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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 174 - 174
1 May 2012
R. L
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Introduction

Intra-articular (IA) injections of corticosteroids and hyaluronic acid (HA) products are used to treat patients with knee osteoarthritis pain that has not responded to more conservative treatment. Corticosteroids are a standard of care despite only suggestive clinical evidence of 12 or more weeks of pain relief. However the duration of pain relief with this treatment appears to be short and not a long term solution.

Methods

A double-blinded, randomised, active controlled, multicentre non-inferiority trial with 442 subjects provided a pragmatic comparison of HA to methylprednisolone. These patients were collected prospectively and with excellent long term follow-up.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 159 - 159
1 May 2012
P. NS B. Q R. L
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Aim

Ultrahigh molecular weight polyethylene (UHMWPE) has been used for many years as a bearing surface in total joint replacement (TJR). However, late-state failure in TJR is predominantly caused by osteolysis mediated by wear particles. We tested our hypothesis that UHMWPE nanoparticles are important determinants in activating dendritic cells (DCs).

Methods

UHMWPE wear particles generated from a knee simulator were profiled using an atomic force microscopy and fractionated into six fractions: 0.05-0.2, 0.2-0.8, 0.8-1, 1-5, 5-10, and 10-20 micrometer. Effects of each fraction, a mixture of nano-sized fractions, and a mixture of all fractions on the activation of mice spleen DCs were determined using flow cytometry with specific antibodies of anti-CD11c-APC, anti-CD80-PE, anti-CD11b-PerCp, anti-CD86-Biotin and streptavidin-FITC. Supernatant from DCs treated with wear particles were assayed for IL-1beta, IL-6, IL-12/23, TNF-alpha and IFN-gamma. Activation of human osteoclasts (OCs) by wear particles were determined using TRAP stain.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 66 - 66
1 May 2012
A. H R. L A. P L. B K. T D. S H. K E. S M. M D. S M. M P. O P. B P. G H. B R. B P. D
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The distal femur fracture is a difficult injury that affects young men andelderly women. The tissue stripping that occurs with the traditional approach has been a factor in the development of complications like infection and nonunion. This study addresses the issue of minimally invasive approach. Does the LISS system really improve the results of such fracture?

Fifty-two patients were included in the trial from six academic trauma centres. Twenty-eight fractures had been randomised to be fixed with the LISS device, while twenty-four had the DCS implant. Type C3 fractures were excluded as they were not amenable for fixation with DCS system. All procedures were performed via minimally invasive technique. The LISS system had the targeter that helped with plate insertion and distal diaphyseal screws placement. Radiography was utilised in the case of the DCS distal screws insertion.

All fractures went onto union, except two participants in LISS group who had to be revised due to loss of reduction, in the early post-operative peroid. There were three nonunions in the same group. These required a re-operation. Further more, a LISS participant who had re-injured his distal femur (unrelated to LISS plate), was fixed with different implant. There was a single nonunion with the DCS group that needed revision surgery. There was one participant from each group who had drifted into varus. Neither required a re-operation. This translated into a 21% re-operation rate in the LISS system compared to 4% with the DCS device.

Our data supports the use of the DCS system in the fixation of distal femur fractures (except Type C3} via a minimally invasive approach. The LISS implant seems to be technique dependent. In our centre, the LISS plate had been discontinued in favour of the DCP and LCP systems.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 127 - 127
1 May 2012
R. P R. L D. P K. T G. D A. H
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Introduction

The precise indications for tibial component metal backing and modularity remain controversial in routine primary total knee arthroplasty. This is particularly true in elderly patients where the perceived benefits of metal backing such as load redistribution and the reduction of polyethylene strain may be clinically less relevant. The cost implications for choosing a metal-backed design over an all-polyethylene design may exceed USD500 per primary knee arthroplasty case.

Methods

A prospective randomised clinical trial was carried out at the QEII Health Sciences Centre, Halifax, Nova Scotia, to compare modular metal-backed versus an all-polyethylene tibial component. Outcome measures included clinical range of motion, radiographs, survivorship, Knee Society Clinical Rating System, WOMAC and SF-12.