The use of a noninvasive growing endoprosthesis in the management
of primary bone tumours in children is well established. However,
the efficacy of such a prosthesis in those requiring a revision
procedure has yet to be established. The aim of this series was
to present our results using extendable prostheses for the revision
of previous endoprostheses. All patients who had a noninvasive growing endoprosthesis inserted
at the time of a revision procedure were identified from our database.
A total of 21 patients (seven female patients, 14 male) with a mean
age of 20.4 years (10 to 41) at the time of revision were included.
The indications for revision were mechanical failure, trauma or infection
with a residual leg-length discrepancy. The mean follow-up was 70
months (17 to 128). The mean shortening prior to revision was 44 mm
(10 to 100). Lengthening was performed in all but one patient with
a mean lengthening of 51 mm (5 to 140).Aims
Patients and Methods
Plots are an elegant and effective way to represent
data. At their best they encourage the reader and promote comprehension.
A graphical representation can give a far more intuitive feel to
the pattern of results in the study than a list of numerical data,
or the result of a statistical calculation. The temptation to exaggerate differences or relationships between
variables by using broken axes, overlaid axes, or inconsistent scaling
between plots should be avoided. A plot should be self-explanatory and not complicated. It should
make good use of the available space. The axes should be scaled
appropriately and labelled with an appropriate dimension. Plots are recognised statistical methods of presenting data and
usually require specialised statistical software to create them.
The statistical analysis and methods to generate the plots are as
important as the methodology of the study itself. The software,
including dates and version numbers, as well as statistical tests
should be appropriately referenced. Following some of the guidance provided in this article will
enhance a manuscript. Cite this article:
Aims
Patients and Methods
Bone fracture healing is regulated by a series of complex physicochemical and biochemical processes. One of these processes is bone mineralization, which is vital for normal bone development. Phosphatase, orphan 1 (PHOSPHO1), a skeletal tissue-specific phosphatase, has been shown to be involved in the mineralization of the extracellular matrix and to maintain the structural integrity of bone. In this study, we examined how PHOSPHO1 deficiency might affect the healing and quality of fracture callus in mice. Tibial fractures were created and then stabilized in control wild-type (WT) and Objectives
Methods
We evaluated the clinical results and complications
after extra-articular resection of the distal femur and/or proximal
tibia and reconstruction with a tumour endoprosthesis (MUTARS) in
59 patients (mean age 33 years (11 to 74)) with malignant bone or
soft-tissue tumours. According to a Kaplan–Meier analysis, limb
survival was 76% (95% confidence interval (CI) 64.1 to 88.5) after
a mean follow-up of 4.7 years (one month to 17 years). Peri-prosthetic infection
was the most common indication for subsequent amputation (eight
patients). Survival of the prosthesis without revision was 48% (95%
CI 34.8 to 62.0) at two years and 25% (95% CI 11.1 to 39.9) at five years
post-operatively. Failure of the prosthesis was due to deep infection
in 22 patients (37%), aseptic loosening in ten patients (17%), and
peri-prosthetic fracture in six patients (10%). Wear of the bearings
made a minor revision necessary in 12 patients (20%). The mean Musculoskeletal
Tumor Society score was 23 (10 to 29). An extensor lag >
10° was
noted in ten patients (17%). These results suggest that limb salvage after extra-articular
resection with a tumour prosthesis can achieve good functional results
in most patients, although the rates of complications and subsequent
amputation are higher than in patients treated with intra-articular
resection. Cite this article:
The World Health Organization (WHO) and the Centre
for Disease Control and Prevention (CDC) recently published guidelines
for the prevention of surgical site infection. The WHO guidelines,
if implemented worldwide, could have an immense impact on our practices
and those of the CDC have implications for healthcare policy in
the United States. Our aim was to review the strategies for prevention of periprosthetic
joint infection in light of these and other recent guidelines. Cite this article:
We investigated the effects on fracture healing of two up-regulators of inducible nitric oxide synthase (iNOS) in a rat model of an open femoral osteotomy: tadalafil, a phosphodiesterase inhibitor, and the recently reported nutraceutical, COMB-4 (consisting of L-citrulline, Paullinia cupana, ginger and muira puama), given orally for either 14 or 42 days. Unilateral femoral osteotomies were created in 58 male rats and fixed with an intramedullary compression nail. Rats were treated daily either with vehicle, tadalafil or COMB-4. Biomechanical testing of the healed fracture was performed on day 42. The volume, mineral content and bone density of the callus were measured by quantitative CT on days 14 and 42. Expression of iNOS was measured by immunohistochemistry.Objectives
Materials and Methods
Fractures around total knee arthroplasties pose
a significant surgical challenge. Most can be managed with osteosynthesis
and salvage of the replacement. The techniques of fixation of these
fractures and revision surgery have evolved and so has the assessment
of outcome. This specialty update summarises the current evidence
for the classification, methods of fixation, revision surgery and
outcomes of the management of periprosthetic fractures associated
with total knee arthroplasty. Cite this article:
Extendible endoprostheses have been available for more than 30
years and have become more sophisticated with time. The latest generation
is ‘non-invasive’ and can be lengthened with an external magnetic
force. Early results have shown a worryingly high rate of complications
such as infection. This study investigates the incidence of complications
and the need for further surgery in a cohort of patients with a
non-invasive growing endoprosthesis. Between 2003 and June 2014, 50 children (51 prostheses) had a
non-invasive growing prosthesis implanted for a primary bone sarcoma.
The minimum follow-up was 24 months for those who survived. Their
mean age was 10.4 years (6 to 14). The incidence of complications
and further surgery was documented.Aims
Patients and Methods
Periprosthetic joint infection (PJI) complicates
between 0.5% and 1.2% primary total hip arthroplasties (THAs) and
may have devastating consequences. The traditional assessment of
patients suffering from PJI has involved the serological study of
inflammatory markers and microbiological analysis of samples obtained
from the joint space. Treatment has involved debridement and revision
arthroplasty performed in either one or two stages. We present an update on the burden of PJI, strategies for its
diagnosis and treatment, the challenge of resistant organisms and
the need for definitive evidence to guide the treatment of PJI after
THA. Cite this article:
The purpose of this article is to provide the
reader with a seven-step checklist that could help in minimising
the risk of PJI. The check list includes strategies that can be
implemented pre-operatively such as medical optimisation, and reduction
of the bioburden by effective skin preparation or actions taking
during surgery such as administration of timely and appropriate
antibiotics or blood conservation, and finally implementation of
post-operative protocols such as efforts to minimise wound drainage
and haematoma formation. Cite this article:
The aim of this study was to evaluate whether
coating titanium discs with selenium in the form of sodium selenite decreased
bacterial adhesion of In order to evaluate bacterial adhesion, sterile titanium discs
were coated with increasing concentrations of selenium and incubated
with bacterial solutions of The tested Selenium coating is a promising method to reduce bacterial attachment
on prosthetic material. Cite this article:
The purpose of this prospective study was to evaluate the outcomes
of coccygectomy for patients with chronic coccydynia. Between 2007 and 2011, 98 patients underwent coccygectomy for
chronic coccydynia. The patients were aged >
18 years, had coccygeal
pain, local tenderness and a radiological abnormality, and had failed
conservative management. Outcome measures were the Short Form 36
(SF-36), the Oswestry Disability Index (ODI) and a visual analogue
scale (VAS) for pain. Secondary analysis compared the pre-operative
features and the outcomes of patients with successful and failed
treatment, two years post-operatively. The threshold for success
was based on a minimum clinically important difference (MCID) on
the ODI of 20 points. All other patients, including those lost to
follow-up, were classified as failures.Aims
Patients and Methods
The period of post-operative treatment before surgical wounds
are completely closed remains a key window, during which one can
apply new technologies that can minimise complications. One such
technology is the use of negative pressure wound therapy to manage
and accelerate healing of the closed incisional wound (incisional
NPWT). We undertook a literature review of this emerging indication
to identify evidence within orthopaedic surgery and other surgical
disciplines. Literature that supports our current understanding
of the mechanisms of action was also reviewed in detail. Objectives
Methods
A self-control ratio, the spine-pelvis index
(SPI), was proposed for the assessment of patients with adolescent idiopathic
scoliosis (AIS) in this study. The aim was to evaluate the disproportionate
growth between the spine and pelvis in these patients using SPI.
A total of 64 female patients with thoracic AIS were randomly enrolled
between December 2010 and October 2012 (mean age 13 years, standard
deviation ( No significant difference in SPI was found in different age groups
in the control group, making the SPI an age-independent parameter
with a mean value of 2.219 (2.164 to 2.239). We also found that
the SPI was not related to maturity in the control group. This study, for the first time, used a self-control ratio to
confirm the disproportionate patterns of growth of the spine and
pelvis in patients with thoracic AIS, highlighting that the SPI
is not affected by age or maturity. Cite this article:
There has been a substantial increase in the
number of hip and knee prostheses implanted in recent years, with
a consequent increase in the number of revisions required. Total
femur replacement (TFR) following destruction of the entire femur,
usually after several previous revision operations, is a rare procedure
but is the only way of avoiding amputation. Intramedullary femur
replacement (IFR) with preservation of the femoral diaphysis is
a modification of TFR. Between 1999 and 2010, 27 patients with non-oncological
conditions underwent surgery in our department with either IFR (n
= 15) or TFR (n = 12) and were included in this study retrospectively.
The aim of the study was to assess the indications, complications
and outcomes of IFR and TFR in revision cases. The mean follow-up
period was 31.3 months (6 to 90). Complications developed in 37%
of cases, 33% in the IFR group and 4% in the TFR group. Despite
a trend towards a slightly better functional outcome compared with
TFR, the indication for intramedullary femur replacement should
be established on a very strict basis in view of the procedure’s
much higher complication rate.
