Aims

The aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approaches

We reviewed a consecutive series of 527 uninfected hip replacements in patients resident in the UK which had been implanted from 1981 to 1993. All had the same basic design of femoral prosthesis, but four fixation techniques had been used: two press-fit, one HA-coated and one cemented. Review and radiography were planned prospectively. For assessment the components were retrospectively placed into two groups: those which had failed from two years onwards by aseptic femoral loosening and those in which the femoral component had survived without revision or recommendation for revision. All available radiographs in both groups were measured to determine vertical migration and examined by two observers to agree the presence of radiolucent lines (RLLs), lytic lesions, resorption of the neck, proximal osteopenia and distal intramedullary and distal subperiosteal formation of new bone. We then related the presence or absence of these features and the rate of migration at two years to the outcome with regard to aseptic loosening and determined the predictive value of each of these variables. Migration of ≥2 mm at two years, the presence of an RLL of 2 mm occupying one-third of any one zone, and subperiosteal formation of new bone at the tip of the stem were predictors of aseptic loosening after two years. There were too few lytic lesions to assess at two years, but at five years a lytic lesion ≥2 mm also predicted failure. We discuss the use of these variables as predictors of femoral aseptic loosening for groups of hips and for individual hips. We conclude that if a group of about 50 total hip replacements, perhaps with a new design of femoral stem, were studied in this way at two years, a mean migration of < 0.4 mm and an incidence of < 10% of RLLs of 2 mm in any one zone would predict 95% survival at ten years. For an individual prosthesis, migration of < 2 mm and the absence of an RLL of ≤2 mm at two years predict a 6% chance of revision over approximately ten years. If either 2 mm of migration or an RLL of 2 mm is present, the chances of revision rise to 27%, and if both radiological signs are present they are 50%. If at five years a lytic lesion has developed, whatever the situation at two years, there is approximately a 50% chance of failure in the following five years. Our findings suggest that replacements using a limited number of any new design of femoral prosthesis should be screened radiologically at two years before they are generally introduced. We also suggest that radiographs of individual patients at two years and perhaps at five years should be studied to help to decide whether or not the patient should remain under close review or be discharged from specialist follow-up

Objectives

The aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic ultrasound in fracture management.

Aims

The aim of this randomized trial was to compare the functional outcome of two different surgical approaches to the hip in patients with a femoral neck fracture treated with a hemiarthroplasty.

Aims

Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation fails in these patients. The aim of this study was to analyze the complications of THA following failed intertrochanteric hip fracture fixation using a CMN.

Aims

Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory arthritis.

Aims

A variety of surgical approaches are used for total hip arthroplasty (THA), all with reported advantages and disadvantages. A number of common complications can occur following THA regardless of the approach used. The purpose of this study was to compare five commonly used surgical approaches with respect to the incidence of surgery-related complications.

Aims

Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and reverse shoulder arthroplasty (RSA).

Aims

The aim of this study was to investigate the association between the type of operation used to treat a trochanteric fracture of the hip and 30-day mortality.

Implant-related infection is one of the leading reasons for failure in orthopaedics and trauma, and results in high social and economic costs. Various antibacterial coating technologies have proven to be safe and effective both in preclinical and clinical studies, with post-surgical implant-related infections reduced by 90% in some cases, depending on the type of coating and experimental setup used. Economic assessment may enable the cost-to-benefit profile of any given antibacterial coating to be defined, based on the expected infection rate with and without the coating, the cost of the infection management, and the cost of the coating. After reviewing the latest evidence on the available antibacterial coatings, we quantified the impact caused by delaying their large-scale application. Considering only joint arthroplasties, our calculations indicated that for an antibacterial coating, with a final user’s cost price of €600 and able to reduce post-surgical infection by 80%, each year of delay to its large-scale application would cause an estimated 35 200 new cases of post-surgical infection in Europe, equating to additional hospital costs of approximately €440 million per year. An adequate reimbursement policy for antibacterial coatings may benefit patients, healthcare systems, and related research, as could faster and more affordable regulatory pathways for the technologies still in the pipeline. This could significantly reduce the social and economic burden of implant-related infections in orthopaedics and trauma.

Cite this article: C. L. Romanò, H. Tsuchiya, I. Morelli, A. G. Battaglia, L. Drago. Antibacterial coating of implants: are we missing something? Bone Joint Res 2019;8:199–206. DOI: 10.1302/2046-3758.85.BJR-2018-0316.

Abstract

The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. However, there is recent evidence to suggest that nonoperative management of well-reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants.

Cite this article: Bone Joint J 2019;101-B:512–521.

Aims

Single-stage revision is not widely pursued due to restrictive inclusion criteria. In this study, we evaluated the results of single-stage revision of chronically infected total hip arthroplasty (THA) using broad inclusion criteria and cementless implants.

Objectives

Long bone defects often require surgical intervention for functional restoration. The ‘gold standard’ treatment is autologous bone graft (ABG), usually from the patient’s iliac crest. However, autograft is plagued by complications including limited supply, donor site morbidity, and the need for an additional surgery. Thus, alternative therapies are being actively investigated. Autologous bone marrow (BM) is considered as a candidate due to the presence of both endogenous reparative cells and growth factors. We aimed to compare the therapeutic potentials of autologous bone marrow aspirate (BMA) and ABG, which has not previously been done.

Aims

Many authors have reported a shorter treatment time when using trifocal bone transport (TFT) rather than bifocal bone transport (BFT) in the management of long segmental tibial bone defects. However, the difference in the incidence of additional procedures, the true complications, and the final results have not been investigated.