We wished to compare the clinical outcome, as assessed by questionnaires
and the rate of complications, in total knee arthroplasty (TKA)
undertaken with patient-matched positioning guides (PMPGs) or conventional
instruments. A total of 180 patients (74 men, 106 women; mean age 67 years)
were included in a multicentre, adequately powered, double-blind,
randomised controlled trial. The mean follow-up was 44 months (24
to 57).Aims
Patients and Methods
Fractures of the distal femur are an important cause of morbidity.
Their optimal management remains controversial. Contemporary implants
include angular-stable anatomical locking plates and locked intramedullary
nails (IMNs). We compared the long-term patient-reported functional
outcome of fixation of fractures of the distal femur using these
two methods of treatment. A total of 297 patients were retrospectively identified from
a State-wide trauma registry in Australia: 195 had been treated
with a locking plate and 102 with an IMN. Baseline characteristics
of the patients and their fractures were recorded. Health-related
quality-of-life, functional and radiographic outcomes were compared
using mixed effects regression models at six months and one year.Aims
Patients and Methods
Charcot neuro-osteoarthropathy (CN) of the midfoot
presents a major reconstructive challenge for the foot and ankle
surgeon. The Synthes 6 mm Midfoot Fusion Bolt is both designed and
recommended for patients who have a deformity of the medial column
of the foot due to CN. We present the results from the first nine
patients (ten feet) on which we attempted to perform fusion of the
medial column using this bolt. Six feet had concurrent hindfoot fusion
using a retrograde nail. Satisfactory correction of deformity of
the medial column was achieved in all patients. The mean correction
of calcaneal pitch was from 6°
(-15° to +18°) pre-operatively to 16° (7° to 23°) post-operatively;
the mean Meary angle from 26° (3° to 46°) to 1° (1° to 2°); and
the mean talometatarsal angle on dorsoplantar radiographs from 27°
(1° to 48°) to 1° (1° to 3°). However, in all but two feet, at least one joint failed to fuse.
The bolt migrated in six feet, all of which showed progressive radiographic
osteolysis, which was considered to indicate loosening. Four of
these feet have undergone a revision procedure, with good radiological
evidence of fusion. The medial column bolt provided satisfactory correction
of the deformity but failed to provide adequate fixation for fusion
in CN deformities in the foot. In its present form, we cannot recommend the routine use of this
bolt. Cite this article:
Primary total knee arthroplasty (TKA) is a reliable
procedure with reproducible long-term results. Nevertheless, there
are conditions related to the type of patient or local conditions
of the knee that can make it a difficult procedure. The most common
scenarios that make it difficult are discussed in this review. These
include patients with many previous operations and incisions, and
those with severe coronal deformities, genu recurvatum, a stiff knee,
extra-articular deformities and those who have previously undergone
osteotomy around the knee and those with chronic dislocation of
the patella. Each condition is analysed according to the characteristics of
the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use
a systematic approach, which begins with the review of the existing
literature for each specific clinical situation. Cite this article:
The aim of this study was to identify patient- and surgery-related
risk factors for sustaining an early periprosthetic fracture following
primary total hip arthroplasty (THA) performed using a double-tapered
cementless femoral component (Bi-Metric femoral stem; Biomet Inc.,
Warsaw, Indiana). A total of 1598 consecutive hips, in 1441 patients receiving
primary THA between January 2010 and June 2015, were retrospectively
identified. Level of pre-operative osteoarthritis, femoral Dorr
type and cortical index were recorded. Varus/valgus placement of
the stem and canal fill ratio were recorded post-operatively. Periprosthetic
fractures were identified and classified according to the Vancouver
classification. Regression analysis was performed to identify risk
factors for early periprosthetic fracture.Aims
Patients and Methods
To assess complications and failure mechanisms of osteoarticular
allograft reconstructions for primary bone tumours. We retrospectively evaluated 38 patients (28 men, 74%) who were
treated at our institution with osteoarticular allograft reconstruction
between 1989 and 2010. Median age was 19 years (interquartile range
14 to 32). Median follow-up was 19.5 years (95% confidence interval
(CI) 13.0 to 26.1) when 26 patients (68%) were alive. In addition, we
systematically searched the literature for clinical studies on osteoarticular
allografts, finding 31 studies suitable for analysis. Results of
papers that reported on one site exclusively were pooled for comparison.Aims
Patients and Methods
Following the introduction of national standards in 2009, most
major paediatric trauma is now triaged to specialist units offering
combined orthopaedic and plastic surgical expertise. We investigated
the management of open tibia fractures at a paediatric trauma centre,
primarily reporting the risk of infection and rate of union. A retrospective review was performed on 61 children who between
2007 and 2015 presented with an open tibia fracture. Their mean
age was nine years (2 to 16) and the median follow-up was ten months
(interquartile range 5 to 18). Management involved IV antibiotics,
early debridement and combined treatment of the skeletal and soft-tissue injuries
in line with standards proposed by the British Orthopaedic Association.Aims
Patients and Methods
Preservation of posterior condylar offset (PCO) has been shown to correlate with improved functional results after primary total knee arthroplasty (TKA). Whether this is also the case for revision TKA, remains unknown. The aim of this study was to assess the independent effect of PCO on early functional outcome after revision TKA. A total of 107 consecutive aseptic revision TKAs were performed by a single surgeon during an eight-year period. The mean age was 69.4 years (39 to 85) and there were 59 female patients and 48 male patients. The Oxford Knee Score (OKS) and Short-form (SF)-12 score were assessed pre-operatively and one year post-operatively. Patient satisfaction was also assessed at one year. Joint line and PCO were assessed radiographically at one year.Objectives
Methods
Sustained intra-articular delivery of pharmacological agents is an attractive modality but requires use of a safe carrier that would not induce cartilage damage or fibrosis. Collagen scaffolds are widely available and could be used intra-articularly, but no investigation has looked at the safety of collagen scaffolds within synovial joints. The aim of this study was to determine the safety of collagen scaffold implantation in a validated A total of 96 rabbits were randomly and equally assigned to four different groups: arthrotomy alone; arthrotomy and collagen scaffold placement; contracture surgery; and contracture surgery and collagen scaffold placement. Animals were killed in equal numbers at 72 hours, two weeks, eight weeks, and 24 weeks. Joint contracture was measured, and cartilage and synovial samples underwent histological analysis.Objectives
Materials and Methods
The aim of this study was to identify risk factors for the failure
of exchange nailing in nonunion of tibial diaphyseal fractures. A cohort of 102 tibial diaphyseal nonunions in 101 patients with
a mean age of 36.9 years (15 to 74) were treated between January
1992 and December 2012 by exchange nailing. Of which 33 (32%) were
initially open injuries. The median time from primary fixation to
exchange nailing was 6.5 months (interquartile range (IQR) 4.3 to
9.8 months). The main outcome measures were union, number of secondary fixation
procedures required to achieve union and time to union. Univariate analysis and multiple regression were used to identify
risk factors for failure to achieve union. Aims
Patients and Methods
Surgical intervention in patients with bone metastases from breast
cancer is dependent on the estimated survival of the patient. The
purpose of this paper was to identify factors that would predict
survival so that specific decisions could be made in terms of surgical
(or non-surgical) management. The records of 113 consecutive patients (112 women) with metastatic
breast cancer were analysed for clinical, radiological, serological
and surgical outcomes. Their median age was 61 years (interquartile
range 29 to 90) and the median duration of follow-up was 1.6 years
(standard deviation (Aims
Methods
We report on the outcome of the Synergy cementless femoral stem
with a minimum follow-up of 15 years (15 to 17). A retrospective review was undertaken of a consecutive series
of 112 routine primary cementless total hip arthroplasties (THAs)
in 102 patients (112 hips). There were 60 female and 42 male patients
with a mean age of 61 years (18 to 82) at the time of surgery. A
total of 78 hips in the 69 patients remain Aims
Patients and Methods
Periprosthetic joint infection (PJI) is one of
the most feared and challenging complications following total knee arthroplasty.
We provide a detailed description of our current understanding regarding
the management of PJI of the knee, including diagnostic aids,
pre-operative planning, surgical treatment, and outcome. Cite this article:
This study tests the biomechanical properties of adjacent locked
plate constructs in a femur model using Sawbones. Previous studies
have described biomechanical behaviour related to inter-device distances.
We hypothesise that a smaller lateral inter-plate distance will
result in a biomechanically stronger construct, and that addition
of an anterior plate will increase the overall strength of the construct. Sawbones were plated laterally with two large-fragment locking
compression plates with inter-plate distances of 10 mm or 1 mm.
Small-fragment locking compression plates of 7-hole, 9-hole, and
11-hole sizes were placed anteriorly to span the inter-plate distance.
Four-point bend loading was applied, and the moment required to
displace the constructs by 10 mm was recorded.Objectives
Methods
The aim of this study was to evaluate the prognostic
and therapeutic factors which influence the oncological outcome
of parosteal osteosarcoma. A total of 80 patients with a primary parosteal osteosarcoma
were included in this retrospective study. There were 51 females
and 29 males with a mean age of 29.9 years (11 to 78). The mean follow-up was 11.2 years (1 to 40). Overall survival
was 91.8% at five years and 87.8% at ten years. Local recurrence
occurred in 14 (17.5%) patients and was associated with intralesional
surgery and a large volume of tumour. On histological examination,
80% of the local recurrences were dedifferentiated high-grade tumours.
A total of 12 (14.8%) patients developed pulmonary metastases, of
whom half had either a dedifferentiated tumour or a local recurrence.
Female gender and young age were good prognostic factors. Local
recurrence was a poor prognostic factor for survival. Medullary
involvement or the use of chemotherapy had no impact on survival. The main goal in treating a parosteal osteosarcoma must be to
achieve a wide surgical margin, as inadequate margins are associated
with local recurrence. Local recurrence has a significant negative
effect on survival, as 80% of the local recurrences are high-grade
dedifferentiated tumours, and half of these patients develop metastases. The role of chemotherapy in the treatment of parosteal osteosarcoma
is not as obvious as it is in the treatment of conventional osteosarcoma.
The mainstay of treatment is wide local excision. Cite this article:
Studies reporting specifically on squeaking in total hip arthroplasty have focused on cementless, and not on hybrid, fixation. We hypothesised that the cement mantle of the femur might have a damping effect on the sound transmitted through the metal stem. The objective of this study was to test the effect of cement on sound propagation along different stem designs and under different fixation conditions. An Objectives
Methods
