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
Our aim was to analyse the long-term functional outcome of two
forms of surgical treatment for active patients aged >
70 years
with a displaced intracapsular fracture of the femoral neck. Patients
were randomised to be treated with either a hemiarthroplasty or
a total hip arthroplasty (THA). The outcome five years post-operatively
for this cohort has previously been reported. We present the outcome
at 12 years post-operatively. Initially 252 patients with a mean age of 81.1 years (70.2 to
95.6) were included, of whom 205 (81%) were women. A total of 137
were treated with a cemented hemiarthroplasty and 115 with a cemented
THA. At long-term follow-up we analysed the modified Harris Hip
Score (HHS), post-operative complications and intra-operative data
of the patients who were still alive.Aims
Patients and Methods
While medial unicompartmental knee arthroplasty (UKA) is indicated
for patients with full-thickness cartilage loss, it is occasionally
used to treat those with partial-thickness loss. The aim of this
study was to investigate the five-year outcomes in a consecutive
series of UKAs used in patients with partial thickness cartilage
loss in the medial compartment of the knee. Between 2002 and 2014, 94 consecutive UKAs were undertaken in
90 patients with partial thickness cartilage loss and followed up
independently for a mean of six years (1 to 13). These patients
had partial thickness cartilage loss either on both femur and tibia
(13 knees), or on either the femur or the tibia, with full thickness
loss on the other surface of the joint (18 and 63 knees respectively).
Using propensity score analysis, these patients were matched 1:2 based
on age, gender and pre-operative Oxford Knee Score (OKS) with knees
with full thickness loss on both the femur and tibia. The functional
outcomes, implant survival and incidence of re-operations were assessed
at one, two and five years post-operatively. A subgroup of 36 knees
in 36 patients with partial thickness cartilage loss, who had pre-operative
MRI scans, was assessed to identify whether there were any factors
identified on MRI that predicted the outcome.Aims
Patients and Methods
The aims of this study were to increase the diagnostic accuracy
of the analysis of synovial fluid in the differentiation of prosthetic
joint infection (PJI) by the addition of inexpensive biomarkers
such as the levels of C-reactive protein (CRP), adenosine deaminase
(ADA), alpha-2-macrogloblulin (α2M) and procalcitonin. Between January 2013 and December 2015, synovial fluid and removed
implants were requested from 143 revision total joint arthroplasties.
A total of 55 patients met inclusion criteria of the receipt of
sufficient synovial fluid, tissue samples and removed implants for
analysis. The diagnosis of PJI followed the definition from a recent International
Consensus Meeting to create two groups of patients; septic and aseptic.
Using receiver operating characteristic curves we determined the
cutoff values and diagnostic accuracy for each marker.Aims
Patients and Methods
Treatment guidelines for atypical femoral fractures associated
with bisphosphonates have not been established. We conducted a systematic
review of the treatment of atypical femoral fractures first, to
evaluate the outcomes of surgical fixation of complete atypical fractures
and secondly, to assess whether prophylactic surgery is necessary
for incomplete atypical fractures. Case reports and series were identified from the PubMed database
and were included if they described the treatment of atypical femoral
fractures. In total, 77 publications met our inclusion criteria
and 733 patients with 834 atypical complete or incomplete femoral fractures
were identified.Aims
Materials and Methods
To analyse the effectiveness of debridement and implant retention
(DAIR) in patients with hip periprosthetic joint infection (PJI)
and the relationship to patient characteristics. The outcome was
evaluated in hips with confirmed PJI and a follow-up of not less
than two years. Patients in whom DAIR was performed were identified from our
hip arthroplasty register (between 2004 and 2013). Adherence to
criteria for DAIR was assessed according to a previously published
algorithm.Aims
Patients and Methods
To analyse the influence of upper extremity trauma on the long-term
outcome of polytraumatised patients. A total of 629 multiply injured patients were included in a follow-up
study at least ten years after injury (mean age 26.5 years, standard
deviation 12.4). The extent of the patients’ injury was classified
using the Injury Severity Score. Outcome was measured using the
Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation
duration, and employment status. Outcomes for patients with and
without a fracture of the upper extremity were compared and analysed
with regard to specific fracture regions and any additional brachial
plexus lesion.Aims
Patients and Methods
Hemiarthroplasty of the hip is usually carried out through either
a direct lateral or posterior approach. The aim of this prospective
observational study was to determine any differences in patient-reported
outcomes between the two surgical approaches. From the Swedish Hip Arthroplasty Register we identified patients
of 70 years and above who were recorded as having had a hemiarthroplasty
during 2009. Only patients who had been treated with modern prostheses
were included. A questionnaire was posted to those who remained
alive one year after surgery. A total of 2118 patients (78% of those
available) with a mean age of 85 years (70 to 102) returned the
questionnaire. Aims
Patients and Methods
Periacetabular osteotomy is an effective way of treating symptomatic
hip dysplasia. We describe a new minimally invasive technique using
a modification of the Smith-Peterson approach. We performed a prospective, longitudinal cohort study to assess
for any compromise in acetabular correction when using this approach,
and to see if the procedure would have a higher complication rate
than that quoted in the literature for other approaches. We also
assessed for any improvement in functional outcome. From 168 consecutive patients (189 hips) who underwent acetabular
correction between March 2010 and March 2013 we excluded those who
had undergone previous pelvic surgery for DDH and those being treated
for acetabular retroversion. The remaining 151 patients (15 men,
136 women) (166 hips) had a mean age of 32 years (15 to 56) and the
mean duration of follow-up was 2.8 years (1.2 to 4.5). In all 90%
of cases were Tönnis grade 0 or 1. Functional outcomes were assessed
using the Non Arthritic Hip Score (NAHS), University of California,
Los Angeles (UCLA) and Tegner activity scores.Aims
Patients 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
Nail patella syndrome (NPS) is a skeletal dysplasia with patellofemoral
dysfunction as a key symptom. We present the first in-depth radiological
evaluation of the knee in a large series of NPS patients and describe
the typical malformations. Conventional radiological examination of 95 skeletally mature
patients with NPS was performed. Patellar morphology was classified
according to the Wiberg classification as modified by Baumgartl
and Ficat criteria, and trochlear shape was classified according
to the Dejour classification.Aim
Patients and Methods
Vascular injuries during total hip arthroplasty
(THA) are rare but when they occur, have serious consequences. These have
traditionally been managed with open exploration and repair, but
more recently there has been a trend towards percutaneous endovascular
management. We performed a systematic review of the literature to assess
if this change in trend has led to an improvement in the overall
reported rates of morbidity and mortality during the last 22 years
in comparison with the reviews of the literature published previously. We found a total of 61 articles describing 138 vascular injuries
in 124 patients. Injuries because of a laceration were the most
prevalent (n = 51, 44%) and the most common presenting feature,
when recorded, was bleeding (n = 41, 53.3%). Delay in diagnosis
was associated with the type of vascular lesion (p <
0.001) and
the clinical presentation (p = 0.002). Open exploration and repair was the most common form of management,
however percutaneous endovascular intervention was used in one third
of the injuries and more constantly during the last 13 years. The main overall reported complications included death (n = 9,
7.3%), amputation (n = 2, 1.6%), and persistent ischaemia (n = 9,
7.3%). When compared with previous reviews there was a similar rate
of mortality but lower rates of amputation and permanent disability,
especially in patients managed by endovascular strategies. Cite this article:
Lumbar disc herniation (LDH) is uncommon in youth
and few cases are treated surgically. Very few outcome studies exist
for LDH surgery in this age group. Our aim was to explore differences
in gender in pre-operative level of disability and outcome of surgery
for LDH in patients aged ≤ 20 years using prospectively collected
data. From the national Swedish SweSpine register we identified 180
patients with one-year and 108 with two-year follow-up data ≤ 20
years of age, who between the years 2000 and 2010 had a primary
operation for LDH. Both male and female patients reported pronounced impairment
before the operation in all patient reported outcome measures, with
female patients experiencing significantly greater back pain, having
greater analgesic requirements and reporting significantly inferior
scores in EuroQol (EQ-5D-index), EQ-visual analogue scale, most aspects
of Short Form-36 and Oswestry Disabilities Index, when compared
with male patients. Surgery conferred a statistically significant
improvement in all registered parameters, with few gender discrepancies.
Quality of life at one year following surgery normalised in both
males and females and only eight patients (4.5%) were dissatisfied with
the outcome. Virtually all parameters were stable between the one-
and two-year follow-up examination. LDH surgery leads to normal health and a favourable outcome in
both male and female patients aged 20 years or younger, who failed
to recover after non-operative management. Cite this article:
It has been suggested that cemented fixation of total hip arthroplasty
(THA) is associated with an increased peri-operative mortality compared
with cementless THA. Our aim was to investigate this through a nationwide
matched cohort study adjusting for age, comorbidity, and socioeconomic
background. A total of 178 784 patients with osteoarthritis who underwent
either cemented or cementless THA from the Swedish Hip Arthroplasty
Register were matched with 862 294 controls from the general population.
Information about the causes of death, comorbidities, and socioeconomic
background was obtained. Mortality within the first 90 days after
the operation was the primary outcome measure.Aims
Patients and Methods
We evaluated the short-term functional outcome and prevalence
of bearing-specific generation of audible noise in 301 patients
(336 hips) operated on with fourth generation (Delta) medium diameter
head, ceramic-on-ceramic (CoC) total hip arthroplasties (THAs). There were 191 female (63%) and 110 male patients (37%) with
a mean age of 61 years (29 to 78) and mean follow-up of 2.1 years
(1.3 to 3.4). Patients completed three questionnaires: Oxford Hip
Score (OHS), Research and Development 36-item health survey (RAND-36)
and a noise-specific symptom questionnaire. Plain radiographs were also
analysed. A total of three hips (0.9%) were revised. Aims
Patients and Methods
The aims of this study were to establish the incidence of acute
Achilles tendon rupture (AATR) in a North American population, to
select demographic subgroups and to examine trends in the management
of this injury in the province of Ontario, Canada. Patients ≥ 18 years of age who presented with an AATR to an emergency
department in Ontario, Canada between 1 January 2003 and 31 December
2013 were identified using administrative databases. The overall
and annual incidence density rate (IDR) of AATR were calculated
for all demographic subgroups. The annual rate of surgical repair
was also calculated and compared between demographic subgroups.Aims
Patients and Methods
The optimal management of intracapsular fractures of the femoral
neck in independently mobile patients remains open to debate. Successful
fixation obviates the limitations of arthroplasty for this group
of patients. However, with fixation failure rates as high as 30%,
the outcome of revision surgery to salvage total hip arthroplasty
(THA) must be considered. We carried out a systematic review to
compare the outcomes of salvage THA and primary THA for intracapsular
fractures of the femoral neck. We performed a Preferred Reporting Items for Systematic Reviews
and Meta-Analysis (PRISMA) compliant systematic review, using the
PubMed, EMBASE and Cochrane libraries databases. A meta-analysis
was performed where possible, and a narrative synthesis when a meta-analysis
was not possible.Aims
Patients and Methods
Only limited data are available regarding the
infiltration of local anaesthetic for total hip arthroplasty (THA),
and no studies were performed for THA using the anterior approach. In this prospective, randomised placebo-controlled study we investigated
the effect of both standard and reverse infiltration of local anaesthetic
in combination with the anterior approach for THA. The primary endpoint
was the mean numeric rating score for pain four hours post-operatively.
In addition, we recorded the length of hospital stay, the operating
time, the destination of the patient at discharge, the use of pain
medication, the occurrence of side effects and pain scores at various
times post-operatively. Between November 2012 and January 2014, 75 patients were included
in the study. They were randomised into three groups: standard infiltration
of local anaesthetic, reversed infiltration of local anaesthetic,
and placebo. There was no difference in mean numeric rating score
for pain four hours post-operatively (p = 0.87). There were significantly
more side effects at one and eight hours post-operatively in the
placebo group (p = 0.02; p = 0.03), but this did not influence the
mobilisation of the patients. There were no differences in all other
outcomes between the groups. We found no clinically relevant effect when the infiltration
of local anaesthetic with ropivacaine and epinephrine was used in
a multimodal pain protocol for THA using the anterior approach. Cite this article:
Our aim was to assess the effectiveness of a protocol involving
a standardised closed reduction for the treatment of children with
developmental dysplasia of the hip (DDH) in maintaining reduction
and to report the mid-term results. A total of 133 hips in 120 children aged less than two years
who underwent closed reduction, with a minimum follow-up of five
years or until subsequent surgery, were included in the study. The
protocol defines the criteria for an acceptable reduction and the
indications for a concomitant soft-tissue release. All children
were immobilised in a short- leg cast for three months. Arthrograms
were undertaken at the time of closed reduction and six weeks later. Follow-up
radiographs were taken at six months and one, two and five years
later and at the latest follow-up. The Tönnis grade, acetabular
index, Severin grade and signs of osteonecrosis were recorded.Aims
Methods
Our aim was to report survivorship data and lessons learned with
the Corail/Pinnacle cementless total hip arthroplasty (THA) system. Between August 2005 and March 2015, a total of 4802 primary cementless
Corail/Pinnacle THAs were performed in 4309 patients. In March 2016,
we reviewed these hips from a prospectively maintained database.Aims
Patients and Methods
