To investigate the benefits of denosumab in combination with nerve-sparing surgery for treatment of sacral giant cell tumours (GCTs). This is a retrospective cohort study of patients with GCT who presented between January 2011 and July 2017. Intralesional curettage was performed and patients treated from 2015 to 2017 also received denosumab therapy. The patients were divided into three groups: Cohort 1: control group (n = 36); cohort 2: adjuvant denosumab group (n = 9); and cohort 3: neo- and adjuvant-denosumab group (n = 17).Aims
Methods
The aim of this study was to investigate the association between the type of operation used to treat a trochanteric fracture of the hip and 30-day mortality. Data on 82 990 patients from the National Hip Fracture Database were analyzed using generalized linear models with incremental case-mix adjustment for patient, non-surgical and surgical characteristics, and socioeconomic factors.Aims
Patients and Methods
In this randomized study, we aimed to compare quality of regenerate in monolateral Both groups were comparable in demographic and injury characteristics. A phantom (aluminium step wedge of increasing thickness) was designed to compare the density of regenerate on radiographs. A CT scan was performed at three and six months postoperatively to assess regenerate density. A total of 30 patients (29 male, one female; mean age 32.54 years (18 to 60)) with an infected nonunion of a tibial fracture presenting to our tertiary institute between June 2011 and April 2016 were included in the study.Aims
Patients and Methods
The aim of this paper was to present the clinical features of
patients with musculoskeletal sources of methicillin-sensitive A total of 137 patients presented with MSSA septicaemia between
2012 and 2015. The primary source of infection was musculoskeletal
in 48 patients (35%). Musculoskeletal infection was considered the
primary source of septicaemia when endocarditis and other obvious
sources were excluded. All patients with an arthroplasty at the time
were evaluated for any prosthetic involvement. Aims
Patients and Methods
The aim of this study was to evaluate the outcome of spinal instrumentation in haemodialyzed patients with native pyogenic spondylodiscitis. Spinal instrumentation in these patients can be dangerous due to rates of complications and mortality, and biofilm formation on the instrumentation. A total of 134 haemodialyzed patients aged more than 50 years who underwent surgical treatment for pyogenic spondylodiscitis were included in the study. Their mean age was 66.4 years (50 to 83); 66 were male (49.3%) and 68 were female (50.7%). They were divided into two groups according to whether spinal instrumentation was used or not. Propensity score matching was used to attenuate the potential selection bias. The outcome of treatment was compared between these two groups.Aims
Patients and Methods
The aim of this study was to compare the rate of perioperative
complications following aseptic revision total hip arthroplasty
(THA) in patients aged ≥ 80 years with that in those aged <
80
years, and to identify risk factors for the incidence of serious
adverse events in those aged ≥ 80 years using a large validated
national database. Patients who underwent aseptic revision THA were identified in
the 2005 to 2015 National Surgical Quality Improvement Program (NSQIP)
database and stratified into two age groups: those aged <
80
years and those aged ≥ 80 years. Preoperative and procedural characteristics
were compared. Multivariate regression analysis was used to compare
the risk of postoperative complications and readmission. Risk factors
for the development of a serious adverse event in those aged ≥ 80
years were characterized.Aims
Patients and Methods
Tuberculosis (TB) remains endemic in many parts
of the developing world and is increasingly seen in the developed world
due to migration. A total of 1.3 million people die annually from
the disease. Spinal TB is the most common musculoskeletal manifestation,
affecting about 1 to 2% of all cases of TB. The coexistence of HIV,
which is endemic in some regions, adds to the burden and the complexity
of management. This review discusses the epidemiology, clinical presentation,
diagnosis, impact of HIV and both the medical and surgical options
in the management of spinal TB. Cite this article:
Cementless primary total hip arthroplasty (THA) is associated with risks of bleeding and thromboembolism. Anticoagulants are effective as venous thromboprophylaxis, but with an increased risk of bleeding. Tranexamic acid (TXA) is an efficient antifibrinolytic agent, but the mode and timing of its administration remain controversial. This study aimed to determine whether two intravenous (IV) TXA regimens (a three-hour two-dose (short-TXA) and 11-hour four-dose (long-TXA)) were more effective than placebo in reducing perioperative real blood loss (RBL, between baseline and day 3 postoperatively) in patients undergoing THA who receive rivaroxaban as thromboprophylaxis. The secondary aim was to assess the non-inferiority of the reduction of blood loss of the short protocol A multicentre, prospective, randomized, double-blind, placebo-controlled trial was undertaken involving 229 patients undergoing primary cementless THA using a posterior approach, whose extended rivaroxaban thromboprophylaxis started on the day of surgery. There were 98 male and 131 female patients, with a mean age of 65.5 years (32 to 91). The primary outcome, perioperative RBL, was evaluated at 72 hours postoperatively. The efficacy of short- and long-TXA protocols in the reduction of perioperative RBL was compared with a placebo group.Aims
Patients and Methods
The aim of this study was to determine the influence of developmental spinal stenosis (DSS) on the risk of re-operation at an adjacent level. This was a retrospective study of 235 consecutive patients who had undergone decompression-only surgery for lumbar spinal stenosis and had a minimum five-year follow-up. There were 106 female patients (45.1%) and 129 male patients (54.9%), with a mean age at surgery of 66.8 years (Aims
Patients and Methods
Multimodal infiltration of local anaesthetic provides effective
control of pain in patients undergoing total knee arthroplasty (TKA).
There is little information about the added benefits of posterior
capsular infiltration (PCI) using different combinations of local
anaesthetic agents. Our aim was to investigate the effectiveness
of the control of pain using multimodal infiltration with and without
infiltration of the posterior capsule of the knee. In a double-blind, randomised controlled trial of patients scheduled
for unilateral primary TKA, 86 were assigned to be treated with
multimodal infiltration with (Group I) or without (Group II) PCI.
Routine associated analgesia included the use of bupivacaine, morphine,
ketorolac and epinephrine. All patients had spinal anaesthesia and patient-controlled
analgesia (PCA) post-operatively. A visual analogue scale (VAS)
for pain and the use of morphine were recorded 24 hours post-operatively.
Side effects of the infiltration, blood loss, and length of stay
in hospital were recorded.Aims
Patients and Methods
To investigate whether elective joint arthroplasty performed
at the weekend is associated with a different 30-day mortality We examined the 30-day cumulative mortality rate (Kaplan-Meier)
for all elective hip and knee arthroplasties performed in England
and Wales between 1st April 2003 and 31st December 2014, comprising
118 096 episodes undertaken at the weekend and 1 233 882 episodes
performed on a weekday. We used Cox proportional-hazards regression
models to assess for time-dependent variation and adjusted for identified
risk factors for mortality.Aims
Patients and Methods
In a multicentre, randomised study of adolescents undergoing
posterior spinal fusion for idiopathic scoliosis, we investigated
the effect of adding gelatine matrix with human thrombin to the
standard surgical methods of controlling blood loss. Patients in the intervention group (n = 30) were randomised to
receive a minimum of two and a maximum of four units of gelatine
matrix with thrombin in addition to conventional surgical methods
of achieving haemostasis. Only conventional surgical methods were
used in the control group (n = 30). We measured the intra-operative
and total blood loss (intra-operative blood loss plus post-operative
drain output).Aims
Patients and Methods
The mucopolysaccharidoses (MPS) are a group of
inherited lysosomal storage disorders with clinical manifestations relevant
to the orthopaedic surgeon. Our aim was to review the recent advances
in their management and the implications for surgical practice. The current literature about MPSs is summarised, emphasising
orthopaedic complications and their management. Recent advances in the diagnosis and management of MPSs include
the recognition of slowly progressive, late presenting subtypes,
developments in life-prolonging systemic treatment and potentially
new indications for surgical treatment. The outcomes of surgery
in these patients are not yet validated and some procedures have
a high rate of complications which differ from those in patients
who do not have a MPS. The diagnosis of a MPS should be considered in adolescents or
young adults with a previously unrecognised dysplasia of the hip.
Surgeons treating patients with a MPS should report their experience
and studies should include the assessment of function and quality
of life to guide treatment. Cite this article:
Many aspects of the surgical treatment of patients with tuberculosis
(TB) of the spine, including the use of instrumentation and the
types of graft, remain controversial. Our aim was to report the
outcome of a single-stage posterior procedure, with or without posterior
decompression, in this group of patients. Between 2001 and 2010, 51 patients with a mean age of 62.5 years
(39 to 86) underwent long posterior instrumentation and short posterior
or posterolateral fusion for TB of the thoracic and lumbar spines,
followed by anti-TB chemotherapy for 12 months. No anterior debridement
of the necrotic tissue was undertaken. Posterior decompression with
laminectomy was carried out for the 30 patients with a neurological
deficit.Aim
Patients and Methods
The October 2015 Spine Roundup360 looks at: Traumatic spinal cord injury under the spotlight; The odontoid peg nonunion; Driving and spinal surgery; Drains and antibiotics post-spinal surgery; Vertebroplasty and kyphoplasty equally effective; Who will benefit from steroid injections?; Back pain following lumbar discectomy
To employ a simple and fast method to evaluate those patients with neurological deficits and misplaced screws in relatively safe lumbosacral spine, and to determine if it is necessary to undertake revision surgery. A total of 316 patients were treated by fixation of lumbar and lumbosacral transpedicle screws at our institution from January 2011 to December 2012. We designed the criteria for post-operative revision scores of pedicle screw malpositioning (PRSPSM) in the lumbosacral canal. We recommend the revision of the misplaced pedicle screw in patients with PRSPSM = 5′ as early as possible. However, patients with PRSPSM < 5′ need to follow the next consecutive assessment procedures. A total of 15 patients were included according to at least three-stage follow-up.Objectives
Methods
