Fretting and corrosion at the modular head/neck junction, known
as trunnionosis, in total hip arthroplasty (THA) is a cause of adverse
reaction to metal debris (ARMD). We describe the outcome of revision
of metal-on-polyethylene (MoP) THA for ARMD due to trunnionosis
with emphasis on the risk of major complications. A total of 36 patients with a MoP THA who underwent revision
for ARMD due to trunnionosis were identified. Three were excluded
as their revision had been to another metal head. The remaining
33 were revised to a ceramic head with a titanium sleeve. We describe
the presentation, revision findings, and risk of complications in
these patients.Aims
Patients and Methods
The purpose of this retrospective study was to evaluate the minimum
five-year outcome of revision total hip arthroplasty (THA) using
the Kerboull acetabular reinforcement device (KARD) in patients
with Paprosky type III acetabular defects and destruction of the
inferior margin of the acetabulum. We identified 36 patients (37 hips) who underwent revision THA
under these circumstances using the KARD, fresh frozen allograft
femoral heads, and reconstruction of the inferior margin of the
acetabulum. The Merle d’Aubigné system was used for clinical assessment.
Serial anteroposterior pelvic radiographs were used to assess migration
of the acetabular component.Aims
Patients and Methods
The aim of this study was to evaluate antegrade autologous bone
grafting with the preservation of articular cartilage in the treatment
of symptomatic osteochondral lesions of the talus with subchondral
cysts. The study involved seven men and five women; their mean age was
35.9 years (14 to 70). All lesions included full-thickness articular
cartilage extending through subchondral bone and were associated
with subchondral cysts. Medial lesions were exposed through an oblique
medial malleolar osteotomy, and one lateral lesion was exposed by
expanding an anterolateral arthroscopic portal. After refreshing
the subchondral cyst, it was grafted with autologous cancellous
bone from the distal tibial metaphysis. The fragments of cartilage
were fixed with 5-0 nylon sutures to the surrounding cartilage.
Function was assessed at a mean follow-up of 25.3 months (15 to
50), using the American Orthopaedic Foot and Ankle Society (AOFAS)
ankle-hindfoot outcome score. The radiological outcome was assessed
using MRI and CT scans.Aims
Patients and Methods
Outcome measures quantifying aspects of health in a precise,
efficient, and user-friendly manner are in demand. Computer adaptive
tests (CATs) may overcome the limitations of established fixed scales
and be more adept at measuring outcomes in trauma. The primary objective
of this review was to gain a comprehensive understanding of the
psychometric properties of CATs compared with fixed-length scales
in the assessment of outcome in patients who have suffered trauma
of the upper limb. Study designs, outcome measures and methodological
quality are defined, along with trends in investigation. A search of multiple electronic databases was undertaken on 1
January 2017 with terms related to “CATs”, “orthopaedics”, “trauma”,
and “anatomical regions”. Studies involving adults suffering trauma
to the upper limb, and undergoing any intervention, were eligible.
Those involving the measurement of outcome with any CATs were included.
Identification, screening, and eligibility were undertaken, followed
by the extraction of data and quality assessment using the Consensus-Based
Standards for the Selection of Health Measurement Instruments (COSMIN) criteria.
The review is reported according to the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) criteria and reg istered (PROSPERO: CRD42016053886).Aims
Materials and Methods
In the time since Letournel popularised the surgical
treatment of acetabular fractures, more than 25 years ago, there
have been many changes within the field, related to patients, surgical
technique, implants and post-operative care. However, the long-term
outcomes appear largely unchanged. Does this represent stasis or
have the advances been mitigated by other negative factors? In this
article we have attempted to document the recent changes within
the surgery of patients with a fracture involving the acetabulum,
outline contemporary management, and identify the major problem
areas where further research is most needed. Cite this article:
To evaluate the outcomes of cemented total hip arthroplasty (THA)
following a fracture of the acetabulum, with evaluation of risk
factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of
57 years (25 to 87) underwent cemented THA at a mean of 6.5 years
(0.1 to 25) following acetabular fracture. A total of 38 had undergone
surgical fixation and 11 had been treated non-operatively; 13 patients
died at a mean of 10.2 years after THA (0.6 to 19). Patients were
assessed pre-operatively, at one year and at final follow-up (mean
9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant
survivorship was assessed. An age and gender-matched cohort of THAs
performed for non-traumatic osteoarthritis (OA) or avascular necrosis
(AVN) (n = 98) were used to compare complications and patient-reported outcome
measures (PROMs).Aims
Patients and Methods
Non-traumatic osteonecrosis of the femoral head
is a potentially devastating condition, the prevalence of which
is increasing. Many joint-preserving forms of treatment, both medical
and surgical, have been developed in an attempt to slow or reverse
its progression, as it usually affects young patients. However, it is important to evaluate the best evidence that is
available for the many forms of treatment considering the variation
in the demographics of the patients, the methodology and the outcomes
in the studies that have been published, so that it can be used
effectively. The purpose of this review, therefore, was to provide an up-to-date,
evidence-based guide to the management, both non-operative and operative,
of non-traumatic osteonecrosis of the femoral head. Cite this article:
Large bone defects remain a tremendous clinical challenge. There is growing evidence in support of treatment strategies that direct defect repair through an endochondral route, involving a cartilage intermediate. While culture-expanded stem/progenitor cells are being evaluated for this purpose, these cells would compete with endogenous repair cells for limited oxygen and nutrients within ischaemic defects. Alternatively, it may be possible to employ extracellular vesicles (EVs) secreted by culture-expanded cells for overcoming key bottlenecks to endochondral repair, such as defect vascularization, chondrogenesis, and osseous remodelling. While mesenchymal stromal/stem cells are a promising source of therapeutic EVs, other donor cells should also be considered. The efficacy of an EV-based therapeutic will likely depend on the design of companion scaffolds for controlled delivery to specific target cells. Ultimately, the knowledge gained from studies of EVs could one day inform the long-term development of synthetic, engineered nanovesicles. In the meantime, EVs harnessed from
We carried out a further study of the long-term results of the
cemented Exeter femoral component in patients under the age of 40
with a mean follow-up of 13.6 years (10 to 20). We reviewed our original cohort of 104 cemented Exeter stems
in 78 consecutive patients with a mean age of 31 years (16 to 39).
Only one patient was lost to radiological follow-up.Aims
Patients and Methods
The aim of this independent multicentre study was to assess the
mid-term results of mobile bearing unicondylar knee arthroplasty
(UKA) for isolated lateral osteoarthritis of the knee joint. We retrospectively evaluated 363 consecutive, lateral UKAs (346
patients) performed using the Oxford domed lateral prosthesis undertaken
in three high-volume knee arthroplasty centres between 2006 and
2014. Mean age of the patients at surgery was 65 years (36 to 88)
with a mean final follow-up of 37 months (12 to 93)Aims
Patients and Methods
The aims of this study were to examine the rate at which the
positioning of the acetabular component, leg length discrepancy
and femoral offset are outside an acceptable range in total hip
arthroplasties (THAs) which either do or do not involve the use
of intra-operative digital imaging. A retrospective case-control study was undertaken with 50 patients
before and 50 patients after the integration of an intra-operative
digital imaging system in THA. The demographics of the two groups
were comparable for body mass index, age, laterality and the indication
for surgery. The digital imaging group had more men than the group without.
Surgical data and radiographic parameters, including the inclination
and anteversion of the acetabular component, leg length discrepancy,
and the difference in femoral offset compared with the contralateral
hip were collected and compared, as well as the incidence of altering
the position of a component based on the intra-operative image.Aims
Patients and Methods
We present the ten-year data of a cohort of patients, aged between
18 and 65 years (mean age 52.7 years; 19 to 64), who underwent total
hip arthroplasty. Patients were randomised to be treated with a
cobalt-chrome (CoCr) femoral head with an ultra-high molecular weight
polyethylene (UHMWPE), highly cross-linked polyethylene (XLPE) or
ceramic-on-ceramic (CoC) bearing surface. A total of 102 hips (91 patients) were randomised into the three
groups. At ten years, 97 hips were available for radiological and
functional follow-up. Two hips (two patients) had been revised (one
with deep infection and one for periprosthetic fracture) and three
were lost to follow-up. Radiological analysis was performed using
a validated digital assessment programme to give linear, directional
and volumetric wear of the two polyethylene groups.Aims
Patients and Methods
To determine the incidence and timing of post-operative fevers
following shoulder arthroplasty and the resulting investigations
performed. A retrospective review was conducted of all patients undergoing
shoulder arthroplasty over a nine-year period. The charts of all
patients with a post-operative fever (≥ 38.6°C) were reviewed and
the results of all investigations were analysed.Aims
Patients and Methods
