The aim of this study was to analyse the effect of altered viewing
perspectives on the measurement of the glenopolar angle (GPA) and
the differences between these measurements made on 3D CT reconstructions
and anteroposterior (AP) scapular view radiographs. The influence of the viewing perspective on the GPA was assessed,
as were the differences in the measurements of the GPA between 3D
CT reconstructions and AP scapular view radiographs in 68 cadaveric
scapulae.Aims
Materials and Methods
The aim of the current study was to assess whether calcaneal broadband ultrasound attenuation (BUA) can predict whole body and regional dual-energy x-ray absorptiometry (DXA)-derived bone mass in healthy, Australian children and adolescents at different stages of maturity. A total of 389 boys and girls across a wide age range (four to 18 years) volunteered to participate. The estimated age of peak height velocity (APHV) was used to classify children into pre-, peri-, and post-APHV groups. BUA was measured at the non-dominant heel with quantitative ultrasonometry (QUS) (Lunar Achilles Insight, GE), while bone mineral density (BMD) and bone mineral content (BMC) were examined at the femoral neck, lumbar spine and whole body (DXA, XR-800, Norland). Associations between BUA and DXA-derived measures were examined with Pearson correlations and linear regression. Participants were additionally ranked in quartiles for QUS and DXA measures in order to determine agreement in rankings.Objectives
Methods
Although vertebroplasty is very effective for relieving acute pain from an osteoporotic vertebral compression fracture, not all patients who undergo vertebroplasty receive the same degree of benefit from the procedure. In order to identify the ideal candidate for vertebroplasty, pre-operative prognostic demographic or clinico-radiological factors need to be identified. The objective of this study was to identify the pre-operative prognostic factors related to the effect of vertebroplasty on acute pain control using a cohort of surgically and non-surgically managed patients. Patients with single-level acute osteoporotic vertebral compression fracture at thoracolumbar junction (T10 to L2) were followed. If the patients were not satisfied with acute pain reduction after a three-week conservative treatment, vertebroplasty was recommended. Pain assessment was carried out at the time of diagnosis, as well as three, four, six, and 12 weeks after the diagnosis. The effect of vertebroplasty, compared with conservative treatment, on back pain (visual analogue score, VAS) was analysed with the use of analysis-of-covariance models that adjusted for pre-operative VAS scores.Objectives
Patients and Methods
Smoking is associated with post-operative complications but smokers
often under-report the amount they smoke. Our objective was to determine
whether a urine dipstick test could be used as a substitute for
quantitative cotinine assays to determine smoking status in patients. Between September 2013 and July 2014 we conducted a prospective
cohort study in which 127 consecutive patients undergoing a planned
foot and ankle arthrodesis or osteotomy were included. Patients
self-reported their smoking status and were classified as: ‘never
smoked’ (61 patients), ‘ex-smoker’ (46 patients), or ‘current smoker’ (20
patients). Urine samples were analysed with cotinine assays and
cotinine dipstick tests.Aims
Patients and Methods
The surgical management of ankle arthritis with tibiotalar arthrodesis
is known to alter gait, as compared with normal ankles. The purpose
of this study was to assess post-operative gait function with gait
before arthrodesis. We prospectively studied 20 patients who underwent three-dimensional
gait analysis before and after tibiotalar arthrodesis. Cadence,
step length, walking velocity and total support time were assessed.
Kinetic parameters, including the moment and power of the ankle
in the sagittal plane and hip power were also recorded.Aims
Patients and Methods
The interest in unicompartmental knee arthroplasty (UKA) for
medial osteoarthritis has increased rapidly but the long-term follow-up
of the Oxford UKAs has yet to be analysed in non-designer centres.
We have examined our ten- to 15-year clinical and radiological follow-up
data for the Oxford Phase III UKAs. Between January 1999 and January 2005 a total of 138 consecutive
Oxford Phase III arthroplasties were performed by a single surgeon
in 129 patients for medial compartment osteoarthritis (71 right
and 67 left knees, mean age 72.0 years (47 to 91), mean body mass
index 28.2 (20.7 to 52.2)). Both clinical data and radiographs were
prospectively recorded and obtained at intervals. Of the 129 patients,
32 patients (32 knees) died, ten patients (12 knees) were not able
to take part in the final clinical and radiological assessment due
to physical and mental conditions, but via telephone interview it
was confirmed that none of these ten patients (12 knees) had a revision
of the knee arthroplasty. One patient (two knees) was lost to follow-up.Aims
Patients and Methods
We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis. The MEDLINE, EMBASE and Cochrane Library databases were searched using defined search terms. The primary outcome measure was spinal fusion, assessed as success or failure in accordance with radiograph, MRI or CT scan review at 24-month follow-up. The secondary outcome measure was time to fusion.Objectives
Methods
We present the clinical and radiographic outcome of 81 children
with Gartland type I to III supracondylar humeral fractures at a
minimum follow-up of ten years (mean 12.1 years; 10.3 to 16.1) following
injury. The clinical and functional outcomes are compared with normal
age- and gender-matched individuals. The population-based study
setting was first identified from the institutional registries;
the rate of participation was 76%. Controls were randomly selected
from Finnish National Population Registry.Aims
Patients and Methods
Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck. The trial manual illustrated the Neer classification of proximal humeral fractures. However, in addition to surgical neck displacement, surgeons assessing patient eligibility reported on whether either or both of the tuberosities were involved. Anonymised electronic versions of baseline radiographs were sought for all 250 trial participants. A protocol, data collection tool and training presentation were developed and tested in a pilot study. These were then used in a formal assessment and classification of the trial fractures by two independent senior orthopaedic shoulder trauma surgeons.Objectives
Methods
Our aim was to determine whether, based on the current literature,
bariatric surgery prior to total hip (THA) or total knee arthroplasty
(TKA) reduces the complication rates and improves the outcome following
arthroplasty in obese patients. A systematic literature search was undertaken of published and
unpublished databases on the 5 November 2015. All papers reporting
studies comparing obese patients who had undergone bariatric surgery
prior to arthroplasty, or not, were included. Each study was assessed
using the Downs and Black appraisal tool. A meta-analysis of risk ratios
(RR) and 95% confidence intervals (CI) was performed to determine
the incidence of complications including wound infection, deep vein
thrombosis (DVT), pulmonary embolism (PE), revision surgery and
mortality.Aims
Methods
The primary purpose of this meta-analysis was to determine whether statin usage could reduce the risk of glucocorticoid-related osteonecrosis in animal models. A systematic literature search up to May 2015 was carried out using the PubMed, Ovid, EBM reviews, ISI Web of Science, EBSCO, CBM, CNKI databases with the term and boolean operators: statins and osteonecrosis in all fields. Risk ratio (RR), as the risk estimate of specific outcome, was calculated along with 95% confidence intervals (CI). The methodological quality of individual studies was assessed using a quantitative tool based on the updated Stroke Therapy Academic Industry Roundtable (STAIR) recommendations.Objectives
Methods
We sought to determine if a durable bilayer implant composed of trabecular metal with autologous periosteum on top would be suitable to reconstitute large osteochondral defects. This design would allow for secure implant fixation, subsequent integration and remodeling. Adult sheep were randomly assigned to one of three groups (n = 8/group): 1. trabecular metal/periosteal graft (TMPG), 2. trabecular metal (TM), 3. empty defect (ED). Cartilage and bone healing were assessed macroscopically, biochemically (type II collagen, sulfated glycosaminoglycan (sGAG) and double-stranded DNA (dsDNA) content) and histologically.Objectives
Materials and Methods
The optimal treatment for independent patients with a displaced
intracapsular fracture of the hip remains controversial. The recognised
alternatives are hemiarthroplasty and total hip arthroplasty. At
present there is no established standard of care, with both types
of arthroplasty being used in many centres. We conducted a feasibility study comparing the clinical effectiveness
of a dual mobility acetabular component compared with standard polyethylene
component in total hip arthroplasty for independent patients with
a displaced intracapsular fracture of the hip, for a 12-month period
beginning in June 2013. The primary outcome was the risk of dislocation
one year post-operatively. Secondary outcome measures were EuroQol
5 Dimensions, ICEpop CAPability measure for Older people, Oxford
hip score, mortality and re-operation.Aims
Patients and Methods
The diagnosis of surgical site infection following endoprosthetic reconstruction for bone tumours is frequently a subjective diagnosis. Large clinical trials use blinded Central Adjudication Committees (CACs) to minimise the variability and bias associated with assessing a clinical outcome. The aim of this study was to determine the level of inter-rater and intra-rater agreement in the diagnosis of surgical site infection in the context of a clinical trial. The Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial CAC adjudicated 29 non-PARITY cases of lower extremity endoprosthetic reconstruction. The CAC members classified each case according to the Centers for Disease Control (CDC) criteria for surgical site infection (superficial, deep, or organ space). Combinatorial analysis was used to calculate the smallest CAC panel size required to maximise agreement. A final meeting was held to establish a consensus.Objectives
Materials and Methods
A trial-based comparison of the use of resources, costs and quality
of life outcomes of arthroscopic and open surgical management for
rotator cuff tears in the United Kingdom NHS was performed using
data from the United Kingdom Rotator Cuff Study (UKUFF) randomised
controlled trial. Using data from 273 patients, healthcare-related use of resources,
costs and quality-adjusted life years (QALYs) were estimated at
12 months and 24 months after surgery on an intention-to-treat basis
with adjustment for covariates. Uncertainty about the incremental
cost-effectiveness ratio for arthroscopic Aims
Patients and Methods
