We assessed the long-term (more than ten-year) outcomes of the
Kudo type-5 elbow prosthesis in patients with rheumatoid arthritis
(RA). We reviewed 41 elbows (Larsen Grade IV, n = 21; Grade V, n =
20) in 31 patients with RA who had undergone a Kudo type-5 total
elbow arthroplasty (TEA) between 1994 and 2003, and had been followed
up for more than ten years. The humeral component was cementless
and the all-polyethylene ulnar component cemented in every patient. Clinical
outcome was assessed using the Mayo elbow performance score. We
calculated the revision rate and evaluated potential risk factors
for revision. The duration of follow-up was a mean 141 months (120
to 203).Aims
Materials and Methods
The aim of this study was to investigate the incidence, risk factors, and outcome of venous thromboembolism (VTE) following anterior cruciate ligament (ACL) reconstruction in a nationwide cohort. All ACL reconstructions, primary and revision, that were recorded in the Swedish Knee Ligament Register (SKLR) between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare. The incidence of VTE was determined by entries between the day of surgery until 90 days postoperatively based on diagnosis codes and the prescription of anticoagulants. Risk factors, outcome, and the use of thromboprophylaxis were analyzed. Descriptive statistics with multivariate analysis were used to describe the findings.Aims
Patients and Methods
The goal of this study is to investigate the relation between indicators of osteoporosis (i.e., bone mineral density (BMD), and Cortical Index (CI)) and the complexity of a fracture of the proximal humerus as a result of a low-energy trauma. A retrospective chart review of 168 patients (mean age 67.2 years, range 51 to 88.7) with a fracture of the proximal humerus between 2007 and 2011, whose BMD was assessed at the Fracture Liaison Service with Dual Energy X-ray Absorptiometry (DXA) measurements of the hip, femoral neck (FN) and/or lumbar spine (LS), and whose CI and complexity of fracture were assessed on plain anteroposterior radiographs of the proximal humerus.Objectives
Methods
Open wedge high tibial osteotomy (OWHTO) for medial-compartment
osteoarthritis of the knee can be complicated by intra-operative
lateral hinge fracture (LHF). We aimed to establish the relationship
between hinge position and fracture types, and suggest an appropriate
hinge position to reduce the risk of this complication. Consecutive patients undergoing OWHTO were evaluated on coronal
multiplanar reconstruction CT images. Hinge positions were divided
into five zones in our new classification, by their relationship
to the proximal tibiofibular joint (PTFJ). Fractures were classified
into types I, II, and III according to the Takeuchi classification.Aims
Patients and Methods
The purpose of this study was to determine the sensitivity, specificity
and predictive values of previously reported thresholds of proximal
translation and sagittal rotation of cementless acetabular components
used for revision total hip arthroplasty (THA) at various times
during early follow-up. Migration of cementless acetabular components was measured retrospectively
in 84 patients (94 components) using Ein-Bild-Rontgen-Analyse (EBRA-Cup)
in two groups of patients. In Group A, components were recorded
as not being loose intra-operatively at re-revision THA (52 components/48
patients) and Group B components were recorded to be loose at re-revision
(42 components/36 patients).Aims
Patients and Methods
This study aimed to analyze the correlation between transverse
process (TP) fractures of the fourth (L4) and fifth (L5) lumbar
vertebrae and biomechanical and haemodynamic stability in patients
with a pelvic ring injury, since previous data are inconsistent. The study is a retrospective matched-pair analysis of patients
with a pelvic fracture according to the modified Tile AO Müller
and the Young and Burgess classification who presented to a level
1 trauma centre between January 2005 and December 2014.Aims
Patients and Methods
Ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA)
are commonly used, but concerns exist regarding ceramic fracture.
This study aims to report the risk of revision for fracture of modern
CoC bearings and identify factors that might influence this risk,
using data from the National Joint Registry (NJR) for England, Wales, Northern
Ireland and the Isle of Man. We analysed data on 223 362 bearings from 111 681 primary CoC
THAs and 182 linked revisions for bearing fracture recorded in the
NJR. We used implant codes to identify ceramic bearing composition
and generated Kaplan-Meier estimates for implant survivorship. Logistic
regression analyses were performed for implant size and patient specific
variables to determine any associated risks for revision.Aims
Patients and Methods
The aim of this study was to determine whether chilled irrigation
saline decreases the incidence of clinical upper limb palsy (ULP;
a reduction of one grade or more on manual muscle testing; MMT),
based on the idea that ULP results from thermal damage to the nerve
roots by heat generated by friction during bone drilling. Irrigation saline for drilling was used at room temperature (RT,
25.6°C) in open-door laminoplasty in 400 patients (RT group) and
chilled to a mean temperature of 12.1°C during operations for 400
patients (low-temperature (LT) group). We assessed deltoid, biceps,
and triceps brachii muscle strength by MMT. ULP occurring within
two days post-operatively was categorised as early-onset palsy.Aims
Methods
This study identifies early risk factors for symptomatic nonunion
of displaced midshaft fractures of the clavicle that aid identification
of an at risk group who may benefit from surgery. We performed a retrospective study of 88 patients aged between
16 and 60 years that were managed non-operatively. Aims
Methods
The aim of this study was to evaluate improvements in the quality
and safety of paediatric spinal surgery following the implementation
of a specialist Paediatric Spinal Surgical Team (PSST) in the operating
theatre. A retrospective consecutive case study of paediatric spinal operations
before (between January 2008 and December 2009), and after (between
January 2012 and December 2013) the implementation of PSST, was
performed. A comparative analysis of outcome variables including
surgical site infection (SSI), operating time (ORT), blood loss (BL),
length of stay (LOS), unplanned staged procedures (USP) and transfusion
rates (allogenic and cell-saver) was performed between the two groups.
The rate of complications during the first two postoperative years
was also compared between the groups.Aims
Patients and Methods
Patients with an acute Achilles tendon rupture (ATR) take a long
time to heal, have a high incidence of deep vein thrombosis (DVT)
and widely variable functional outcomes. This variation in outcome
may be explained by a lack of knowledge of adverse factors, and
a subsequent shortage of appropriate interventions. A total of 111 patients (95 men, 16 women; mean age 40.3, standard
deviation 8.4) with an acute total ATR were prospectively assessed.
At one year post-operatively a uniform outcome score, Achilles Combined
Outcome Score (ACOS), was obtained by combining three validated,
independent, outcome measures: Achilles tendon Total Rupture Score,
heel-rise height test, and limb symmetry heel-rise height. Predictors
of ACOS included treatment; gender; age; smoking; body mass index;
time to surgery; physical activity level pre- and post-injury; symptoms; quality
of life and incidence of DVT. Aims
Patients and Methods
To investigate the risk factors for progression of articular
cartilage damage after anatomical anterior cruciate ligament (ACL)
reconstruction. A total of 174 patients who underwent second-look arthroscopic
evaluation after anatomical ACL reconstruction were enrolled in
this study. The graded condition of the articular cartilage at the
time of ACL reconstruction was compared with that at second-look
arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction
technique, meniscal conditions, and other variables were assessed
by regression analysis as risk factors for progression of damage
to the articular cartilage.Aims
Patients and Methods
We compared the incidence of pseudotumours after
large head metal-on-metal (MoM) total hip arthroplasty (THA) with
that after conventional metal-on-polyethylene (MoP) THA and assessed
the predisposing factors to pseudotumour formation. From a previous randomised controlled trial which compared large
head (38 mm to 60 mm) cementless MoM THA with conventional head
(28 mm) cementless MoP THA, 93 patients (96 THAs: 41 MoM (21 males,
20 females, mean age of 64 years, standard deviation ( The incidence of pseudotumours, measured using a standardised
CT protocol was 22 (53.7%) after MoM THA and 12 (21.8%) after MoP
THA. Women with a MoM THA were more likely to develop a pseudotumour
than those with a MoP THA (15 Contrary to popular belief, pseudotumours occur frequently around
MoP THAs. Women with a MoM THA and an elevated cobalt level are
at greatest risk. In this study, pseudotumours had no effect on
the functional outcome after either large head MoM or conventional
MoP THA. Cite this article:
There is not adequate evidence to establish whether external
fixation (EF) of pelvic fractures leads to a reduced mortality.
We used the Japan Trauma Data Bank database to identify isolated
unstable pelvic ring fractures to exclude the possibility of blood
loss from other injuries, and analyzed the effectiveness of EF on
mortality in this group of patients. This was a registry-based comparison of 1163 patients who had
been treated for an isolated unstable pelvic ring fracture with
(386 patients) or without (777 patients) EF. An isolated pelvic
ring fracture was defined by an Abbreviated Injury Score (AIS) for
other injuries of <
3. An unstable pelvic ring fracture was defined
as having an AIS ≥ 4. The primary outcome of this study was mortality.
A subgroup analysis was carried out for patients who required blood
transfusion within 24 hours of arrival in the Emergency Department
and those who had massive blood loss (AIS code: 852610.5). Propensity-score
matching was used to identify a cohort like the EF and non-EF groups.Aim
Patients and Methods
Positive ulnar variance is an established risk factor for idiopathic
ulnar impaction syndrome (UIS). However, not all patients with positive
ulnar variance develop symptomatic UIS and other factors, including
the morphology of the lunate, may be involved. The aim of this study
was to clarify the relationship between lunate morphology and idiopathic
UIS. A cohort of 95 patients with idiopathic UIS (UIS group) was compared
with 95 asymptomatic controls with positive ulnar variance. The
shape of the lunate was measured using the capitate-triquetrum distance
(CTD), ulnar coverage ratio (UCR), radiolunate distance and radiolunate
angle. The association of radiographic parameters and lunate types
with the development of UIS was investigated in univariable and
multivariable analyses. Receiver operating characteristic curves
were used to estimate a cutoff for any statistically significant
variables.Aims
Patients and Methods
The Corail stem has good long-term results. After four years
of using this stem, we have detected a small group of patients who
have presented with symptomatic metaphyseal debonding. The aim of
this study was to quantify the incidence of this complication, to
delineate the characteristics of patients presenting with this complication
and to compare these patients with asymptomatic controls to determine
any important predisposing factors. Of 855 Corail collarless cementless stems implanted for osteoarthritis,
18 presented with symptomatic metaphyseal debonding. A control group
of 74 randomly selected patients was assembled. Clinical and radiological
parameters were measured and a logistic regression model was created
to evaluate factors associated with metaphyseal debonding.Aims
Patients and Methods
