postop complications and need for plastic surgery or external fixation. All operations were performed by two surgeons. All patients had similar systemic antibiotic therapy and rehabilitation.

Primary outcomes were recurrence rate, fracture rate and wound leakage rate.

All three groups had very similar mean age and range, microbiological cultures, need for free muscle flaps or local flaps, proportion of femur, tibia and upper limb bones and use of external fixation. There were small differences in the proportion of C-M Class B hosts and anatomic Type IV cases, between the groups. All patients were followed up for at least one year. Mean follow-up was 1.75 years for Septocoll E, 1.96 years for Osteoset T and 1.78 years for Cerament G.

After surgery, there were fewer prolonged wound leaks with Cerament G (leakage persisting for more than 2 weeks). Fracture rates and infection recurrence were twice as common with Osteoset T compared with Cerament G at between one and two years after operation (see Table).

The use of a biocomposite material delivering local aminoglycoside was associated with lower recurrence rates and few wound problems, compared with collagen or calcium sulphate alone. This may reflect the higher levels of antibiotic in the defect and controlled release profile. The improved recurrence rate was despite a higher percentage of compromised Class B hosts.

Component malposition in total hip arthroplasty (THA) contributes to wear, dislocation, and leg length discrepancy (LLD). Robotic assisted total hip arthroplasty (rTHA) utilises computer-assisted haptically guided bone preparation and implant insertion to improve accuracy. The goal of this study is to compare accuracy and clinical outcome with manual THA (mTHA) and rTHA at minimum 1 year follow-up interval.

Consecutive primary THA performed by one fellowship trained surgeon included: the first 100 mTHAs in his clinical practice (Group1- year 2000), the last 100 mTHAs before rTHA use (Group2- year 2010), and the first 100 rTHA (Group3- year 2011). All THAs utilised cementless implants, cross-linked polyethylene, and a posterior approach. Comparisons included age, sex, diagnosis, implant head size, blood loss (EBL), operative time, LLD, early dislocation and infection. Acetabular abduction (AAB), anteversion (AAV), and LLD were measured using validated software (Martell Hip Analysis Suite). The Lewinnek safe zone defined accuracy (AAB- 30°-50°, AAV- 5°-25°). Statistical analysis included ANOVA, Chi squared, and Fisher tests. Power analysis demonstrated adequate sample sizes.

No differences were noted regarding group demographics. Average operative times varied: Group 1, 2, and 3- (160, 129, and 143 minutes, respectively). No deep infections occurred in any group. LLD greater than 1.5 cm varied: Groups 1, 2, and 3 (9%, 1%, 1%, respectively). Dislocation rates varied: Groups 1, 2, and 3- (5%, 3%, and 0%, respectively). EBL was less with rTHA than mTHA (Groups 1, 2, 3: 533cc, 437cc, 357cc, respectively). Average implant head size increased comparing Groups 1, 2, and 3 (31mm, 34.6mm, and 35.2mm, respectively). AAB accuracy varied: Groups 1, 2, and 3 (66%, 91%, and 98%, respectively). AAB greater than 55 degrees varied: Groups 1, 2, and 3 (15%, 1%, and 0%, respectively). There was a 3% fractured acetabular liner rate in Group 1, all cases occurred with AAB > 55 degrees, and AAB greater than 55 degrees correlated with increased acetabular liner fracture rate (20% vs. 0%, P < 0.05). No cases of fractured acetabular liners occurred in Group 2 or 3. rTHA improved AAV accuracy compared with mTHA (Group 2- 48%, Group 3- 75%; p<0.0001). Improved acetabular component accuracy with rTHA correlated with lower dislocation rates compared with mTHA (p<0.001).

Total hip arthroplasty performed with traditional manual techniques has demonstrated excellent clinical outcomes in the majority of patients with many THA designs if components are placed accurately. Limitations in mTHA remain that alter results if accurate component placement is not achieved. In our study, clinical experience over 10 years improved AAB accuracy with mTHA, but AAV remained problematic. rTHA improved AAB and AAV accuracy compared with mTHA and demonstrated reduced early dislocation rates, improved rate of LLD, and reduced acetabular liner fracture risk compared with mTHA (p<0.05). Average rTHA operative times were 14 minutes longer than mTHA (Group 2), but this was not associated with increased EBL or infection rates. Further study is needed to evaluate whether the short term clinical and radiographic advantages noted with rTHA compared with mTHA will be maintained at longer follow up intervals.

Background and purpose

Modic changes (MC) are a risk factor for development of chronic low back pain (CLBP). There is no agreement about the cause of inflammation in MC, but autoimmunity has been suggested. The aim of the study was to investigate whether treatment with lactic acid bacteria for 100 days was associated with change of disability and pain, via a change in the gut microbiota inducing a change in the immune system, in patients with CLBP and type 1 MC during one year follow-up.

The purpose of this historical prospective study was to compare the pre and post-operative Quality of Life (QOL) outcomes twelve months post-operatively in patients with partial thickness rotator cuff tears.

Data of ninety-three consecutive patients diagnosed with Partial Thickness Tear (PTT) who had undergone decompression, acromioplasty, or repair were used to compare the outcome between patients with Articular Tears (AT) and Bursal Tears (BT). The QOL outcome measures included one disease specific outcome measure, the Western Ontario Rotator Cuff Index (WORC) and two shoulder specific measures, the American Shoulder & Elbow Surgeons standardised shoulder assessment form (ASES) and the Constant-Murley score. A statistical paired t-test (pre vs. twelve months) and an independent t-test analysis (Articular vs. Bursal) were conducted to examine the impact of the tear site.

Forty-four Articular and forty-nine Bursal tears (forty-eight females and forty-five males) were included in the analysis. The mean age was 55.5 (SD: 13) and 53.3 (SD: 12) for the AT and BT groups respectively. There was no statistically significant difference between the two groups in pre-operative QOL outcome scores. Both groups showed significant improvement in the above outcomes (p< 0.0001) one year following surgery. However, the AT group was significantly less improved than the BT group in the post-op ASES scores (p=0.04), Constant-Murley scores (p=0.006) and WORC (p=0.01).

The intent of this study was to compare the pre and post operative scores and rate of improvement in two groups of patients suffering from rotator cuff pathology at different sites. The results indicate that the quality of life improves significantly regardless of the tear site. The pattern of recovery however is different indicating that patients with Bursal tears show a higher degree of improvement in their functional measures. The findings suggest that two types of tears are different in their etiology and pathomechanics.

Introduction

The viscoelastic cervical disk prosthesis ESP is an innovative one-piece deformable but cohesive interbody spacer. It is an evolution of the LP ESP lumbar disk implanted since 2006. CP ESP provides 6 full degrees of freedom about the 3 axes including shock absorption. The prosthesis geometry allows limited rotation and translation with resistance to motion (elastic return property) aimed at avoiding overload of the posterior facets. The rotation center can vary freely during motion (figure 1)

It thus differs substantially from current prostheses. This study reports the results of a prospective series of 49 patients who are representative of the current use of the ESP implant since 2012.

Background and Purpose: Retrospective evaluation of short-term (8 weeks) and long-term (54 weeks) radiologic follow-up of vertebral wedge angle and anterior, center and posterior vertebral heights after Percutaneous VertebroPlasty (PVP) in type II Osteoporotic Vertebral Compression Fractures (OVCF).

Methods: Between September 2002 and August 2007 47 PVP’s were performed in 25 consecutive patients (5 male, 20 female (age 70 ± 9,5 yrs) with OVCF’s type II (mean fracture age: 35.0 weeks (range: 10.0 – 136.7)). With pre-vertebroplasty conventional radiographs and MRI’s, post-vertebroplasty CT’s and conventional radiographs follow-up of the vertebral compression fractures were analyzed.

Analysis of vertebral morphometrics with emphasis of the vertebral wedge angle and height of the vertebral body at the anterior, center and posterior border. Determining the loss and gain of height of the vertebra with OVCF pre- and post-PVP up to one year, using pre-PVP estimated heights.

Results: A mean wedge angle reduction of 2.9° and anterior- and center heigth gain of 4.4% and 5.6% directly post-PVP, posterior height remained stable. The parameters at short- and long-term follow-up compared to the pre-PVP parameters showed no significant differences accept for anterior height.

Conclusion: Besides alleviating the refractory back pain in patients a limited decrease in wedge angle and increase of anterior and center height is possible in type II OVCF. Although the long-term follow-up depicts a slight anterior height loss, the wedge angle and restored center height were stable.