Showing papers in "International Orthopaedics in 2014"

Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study

Abstract: The purpose of this study was to evaluate the efficiency of biologic augmentation of rotator cuff repair with iliac crest bone marrow-derived mesenchymal stem cells (MSCs). The prevalence of healing and prevention of re-tears were correlated with the number of MSCs received at the tendon-to-bone interface. Forty-five patients in the study group received concentrated bone marrow-derived MSCs as an adjunct to single-row rotator cuff repair at the time of arthroscopy. The average number of MSCs returned to the patient was 51,000 ± 25,000. Outcomes of patients receiving MSCs during their repair were compared to those of a matched control group of 45 patients who did not receive MSCs. All patients underwent imaging studies of the shoulder with iterative ultrasound performed every month from the first postoperative month to the 24th month. The rotator cuff healing or re-tear was confirmed with MRI postoperatively at three and six months, one and two years and at the most recent follow up MRI (minimum ten-year follow-up). Bone marrow-derived MSC injection as an adjunctive therapy during rotator cuff repair enhanced the healing rate and improved the quality of the repaired surface as determined by ultrasound and MRI. Forty-five (100 %) of the 45 repairs with MSC augmentation had healed by six months, versus 30 (67 %) of the 45 repairs without MSC treatment by six months. Bone marrow concentrate (BMC) injection also prevented further ruptures during the next ten years. At the most recent follow-up of ten years, intact rotator cuffs were found in 39 (87 %) of the 45 patients in the MSC-treated group, but just 20 (44 %) of the 45 patients in the control group. The number of transplanted MSCs was determined to be the most relevant to the outcome in the study group, since patients with a loss of tendon integrity at any time up to the ten-year follow-up milestone received fewer MSCs as compared with those who had maintained a successful repair during the same interval. This study showed that significant improvement in healing outcomes could be achieved by the use of BMC containing MSC as an adjunct therapy in standard of care rotator cuff repair. Furthermore, our study showed a substantial improvement in the level of tendon integrity present at the ten-year milestone between the MSC-treated group and the control patients. These results support the use of bone marrow-derived MSC augmentation in rotator cuff repair, especially due to the enhanced rate of healing and the reduced number of re-tears observed over time in the MSC-treated patients.

The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis.

Abstract: Our study sought to address four issues: (1) the relationship between postoperative overall anatomical knee alignment and the survival of total knee prostheses; (2) the relationship between postoperative coronal alignment of the femoral and tibial component and implant survival; (3) the relationship between postoperative sagittal alignment of the femoral and tibial components and implant survival; and (4) the relationship between postoperative rotational alignment of the femoral and tibial component and implant survival. We reviewed 1,696 consecutive patients (3,048 knees). Radiographic and computed tomographic examinations were performed to determine the alignment of the femoral and tibial components. The mean duration of follow-up was 15.8 years (range, 11–18 years). Thirty (1.0 %) of the 3,048 total knee arthroplasties failed for a reason other than infection and periprosthetic fracture. Risk factors for failure of the components were: overall anatomical knee alignment less than 3° valgus, coronal alignment of the femoral component less than 2.0° valgus, flexion of the femoral component greater than 3°, coronal alignment of the tibial component less than 90°, sagittal alignment of the tibial component less than 0° or greater than 7° slope, and external rotational alignment of the femoral and tibial components less than 2° In order to improve the survival rate of the knee prosthesis, we believe that a surgeon should aim to place the total knee components in the position of: overall anatomical knee alignment at an angle of 3–7.5° valgus; femoral component alignment, 2–8.0° valgus; femoral sagittal alignment, 0–3°; tibial coronal alignment, 90°; tibial sagittal alignment, 0–7°; femoral rotational alignment, 2–5° external rotation; and tibial rotational alignment, 2–5° external rotation.

Opioid use prior to total hip arthroplasty leads to worse clinical outcomes

Abstract: Purpose The purpose of this study was to compare the clinical outcomes of patients undergoing total hip arthroplasty (THA) who had been using narcotic medications prior to surgery to those who had not used them.

Anterior knee pain after total knee arthroplasty: a narrative review

Abstract: Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary.

Total knee arthroplasty in the valgus knee

Abstract: Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10 % of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique.

A comparative and retrospective study of three hundred and twenty primary Charnley type hip replacements with a minimum follow up of ten years to assess wether a dual mobility cup has a decreased dislocation risk

Abstract: Mid- and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional results with 85 % survivorship at 25-year follow-up However, dislocation still remains an unsolved problem Dislocation may occur throughout the patient’s and implant’s life The aim of this study is to answer the question: does a dual mobility cup (DMC) decrease the dislocation risk? We report comparative results at ten years of follow-up of two groups of primary cemented Charnley-type THA, one with a standard polyethylene cup (group 1, n = 215) and the other one with a DMC (group 2, n = 105) In group 1, 26 dislocations (129 %) occurred In group 2 only one dislocation (09 %) occurred This dislocation was successfully reduced by closed reduction, without any recurrence This difference was statistically significant (p = 00018) In group 1, the reason for revision was recurrent dislocation in 21 cases Five patients were revised for other reasons The global revision rate was 129 % In group 2, two patients needed revision surgery for aseptic loosening The global revision rate was 21 % This difference was statistically significant (p = 0054) The goal was reached for the patients of group 2 who had more risks factors for dislocation (age, aetiology, American Society of Anesthesiologists and Devane scores) than those of group 1 When using a DMC, we observed a low rate of dislocation in primary THA (09 %) This surgical choice seems to be a safe and effective technique in Charnley-type THA, especially in a high-risk population

The clinical use of bone morphogenetic proteins revisited: a novel biocompatible carrier device OSTEOGROW for bone healing

Abstract: Purpose The purpose of this study was to revise the clinical use of commercial BMP2 (Infuse) and BMP7 (Osigraft) based bone devices and explore the mechanism of action and efficacy of low BMP6 doses in a novel whole blood biocompatible device OSTEOGROW.

Cytokine Levels (IL-4, IL-6, IL-8 and TGFβ) as Potential Biomarkers of Systemic Inflammatory Response in Trauma Patients

Abstract: Purpose Much research is now being conducted in order to understand the role of cytokines in the development of the inflammatory response following trauma. The purpose of this study was to evaluate whether serum levels of certain cytokines, measured immediately after initial injury, can be used as potential biomarkers for predicting the development and the degree of severity of the systemic inflammatory response (SIRS) in patients with moderate and severe trauma.

Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty

Abstract: Purpose The combined anteversion (CA) technique is a method in which the cup is placed according to the stem anteversion in total hip arthroplasty (THA). We examined whether the CA technique reduced the dislocation rate, and the distribution of CA with the manual placement of the cup.

Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures

Abstract: Purpose Total hip arthroplasty (THA) as primary treatment for displaced femoral neck fractures is controversial as THA is associated with higher rates of dislocation but lower rates of re-operation compared to hemiarthroplasty (HA). A dual mobility cup (DMC) design is associated with lower dislocation and re-operation rates in elective surgery. Is this also the case when used to treat displaced femoral neck fractures? The aim of this study is to compare rates of dislocation and re-operation of any kind following treatment for displaced femoral neck fractures with either bipolar HA or THA with DMC.

Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature

Abstract: Purpose Despite previous studies the management of Rockwood type III acromioclavicular (AC) dislocations remains controversial and the debate continues about whether patients with Rockwood type III AC injuries should be treated conservatively or operatively. In this study, we will review the current literature and present an overview of the outcome of conservative versus operative treatment of Rockwood type III dislocations.

Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach

Abstract: Purpose Post-operative wound infections (PWI) following calcaneal fracture surgery can lead to prolonged hospital stay and additional treatment with antibiotics, surgical debridement or implant removal. Our aim was to determine the incidence of superficial and deep PWI and to identify risk factors (RF).

Feasibility and safety of performing outpatient unicompartmental knee arthroplasty

Abstract: Purpose Unicompartmental knee arthroplasty (UKA) has a faster short-term recovery than total knee arthroplasty (TKA). The purpose of this study was to determine the feasibility and safety of performing outpatient UKAs in a consecutive group of patients presenting with unicompartmental knee osteoarthritis.

Is there an association between periprosthetic joint infection and low vitamin D levels

Abstract: Purpose Vitamin D is increasingly being recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of periprosthetic joint infection. To the best of our knowledge, no other study has examined possible associations between periprosthetic joint infection and vitamin D deficiency. We investigated the rate of vitamin D deficiency in patients treated for periprosthetic joint infection and whether vitamin D deficiency is independent of other risk factors for vitamin D deficiency in patients with periprosthetic joint infection.

Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur

Abstract: Purpose The purpose of this prospective randomised trial was to assess whether an intramedullary nail is superior to a sliding hip screw in the treatment of multifragmentary intertrochanteric fractures

Cementless and cemented total knee arthroplasty in patients younger than fifty five years. Which is better

Abstract: The purpose of this prospective, randomised study was to evaluate long-term clinical results, radiographic findings, complications and revision and survivorship rates in patients <55 years at a minimum of 16 years after undergoing bilateral, sequential, simultaneous, cemented and cementless total knee arthroplasties (TKAs) in the same patients. Bilateral, sequential, simultaneous TKAs were performed in 80 patients (160 knees). There were 63 women and 17 men with a mean age of 54.3 years (range 49–55), who received a cementless prosthesis in one knee and a cemented prosthesis in the other. The mean follow-up was 16.6 years (range 16–17). At final review, the mean Knee Society (KS) knee scores (95.8 versus 96.9), Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index (25.4 versus 25.9), range of motion (ROM) (125°versus 128°), patient satisfaction (8.1 versus 8.3) and radiological results were similar in both groups. Femoral component survival rate was 100 % in both groups at 17 years; at 17 years, the cemented tibial component survival rate was 100 % and the cementless tibial component 98.7 %. No osteolysis was identified in either group. Long-term results of both cementless and cemented TKAs were encouraging in patients with OA who were <55 years. However, we found no evidence to prove the superiority of cementless over cemented TKAs.

Arm lengthening after reverse shoulder arthroplasty: a review

Abstract: The purpose of this review is to provide a better understanding of biomechanical changes induced by reverse shoulder arthroplasty (RSA), discuss the different techniques of radiographic assessment of upper limb lengthening after RSA and determine the ideal soft tissue tension that provides the best functional outcome without increasing the risk of complications. Inclusion criteria were articles in which the primary interest was the technique of measuring upper-extremity lengthening after complications related to lengthening and its role in postoperative function; those written in English, French or German; and those that provided evidence levels I–IV relevant to search terms. Seven articles met our inclusion criteria. Postoperatively, changes in humeral length varied from minus five to five millimetres, and changes in upper-extremity length varied from 15 mm to 27 mm. The acromiohumeral distance averaged 23 mm. Humeral and arm shortening increased the risk of dislocation and led to poor anterior active elevation. The type of surgical approach did not play a role in postoperative function. Subclinical neurological lesions were frequent. Studies in this systematic review indicate that deltoid tensioning by restoring humeral length and increasing the acromiohumeral distance is critical for adequate postoperative function and to prevent dislocation. Excessive arm lengthening should be avoided, with zero to two centimetres of lengthening being a reasonable goal to avoid postoperative neurological impairment.

Benefits of early intramedullary nailing in femoral metastases

Abstract: Purpose Pathological fractures of the long bones are common complications of metastatic disease; however, the outcome of different surgical techniques for the treatment of these fractures has not been clearly defined. The aim of this study was to evaluate differences in prophylactic and therapeutic intramedullary nailing in femoral metastasic implants.

Systematic review and meta-analysis of the additional benefit of local prophylactic antibiotic therapy for infection rates in open tibia fractures treated with intramedullary nailing

Abstract: Purpose This analysis compared the rate of deep wound infections in patients with open tibia fractures, treated with intramedullary nails, receiving additional locally-delivered antibiotics to those receiving standard care.

Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement

Abstract: Purpose This study assesses and compares the clinical outcomes of the arthroscopic matrix-induced autologous chondrocyte implant (MACI) and autologous matrix-induced chondrogenesis (AMIC) techniques for the treatment of acetabular chondral defects between 2 and 4 cm2 consequent to femoral acetabular impingement.

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach.

Abstract: Purpose Our aim was to clarify the effective decrease in blood transfusion after primary total knee arthroplasty (TKA) from a multimodal blood-loss prevention approach (MBLPA) and the related risk factors of blood transfusion.

Free vascularised fibular grafts in orthopaedics

Abstract: Bony defects caused by trauma, tumors, infection or congenital anomalies can present a significant surgical challenge. Free vascularised fibular bone grafts (FVFGs) have proven to be extremely effective in managing larger defects (longer than 6 cm) where other conventional grafts have failed. FVFGs also have a role in the treatment of avascular necrosis (AVN) of the femoral head, failed spinal fusions and complex arthrodeses. Due to the fact that they have their own blood supply, FVFGs are effective even in cases where there is poor vascularity at the recipient site, such as in infection and following radiotherapy. This article discusses the versatility of the FVFG and its successful application to a variety of different pathologies. It also covers the applied anatomy, indications, operative techniques, complications and donor-site morbidity. Though technically challenging and demanding, the FVFG is an extremely useful salvage option and can facilitate limb reconstruction in the most complex of cases.

Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach

Abstract: The first purpose of this study was to introduce an individualized, pathology-based approach for the amount of axis correction in valgus high tibial osteotomy (HTO), in which the weight-bearing line (WBL) is transferred in one of three adjacent 5 %-areas of the transverse diameter of the tibial plateau. The second purpose was to define the corresponding mechanical femorotibial angle (mFTA) for the margins of each 5 %-area. Reported indications for valgus HTO were assorted to one of three groups, based on the underlying pathology and expected accompanying degree of osteoarthritis. Three adjacent 5 %-areas on the tibial plateau were defined, ranging from the 50 % to 65 % coordinate. The medial border of the tibial plateau was defined as 0 % and the lateral border was defined as 100 %. To define the corresponding mFTA, valgus HTO was simulated in 69 patients using commercial available planning software (mediCAD®, Hectec GmbH, Germany). The corresponding mFTA was recorded at four different positions (50 %, 55 %, 60 %, and 65 %). Within the purposed approach, the WBL is aimed in one of three 5 %-areas (50–55 %, 55–60 %, and 60–65 %) of the transverse diameter of the tibial plateau, according to the underlying pathology. Based on the findings of simulated HTO, the mean mFTA was 0.3° ± 0.2° at the 50 % position, 1.3° ± 0.2° at the 55 % position, 2.4° ± 0.3° at the 60 % position, and 3.4° ± 0.3° at the 65 % position. The mean difference of the mFTA between each adjacent valgus position was 1.1° ± 0.1°. The present paper introduces an individualized approach to adopt the degree of valgus correction in dependence of the underlying pathology. The area of interest on the tibial plateau lies in between the 50 % and 65 % coordinate on the tibial plateau, or in between a mean mFTA of 0.3° and 3.4° of valgus, respectively. Differences of the resulting mFTA between each area are small, and therefore a precise surgical technique is mandatory.

Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients.

Abstract: Purpose Reconstruction of the medial patellofemoral ligament (MPFL) has become a popular procedure for patients with patellofemoral instability. Nevertheless, complication rates of up to 26 % have been reported. This study presents the analysis of failure and clinical outcome of subsequent revision surgery in young patients following unsuccessful medial patellofemoral ligament reconstruction.

A comparison of conventional and patient-specific instruments in total knee arthroplasty

Abstract: Purpose Several authors have observed that standard instrumentation (SI) may be insufficient for addressing component malalignment. Patient-matched cutting blocks (PMCB) technology was introduced to improve surgeons’ ability to achieve a neutral postoperative mechanical axis following total knee arthroplasty (TKA). The current retrospective study was designed to compare the ability of SI and PMCB to achieve a hip-knee-ankle angle (HKA) within ±3° of the ideal alignment of 180°.

Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review

Abstract: Purpose The purpose of this study was to retrospectively compare and review the clinical outcomes between the distal clavicular locking plate and clavicular hook plates in the treatment of unstable distal clavicle fractures; moreover, the relevant literature of the two fixation methods was reviewed systematically to identify the non-union, complications, or functional scores, according to the treatment methods and determine which treatment method is better.

Bone loss management in total knee revision surgery

Abstract: Purpose Bone stock reconstruction in TKR surgery is one of the biggest challenges for the surgeon. According to some, authors causes of bone stock loosening are multiple, including stress shielding, osteolysis from wear, septic or aseptic loosening, and bone loss caused by a poorly balanced implant. Moreover, bone loss may be iatrogenic at the time of implant removal, indicating that bone preservation during implant removal is critical.

Trends in epidemiology and patho-anatomical pattern of proximal humeral fractures

Abstract: Purpose Proximal humeral fractures are common and frequently associated with osteoporosis. Little is known about the association between the patho-anatomical fracture pattern of proximal humeral fractures and patient characteristics. The purpose of this six year longitudinal registry analysis of proximal humeral fractures was to study overall numbers, certain predefined pathoanatomical patterns and distribution compared with specific patient characteristics.

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study.

Abstract: Purpose A few studies focused on the methods of treatment for displaced distal tibial shaft fractures have been published, all of which compared two different methods. In this randomized, prospective study, we aimed to compare minimally invasive plate osteosynthesis, locking intramedullary nail stabilization and external fixation combined with limited open reduction and absorbable internal fixation for distal tibial shaft fractures by assessing complications and secondary procedures.

Gait knee kinematic alterations in medial osteoarthritis: three dimensional assessment

Abstract: Purpose Although kinematic changes in the sagittal plane of the osteoarthritic knee (OA) have been elucidated, very few studies have analysed changes in the frontal and horizontal planes. Therefore, the aim of this study was to investigate in vivo 3D knee kinematics during walking in patients wth knee OA.