Revision total elbow arthroplasty (TEA) is often challenging.
The aim of this study was to report on the clinical and radiological
results of revision arthroplasty of the elbow with the Latitude
TEA. Between 2006 and 2010 we used the Latitude TEA for revision in
18 consecutive elbows (17 patients); mean age 53 years (28 to 80);
14 women. A Kudo TEA was revised in 15 elbows and a Souter-Strathclyde
TEA in three. Stability, range of movement (ROM), visual analogue score (VAS)
for pain and functional scores, Elbow Functional Assessment Scale
(EFAS), the Functional Rating Index of Broberg and Morrey (FRIBM)
and the Modified Andrews’ Elbow Scoring System (MAESS) were assessed
pre-operatively and at each post-operative follow-up visit (six,
12 months and biennially thereafter). Radiographs were analysed
for loosening, fractures and dislocation. The mean follow-up was
59 months (26 to 89).Aims
Patients and Methods
Positive ulnar variance is an established risk factor for idiopathic
ulnar impaction syndrome (UIS). However, not all patients with positive
ulnar variance develop symptomatic UIS and other factors, including
the morphology of the lunate, may be involved. The aim of this study
was to clarify the relationship between lunate morphology and idiopathic
UIS. A cohort of 95 patients with idiopathic UIS (UIS group) was compared
with 95 asymptomatic controls with positive ulnar variance. The
shape of the lunate was measured using the capitate-triquetrum distance
(CTD), ulnar coverage ratio (UCR), radiolunate distance and radiolunate
angle. The association of radiographic parameters and lunate types
with the development of UIS was investigated in univariable and
multivariable analyses. Receiver operating characteristic curves
were used to estimate a cutoff for any statistically significant
variables.Aims
Patients and Methods
Sporting injuries around the ankle vary from
simple sprains that will resolve spontaneously within a few days
to severe injuries which may never fully recover and may threaten
the career of a professional athlete. Some of these injuries can
be easily overlooked altogether or misdiagnosed with potentially
devastating effects on future performance. In this review article,
we cover some of the common and important sporting injuries involving
the ankle including updates on their management and outcomes. Cite this article:
We report the incidence of radiolucent lines (RLLs) using two
flanged acetabular components at total hip arthroplasty (THA) and
the effect of the Rim Cutter. We performed a retrospective review of 300 hips in 292 patients
who underwent primary cemented THA. A contemporary flanged acetabular
component was used with (group 1) and without (group 2) the use
of the Rim Cutter and the Rimfit acetabular component was used with
the Rim Cutter (group 3). RLLs and clinical outcomes were evaluated
immediately post-operatively and at five years post-operatively.Aims
Patients and Methods
Injuries to the foot in athletes are often subtle
and can lead to a substantial loss of function if not diagnosed
and treated appropriately. For these injuries in general, even after
a diagnosis is made, treatment options are controversial and become
even more so in high level athletes where limiting the time away
from training and competition is a significant consideration. In this review, we cover some of the common and important sporting
injuries affecting the foot including updates on their management
and outcomes. Cite this article:
To present our experience of using a combination of intra-articular
osteotomy and external fixation to treat different deformities of
the knee. A total of six patients with a mean age of 26.5 years (15 to
50) with an abnormal hemi-joint line convergence angle (HJLCA) and
mechanical axis deviation (MAD) were included. Elevation of a tibial
hemiplateau or femoral condylar advancement was performed and limb
lengthening with correction of residual deformity using a circular
or monolateral Ilizarov frame.Aims
Patients and Methods
Lumbar fusion is known to reduce the variation in pelvic tilt
between standing and sitting. A flexible lumbo-pelvic unit increases
the stability of total hip arthroplasty (THA) when seated by increasing
anterior clearance and acetabular anteversion, thereby preventing
impingement of the prosthesis. Lumbar fusion may eliminate this protective
pelvic movement. The effect of lumbar fusion on the stability of
total hip arthroplasty has not previously been investigated. The Medicare database was searched for patients who had undergone
THA and spinal fusion between 2005 and 2012. PearlDiver software
was used to query the database by the International Classification
of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural
code for primary THA and lumbar spinal fusion. Patients who had
undergone both lumbar fusion and THA were then divided into three
groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of fusion. The
rate of dislocation in each group was established using ICD-9-CM codes.
Patients who underwent THA without spinal fusion were used as a
control group. Statistical significant difference between groups
was tested using the chi-squared test, and significance set at p
<
0.05.Aims
Patients and Methods
Open wedge high tibial osteotomy (OWHTO) for medial-compartment
osteoarthritis of the knee can be complicated by intra-operative
lateral hinge fracture (LHF). We aimed to establish the relationship
between hinge position and fracture types, and suggest an appropriate
hinge position to reduce the risk of this complication. Consecutive patients undergoing OWHTO were evaluated on coronal
multiplanar reconstruction CT images. Hinge positions were divided
into five zones in our new classification, by their relationship
to the proximal tibiofibular joint (PTFJ). Fractures were classified
into types I, II, and III according to the Takeuchi classification.Aims
Patients and Methods
To address the natural history of severe post-tuberculous (TB)
kyphosis, with focus upon the long-term neurological outcome, occurrence
of restrictive lung disease, and the effect on life expectancy. This is a retrospective clinical review of prospectively collected
imaging data based at a single institute. A total of 24 patients
of Southern Chinese origin who presented with spinal TB with a mean
of 113° of kyphosis (65° to 159°) who fulfilled inclusion criteria
were reviewed. Plain radiographs were used to assess the degree
of spinal deformity. Myelography, CT and MRI were used when available
to assess the integrity of the spinal cord and canal. Patient demographics,
age of onset of spinal TB and interventions, types of surgical procedure,
intra- and post-operative complications, and neurological status
were assessed. Aims
Patients and Methods
Little is known about the relative outcomes of revision of unicompartmental
knee arthroplasty (UKA) and high tibial osteotomy (HTO) to total
knee arthroplasty (TKA). The aim of this study is to compare the
outcomes of revision surgery for the two procedures in terms of
complications, re-revision and patient-reported outcome measures (PROMs)
at a minimum of two years follow-up. This study was a retrospective review of data from an institutional
arthroplasty registry for cases performed between 2001 and 2014.
A total of 292 patients were identified, of which 217 had a revision
of HTO to TKA, and 75 had revision of UKA to TKA. While mean follow-up
was longer for the HTO group compared with the UKA group, patient
demographics (age, body mass index and Charlson co-morbidity index)
and PROMs (Short Form-36, Oxford Knee Score, Knee Society Score,
both objective and functional) were similar in the two groups prior
to revision surgery. Outcomes included the rate of complications
and
re-operation, PROMS and patient-reported satisfaction at six months
and two years post-operatively. We also compared the duration of
surgery and the need for revision implants in the two groups. Aims
Patients and Methods
We compared the clinical and radiological outcomes of using a
polyetheretherketone cage with (TiPEEK) and without a titanium coating
(PEEK) for instrumented transforaminal lumbar interbody fusion (TLIF). We conducted a randomised clinical pilot trial of 40 patients
who were scheduled to undergo a TLIF procedure at one or two levels
between L2 and L5. The Oswestry disability index (ODI), EuroQoL-5D,
and back and leg pain were determined pre-operatively, and at three,
six, and 12 months post-operatively. Fusion rates were assessed
by thin slice CT at three months and by functional radiography at
12 months.Aims
Materials and Methods
The purpose of this study was to compare the clinical and radiographic
outcomes of total ankle arthroplasty (TAA) in patients with pre-operatively
moderate and severe arthritic varus ankles to those achieved for
patients with neutral ankles. A total of 105 patients (105 ankles), matched for age, gender,
body mass index, and follow-up duration, were divided into three
groups by pre-operative coronal plane tibiotalar angle; neutral
(<
5°), moderate (5° to 15°) and severe (>
15°) varus deformity.
American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot
score, a visual analogue scale (VAS), and Short Form (SF)-36 score
were used to compare the clinical outcomes after a mean follow-up period
of 51 months (24 to 147).Aims
Patients and Methods
Risk of revision following total knee arthroplasty (TKA) is higher
in patients under 55 years, but little data are reported regarding
non-revision outcomes. This study aims to identify predictors of
dissatisfaction in these patients. We prospectively assessed 177 TKAs (157 consecutive patients,
99 women, mean age 50 years; 17 to 54) from 2008 to 2013. Age, gender,
implant, indication, body mass index (BMI), social deprivation,
range of movement, Kellgren-Lawrence (KL) grade of osteoarthritis
(OA) and prior knee surgery were recorded. Pre- and post-operative
Oxford Knee Score (OKS) as well as Short Form-12 physical (PCS)
and mental component scores were obtained. Post-operative range
of movement, complications and satisfaction were measured at one
year.Aims
Patients and Methods
The aims of this study were to determine the proportion of patients
with outlier varus or valgus alignment in kinematically aligned
total knee arthroplasty (TKA), whether those with outlier varus
or valgus alignment have higher forces in the medial or lateral
compartments of the knee than those with in-range alignment and
whether measurements of the alignment of the limb, knee and components
predict compartment forces. The intra-operative forces in the medial and lateral compartments
were measured with an instrumented tibial insert in 67 patients
who underwent a kinematically aligned TKA during passive movement.
The mean of the forces at full extension, 45° and 90° of flexion
determined the force in the medial and lateral compartments. Measurements
of the alignment of the limb and the components included the hip-knee-ankle
(HKA) angle, proximal medial tibial angle (PMTA), and distal lateral
femoral angle (DLFA). Measurements of the alignment of the knee
and the components included the tibiofemoral angle (TFA), tibial
component angle (TCA) and femoral component angle (FCA). Alignment was
measured on post-operative, non-weight-bearing anteroposterior (AP)
scanograms and categorised as varus or valgus outlier or in-range
in relation to mechanically aligned criteria.Aims
Patients and Methods
Despite the presence of screening programmes, infants continue
to present with late developmental dysplasia of the hip (DDH), the
impact of which is significant. The aim of this study was to assess
infants with late presenting dislocation of the hip despite universal
clinical neonatal and selective ultrasound screening. Between 01 January 1997 to 31 December 2011, a prospective, longitudinal
study was undertaken of a cohort of 64 670 live births. Late presenting
dislocation was defined as presentation after three months of age.
Diagnosis was confirmed by ultrasound and plain radiography. Patient
demographics, referral type, reason for referral, risk factors (breech
presentation/strong family history) and clinical and radiological
findings were recorded.Aims
Patients and Methods
We report on the outcome of the Synergy cementless femoral stem
with a minimum follow-up of 15 years (15 to 17). A retrospective review was undertaken of a consecutive series
of 112 routine primary cementless total hip arthroplasties (THAs)
in 102 patients (112 hips). There were 60 female and 42 male patients
with a mean age of 61 years (18 to 82) at the time of surgery. A
total of 78 hips in the 69 patients remain Aims
Patients and Methods
The purpose of this current multicentre study is to analyse the
presence of alpha-defensin proteins in synovial fluid using the
Synovasure lateral flow device and to determine its diagnostic reliability
and accuracy compared with the prosthetic joint infection (PJI)
criteria produced by the Musculoskeletal Infection Society (MSIS). A cohort of 121 patients comprising 85 total knee arthroplasties
and 36 total hip arthroplasties was prospectively evaluated between
May 2015 and June 2016 in three different orthopaedic centres. The
tests were performed on patients with a chronically painful prosthesis
undergoing a joint aspiration in a diagnostic pathway or during revision
surgery.Aims
Patients and Methods