Using a systematic review, we investigated whether there is an
increased risk of post-operative infection in patients who have
received an intra-articular corticosteroid injection to the hip
for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection
to the hip and infection following subsequent THA were identified
from databases for the period between 1990 to 2013. Retrieved articles
were independently assessed for their methodological quality.Aims
Methods
The authors present the results of a cohort study of 60 adult
patients presenting sequentially over a period of 15 years from
1997 to 2012 to our hospital for treatment of thoracic and/or lumbar
vertebral burst fractures, but without neurological deficit. All patients were treated by early mobilisation within the limits
of pain, early bracing for patient confidence and all progress in
mobilisation was recorded on video. Initial hospital stay was one
week. Subsequent reviews were made on an outpatient basis. Aims
Method
Pelvic obliquity is a common finding in adolescents
with cerebral palsy, however, there is little agreement on its measurement
or relationship with hip development at different gross motor function
classification system (GMFCS) levels. The purpose of this investigation was to study these issues in
a large, population-based cohort of adolescents with cerebral palsy
at transition into adult services. The cohort were a subset of a three year birth cohort (n = 98,
65M: 33F, with a mean age of 18.8 years (14.8 to 23.63) at their
last radiological review) with the common features of a migration
percentage greater than 30% and a history of adductor release surgery. Different radiological methods of measuring pelvic obliquity
were investigated in 40 patients and the angle between the acetabular
tear drops (ITDL) and the horizontal reference frame of the radiograph
was found to be reliable, with good face validity. This was selected
for further study in all 98 patients. The median pelvic obliquity was 4° (interquartile range 2° to
8°). There was a strong correlation between hip morphology and the
presence of pelvic obliquity (effect of ITDL on Sharpe’s angle in
the higher hip; rho 7.20 (5% confidence interval 5.59 to 8.81, p
<
0.001). This was particularly true in non-ambulant adolescents
(GMFCS IV and V) with severe pelvic obliquity, but was also easily
detectable and clinically relevant in ambulant adolescents with mild
pelvic obliquity. The identification of pelvic obliquity and its management deserves
closer scrutiny in children and adolescents with cerebral palsy. Cite this article:
The last decade has seen a considerable increase
in the use of in total ankle arthroplasty (TAA) to treat patients
with end-stage arthritis of the ankle. However, the longevity of
the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment
algorithm for the painful TAA to be used when considering revision
surgery. Cite this article:
Our purpose was to determine the quality of current randomised
controlled trials (RCTs) in hand surgery using standardised metrics. Based on five-year mean impact factors, we selected the six journals
that routinely publish studies of upper extremity surgery. Using
a journal-specific search query, 62 RCTs met our inclusion criteria.
Then three blinded reviewers used the Jadad and revised Coleman Methodology
Score (RCMS) to assess the quality of the manuscripts.Aims
Materials and Methods
We evaluated the outcome of treatment of nonunion
of an intracapsular fracture of the femoral neck in young patients
using two cannulated screws and a vascularised bone graft. A total
of 32 patients (15 women and 17 men, with a mean age of 36.5 years;
20 to 50) with failed internal fixation of an intracapsular fracture
were included in the study. Following removal of the primary fixation,
two cannulated compression screws were inserted with a vascularised
iliac crest bone graft based on the ascending branch of the lateral
femoral circumflex artery. At a mean follow-up of 6.8 years (4 to 10), union was achieved
in 27 hips (84%). A total of five patients with a mean age of 40.5
years (35 to 50) had a persistent nonunion and underwent total hip
arthroplasty as also did two patients whose fracture united but
who developed osteonecrosis of the femoral head two years post-operatively. Statistical
analysis showed that younger patients achieved earlier and more
reliable union (p <
0.001). The functional outcome, as assessed
by the Harris Hip score, was better in patients aged <
45 years
compared with those aged >
45 years (p <
0.001). These findings suggest that further fixation using two cannulated
compression screws and a vascularised iliac crest bone graft is
an effective salvage treatment in patients aged <
45 years, in
whom osteosynthesis of a displaced intracapsular fractures of the
femoral neck has failed. Cite this article:
We aimed to quantify the relative contributions of the medial
femoral circumflex artery (MFCA) and lateral femoral circumflex
artery (LFCA) to the arterial supply of the head and neck of the
femur. We acquired ten cadaveric pelvises. In each of these, one hip
was randomly assigned as experimental and the other as a matched
control. The MFCA and LFCA were cannulated bilaterally. The hips
were designated LFCA-experimental or MFCA-experimental and underwent
quantitative MRI using a 2 mm slice thickness before and after injection
of MRI-contrast diluted 3:1 with saline (15 ml Gd-DTPA) into either
the LFCA or MFCA. The contralateral control hips had 15 ml of contrast
solution injected into the root of each artery. Next, the MFCA and
LFCA were injected with a mixture of polyurethane and barium sulfate
(33%) and their extra-and intra-arterial course identified by CT
imaging and dissection.Aims
Materials and Methods
The aims of this study were to describe the course of non-operatively
managed, bilateral Perthes’ disease, and to determine specific prognostic
factors for the radiographic and clinical outcome. We identified 40 children with a mean age of 5.9 years (1.8 to
13.5), who were managed non-operatively for bilateral Perthes’ disease
from our prospective, multicentre study of this condition, which
included all children in Norway who were diagnosed with Perthes’
disease in the five-year period between 1996 and 2000. All children
were followed up for five years. The hips were classified according to the Catterall classification.
A modified three-group Stulberg classification was used as an outcome
measure, with a spherical femoral head being defined as a good outcome,
an oval head as fair, and a flat femoral head as a poor outcome. Aims
Patients and Methods
The widespread use of MRI has revolutionised
the diagnostic process for spinal disorders. A typical protocol
for spinal MRI includes T1 and T2 weighted sequences in both axial
and sagittal planes. While such an imaging protocol is appropriate
to detect pathological processes in the vast majority of patients,
a number of additional sequences and advanced techniques are emerging.
The purpose of the article is to discuss both established techniques
that are gaining popularity in the field of spinal imaging and to
introduce some of the more novel ‘advanced’ MRI sequences with examples
to highlight their potential uses. Cite this article:
We present an audit comparing our level I major trauma centre’s
data for a cohort of patients with hip fractures in the National
Hip Fracture Database (NHFD) with locally held data on these patients. A total of 2036 records for episodes between July 2009 and June
2014 were reviewed. Aims
Patients and Methods
The August 2015 Research Roundup360 looks at: Lightbulbs, bleeding and procedure durations; Infection and rheumatoid agents; Infection rates and ‘bundles of care’ revisited; ACI: new application for a proven technology?; Hydrogel coating given the thumbs up; Hydroxyapatite as a smart coating?
Accurate placement of the acetabular component during total hip
arthroplasty (THA) is an important factor in the success of the
procedure. However, the reported accuracy varies greatly and is
dependent upon whether free hand or navigated techniques are used.
The aim of this study was to assess the accuracy of an instrument
system that incorporates 3D printed, patient-specific guides designed
to optimise the placement of the acetabular component. A total of 100 consecutive patients were prospectively enrolled
and the accuracy of placement of the acetabular component was measured
using post-operative CT scans.Aims
Patients and Methods
This study aimed to determine the relationship between pedicle-lengthening
distance and bulge-canal volume ratio in cases of lumbar spinal
stenosis, to provide a theoretical basis for the extent of lengthening
in pedicle-lengthening osteotomies. Three-dimensional reconstructions of CT images were performed
for 69 patients (33 men and 36 women) (mean age 49.96 years; 24
to 81). Simulated pedicle-lengthening osteotomies and disc bulge
and spinal canal volume calculations were performed using Mimics
software. Aims
Methods
We investigated changes in the axial alignment of the ipsilateral
hip and knee after total hip arthroplasty (THA). We reviewed 152 patients undergoing primary THA (163 hips; 22
hips in men, 141 hips in women) without a pre-operative flexion
contracture. The mean age was 64 years (30 to 88). The diagnosis
was osteoarthritis (OA) in 151 hips (primary in 18 hips, and secondary
to dysplasia in 133) and non-OA in 12 hips. A posterolateral approach
with repair of the external rotators was used in 134 hips and an
anterior approach in 29 hips. We measured changes in leg length
and offset on radiographs, and femoral anteversion, internal rotation
of the hip and lateral patellar tilt on CT scans, pre- and post-operatively. Aims
Patients and Methods
The National Joint Registry for England, Wales and Northern Ireland
(NJR) has extended its scope to report on hospital, surgeon and
implant performance. Data linkage of the NJR to the London Implant
Retrieval Centre (LIRC) has previously evaluated data quality for
hip primary procedures, but did not assess revision records. We analysed metal-on-metal hip revision procedures performed
between 2003 and 2013. A total of 69 929 revision procedures from
the NJR and 929 revised pairs of components from the LIRC were included.Aims
Methods
In this paper we propose a new classification
of neurogenic peri-articular heterotopic ossification (HO) of the
hip based on three-dimensional (3D) CT, with the aim of improving
pre-operative planning for its excision. A total of 55 patients (73 hips) with clinically significant
HO after either traumatic brain or spinal cord injury were assessed
by 3D-CT scanning, and the results compared with the intra-operative
findings. At operation, the gross pathological anatomy of the HO as identified
by 3D-CT imaging was confirmed as affecting the peri-articular hip
muscles to a greater or lesser extent. We identified seven patterns
of involvement: four basic (anterior, medial, posterior and lateral)
and three mixed (anteromedial, posterolateral and circumferential).
Excellent intra- and inter-observer agreement, with kappa values
>
0.8, confirmed the reproducibility of the classification system. We describe the different surgical approaches used to excise
the HO which were guided by the 3D-CT findings. Resection was always
successful. 3D-CT imaging, complemented in some cases by angiography, allows
the surgeon to define the 3D anatomy of the HO accurately and to
plan its surgical excision with precision. Cite this article:
