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Bone & Joint Research
Vol. 8, Issue 1 | Pages 1 - 2
1 Jan 2019
Clauss M Breusch SJ


The Bone & Joint Journal
Vol. 100-B, Issue 8 | Pages 1043 - 1053
1 Aug 2018
Scott CEH Turnbull GS Powell-Bowns MFR MacDonald DJ Breusch SJ

Aims

The aim of this study was to identify predictors of return to work (RTW) after revision lower limb arthroplasty in patients of working age in the United Kingdom.

Patients and Methods

We assessed 55 patients aged ≤ 65 years after revision total hip arthroplasty (THA). There were 43 women and 12 men with a mean age of 54 years (23 to 65). We also reviewed 30 patients after revision total knee arthroplasty (TKA). There were 14 women and 16 men with a mean age of 58 years (48 to 64). Preoperatively, age, gender, body mass index, social deprivation, mode of failure, length of primary implant survival, work status and nature, activity level (University of California, Los Angeles (UCLA) score), and Oxford Hip and Knee Scores were recorded. Postoperatively, RTW status, Oxford Hip and Knee Scores, EuroQol-5D (EQ-5D), UCLA score, and Work, Osteoarthritis and Joint-Replacement Questionnaire (WORQ) scores were obtained. Univariate and multivariate analysis was performed.


The Bone & Joint Journal
Vol. 99-B, Issue 8 | Pages 1037 - 1046
1 Aug 2017
Scott CEH Turnbull GS MacDonald D Breusch SJ

Aims

Little is known about employment following total knee arthroplasty (TKA). This study aims to identify factors which predict return to work following TKA in patients of working age in the United Kingdom.

Patients & Methods

We prospectively assessed 289 patients (289 TKAs) aged ≤ 65 years who underwent TKA between 2010 and 2013. There were 148 women. The following were recorded pre-operatively: age, gender, body mass index, social deprivation, comorbidities, indication for surgery, work status and nature of employment, activity level as assessed by the University of California, Los Angeles (UCLA) activity score and Oxford Knee Score (OKS). The intention of patients to return to work or to retire was not assessed pre-operatively. At a mean of 3.4 years (2 to 4) post-operatively, the return to work status, OKS, the EuroQol-5 dimensions (EQ-5D) score, UCLA activity score and Work, Osteoarthritis and joint-Replacement (WORQ) score were obtained. Univariate and multivariate analyses were performed.


The Bone & Joint Journal
Vol. 98-B, Issue 12 | Pages 1625 - 1634
1 Dec 2016
Scott CEH Oliver WM MacDonald D Wade FA Moran M Breusch SJ

Aims

Risk of revision following total knee arthroplasty (TKA) is higher in patients under 55 years, but little data are reported regarding non-revision outcomes. This study aims to identify predictors of dissatisfaction in these patients.

Patients and Methods

We prospectively assessed 177 TKAs (157 consecutive patients, 99 women, mean age 50 years; 17 to 54) from 2008 to 2013. Age, gender, implant, indication, body mass index (BMI), social deprivation, range of movement, Kellgren-Lawrence (KL) grade of osteoarthritis (OA) and prior knee surgery were recorded. Pre- and post-operative Oxford Knee Score (OKS) as well as Short Form-12 physical (PCS) and mental component scores were obtained. Post-operative range of movement, complications and satisfaction were measured at one year.


The Bone & Joint Journal
Vol. 98-B, Issue 10 | Pages 1376 - 1381
1 Oct 2016
Bucknall V Rutherford D MacDonald D Shalaby H McKinley J Breusch SJ

Aims

This is the first prospective study to report the pre- and post-operative patient reported outcomes and satisfaction scores following excision of interdigital Morton’s neuroma.

Patients and Methods

Between May 2006 and April 2013, we prospectively studied 99 consecutive patients (111 feet) who were to undergo excision of a Morton’s neuroma. There were 78 women and 21 men with a mean age at the time of surgery of 56 years (22 to 78). Patients completed the Manchester-Oxford Foot Questionnaire (MOXFQ), Short Form-12 (SF-12) and a supplementary patient satisfaction survey three months pre-operatively and six months post-operatively.


The Bone & Joint Journal
Vol. 95-B, Issue 1 | Pages 52 - 58
1 Jan 2013
Clement ND Jenkins PJ DM Nie YX Patton JT Breusch SJ Howie CR Biant LC

We assessed the effect of social deprivation upon the Oxford knee score (OKS), the Short-Form 12 (SF-12) and patient satisfaction after total knee replacement (TKR). An analysis of 966 patients undergoing primary TKR for symptomatic osteoarthritis (OA) was performed. Social deprivation was assessed using the Scottish Index of Multiple Deprivation. Those patients that were most deprived underwent surgery at an earlier age (p = 0.018), were more likely to be female (p = 0.046), to endure more comorbidities (p = 0.04) and to suffer worse pain and function according to the OKS (p < 0.001). In addition, deprivation was also associated with poor mental health (p = 0.002), which was assessed using the mental component (MCS) of the SF-12 score. Multivariable analysis was used to identify independent predictors of outcome at one year. Pre-operative OKS, SF-12 MCS, back pain, and four or more comorbidities were independent predictors of improvement in the OKS (all p < 0.001). Pre-operative OKS and improvement in the OKS were independent predictors of dissatisfaction (p = 0.003 and p < 0.001, respectively). Although improvement in the OKS and dissatisfaction after TKR were not significantly associated with social deprivation per se, factors more prevalent within the most deprived groups significantly diminished their improvement in OKS and increased their rate of dissatisfaction following TKR.

Cite this article: Bone Joint J 2013;95-B:52–8.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 333 - 333
1 Mar 2004
Aldinger PR Thomsen M Mau H Ewerbeck V Breusch SJ
Full Access

Aim: The early results of cementless femoral components in young patients have been reported, but there are only few reports with more than 10 years follow-up. Methods: We evaluated the clinical and radiographic results of the þrst consecutive 154 implantations of a cementless, double tapered straight femoral stem (cementless Spotorno (CLS), Sulzer Orthopedics) in 141 patients under the age of 55 (mean 47, 13–55) years. Results: After a mean follow-up of 12 (10Ð15) years, 11 patients (11 hips) had died and 7 (7 hips) could not be located. 5 patients (5 hips) underwent femoral revision- 1 for infection, 1 for periprosthetic fracture and 3 for aseptic loosening of the stem. Overall survival was 97% at 12 years (95%-conþdence limits, 93% Ð 100%), survival with femoral revision for aseptic loosening as an end point was 98% (95%-conþdence limits, 95% Ð 100%). The median Harris-Hip-Score at follow-up was 84 points. No thigh pain was found. Radiolucent lines in Gruen regions 1 and 7 were present in 21 hips (17%). 2 hips had radiolucent lines in regions 2 Ð 6 on anterio-posterior (AP) radiographs. No femoral osteolysis was found. Conclusions: The mid- to long-term survival with this type of femoral component is excellent and compares favorably with cemented stems in this age group. However the high rate of cup loosening and the low Harris Hip Scores are concerning in this group of young patients.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 274 - 274
1 Mar 2004
Breusch SJ Heisel C
Full Access

Aims: Thrombembolic complications, which include the fat embolism syndrome, are well known consequences of cementless and cemented total hip replacement. Embolic phenomena could be demonstrated clinically and experimentally with both fixation techniques. Methods: We investigated in a standardized animal model in 15 Merino sheep the fat intravasation into the blood stream during bilateral simultaneous prosthetic implantation (cemented versus cementless). After identical preparation of the intramedullary canal a cement restrictor was additionally inserted on the cemented side and the canal was cleaned with 250ml jet-lavage. By catheters in the external iliacal veins the drained blood was collected in two phases, one after preparation of the intramedullary canal and another during insertion of the prosthesis, and the fatty contents of these blood samples were measured. Results: Cemented implantation (2,2749g; S=±1,0079) produced a two-fold amount of fat intravasation into the venous draining system of the femur compared to the cementless implantation (1,1586g; S=±0,4555)(p= 0,0002). An obvious effect of the canal preparation was recognizable with the cemented implantation. Eight of thirteen evaluated animals showed a peak in the fat intravasation caused by the application of the cement restrictor. Conclusions: Our results emphasize the importance of a thorough preparation of the intramedullary canal, particularly when cemented fixation is performed. The jet lavage, which should be standard in cemented total hip arthroplasty, should be implemented prior to the insertion of the plug in order to further reduce the risk of fat embolism.


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 8 | Pages 1208 - 1208
1 Nov 2003
ALDINGER PR BREUSCH SJ THOMSEN M


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 2 | Pages 209 - 214
1 Mar 2003
Aldinger PR Breusch SJ Lukoschek M Mau H Ewerbeck V Thomsen M

We followed the first 354 consecutive implantations of a cementless, double-tapered straight femoral stem in 326 patients. Follow-up was at a mean of 12 years (10 to 15). The mean age of the patients was 57 years (13 to 81). At follow-up, 56 patients (59 hips) had died, and eight (eight hips) had been lost to follow-up. Twenty-five hips underwent femoral revision, eight for infection, three for periprosthetic fracture and 14 for aseptic loosening.

The overall survival was 92% at 12 years (95% CI 88 to 95). Survival with femoral revision for aseptic loosening as an endpoint was 95% (95% CI 92 to 98). The median Harris hip score at follow-up was 84 points (23 to 100). Radiolucent lines (< 2 mm) in Gruen zones 1 and 7 were present in 38 (16%) and 34 hips (14%), respectively. Radiolucencies in zones 2 to 6 were found in five hips (2%).

The results for mid- to long-term survival with this femoral component are encouraging and compare with those achieved in primary cemented total hip arthroplasty. The high rate of loosening of the cup and the high rate of pain are, however, a source of concern.


The Journal of Bone & Joint Surgery British Volume
Vol. 82-B, Issue 2 | Pages 250 - 254
1 Mar 2000
Breusch SJ Wenz W Döderlein L

We carried out a cross-sectional study in 51 patients (81 feet) with a clawed hallux in association with a cavus foot after a modified Robert Jones tendon transfer. The mean follow-up was 42 months (9 to 88). In all feet, concomitant procedures had been undertaken, such as extension osteotomy of the first metatarsal and transfer of the tendon of the peroneus longus to peroneus brevis, to correct the underlying foot deformity. All patients were evaluated clinically and radiologically.

The overall rate of patient satisfaction was 86%. The deformity of the hallux was corrected in 80 feet. Catching of the big toe when walking barefoot, transfer lesions and metatarsalgia, hallux flexus, hallux limitus and asymptomatic nonunion of the interphalangeal joint were the most frequent complications. Hallux limitus was more likely when elevation of the first ray occurred (p = 0.012). Additional transfer of the tendon of peroneus longus to peroneus brevis was a significant risk factor for elevation of the first metatarsal (p < 0.0001).

The deforming force of extensor hallucis longus is effectively eliminated by the Jones transfer, but the mechanics of the first metatarsophalangeal joint are altered. The muscle balance and stability of the entire first ray should be taken into consideration in the management of clawed hallux.