Showing papers in "Journal of Bone and Joint Surgery-british Volume in 2003"
TL;DR: A prospective, randomised, clinical trial has shown significant superiority of ACI over mosaicplasty for the repair of articular defects in the knee and suggests that its continued use is of dubious value.
Abstract: Autologous chondrocyte implantation (ACI) and mosaicplasty are both claimed to be successful for the repair of defects of the articular cartilage of the knee but there has been no comparative study of the two methods. A total of 100 patients with a mean age of 31.3 years (16 to 49) and with a symptomatic lesion of the articular cartilage in the knee which was suitable for cartilage repair was randomised to undergo either ACI or mosaicplasty; 58 patients had ACI and 42 mosaicplasty. Most lesions were post-traumatic and the mean size of the defect was 4.66 cm2. The mean duration of symptoms was 7.2 years and the mean number of previous operations, excluding arthroscopy, was 1.5. The mean follow-up was 19 months (12 to 26).Functional assessment using the modified Cincinatti and Stanmore scores and objective clinical assessment showed that 88% had excellent or good results after ACI compared with 69% after mosaicplasty. Arthroscopy at one year demonstrated excellent or good repairs in 82% after ACI and in 34%...
922 citations
TL;DR: The use of a navigation system was shown to improve the alignment of the implant and revealed a highly significant difference between the two groups in favour of navigation with regard to the mechanical axis, the frontal and sagittal femoral axis and the frontal tibial axis.
Abstract: We conducted this prospective randomised and externally evaluated study to investigate whether the use of a navigation system during total knee arthroplasty leads to significantly better results than the hand-guided technique A total of 240 patients was included in the study All patients received a condylar knee prosthesis Two surgeons performed all the operations using the Stryker knee navigation system Exclusion criteria included the necessity for the primary use of constrained implants The results revealed a highly significant difference between the two groups in favour of navigation with regard to the mechanical axis, the frontal and sagittal femoral axis and the frontal tibial axis (p < 00001) The use of a navigation system was therefore shown to improve the alignment of the implant
549 citations
TL;DR: Between 1993 and 2000 the authors implanted 200 cementless, mobile-bearing STAR total ankle replacements and the radiological appearance of the interface of the tibial implant was significantly related to its operative fit and the type of bioactive coating.
Abstract: Between 1993 and 2000 we implanted 200 cementless, mobile-bearing STAR total ankle replacements. None was lost to follow-up for reasons other than the death of a patient. The mean follow-up was for 46 months (24 to 101). A complication requiring further surgery developed in eight ankles and 14 were revised or fused. The cumulative survival rate at five years was 92.7% (95% CI 86.6 to 98.8) with time to decision to revision or fusion as an endpoint. The most frequent complications were delayed wound healing and fracture of a malleolus. These became less common with experience of the operation. The radiological appearance of the interface of the tibial implant was significantly related to its operative fit and to the type of bioactive coating.
543 citations
TL;DR: In this paper, a multi-surgeon audit of infection after total hip replacement in the UK is presented, showing that a large cohort of surgeons of varying seniority can achieve infection rates of 1% and revision rates for infection of less than 0.5%.
Abstract: Our aim in this study was to determine the outcome of hip arthroplasty with regard to infection at our unit. Infection after total joint arthroplasty is a devastating complication. The MRC study in 1984 recommended using vertical laminar flow and prophylactic antibiotics to reduce infection rates. These measures are now routinely used. Between 1993 and 1996, 1727 primary total hip arthroplasties and 305 revision hip arthroplasties were performed and 1567 of the primary and 284 of the revision arthroplasties were reviewed between five and eight years after surgery by means of a postal questionnaire, telephone interview or examination of the medical records of those who had died. Seventeen (1.08%) of the patients who underwent primary and six (2.1%) of those who underwent revision arthroplasty had a post-operative infection. Only 0.45% of patients who underwent primary arthroplasty required revision for infection. To our knowledge this is the largest multi-surgeon audit of infection after total hip replacement in the UK. The follow-up of between five and eight years is longer than that of most comparable studies. Our study has shown that a large cohort of surgeons of varying seniority can achieve infection rates of 1% and revision rates for infection of less than 0.5%.
410 citations
TL;DR: In this article, a review of 65 patients who had undergone arthroscopic treatment for osteochondral lesions of the talus was carried out for a mean of 3.5 years.
Abstract: We reviewed, retrospectively, 65 patients who had undergone arthroscopic treatment for osteochondral lesions of the talus. The 46 men and 19 women with a mean age at operation of 34.25 years, were followed up for a mean of 3.5 years. The medial aspect was affected in 45 patients and the lateral aspect in 20. All the lateral lesions and 35 (75%) of the medial lesions were traumatic in origin. Medial lesions presented later than lateral lesions (3 v 1.5 years) and had a much greater incidence of cystic change (46% v 8%). At follow-up, 34 patients had achieved a good result, and 17 and 14 fair and poor results, respectively. Of the 14 poor results, 13 involved medial lesions. Cystic lesions had a poor outcome in 53% of patients. Excision and curettage led to better results than excision and drilling of the base. Further arthroscopic surgery for patients with a poor result was disappointing. There was no association between outcome and the patient's age.
403 citations
TL;DR: The most important issue in cerebral palsy is the elucidation of the causal pathways from population-based epidemiological studies which will lead to primary prevention, which in a chronic, incurable condition is clearly the most humane and cost-effective strategy.
Abstract: ©2003 British Editorial Society of Bone and Joint Surgery doi101302/0301-620X85B214066 $200 J Bone Joint Surg [Br] 2003;85-B:157-66 Cerebral palsy is the most common cause of physical disability affecting children in developed countries, with an incidence of 20 to 25 per 1000 live births1 It is not a single entity but a heterogeneous collection of clinical syndromes, characterised by abnormal motor patterns and postures Although in most parts of the world the orthopaedic burden secondary to poliomyelitis and myelomeningocele is declining rapidly, the prevalence of cerebral palsy is static or increasing It is the most common diagnosis after trauma in most paediatric orthopaedic units and is therefore of enormous strategic importance in terms of allocation of resources, planning and service delivery The definitions of cerebral palsy have undergone a number of refinements by developmental paediatricians and neurologists They stress two features First, cerebral palsy is the result of a lesion in the immature brain, which is nonprogressive; it is a static encephalopathy2 It is clearly important to differentiate cerebral palsy from progressive neurological conditions from the standpoint of both taxonomy and clinical management Secondly, cerebral palsy results in a disorder of posture and movement which is permanent but not unchanging3 To this we would add a third feature, that it results in progressive musculoskeletal pathology in most affected children4 It is inappropriate to emphasise that the cerebral lesion is static without clearly stating that the musculoskeletal pathology will be progressive In Little’s original description5 of spastic diplegia, prominence was given to the description of the musculoskeletal deformities The newborn child with cerebral palsy usually has no deformities or musculoskeletal abnormalities at birth Scoliosis, dislocation of the hip and fixed contractures develop during the rapid growth of childhood Cerebral palsy is a useful term which describes a large group of children with motor impairment from many causes and expressed as a wide variety of clinical syndromes The preferred term is therefore ‘the cerebral palsies’6 It was formerly considered that most cases of cerebral palsy were the result of obstetric misadventure Careful epidemiological and brain-imaging studies suggest that it frequently has antenatal antecedents and is often multifactorial Recent studies also point to an increasing number of specific aetiological factors including intrauterine infections and inherited malformations1 These investigations will in time lead to both primary prevention and secondary minimisation of cerebral injury The increase in the incidence of cerebral palsy in preterm infants is because of neonatal intensive care and a rise in multiple births The rates of cerebral palsy in babies born at term are steady, despite strategies to reduce birth asphyxia The most important issue in cerebral palsy is the elucidation of the causal pathways from population-based epidemiological studies This will lead to primary prevention, which in a chronic, incurable condition is clearly the most humane and cost-effective strategy Cerebral palsy is subdivided according to the movement disorder and its topographical distribution Spastic and mixed motor disorders account for more than 85% of children on current registers; dyskinetic cerebral palsy is much less common1,6 The most common topographical syndromes are spastic hemiplegia, spastic diplegia and spastic quadriplegia which is also known as ‘whole-body involvement’1,3,6
381 citations
TL;DR: Analysis of CT scans and radiographs of 76 vertebrae in 49 patients who underwent vertebroplasty for painful osteoporotic compression fractures showed that cement in the neural foramina had the highest positive predictive value.
Abstract: e analysed the CT scans and radiographs of 76 vertebrae in 49 patients who underwent vertebroplasty for painful osteoporotic compression fractures. Leaks of cement were classified into three types: those via the basivertebral vein (type B), via the segmental vein (type S), and through a cortical defect (type C). More leaks were identified on CT scans than on radiographs by a factor of 1.5 (74/49). Most type-B (93%) and type-S (86%) leaks were missed or underestimated on a lateral radiograph which is usually the only view used during the injection of cement. Of the leaks into the spinal canal, only 7% (2/28) were correctly identified on radiographs. The areas on lateral radiographs where this type of leak may be observed were divided into four zones, and their diagnostic value in predicting a leak into the spinal canal was evaluated. The results showed that cement in the neural foramina had the highest positive predictive value (86%).
352 citations
TL;DR: In this paper, a long-term study of the quality of life of 17 patients with 18 arthrodeses of the ankle, over a period of more than 20 years, was conducted.
Abstract: biotalar fusion is considered to be the standard treatment for end-stage post-traumatic arthritis of the ankle. We report a retrospective, objective long-term study of the quality of life of 17 patients with 18 arthrodeses of the ankle, over a period of more than 20 years. We looked particularly for correlation between clinical and radiological signs of osteoarthritis in adjoining joints. At serial physical examinations, clinical grades were awarded according to the Olerud Molander Ankle (OMA) score. Any degree of degenerative change in the adjoining joints was recorded on standing radiographs. Patients filled out a SF-36 Health Survey form. Subjectively, 50% of patients were not handicapped in the performance of daily activities and 44% were in the same job as at the time of injury. At follow-up the mean OMA score was 59.4 points, the visual analogue scale was 1.99 and the radiological score was 2.7. The SF-36 for physical function, emotional disturbance and bodily pain revealed significant deficits. There was a significant correlation between the OMA and the radiological score (p = 0.05), and between the clinical and the SF-36 score (p = 0.01), but no significant correlation between the radiological score and the SF-36 score. Arthrodesis of the ankle leads to deficits in the functional outcome, to limitations in the activities of daily living and to radiological changes in the adjoining joints. The clinical outcome score correlates closely with the SF-36 score.
349 citations
TL;DR: Radiological and histological analysis indicated that the PLA cells induced into the chondrogenic phenotype had the histological appearance of hyaline cartilage, which may prove to be useful for the treatment of osteochondral defects.
Abstract: Multipotential processed lipoaspirate (PLA) cells extracted from five human infrapatellar fat pads and embedded into fibrin glue nodules, were induced into the chondrogenic phenotype using chondrogenic media. The remaining cells were placed in osteogenic media and were transfected with an adenovirus carrying the cDNA for bone morphogenetic protein-2 (BMP-2). We evaluated the tissue-engineered cartilage and bone using in vitro techniques and by placing cells into the hind legs of five severe combined immunodeficient mice. After six weeks, radiological and histological analysis indicated that the PLA cells induced into the chondrogenic phenotype had the histological appearance of hyaline cartilage. Cells transfected with the BMP-2 gene media produced abundant bone, which was beginning to establish a marrow cavity. Tissue-engineered cartilage and bone from infrapatellar fat pads may prove to be useful for the treatment of osteochondral defects.
324 citations
TL;DR: Acute compartment syndrome is seen more commonly in younger patients, under 35 years of age and therefore leads to loss of function and long-term productivity in patients who would otherwise contribute to the country’s workforce for up to 40 years.
Abstract: Compartment syndrome has been defined as “a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space”.1 It is most commonly seen after injuries to the leg2-5 and forearm6-8 but may also occur in the arm,9 thigh,10 foot,11-13 buttock,14 hand15 and abdomen.16 It typically follows traumatic injury, but may also occur after ischaemic reperfusion injuries,17 burns,18 prolonged limb compression after drug overdose19 or poor positioning during surgery.20-24 Furthermore, subclinical compartment syndromes may explain the occurrence of a variety of postoperative disabilities which have been identified after the treatment of fractures of long bones using intramedullary nails.25 Approximately 40% of all acute compartment syndromes occur after fractures of the tibial shaft26 with an incidence in the range of 1% to 10%.26-30 A further 23% of compartment syndromes are caused by soft-tissue injuries with no fracture and fractures of the forearm account for 18%.26 Acute compartment syndrome is seen more commonly in younger patients, under 35 years of age31 and therefore leads to loss of function and long-term productivity in patients who would otherwise contribute to the country’s workforce for up to 40 years.
306 citations
TL;DR: It is found that smoking was the single most important risk factor for the development of postoperative complications, particularly those relating to wound healing, cardiopulmonary complications, and the requirement of postoperatively intensive care.
Abstract: Smoking is an important risk factor for the development of postoperative pulmonary complications after major surgical procedures. We studied 811 consecutive patients who had undergone hip or knee arthroplasty, recording current smoking and drinking habits, any history of chronic disease and such intraoperative factors as the type of anaesthesia and the type and duration of surgery. We recorded any postoperative complications occurring before discharge from hospital. There were 232 smokers (28.6%) and 579 non-smokers. We found that smoking was the single most important risk factor for the development of postoperative complications, particularly those relating to wound healing, cardiopulmonary complications, and the requirement of postoperative intensive care. A delay in discharge from hospital was usual for those suffering a complication. In those patients requiring prolonged hospitalisation (>15 days) the proportion of smokers with wound complications was twice that of non-smokers.
TL;DR: The results of this study strongly suggest that THR provides a better outcome than IF for elderly, relatively healthy, lucid patients with a displaced fracture of the femoral neck.
Abstract: The treatment algorithms for displaced fractures of the femoral neck need to be improved if we are to reduce the need for secondary surgery. We have studied 102 patients of mean age 80 years, with an acute displaced fracture of the femoral neck. They were randomly placed into two groups, treated either by internal fixation (IF) with two cannulated screws or total hip replacement (THR). None showed severe cognitive dysfunction, all were able to walk independently, and all lived in their own home. They were reviewed at four, 12 and 24 months after surgery. Outcome measurements included hip complications, revision surgery, hip function according to Charnley and the health-related quality of life (HRQoL) according to EuroQol (EQ-5D). The failure rate after 24 months was higher in the IF group than in the THR group with regard to hip complications (36% and 4%, respectively; p < 0.001), and the number of revision procedures (42% and 4%, p < 0.001). Hip function was significantly better in the THR group at all follow-up reviews regarding pain (p < 0.005), movement (p < 0.05 except at 4 months) and walking (p < 0.05). The reduction in HRQoL (EQ-5D index score) was also significantly lower in the THR group than in the IF group, comparing the pre-fracture situation with that at all follow-up reviews (p < 0.05). The results of our study strongly suggest that THR provides a better outcome than IF for elderly, relatively healthy, lucid patients with a displaced fracture of the femoral neck.
TL;DR: Patients with concurrent fractures of the acetabulum and long bones who receive indomethacin have a significantly greater risk of nonunion of the fractures ofThe long bones when compared with those who receive XRT or no prophylaxis.
Abstract: Indomethacin is commonly administered for the prophylaxis of heterotopic ossification (HO) after the surgical treatment of acetabular fractures. Non-steroidal anti-inflammatory drugs such as indomethacin, have been associated with delayed healing of fractures and mechanically weaker callus. Our aim was to determine if patients with an acetabular fracture, who received indomethacin for prophylaxis against HO, were at risk of delayed healing or nonunion of any associated fractures of long bones. We reviewed 282 patients who had had open reduction and internal fixation of an acetabular fracture. Patients at risk of HO were randomised to receive either radiation therapy (XRT) or indomethacin. Of these patients, 112 had sustained at least one concomitant fracture of a long bone; 36 needed no prophylaxis, 38 received focal radiation and 38 received indomethacin. Fifteen patients developed 16 nonunions. When comparing patients who received indomethacin with those who did not, a significant difference was noted in the rate of nonunion (26% v 7%; p = 0.004). Patients with concurrent fractures of the acetabulum and long bones who receive indomethacin have a significantly greater risk of nonunion of the fractures of the long bones when compared with those who receive XRT or no prophylaxis.
TL;DR: MOM bearings of large diameter result in a greater systemic exposure of cobalt and chromium ions than bearings of small diameter, which may be of relevance for potential long-term side-effects.
Abstract: Metal-on-metal (MOM) bearings for hip arthroplasty are increasing in popularity. Concern remains, however, regarding the potential toxicological effects of the metal ions which these bearings release.
The serum levels of cobalt and chromium in 22 patients who had undergone MOM resurfacing arthroplasty were compared with a matched group of 22 patients who had undergone 28 mm MOM total hip arthroplasty (THA).
At a median of 16 months (7 to 56) after resurfacing arthroplasty, we found the median serum levels of cobalt and chromium to be 38 nmol/l (14 to 44) and 53 nmol/l (23 to 165) respectively. These were significantly greater than the levels after 28 mm MOM THA which were 22 nmol/l (15 to 87, p = 0.021) and 19 nmol/l (2 to 58, p < 0.001) respectively.
Since the upper limit for normal patients without implants is typically 5 nmol/l, both groups had significantly raised levels of metal ions. MOM bearings of large diameter, however, result in a greater systemic exposure of cobalt and chromium ions than bearings of small diameter. This may be of relevance for potential long-term side-effects. It is not known to what extent this difference is due to corrosion of the surfaces of the component or of the wear particles produced.
Abstract: In 52 patients we compared the accuracy of standard anteroposterior (AP) radiography, mortise radiography and MRI with arthroscopy of the ankle for the diagnosis of a tear of the tibiofibular syndesmosis. In comparison with arthroscopy, the sensitivity, specificity and accuracy were 44.1%, 100% and 63.5% for standard AP radiography and 58.3%, 100% and 71.2% for mortise radiography. For MRI they were 100%, 93.1% and 96.2% for a tear of the anterior inferior tibiofibular ligament and 100%, 100% and 100% for a tear of the posterior inferior tibiofibular ligament. Standard AP and mortise radiography did not always provide a correct diagnosis. MRI was useful although there were two-false positive cases. We suggest that arthroscopy of the ankle is indispensable for the accurate diagnosis of a tear of the tibiofibular syndesmosis.
TL;DR: The technique is modified with an increased use of longer stems with impacted allograft, indicated when the host bone around the tip of a short stem is compromised, in patients with major loss of bone stock, or when a femoral fracture occurs.
Abstract: We report the results of cancellous femoral impaction grafting with cement in revision hip arthroplasty in all patients from one centre who had undergone surgery more than five years previously. A total of 32 surgeons undertook femoral impaction grafting in 207 patients (226 hips). There were no deaths attributable to the revision surgery; 33 patients with 35 functioning hips died with less than five years' follow-up. One patient was lost to follow-up. Two hips (1%) developed early postoperative infection. Of the 12 stems which underwent a further surgical procedure for aseptic failure, ten were for femoral fracture and two for loosening. Survivorship with any further femoral operation as the endpoint was 90.5% (confidence intervals, 82 to 98) and using femoral reoperation for symptomatic aseptic loosening as the endpoint, the survivorship was 99.1% (confidence intervals, 96 to 100) at 10 to 11 years. As a consequence of the experience in this series, we have modified our technique with an increased use of longer stems with impacted allograft. Long stems are indicated when the host bone around the tip of a short stem is compromised, in patients with major loss of bone stock, or when a femoral fracture occurs.
TL;DR: The aim was to evaluate a new method which allows prediction of the bone quality of the proximal humerus from radiographs, and a significant positive correlation was found between cortical thickness and the BMD for each region of interest.
Abstract: The operative treatment of fractures of the proximal humerus can be complicated by poor bone quality. Our aim was to evaluate a new method which allows prediction of the bone quality of the proximal humerus from radiographs. Anteroposterior radiographs were taken of 19 human cadaver humeri. The cortical thickness was measured at two levels of the proximal humeral diaphysis. The bone mineral density (BMD) was determined for the humeral head (HH), the surgical neck (SN), the greater tuberosity (GT) and lesser tuberosity (LT) using dual-energy x-ray absorptiometry. The mean cortical thickness was 4.4 +/- 1.0 mm. Specimens aged 70 years or less had a significantly higher cortical thickness than those aged over 70 years. A significant positive correlation was found between cortical thickness and the BMD for each region of interest. The cortical thickness of the proximal diaphysis is a reliable predictor of the bone quality of the proximal humerus.
TL;DR: Those occurring in young overhead athletes resulting from repetitive microtraumata or internal impingement1,2 are included to allow their different causes to be recognised, which may necessitate specific treatment.
Abstract: ©2003 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.85B1.13846 $2.00 J Bone Joint Surg [Br] 2003;85-B:3-11. Partial-thickness tears of the rotator cuff are not rare and can be a cause of unexplained pain in the shoulder giving considerable disability. Although they occupy a significant position in the spectrum of disease of the rotator cuff, they have been inadequately defined and often elude diagnosis even by MRI and arthroscopy. In this review the management of degenerative partial tears is considered. Those occurring in young overhead athletes resulting from repetitive microtraumata or internal impingement1,2 are included to allow their different causes to be recognised, which may necessitate specific treatment.
TL;DR: This review highlights the current concepts in the management of patients with multiple injuries with particular emphasis on the surgical priorities in damage control orthopaedics.
Abstract: ©2003 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.85B4.14217 $2.00 J Bone Joint Surg [Br] 2003;85-B:478-83. The management of the multiply-injured patient has been revolutionised during the past century. Advances in prehospital care, resuscitation, implants and intensive-care medicine have all contributed to better treatment of the patient in physiological crisis after trauma, who is at risk for the multiple-organ dysfunction syndrome and is battling for survival. The introduction of standardised surgical treatment for fractures in the early 1950s by the AO group and the implementation of advanced trauma life-support training were probably the greatest stimuli affecting the philosophy in the treatment of patients with polytrauma. However, more recent developments in molecular medicine and genetics have influenced our perception of management leading to the concept of ‘damage control orthopaedics’. While the basic concept of ‘save life limit disability’ has not changed, the type and timing of our interventions have been gradually modified. This review highlights the current concepts in the management of patients with multiple injuries with particular emphasis on the surgical priorities in damage control orthopaedics.
TL;DR: The outcome in terms of overall knee function, activity levels and anterior tibial translation were better in those knees which had been reconstructed within two weeks of injury, and instrumented testing of knee stability indicated better results for anterior cruciate ligament reconstructions which had had been undertaken in the acute phase.
Abstract: We treated 21 patients with 22 dislocations of the knee by repair or reconstruction of all injured ligaments. Eight knees were treated in the acute phase (less than two weeks after injury); the remainder were treated more than six months after injury (6 to 72). Reconstructions were carried out with a combination of autograft and allograft tendons and by direct ligament repair where possible. At a mean follow-up of 32 months (11 to 77) the mean Lysholm score was 87 (81 to 91) in the acute group and 75 (53 to 100) in the delayed group. The mean Tegner activity rating was 5 in the acute group and 4.4 in the delayed group. The International Knee Documentation Committee assessment revealed no differences between the two groups. Instrumented testing of knee stability indicated better results for anterior cruciate ligament reconstructions which had been undertaken in the acute phase, but no difference in the outcome of posterior cruciate ligament reconstructions. There was no difference in the loss of knee movement between the two groups. Although the differences were small, the outcome in terms of overall knee function, activity levels and anterior tibial translation were better in those knees which had been reconstructed within two weeks of injury.
TL;DR: It is concluded that this technique can be recommended for the treatment of habitual or recurrent patellar dislocation in children, although hypermobility and patella alta are not fully corrected.
Abstract: We investigated the clinical outcome of a reconstructive procedure of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in four children (6 knees), with a minimum follow-up of four years. The technique involves transfer of the tendon of semitendinosus to the patella using the posterior one-third of the femoral insertion of the medial collateral ligament as a pulley. There was no recurrence of dislocation after surgery. The mean Kujala score at follow-up was 96.3 points. Radiological assessment showed that the congruence angle, the tilt angle and the lateral shift radio were restored to normal. The lateral and medial stress shift ratios and the Insall-Salvati ratio remained abnormal. We conclude that this technique can be recommended for the treatment of habitual or recurrent patellar dislocation in children, although hypermobility and patella alta are not fully corrected.
TL;DR: MRI at 12 months is a reasonable non-invasive means of assessment of ACI and suggested production of normal or nearly normal cartilage in 82%, corresponding to a subjective improvement in 81% of patients and 88% IKDC A/B scores.
Abstract: In order to determine the usefulness of MRI in assessing autologous chondrocyte implantation (ACI) the first 57 patients (81 chondral lesions) with a 12-month review were evaluated clinically and with specialised MRI at three and 12 months. Improvement 12 months after operation was found subjectively (37.6 to 51.9) and in knee function levels (from 85% International Cartilage Repair Society (ICRS) III/IV to 61% I/II). The International Knee Documentation Committee (IKDC) scores showed an initial deterioration at three months (56% IKDC A/B) but marked improvement at 12 months (88% A/B). The MRI at three months showed 82% of patients with at least 50% defect fill, 59% with a normal or nearly normal signal at repair sites, 71% with a mild or no effusion and 80% with a mild or no underlying bone-marrow oedema. These improved at 12 months to 93%, 93%, 94% and 91%, respectively. The overall MR score at 12 months suggested production of normal or nearly normal cartilage in 82%, corresponding to a subjective improvement in 81% of patients and 88% IKDC A/B scores. Second-look surgery and biopsies in 15 patients (22 lesions) showed a moderate correlation of MRI with visual scoring; 70% of biopsies showed hyaline and hyaline-like cartilage. Thus, MRI at 12 months is a reasonable non-invasive means of assessment of ACI.
TL;DR: In this paper, the authors compared two-portal endoscopic release (ECTR) and limited open carpal tunnel release (LOCTR) techniques in a prospective, randomised trial.
Abstract: Endoscopic carpal tunnel release has the advantage over open release of reduced tissue trauma and postoperative morbidity. Limited open carpal tunnel release has also been shown to have comparable results, but is easier to perform and is safer. We have compared the results of both techniques in a prospective, randomised trial. Thirty patients with bilateral carpal tunnel syndrome had simultaneous bilateral release. The technique of release was randomly allocated to either two-portal endoscopic release (ECTR) or limited open release using the Strickland instrumentation (LOCTR). The results showed that the outcome was similar at follow-up of one year using both techniques. However, the LOCTR group had significantly less tenderness of the scar at the second and fourth postoperative week (p < 0.01). There was also less thenar and hypothenar (pillar) pain after LOCTR. Subjective evaluation showed a preference for LOCTR.
TL;DR: The increased trabecular thickness and density, but relatively decreased connectivity suggest a mechanism of bone remodelling in early OA as a process of filling trABecular cavities, which leads to a progressive change oftrabeculae from rod-like to plate-like, the opposite to that of normal ageing.
Abstract: We obtained medial and lateral subchondral cancellous bone specimens from ten human post-mortem proximal tibiae with early osteoarthritis (OA) and ten normal age- and gender-matched proximal tibiae. The specimens were scanned by micro-CT and the three-dimensional microstructural properties were quantified. Medial OA cancellous bone was significantly thicker and markedly plate-like, but lower in mechanical properties than normal bone. Similar microstructural changes were also observed for the lateral specimens from OA bone, although there had been no sign of cartilage damage. The increased trabecular thickness and density, but relatively decreased connectivity suggest a mechanism of bone remodelling in early OA as a process of filling trabecular cavities. This process leads to a progressive change of trabeculae from rod-like to plate-like, the opposite to that of normal ageing. The decreased mechanical properties of subchondral cancellous bone in OA, which are due to deterioration in architecture and density, indicate poor bone quality.
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TL;DR: In this article, clinical and experimental evidence is reviewed with respect to implant survival in relation to cement mantle thickness, and the so-called French paradox of excellent survival with thin cement mantles is discussed.
Abstract: In this chapter, clinical and experimental evidence is reviewed with respect to implant survival in relation to cement mantle thickness. The so-called French paradox of excellent survival with thin cement mantles is discussed. Cement mantles perceived as ≫thin≪ may in fact by thicker than expected.
TL;DR: The text for this EFG was written by Professor Jack Cheng and his colleagues who used whole spine magnetic resonance imaging (MRI) to re-investigate the relative anterior spinal overgrowth of progressive AIS in a cross-sectional study and three new hypotheses are proposed to interpret their findings.
Abstract: We undertook a comparative study of magnetic resonance imaging (MRI) vertebral morphometry of thoracic vertebrae of girls with adolescent idiopathic thoracic scoliosis (AIS) and age and gender-matched normal subjects, in order to investigate abnormal differential growth of the anterior and posterior elements of the thoracic vertebrae in patients with scoliosis. Previous studies have suggested that disproportionate growth of the anterior and posterior columns may contribute to the development of AIS. Whole spine MRI was undertaken on 83 girls with AIS between the age of 12 and 14 years, and Cobb's angles of between 20 degrees and 90 degrees, and 22 age-matched controls. Multiple measurements of each thoracic vertebra were obtained from the best sagittal and axial MRI cuts. Compared with the controls, the scoliotic spines had longer vertebral bodies between T1 and T12 in the anterior column and shorter pedicles with a larger interpedicular distance in the posterior column. The differential growth between the anterior and the posterior elements of each thoracic vertebra in the patients with AIS was significantly different from that in the controls (p < 0.01). There was also a significant positive correlation between the scoliosis severity score and the ratio of differential growth between the anterior and posterior columns for each thoracic vertebra (p < 0.01). Compared with age-matched controls, the longitudinal growth of the vertebral bodies in patients with AIS is disproportionate and faster and mainly occurs by endochondral ossification. In contrast, the circumferential growth by membranous ossification is slower in both the vertebral bodies and pedicles.
TL;DR: It is concluded that a patellofemoral prosthesis is a good treatment option with successful long-term results in middle-aged patients with radiologically documented, isolated, patell ofemoral osteoarthritis.
Abstract: We studied retrospectively the outcome of patellofemoral arthroplasty (PFA) using the Richards prosthesis in 51 patients (56 knees). Their mean age was 50 years (30 to 77). In 43 patients (45 knees), the American Knee Society score and the patients' subjective judgement were assessed. Excellent or good results were obtained in 86% of cases at a mean follow-up of 17 years (15 to 21). Because of ongoing tibiofemoral osteoarthritis, two patients required a high tibial osteotomy and ten PFAs were converted to a total knee arthroplasty after a mean of 15.6 years (10 to 21). The PFAs were stable during follow-up with a loosening rate of only 2%. We conclude that a patellofemoral prosthesis is a good treatment option with successful long-term results in middle-aged patients with radiologically documented, isolated, patellofemoral osteoarthritis.
TL;DR: The study suggests that nerve-root injections are effective in reducing pain in patients with osteoporotic vertebral fractures and that these patients should be considered for this treatment before percutaneous vertebroplasty or operative intervention is attempted.
Abstract: We have studied 58 patients with pain from osteoporotic vertebral fractures which did not respond to conservative treatment. These were 53 women and five men with a mean age of 72.5 years. They received a nerve-root injection with lidocaine, bupivicaine and DepoMedrol. The mean follow-up period was 13.5 months. The mean pain scores before treatment, at one and six months after treatment and at the final follow-up were 85, 24.9, 14.1, and 17.4, respectively. According to our modified criteria for grading results, six patients were considered to have an excellent result, 42 good and ten fair. A newly developed compression fracture was noted in three patients. There were no complications related to the injection. Our study suggests that nerve-root injections are effective in reducing pain in patients with osteoporotic vertebral fractures and that these patients should be considered for this treatment before percutaneous vertebroplasty or operative intervention is attempted.
TL;DR: In this paper, the authors used prospective data from 862 total knee and 716 total hip replacements three years after surgery to derive and validate a reduced Western Ontario and McMasters University Osteoarthritis Index (WOMAC) function scale.
Abstract: We used prospective data from 862 total knee and 716 total hip replacements three years after surgery in order to derive and validate a reduced Western Ontario and McMasters University Osteoarthritis Index (WOMAC) function scale. The reduced scale was derived using the advice of clinical experts as well as analysis of data. The scale was tested for validity, reliability and responsiveness. Items which were retained included: ascending stairs, rising from sitting, walking on the flat, getting in or out of a car, putting on socks, rising from bed, and sitting. The reduced and full scales had comparable, moderate correlations with other measures of function, confirming convergent validity. Cronbach's alpha was high (alpha > 0.85) with the reduced scale confirming reliability. Responsiveness was greater for the reduced scale (full = 1.4, reduced = 1.6). This reduced version of the WOMAC function scale provides a practical, valid, reliable and responsive alternative to the full function scale for use after total joint replacement. Further work is needed to demonstrate its wider applicability.