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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 104 - 104
1 May 2012
M. B D. DT I. VK V. MP G. B D. S J. S S. V
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Background

Identification of novel therapeutics to accelerate acute fracture healing remains critical. A prostaglandin EP-2 receptor agonist (CP-533,536) has demonstrated acceleration of fracture healing in preclinical models. The objective of this study is to assess the efficacy of a single dose of CP-533,536 in subjects with a closed fracture of the tibial shaft using radiographic measurements compared to placebo treatment.

Methods

In a phase II randomised, blinded, placebo-controlled trial, the efficacy of a single local injection of three doses of CP-533,536 (0.5mg, 1.5mg and 15mg) was compared to a placebo and a standard of care arm in patients with closed tibial shaft fractures. The tibial fractures were treated with reamed inter-locked intramedullary nails. Patients were followed at two week intervals to six months with a final evaluation at one year. Fracture healing was independently adjudicated by a radiologist panel and an orthopaedic surgeon panel.


Background

Autologous chondrocyte implantation (ACI) and mosaicplasty (MP) are two methods of repair of symptomatic articular cartilage defects in the adult knee. This study represents the only long-term comparative clinical trial of the two methods.

Methods

A prospective, randomised comparison of the two modalities involving 100 patients with symptomatic articular cartilage lesions was undertaken. Patients were followed for ten years. Pain and function were assessed using the modified Cincinnati score, Bentley Stanmore Functional rating system and visual analogue scores. ‘Failure’ was determined by pain, a poor outcome score and arthroscopic evidence of graft disintegration.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 31 - 31
1 May 2012
G. C S. V K. F E.D. F M.R. N
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The role of magnetic resonance arthrography (MRA) in the evaluation of patients with femoroacetabular impingement (FAI) to assess femoral head-neck junction asphericity and labral pathology is well established. However, in our experience, the presence of acetabular cysts on MRA, which may signify underlying full thickness articular cartilage delamination and progression towards arthropathy, is also an important feature.

We retrospectively reviewed 142 hips (mean age 32 years, 47 men, 95 women), correlating the findings on MRA with those found at the time of open surgical hip debridement to ascertain the prevalence of acetabular cysts and the association with underlying acetabular changes. Fourteen MRAs demonstrated features consistent with underlying acetabular cystic change. At the time of surgery, this was confirmed in eleven cases that demonstrated a full thickness articular chondral flap in all cases and an underlying acetabular cyst. The sensitivity, specificity, positive predictive value and negative predictive value of MRA in relation to acetabular cysts was 55%, 97.5%, 78.5% and 92.9% respectively.

We believe acetabular cysts on MRA to be a significant finding. Such patients are likely to have an associated full thickness chondral lesion and features of early degenerative change, influencing outcome and prognosis. Our clinical practice has changed to reflect this finding. For those patients with cysts on MRA, we offer open debridement only to the severely affected young and favour arthroscopic debridement in older patients with smaller cams. We believe hip preservation surgeons should be aware of the significance of acetabular cysts and be prepared to adjust treatment accordingly.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 291 - 291
1 Mar 2004
Messerli G Saudan M Riand N Pru•s-Latour V Fritschy D
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Aims: Evaluation of unicompartmental knee arthroplasty (UKA) as an alternative to total knee replacement. Methods: 66 patients (76 knees) underwent UKA with the Allegretto prosthesis. The indication was age greater than 60 years, single compartment arthrosis, normal functioning anterior cruciate ligament, and varus/valgus deformity < 20û. Etiology was primary or secondary osteoarthrosis, the latter secondary to avascular necrosis. Mean age at operation was 70 years (range, 55 to 90 years). Patients were evaluated using the Hospital for Special Surgery (HSS) rating score. Eight patients (8 knees), with less than 12 month follow-up were excluded. 58 patients (68 knees) were available at þnal review with a mean follow-up of 65 months (range, 12 to 120 months). Results: The average HSS score was 87.7 (range, 55 to 99). There were 53 (78%) excellent, 12 (17.5%) good, 2 fair, and 1 poor result. 52 patients (76%) had a BMI > 25. There was no signiþcant difference in HSS score between these patients and those with BMI < 25. Six knees (8.8%) were revised, 4 in obese patients (BMI > 25), and 2 in the same patient (bilateral) with a BMI of 32.9 (100kg). All 6 patients had a satisfactory outcome after total knee arthroplasty. There were no infections. Conclusions: UKA for uni-compartmental knee osteoarthrosis in properly selected patients produces satisfactory results. Moderate weight obesity is not an exclusion criteria.