The aim of this double-blind prospective randomised controlled
trial was to assess whether low intensity pulsed ultrasound (LIPUS)
accelerated or enhanced the rate of bone healing in adult patients
undergoing distraction osteogenesis. A total of 62 adult patients undergoing limb lengthening or bone
transport by distraction osteogenesis were randomised to treatment
with either an active (n = 32) or a placebo (n = 30) ultrasound
device. A standardised corticotomy was performed in the proximal
tibial metaphysis and a circular Ilizarov frame was used in all
patients. The rate of distraction was also standardised. The primary
outcome measure was the time to removal of the frame after adjusting
for the length of distraction in days/cm for both the per protocol
(PP) and the intention-to-treat (ITT) groups. The assessor was blinded
to the form of treatment. A secondary outcome was to identify covariates affecting
the time to removal of the frame.Aims
Patients and Methods
External fixators are the traditional fixation method of choice for contaminated open fractures. However, patient acceptance is low due to the high profile and therefore physical burden of the constructs. An externalised locking compression plate is a low profile alternative. However, the biomechanical differences have not been assessed. The objective of this study was to evaluate the axial and torsional stiffness of the externalised titanium locking compression plate (ET-LCP), the externalised stainless steel locking compression plate (ESS-LCP) and the unilateral external fixator (UEF). A fracture gap model was created to simulate comminuted mid-shaft tibia fractures using synthetic composite bones. Fifteen constructs were stabilised with ET-LCP, ESS-LCP or UEF (five constructs each). The constructs were loaded under both axial and torsional directions to determine construct stiffness.Objectives
Methods
Alarm over the reported high failure rates for metal-on-metal (MoM) hip implants as well as their potential for locally aggressive Adverse Reactions to Metal Debris (ARMDs) has prompted government agencies, internationally, to recommend the monitoring of patients with MoM hip implants. Some have advised that a blood ion level >7 µg/L indicates potential for ARMDs. We report a systematic review and meta-analysis of the performance of metal ion testing for ARMDs. We searched MEDLINE and EMBASE to identify articles from which it was possible to reconstruct a 2 × 2 table. Two readers independently reviewed all articles and extracted data using explicit criteria. We computed a summary receiver operating curve using a Bayesian random-effects hierarchical model.Objectives
Methods
We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice.Objectives
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
There is a paucity of information on the pre-operative coronal
imbalance in patients with degenerative lumbar scoliosis (DLS) and
its influence on surgical outcomes. A total of 284 DLS patients were recruited into this study, among
whom 69 patients were treated surgically and the remaining 215 patients
conservatively Patients were classified based on the coronal balance
distance (CBD): Type A, CBD <
3 cm; Type B, CBD >
3 cm and C7
Plumb Line (C7PL) shifted to the concave side of the curve; Type
C, CBD >
3 cm and C7PL shifted to the convex side.Aims
Patients and Methods
The aim of this study was to investigate the long-term clinical
and radiological outcome of patients who suffer recurrent injuries
to the anterior cruciate ligament (ACL) after reconstruction and
require revision surgery. From a consecutive series of 200 patients who underwent primary
reconstruction following rupture of the ACL, we identified 36 who
sustained a further rupture, 29 of whom underwent revision surgery.
Patients were reviewed prospectively at one, two, seven, 15 and
about 20 years after their original surgery. Primary outcome measures
were the number of further ruptures, the posterior tibial slope
(PTS), and functional and radiological outcomes. These were compared
with a gender and age matched cohort of patients who underwent primary
ACL reconstruction only.Aims
Patients and Methods
Our objective was to predict the knee extension strength and post-operative function in quadriceps resection for soft-tissue sarcoma of the thigh. A total of 18 patients (14 men, four women) underwent total or partial quadriceps resection for soft-tissue sarcoma of the thigh between 2002 and 2014. The number of resected quadriceps was surveyed, knee extension strength was measured with the Biodex isokinetic dynamometer system (affected side/unaffected side) and relationships between these were examined. The Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D) score and the Short Form 8 were used to evaluate post-operative function and examine correlations with extension strength. The cutoff value for extension strength to expect good post-operative function was also calculated using a receiver operating characteristic (ROC) curve and Fisher’s exact test.Objectives
Methods
In total hip arthroplasty (THA), the cementless, tapered-wedge stem design contributes to achieving initial stability and providing optimal load transfer in the proximal femur. However, loading conditions on the femur following THA are also influenced by femoral structure. Therefore, we determined the effects of tapered-wedge stems on the load distribution of the femur using subject-specific finite element models of femurs with various canal shapes. We studied 20 femurs, including seven champagne flute-type femurs, five stovepipe-type femurs, and eight intermediate-type femurs, in patients who had undergone cementless THA using the Accolade TMZF stem at our institution. Subject–specific finite element (FE) models of pre- and post-operative femurs with stems were constructed and used to perform FE analyses (FEAs) to simulate single-leg stance. FEA predictions were compared with changes in bone mineral density (BMD) measured for each patient during the first post-operative year.Objectives
Patients and Methods
Children treated for osteosarcoma around the knee often have
a substantial leg-length discrepancy at skeletal maturity. The aim
of this study was to investigate the results of staged skeletal
reconstruction after a leg lengthening procedure using an external
fixator in these patients. We reviewed 11 patients who underwent staged reconstruction with
either an arthroplasty (n = 6) or an arthrodesis (n = 5). A control
group of 11 patients who had undergone wide excision and concurrent
reconstruction with an arthroplasty were matched for gender, location,
and size of tumour. We investigated the change in leg-length discrepancy,
function as assessed by the Musculoskeletal Tumor Society Scale
(MSTS) score and complications.Aims
Patients and Methods
We conducted a randomised controlled trial to assess the accuracy
of positioning and alignment of the components in total knee arthroplasty
(TKA), comparing those undertaken using standard intramedullary
cutting jigs and those with patient-specific instruments (PSI). There were 64 TKAs in the standard group and 69 in the PSI group. The post-operative hip-knee-ankle (HKA) angle and positioning
was investigated using CT scans. Deviation of >
3° from the planned
position was regarded as an outlier. The operating time, Oxford
Knee Scores (OKS) and Short Form-12 (SF-12) scores were recorded.Aims
Patients and Methods
Tranexamic acid (TXA) is an antifibrinolytic agent used as a blood-sparing technique in total knee arthroplasty (TKA), and is routinely administered by intravenous (IV) or intra-articular (IA) injection. Recently, a novel method of TXA administration, the combined IV and IA application of TXA, has been applied in TKA. However, the scientific evidence of combined administration of TXA in TKA is still meagre. This meta-analysis aimed to investigate the efficacy and safety of combined IV and IA TXA in patients undergoing TKA. A systematic search was carried out in PubMed, the Cochrane Clinical Trial Register (Issue12 2015), Embase, Web of Science and the Chinese Biomedical Database. Only randomised controlled trials (RCT) evaluating the efficacy and safety of combined use TXA in TKA were identified. Two authors independently identified the eligible studies, extracted data and assessed the methodological quality of included studies. Meta-analysis was conducted using Review Manager 5.3 software.Objectives
Materials and Methods
The objective of this double-blind randomised controlled trial
was to assess whether ultrasound guidance improved the efficacy
of corticosteroid injections for Morton’s neuroma (MN). In all, 50 feet (40 patients) were recruited for this study but
five feet were excluded due to the patients declining further participation.
The mean age of the remaining 36 patients (45 feet) was 57.8 years
(standard deviation (Aims
Patients and Methods
The injured anterior cruciate ligament (ACL) is thought to exhibit an impaired healing response, and attempts at surgical repair have not been successful. Connective tissue growth factor (CTGF) is reported to be associated with wound healing, probably through transforming growth factor beta 1 (TGF-β1). A rabbit ACL injury model was used to study the effect of CTGF on ligament recovery. Quantitative real-time PCR (qRT-PCR) was performed for detection of changes in RNA levels of TGF-β1, type 1 collagen (COL1), type 2 collagen (COL2), SRY-related high mobility group-box gene9 (SOX9), tissue inhibitor of metalloproteinase-1 (TIMP-1) and matrix metallopeptidase 13 (MMP-13). Expression of related proteins was detected by Western blotting.Objectives
Methods
Lifestyle risk factors are thought to increase the risk of infection
after acute orthopaedic surgery but the evidence is scarce. We aimed
to investigate whether smoking, obesity and alcohol overuse are
risk factors for the development of infections after surgery for
a fracture of the ankle. We retrospectively reviewed all patients who underwent internal
fixation of a fracture of the ankle between 2008 and 2013. The primary
outcome was the rate of deep infection and the secondary outcome
was any surgical site infection (SSI). Associations with the risk
factors and possible confounding variables were analysed univariably
and multivariably with backwards elimination.Aims
Patients and Methods
To validate the English language Forgotten Joint Score-12 (FJS-12)
as a tool to evaluate the outcome of hip and knee arthroplasty in
a United Kingdom population. All patients undergoing surgery between January and August 2014
were eligible for inclusion. Prospective data were collected from
205 patients undergoing total hip arthroplasty (THA) and 231 patients
undergoing total knee arthroplasty (TKA). Outcomes were assessed
with the FJS-12 and the Oxford Hip and Knee Scores (OHS, OKS) pre-operatively,
then at six and 12 months post-operatively. Internal consistency,
convergent validity, effect size, relative validity and ceiling
effects were determined.Aims
Patients and Methods
Mechanical wear and corrosion at the head-stem junction of total hip arthroplasties (THAs) (trunnionosis) have been implicated in their early revision, most commonly in metal-on-metal (MOM) hips. We can isolate the role of the head-stem junction as the predominant source of metal release by investigating non-MOM hips; this can help to identify clinically significant volumes of material loss and corrosion from these surfaces. In this study we examined a series of 94 retrieved metal-on-polyethylene (MOP) hips for evidence of corrosion and material loss at the taper junction using a well published visual grading method and an established roundness-measuring machine protocol. Hips were retrieved from 74 male and 20 female patients with a median age of 57 years (30 to 76) and a median time to revision of 215 months (2 to 324). The reasons for revision were loosening of both the acetabular component and the stem (n = 29), loosening of the acetabular component (n = 58) and infection (n = 7). No adverse tissue reactions were reported by the revision surgeons.Objectives
Methods
In this prospective observational study, we investigated the
time-dependent changes and correlations of upper arm performance
tests (ten-second test and Simple Test for Evaluating Hand Function
(STEF), the Japanese Orthopaedic Association (JOA) score, and the
JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) in 31
patients with cervical myelopathy who had undergone surgery. We hypothesised that all the indices correlate with each other,
but show slightly different recovery patterns, and that the newly
described JOACMEQ is a sensitive outcome measure.Aims
Patients and Methods
The aim of this systematic review was to report the rate of dislocation
following the use of dual mobility (DM) acetabular components in
primary and revision total hip arthroplasty (THA). A systematic review of the literature according to the Preferred
Reporting Items for Systematic Reviews and Meta-analyses guidelines
was performed. A comprehensive search of Pubmed/Medline, Cochrane
Library and Embase (Scopus) was conducted for English articles between
January 1974 and March 2016 using various combinations of the keywords “dual
mobility”, “dual-mobility”, “tripolar”, “double-mobility”, “double
mobility”, “hip”, “cup”, “socket”. The following data were extracted
by two investigators independently: demographics, whether the operation
was a primary or revision THA, length of follow-up, the design of
the components, diameter of the femoral head, and type of fixation
of the acetabular component.Aims
Materials and Methods
Patients with osteoarthritis of the knee commonly have degenerative
meniscal tears. Arthroscopic meniscectomy is frequently performed,
although the benefits are debatable. Recent studies have concluded
that there is no role for arthroscopic washout in osteoarthritis
of the knee. Our aim was to perform a systematic review to assess
the evidence for the efficacy of arthroscopic meniscectomy in patients
with meniscal tears and degenerative changes in the knee. A literature search was performed, using the PubMed/MEDLINE database,
for relevant articles published between 1975 and 2015. A total of
six studies, including five randomised controlled trials and one
cross-sectional study of a prospective cohort, met the inclusion
criteria. Relevant information including study design, operations,
the characteristics of the patients, outcomes, adverse events and
further operations were extracted.Aims
Patients and Methods