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Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_8 | Pages 73 - 73
1 Aug 2020
Dust P Antoniou J Huk OL Zukor DJ Kruijt J Bergeron S Stavropoulos N
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Osteoarthritis (OA) is one of the most common causes of knee pain in the aging population and presents with higher odds with increased BMI. Total knee arthroplasty (TKA) has become the standard of care for the treatment of OA. Over “719,000 TKA's were performed in 2010 in the USA alone, with dramatic economic burden- costing 16,000 USD per TKA” (CDC 2012). Over the past two decades, this cost was compounded by the unknown increasing rate of primary TKA and cannot be explained by the expanding population or worldwide obesity epidemic. These facts raise two key questions: are patients' quality of life expectations higher and driving the TKA rate up, or have surgeons changed their indications and started to operate on less disabled people? Our study aimed to determine the average functional profile for patients undergoing TKA using patient reported Outcome Measure (SF-36), to document if preoperative SF-36 scores have changed over the past two decades, and lastly to asses if patient pre-operative SF-36 scores are lower in in the USA vs the rest of the world.

A literature search of Medline, Embase and Cochrane databases was performed extracting data from publishing year 1966 to 2016 with a search date of Dec 12, 2016. Two independent reviewers revised the abstracts and excluded articles with: no TKA, revision TKA, no pre-op SF-36, no SF-36 reported, incomplete scores to calculate SF-36, duplicates, review article, meta-analysis, letter to the editor, conference proceeding or abstract, disagreements were resolved with a third reviewer. All languages were included to maximize the catchment of data. All remaining articles were independently read and excluded if they did not provide data required for our study. Included articles were analyzed for data including: for year of patient enrollment, location (USA vs. non-USA), pre-operative SF-36 mental (MCS) and physical (PCS) component summary, level of evidence. Recorded data was compared post completion to assess inter-observer accuracy as per PRISMA guidelines for meta-analysis.

After applying all the exclusion criteria on 923 selected abstracts, a total of 136 articles of which 30 were randomized control trials, were completely reviewed and included in our study. A total of 56,713 patients' physical component scores were analyzed and revealed an overall pre-operative SF-36 physical component score 31.93. When stratifying the data, it was revealed that patients operated in the USA had an average score of 32.3 whereas Non-US countries were 31.7, with no statistical significance. No statistical difference between SF36 scores was seen over time amongst studies of all nations.

Based on the results of this study, we have shown that orthopaedic surgeons are performing TKA universally at the same pre-operative scores, independent of country of origin or year of surgery. The indications thus have remained consistent for two decades regardless of the advances in technology. Functional profiles of patients appear similar among US and Non-US countries. Further, we infer that based on pre-operative SF-36 PCS scores, the optimal time to undergo a TKA is when PCS is 31.9 +/−3.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_21 | Pages 91 - 91
1 Dec 2016
Stavropoulos N Epure L Zukor D Huk O Antoniou J
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Hip resurfacing offers an attractive alternative to conventional total hip arthroplasty in young active patients. It is particularly advantageous for bone preservation for future revisions. Articular Surface Replacement (ASR) is a hip resurfacing prosthesis manufactured by DePuy Orthopaedics Inc. (Warsaw, IN). The manufacturer voluntarily recalled the ASR system in 2010 after an increasing number of product failures. The present study aimed to determine the long-term results in a large cohort of patients who received the ASR prosthesis.

Between February 2004 and August 2010, 592 consecutive hip resurfacings using the ASR (DePuy Orthopaedics Inc., Warsaw, IN) resurfacing implant were performed in 496 patients (391 males and 105 females). The mean age of the patients at the time of the surgery was 54 (range: 25 to 74) years. Osteoarthritis was the most common diagnosis in 575 hips (97.1%). The remaining patients (2.9%) developed secondary degenerative disease from ankylosing spondylitis, avascular necrosis, developmental hip dysplasia, and rheumatoid arthritis. Clinical and radiographic information was available for all patients at the last follow up. Cobalt (Co) and chromium (Cr) levels were measured in 265 patients (298 hips) by inductively coupled plasma-mass spectrometry (ICP-MS).

The average follow up of the study was 8.6 years (range: 5.2 to 11.6 years). The mean Harris hip and UCLA scores significantly improved from 44 and 2 pre-operatively to 85.3 and 7.1 respectively. The median Co and Cr ion level was 3.81 microgram per liter and 2.15 microgram per liter respectively. Twenty-seven patients (5.4%) were found to have blood levels of both Co and Cr ions that were greater than 7 microgram per liter. Fifty-four patients (9.1%) were revised to a total hip arthroplasty. Kaplan-Meier survival analysis showed a survival rate of 87.1% at 8.6 years with revision for any cause and 87.9% if infection is removed. A significantly higher survival rate was observed for the male patients (90.2%, p <0.0001) and for the patients with ASRs with femoral heads diameters larger than 52 mm (90.1%, p=0.0003).

This study confirms that patient selection criteria are of great importance to the overall survivorship of hip resurfacing arthroplasty. Improved clinical results have been reconfirmed with the use of larger diameter femoral heads.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 169 - 169
1 May 2011
Alevrogiannis S Skarpas G Triantafyllopoulos A Lygdas P Stavropoulos N
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Purpose: To present our experience in using autologous 3D chondrocyte implantation, performed in fully arthroscopical manner, for treatment of cartilage defects, due to osteochondritis descecans in the talus.

Materials and Methods: A total of 12 patients were presented to our clinic with severe ankle pain due to osteochondritis descecans in the right(8) and left(4) talus between June 2008 and June 2009. The lesions were located at the medial aspect of the right talus (7) and the medial aspect of the left talus (4) as well as the central aspect (1) of the right talus, measuring (8) 1×1.5 cm2 and (4) 1.5x1.5 cm2 were classified intraoperatively as Outerbridge IV. They underwent arthroscopy in order to collect cartilage from non-weight bearing area of the talus(1st stage ACI) and then send it for chondrocyte culture. After 6 weeks the cultivated chondrocytes were applied fully arthroscopically as 3D chondrospheres to cover the chondral defects(2nd stage ACI). Pre-op and post-op evaluation was done using the LYSHOLM & GILLQUIST score, Patient Outcome Function score and Visual Analogue Pain score.

Results: The procedures progressed uneventfully. A specialized rehabilitation protocol was followed. We assessed the patient at six months and 1 year post-operatively; the Lysholm & Gillquist Score rose from 45.5 to 72.5, in VAS pain significantly reduced from 6.3 to 1.7 in the 1 year period and the Patient Outcome Function score showed significantly better performance. The follow-up using MRI showed adequate filling of the defect without significant graft-associated complications for the same period. The clinical outcome was excellent.

Conclusions: Our preliminary results of autologous 3D chondrocyte implantation for the treatment of cartilage defects, due to osteochondritis descecans in the talus seems to be more than encouraging. A greater number of cases and further mid and long term follow-up has to be studied in order to prove the efficacy of the method. As far as we know this is the first publication in the literature regarding 3nd generation ACI technique fully arthroscopically performed, concerning the talus, in our country.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 215 - 215
1 Mar 2003
Drosos C Kouzoubasis P Stavropoulos N Kayias E Tsioros K Miliotis E
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Aim: The aim was to study the blood loss and the need for transfusion in patients with fracture of the upper end of the femur.

Patients – Methods: In a prospective study we included 50 patients with intertrochanteric fractures (Group 1) and patients with fractures of the femoral neck (Group 2). Patients with other concomitant injuries or fractures were excluded. The blood loss and the need for transfusion were studied using as lower limit for transfusion Hb 10 gr./dl.

Results: The average age of the patients was 80.2 years (s.d. 8.3). Patients of the Group 2 (mean 73, s.d. 10) were younger than patients in Group 1 (average 82, s.d. 5.6).

Two thirds of the patients were women, with higher proportion of women in Group 1 (women: 81.3%, men:18.7%) than in Group 2 (women: 66.7%, men:33.3%).

In Group 1 the average blood loss (3.4 units) as well as the average need for transfusion (1.9 units) was higher than in Croup 2 (average blood loss 2.8 units, average need for transfusion 1.6 units). The average Hb admission in Group 1 was 11.4 and in Group 2 was 11.8.

In patients that were operated on within the first 24 hours after the injury, the average blood loss was lower than in patients who were operated on later.

Conclusions: In patients with intertrochanteric fractures the blood loss as well as the need for transfusion was higher than in patients with femoral neck fractures. Early surgical treatment led to less blood loss.