1. Three hundred and twenty cases of tuberculosis of the hip joint have been analysed and the late results assessed three or more years after discharge from hospital. 2. The primary bone focus involved the acetabulum alone in 39·3 per cent; the acetabulum and femoral head in 34·1 per cent; the head of femur alone in 19·2 per cent, and the femoral neck alone in 7·4 per cent. In 101 cases widespread destruction of the joint had taken place by the time the patient first came under observation. 3. Premature epiphysial fusion round the knee joint of the affected side occurred in 23 per cent of all patients under the age of fifteen years. 4. When hip disease was complicated by multiple foci of active tuberculosis or by secondarily infected abscesses and sinuses, the prognosis was seriously worsened. 5. Significant late deformity occurred in 38·3 per cent of patients discharged with "sound" fibrous ankylosis, and in 60·5 per cent of those with an unstable fibrous ankylosis. 6. Of 187 patients observed for more than three years after discharge from hospital 174 returned to full activity, seven were partly incapacitated and six were totally incapacitated. 7. Analysis of the late results suggests that the prognosis is best when an adequate period of conservative treatment is followed by some form of arthrodesis operation

The ability to edit DNA at the nucleotide level using clustered regularly interspaced short palindromic repeats (CRISPR) systems is a relatively new investigative tool that is revolutionizing the analysis of many aspects of human health and disease, including orthopaedic disease. CRISPR, adapted for mammalian cell genome editing from a bacterial defence system, has been shown to be a flexible, programmable, scalable, and easy-to-use gene editing tool. Recent improvements increase the functionality of CRISPR through the engineering of specific elements of CRISPR systems, the discovery of new, naturally occurring CRISPR molecules, and modifications that take CRISPR beyond gene editing to the regulation of gene transcription and the manipulation of RNA. Here, the basics of CRISPR genome editing will be reviewed, including a description of how it has transformed some aspects of molecular musculoskeletal research, and will conclude by speculating what the future holds for the use of CRISPR-related treatments and therapies in clinical orthopaedic practice.

Cite this article: Bone Joint Res 2020;9(7):351–359.

Aims

Total knee arthroplasty (TKA) using functional alignment aims to implant the components with minimal compromise of the soft-tissue envelope by restoring the plane and obliquity of the non-arthritic joint. The objective of this study was to determine the effect of TKA with functional alignment on mediolateral soft-tissue balance as assessed using intraoperative sensor-guided technology.

A study of limb shortening after poliomyelitis in 225 children in whom paralysis was confined to one leg shows:. 1. The paralysed leg became shorter than its fellow in 219 patients (97 per cent). 2. The discrepancy in leg length only once exceeded three and a half inches. 3. Both the tibia and the femur were shorter than their fellows in 171 out of 184 studied (93 per cent). In only one patient was the femur alone shortened. 4. Three patterns of progress of shortening are described. No evidence was found that reduction of shortening ever occurs. 5. It is impossible accurately to predict shortening. In general, the more severe the paralysis the greater the shortening, but there are notable exceptions. 6. No relationship could be found between the amount of shortening and the incidence of paralysis of any individual muscle-group. 7. There was no significant difference in leg shortening in adult life between those who had developed the disease in the first two years of life and those who had developed it later. 8. A cold blue limb is not more likely to undergo severe shortening. 9. When the paralysis was confined below the knee the greatest shortening seen was one and three-quarter inches. When muscles both above and below the knee were involved severe paralysis may produce shortening up to three and a half inches. 10. Lengthening of a paralysed leg can occur during the first two years after the onset of the disease, but this is always a temporary phase. 11. The cause of leg shortening is unknown. In only two patients in this series was there evidence of premature epiphysial fusion

Aims

The aim of this study was to determine if a three-month course of microorganism-directed oral antibiotics reduces the rate of failure due to further infection following two-stage revision for chronic prosthetic joint infection (PJI) of the hip and knee.

Aims

Guided growth has been used to treat coxa valga for cerebral palsy (CP) children. However, there has been no study on the optimal position of screw application. In this paper we have investigated the influence of screw position on the outcomes of guided growth.

The imminent introduction of the new Trauma & Orthopaedic (T&O) curriculum, and the implementation of the Improving Surgical Training initiative, reflect yet another paradigm shift in the recent history of trauma and orthopaedic training. The move to outcome-based training without time constraints is a radical departure from the traditional time-based structure and represents an exciting new training frontier. This paper summarizes the history of T&O training reform, explains the rationale for change, and reflects on lessons learnt from the past.

Cite this article: Bone Jt Open 2021;2-3:181–190.

Aims

This study aimed to identify the tibial component and femoral component coronal angles (TCCAs and FCCAs), which concomitantly are associated with the best outcomes and survivorship in a cohort of fixed-bearing, cemented, medial unicompartmental knee arthroplasties (UKAs). We also investigated the potential two-way interactions between the TCCA and FCCA.

After open reduction for developmental dysplasia of the hip (DDH), a pelvic or femoral osteotomy may be required to maintain a stable concentric reduction. We report the clinical and radiological outcome in 82 children (95 hips) with DDH treated by open reduction through an anterior approach in which a test of stability was used to assess the need for a concomitant osteotomy. The mean age at the time of surgery was 28 months (9 to 79) and at the latest follow-up, 17 years (12 to 25). All patients have been followed up until closure of the triradiate cartilage with a mean period of 15 years (8 to 23). At the time of open reduction before closure of the joint capsule, the position of maximum stability was assessed. A hip which required flexion with abduction for stability was considered to need an innominate osteotomy. If only internal rotation and abduction were required, an upper femoral derotational and varus osteotomy was carried out. For a ‘double-diameter’ acetabulum with anterolateral deficiency, a Pemberton-type osteotomy was used. A hip which was stable in the neutral position required no concomitant osteotomy. Overall, 86% of the patients have had a satisfactory radiological outcome (Severin groups I and II) with an incidence of 7% of secondary procedures for persistent dysplasia including one hip which redislocated. The results were better (p = 0.04) in children under the age of two years. Increased leg length on the affected side was associated with poor acetabular development and recurrence of joint dysplasia (p = 0.01). The incidence of postoperative avascular necrosis was 7%. In a further 18%, premature physeal arrest was noted during the adolescent growth spurt (Kalamchi-MacEwen types II and III). Both of these complications were also associated with recurrence of joint dysplasia (p = 0.01). Studies with a shorter follow-up are therefore likely to underestimate the proportion of poor radiological results

Osteoarthritis (OA), one of the most common motor system disorders, is a degenerative disease involving progressive joint destruction caused by a variety of factors. At present, OA has become the fourth most common cause of disability in the world. However, the pathogenesis of OA is complex and has not yet been clarified. Long non-coding RNA (lncRNA) refers to a group of RNAs more than 200 nucleotides in length with limited protein-coding potential, which have a wide range of biological functions including regulating transcriptional patterns and protein activity, as well as binding to form endogenous small interference RNAs (siRNAs) and natural microRNA (miRNA) molecular sponges. In recent years, a large number of lncRNAs have been found to be differentially expressed in a variety of pathological processes of OA, including extracellular matrix (ECM) degradation, synovial inflammation, chondrocyte apoptosis, and angiogenesis. Obviously, lncRNAs play important roles in regulating gene expression, maintaining the phenotype of cartilage and synovial cells, and the stability of the intra-articular environment. This article reviews the results of the latest research into the role of lncRNAs in a variety of pathological processes of OA, in order to provide a new direction for the study of OA pathogenesis and a new target for prevention and treatment.

Cite this article: Bone Joint Res 2021;10(2):122–133.

The successful management of femoral neck fractures is obviously based upon many factors. The forces acting upon the proximal end of the femur are believed to be mainly compressive in nature, and the low-angle nail by stabilising the fully reduced fracture in the line of these forces is held to allow weight bearing to take place. Low-angle nailing is believed to offer many advantages over conventional methods of treatment but only in the presence of stability. Stable reduction is the essential preliminary to any form of treatment, and low-angle fixation with early weight bearing in the absence of stability is regarded as futile. It is suggested that those subcapital separations which follow trivial injury may originate as stress fractures accompanying the process of bone remodelling in the aged, and that many of these fractures may remain unrecognised and heal spontaneously. With rare exceptions, subcapital fractures are regarded as being of the same essential pattern, and their varying radiological appearance is considered to be due to the different degrees of displacement to which they have been subjected. A new classification based on this premise has been suggested. In a series of eighty subcapital fractures the incidence of avascular necrosis was not adversely affected by early weight bearing, but reduction in the extreme valgus position was invariably followed by this disaster. This is probably also true of any malposition in extreme rotation which must stretch and obliterate the vessels in the ligamentum teres. A rough alignment index of reduction was found to provide an almost infallible guide to the prognosis both in regard to union and to avascular change. It may therefore be possible to base prognosis on the quality of reduction before the fixation appliance has been inserted. The unsatisfactory results in those cases apparently destined to non-union or avascular necrosis may then be avoided by alternative means of treatment at an early stage. Whether this will prove to be true must depend upon a much longer experience of low-angle fixation, and, in common with almost every communication on this subject, premature publication must largely offset the value of the present findings

Aims

The aim of this study was to investigate whether including the stages of ulnar physeal closure in Sanders stage 7 aids in a more accurate assessment for brace weaning in patients with adolescent idiopathic scoliosis (AIS).

Aims

Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°.

Aims

Accurate measurement of the glenoid version is important in performing total shoulder arthroplasty (TSA). Our aim was to evaluate the Ellipse method, which involves formally defining the vertical mid-point of the glenoid prior to measuring the glenoid version and comparing it with the ‘classic’ Friedman method.

Aims

The aims of this study were to investigate the mortality following a proximal humeral fracture. Data from a large population-based fracture register were used to quantify 30-day, 90-day, and one-year mortality rates after a proximal humeral fracture. Associations between the risk of mortality and the type of fracture and its treatment were assessed, and mortality rates were compared between patients who sustained a fracture and the general population.

Injuries to the hamstring muscle complex are common in athletes, accounting for between 12% and 26% of all injuries sustained during sporting activities. Acute hamstring injuries often occur during sports that involve repetitive kicking or high-speed sprinting, such as American football, soccer, rugby, and athletics. They are also common in watersports, including waterskiing and surfing. Hamstring injuries can be career-threatening in elite athletes and are associated with an estimated risk of recurrence in between 14% and 63% of patients. The variability in prognosis and treatment of the different injury patterns highlights the importance of prompt diagnosis with magnetic resonance imaging (MRI) in order to classify injuries accurately and plan the appropriate management.

Low-grade hamstring injuries may be treated with nonoperative measures including pain relief, eccentric lengthening exercises, and a graduated return to sport-specific activities. Nonoperative management is associated with highly variable times for convalescence and return to a pre-injury level of sporting function. Nonoperative management of high-grade hamstring injuries is associated with poor return to baseline function, residual muscle weakness and a high-risk of recurrence. Proximal hamstring avulsion injuries, high-grade musculotendinous tears, and chronic injuries with persistent weakness or functional compromise require surgical repair to enable return to a pre-injury level of sporting function and minimize the risk of recurrent injury.

This article reviews the optimal diagnostic imaging methods and common classification systems used to guide the treatment of hamstring injuries. In addition, the indications and outcomes for both nonoperative and operative treatment are analyzed to provide an evidence-based management framework for these patients.

Cite this article: Bone Joint J 2020;102-B(10):1281–1288.

Aims

The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients.

Aims

The aim of this study is to report the results of a case series of olecranon fractures and olecranon osteotomies treated with two bicortical screws.