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The use of ultrasound in the assessment and treatment of Achilles tendinosis.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The use of ultrasound in the diagnosis and management of disorders of the tendo Achillis is discussed. Some of the pathological processes which occur in Achilles tendinopathy can be identified by ultrasound, which may also be used to direct local treatment. PMID: 19880880 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Mitchell AW, Lee JC, Healy JC Tags: J Bone Joint Surg Br Source Type: journals

The pink, pulseless hand after supracondylar fracture of the humerus in children.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This annotation discusses the findings of two papers in the current issue describing the management of the neurovascular complications of supracondylar fractures of the humerus in childhood, with particular reference to the indications for and the timing of exploration of the brachial artery and the affected nerves. PMID: 19880881 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Robb JE Tags: J Bone Joint Surg Br Source Type: journals

The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The aim of this study was to determine whether the foundation programme for junior doctors, implemented across the United Kingdom in 2005, provides adequate training in musculoskeletal medicine. We recruited 112 doctors on completion of their foundation programme and assessed them using the Freedman and Bernstein musculoskeletal examination tool. Only 8.9% passed the assessment. Those with exposure to orthopaedics, with a career interest in orthopaedics, and who felt that they had gained adequate exposure to musculoskeletal medicine obtained significantly higher scores. Those interested in general practice as a career ...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Al-Nammari SS, James BK, Ramachandran M Tags: J Bone Joint Surg Br Source Type: journals

Mid- to long-term results of irradiated allograft in acetabular reconstruction: a follow-up report.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Between 1990 and 2000, 123 hips in 110 patients were reconstructed for aseptic loosening using impaction bone grafting with frozen, irradiated, morsellised femoral heads and cemented acetabular components. This series was reported previously at a mean follow-up of five years. We have extended this follow-up and now describe the outcome of 86 hips in 74 patients at a mean of ten years. There have been 19 revisions, comprising nine for infection, seven for aseptic loosening and three for dislocation. In surviving acetabular reconstructions, union of the graft had occurred in 64 of 67 hips (95.5%). Survival analysis for a...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Emms NW, Buckley SC, Stockley I, Hamer AJ, Kerry RM Tags: J Bone Joint Surg Br Source Type: journals

An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The use of plate-and-cable constructs to treat periprosthetic fractures around a well-fixed femoral component in total hip replacements has been reported to have high rates of failure. Our aim was to evaluate the results of a surgical treatment algorithm to use these lateral constructs reliably in Vancouver type-B1 and type-C fractures. The joint was dislocated and the stability of the femoral component was meticulously evaluated in 45 type-B1 fractures. This led to the identification of nine (20%) unstable components. The fracture was considered to be suitable for single plate-and-cable fixation by a direct reduction ...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL Tags: J Bone Joint Surg Br Source Type: journals

Two-stage revision arthroplasty of the hip for infection using an interim articulated Prostalac hip spacer: a 10- to 15-year follow-up study.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the outcome at ten to 15 years of two-stage revision for hip infection in 99 patients using the Prostalac articulated hip spacer system. All the patients were contacted to determine their current functional and infection status using the Oxford-12, Short form-12, and Western Ontario and McMaster University Osteoarthritis Index questionnaires. A total of 11 of the 99 patients had a further infection, of whom seven responded to repeat surgery with no further sequelae. The mean interval between the stages was five months (1 to 36). We were able to review 48 living patients, with a mean age of 72 years (46 to 86), 34...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Biring GS, Kostamo T, Garbuz DS, Masri BA, Duncan CP Tags: J Bone Joint Surg Br Source Type: journals

Periacetabular osteotomy reduces the dynamic instability of dysplastic hips.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study suggests that periacetabular osteotomy provides pain relief, improves acetabular cover and reduces the dynamic instability in patients with dysplastic hips. PMID: 19880886 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Maeyama A, Naito M, Moriyama S, Yoshimura I Tags: J Bone Joint Surg Br Source Type: journals

Ten-year follow-up of the non-porous Allofit cementless acetabular component.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study demonstrates that a non-porous titanium acetabular component with adjunct surface fixation offers an alternative to standard porous-coated implants. PMID: 19880887 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Zenz P, Stiehl JB, Knechtel H, Titzer-Hochmaier G, Schwagerl W Tags: J Bone Joint Surg Br Source Type: journals

Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study investigated the relationship between the bearing surface and the risk of revision due to dislocation. It was based on 110 239 primary total hip replacements with a diagnosis of osteoarthritis collected by the Australian Orthopaedic Association National Joint Replacement Registry between September 1999 and December 2007. A total of 862 (0.78%) were revised because of dislocation. Ceramic-on-ceramic bearing surfaces had a lower risk of requiring revision due to dislocation than did metal-on-polyethylene and ceramic-on-polyethylene surfaces, with a follow-up of up to seven years. However, ceramic-on-ceramic implan...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Sexton SA, Walter WL, Jackson MP, De Steiger R, Stanford T Tags: J Bone Joint Surg Br Source Type: journals

Clinical and radiological outcome of stemmed hip replacement after revision from metal-on-metal resurfacing.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the outcome of total hip replacement in 29 failed metal-on-metal resurfacing hip replacements in which the primary surgery was performed between August 1995 and February 2005. The mean length of follow-up was five years (1.7 to 11.7). Of the 29 hip resurfacings, 19 acetabular components and all the femoral components were revised (28 uncemented stems and one cemented stem). There were no deaths and none of the patients was lost to follow-up. None of the hips underwent any further revision. The results of the revision resurfacing group were compared with those of a control group of age-matched patients. In the lat...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Eswaramoorthy VK, Biant LC, Field RE Tags: J Bone Joint Surg Br Source Type: journals

Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Valgus high tibial osteotomy for osteoarthritis of the medial compartment of the knee can be performed using medial opening- and lateral closing-wedge techniques. The latter have been thought to offer greater initial stability. We measured and compared the stability of opening- and closing-wedge osteotomies fixed by TomoFix plates using radiostereometry in a series of 42 patients in a prospective, randomised clinical trial. There were no differences between the opening- and closing-wedge groups in the time to regain knee function and full weight-bearing. Pain and knee function were significantly improved in both groups...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Luites JW, Brinkman JM, Wymenga AB, van Heerwaarden RJ Tags: J Bone Joint Surg Br Source Type: journals

Total knee replacement with rotational proximal tibial osteotomy for osteoarthritis with severe external tibial torsion and patellar instability.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The management of osteoarthritis of the knee associated with patellar instability secondary to external tibial torsion > 45 degrees is challenging. Patellofemoral biomechanics in these patients cannot be achieved by intra-articular correction using standard techniques of total knee replacement. We reviewed seven patients (eight knees) with recurrent patellar dislocation and one with bilateral irreducible lateral dislocation who had undergone simultaneous total knee replacement and internal tibial derotational osteotomy. All had osteoarthritis and severe external tibial torsion. The mean follow-up was for 47.2 months...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Ramaswamy R, Kosashvili Y, Cameron HU, Cameron JC Tags: J Bone Joint Surg Br Source Type: journals

Lengthening of fourth brachymetatarsia by three different surgical techniques.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We carried out a retrospective study to assess the clinical results of lengthening the fourth metatarsal in brachymetatarsia in 153 feet of 106 patients (100 female, six males) using three different surgical techniques. In one group lengthening was performed by one-stage intercalary bone grafting secured by an intramedullary Kirschner-wire (45 feet, 35 patients). In the second group lengthening was obtained gradually using a mini-external fixator after performing an osteotomy with a saw (59 feet, 39 patients) and in the third group lengthening was achieved in a gradual manner using a mini-external fixator after underta...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Lee WC, Yoo JH, Moon JS Tags: J Bone Joint Surg Br Source Type: journals

Two extension block Kirschner wire technique for mallet finger fractures.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We treated 32 displaced mallet finger fractures by a two extension block Kirschner-wire technique. The clinical and radiological outcomes were evaluated at a mean follow-up of 49 months (25 to 84). The mean joint surface involvement was 38.4% (33% to 50%) and 18 patients (56%) had accompanying joint subluxation. All 32 fractures united with a mean time to union of 6.2 weeks (5.1 to 8.2). Congruent joint surfaces and anatomical reduction were seen in all cases. The mean flexion of the distal interphalangeal joints was 83.1 degrees (75 degrees to 90 degrees ) and the mean extension loss was 0.9 degrees (0 degrees to 7 de...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Lee YH, Kim JY, Chung MS, Baek GH, Gong HS, Lee SK Tags: J Bone Joint Surg Br Source Type: journals

Neurological deficit after surgical enucleation of schwannomas of the upper limb.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study suggests that a schwannoma in the upper limb can be removed with an acceptable risk of injury to the nerve, although a transient neurological deficit occurs regularly after the operation. Biopsy is not advised. Patients should be informed pre-operatively about the possibility of damage to the nerve: meticulous dissection is required to minimise this. PMID: 19880894 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Park MJ, Seo KN, Kang HJ Tags: J Bone Joint Surg Br Source Type: journals

Ischaemia and the pink, pulseless hand complicating supracondylar fractures of the humerus in childhood: long-term follow-up.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A series of 26 children was referred to our specialist unit with a 'pink pulseless hand' following a supracondylar fracture of the distal humerus after a mean period of three months (4 days to 12 months) except for one referred after almost three years. They were followed up for a mean of 15.5 years (4 to 26). The neurovascular injuries and resulting impairment in function and salvage procedures were recorded. The mean age at presentation was 8.6 years (2 to 12). There were eight girls and 18 boys. Only four of the 26 patients had undergone immediate surgical exploration before referral and three of these four had a sa...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Blakey CM, Biant LC, Birch R Tags: J Bone Joint Surg Br Source Type: journals

Impact of late surgical intervention on heterotopic ossification of the hip after traumatic neurological injury.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report a consecutive series of patients with HO of the hip after injury to the central nervous system who required surgery in a single, specialised tertiary referral unit. As was usual practice, they all underwent CT to determine the location of the HO and to evaluate the density of the femoral head and articular surface. The outcome of surgery was correlated with the pre-, peri- and post-operative findings. In all, 183 hips (143 patients) were included of which 70 were ankylosed. A total of 25 peri-operative fractures of the femoral neck occurred, all of which arose in patients with ankylosed hips and were associated w...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Genet F, Marmorat JL, Lautridou C, Schnitzler A, Mailhan L, Denormandie P Tags: J Bone Joint Surg Br Source Type: journals

Mason type IV fractures of the elbow: a 14- to 46-year follow-up study.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A total of 14 women and seven men with a mean age of 43 years (18 to 68) who sustained a Mason type IV fracture of the elbow, without an additional type II or III coronoid fracture, were evaluated after a mean of 21 years (14 to 46). Primary treatment included closed elbow reduction followed by immobilisation in a plaster in all cases, with an additional excision of the radial head in 11, partial resection in two and suturing of the annular ligament in two. Delayed radial head excision was performed in two patients and an ulnar nerve transposition in one. The uninjured elbows served as controls. Nine patients had no sy...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Herbertsson P, Hasserius R, Josefsson PO, Besjakov J, Nyquist F, Nordqvist A, Karlsson MK Tags: J Bone Joint Surg Br Source Type: journals

Survival of patients with skeletal metastases from hepatocellular carcinoma after surgical management.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Skeletal metastases from hepatocellular carcinoma are highly destructive vascular lesions which severely reduce the quality of life. Pre-existing liver cirrhosis presents unique challenges during the surgical management of such lesions. We carried out a retrospective study of 42 patients who had been managed surgically for skeletal metastases from hepatocellular carcinoma affecting the appendicular skeleton between January 2000 and December 2006. There were 38 men and four women with a mean age of 60.2 years (46 to 77). Surgery for a pathological fracture was undertaken in 30 patients and because of a high risk of frac...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Cho HS, Oh JH, Han I, Kim HS Tags: J Bone Joint Surg Br Source Type: journals

Total femoral endoprosthetic replacement following excision of bone tumours.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We undertook a retrospective review of 33 patients who underwent total femoral endoprosthetic replacement as limb salvage following excision of a malignant bone tumour. In 22 patients this was performed as a primary procedure following total femoral resection for malignant disease. Revision to a total femoral replacement was required in 11 patients following failed segmental endoprosthetic or allograft reconstruction. There were 33 patients with primary malignant tumours, and three had metastatic lesions. The mean age of the patients was 31 years (5 to 68). The mean follow-up was 4.2 years (9 months to 16.4 years). At ...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Sewell MD, Spiegelberg BG, Hanna SA, Aston WJ, Bartlett W, Blunn GW, David LA, Cannon SR, Briggs TW Tags: J Bone Joint Surg Br Source Type: journals

The 'pulseless pink' hand after supracondylar fracture of the humerus in children: the predictive value of nerve palsy.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We compared two management strategies for the perfused but pulseless hand after stabilisation of a Gartland type III supracondylar fracture. We identified 19 patients, of whom 11 were treated conservatively after closed reduction (group 1). Four required secondary exploration, of whom three had median and/or anterior interosseus nerve palsy at presentation. All four were found to have tethering or entrapment of both nerve and vessel at the fracture site. Only two regained patency of the brachial artery, and one patient has a persistent neurological deficit. In six of the eight patients who were explored early (group 2)...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Mangat KS, Martin AG, Bache CE Tags: J Bone Joint Surg Br Source Type: journals

Selective soft-tissue release for recurrent or residual deformity after conservative treatment of idiopathic clubfoot.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We reviewed the results of a selective à la carte soft-tissue release operation for recurrent or residual deformity after initial conservative treatment for idiopathic clubfoot by the Ponseti method. Recurrent or residual deformity occurred in 13 (19 feet) of 33 patients (48 feet; 40%). The mean age at surgery was 2.3 years (1.3 to 4) and the mean follow-up was 3.6 years (2 to 5.3). The mean Pirani score had improved from 2.8 to 1.1 points, and the clinical and radiological results were satisfactory in all patients. However, six of the 13 patients (9 of 19 feet) had required further surgery in the form of tibial d...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Park SS, Kim SW, Jung BS, Lee HS, Kim JS Tags: J Bone Joint Surg Br Source Type: journals

Late spinal subdural haematoma after spinal anaesthesia for total hip replacement.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present a case of delayed presentation of a subdural haematoma causing cauda equina syndrome which occurred 96 hours after a spinal anaesthetic had been administered for an elective total hip replacement in an 86-year-old man. The patient had received low-molecular-weight heparin anticoagulation which had been delayed until 12 hours postoperatively. No other cause of the haemorrhage could be identified. PMID: 19880902 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Moussallem CD, El-Yahchouchi CA, Charbel AC, Nohra G Tags: J Bone Joint Surg Br Source Type: journals

Survival of ceramic bearings in total hip replacement after high-energy trauma and periprosthetic acetabular fracture.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report two patients, each with a ceramic-on-ceramic total hip replacement who sustained high-energy trauma sufficient to cause a displaced periprosthetic acetabular fracture in whom the ceramic bearings survived intact. Simultaneous fixation of the acetabular fracture, revision of the cementless acetabular prosthesis and exchange of the ceramic bearings were performed successfully in both patients. Improved methods of manufacture of new types of alumina ceramic with a smaller grain size, and lower porosity, have produced much stronger bearings. Whether patients should be advised to restrict high-impact activities in ord...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Salih S, Currall VA, Ward AJ, Chesser TJ Tags: J Bone Joint Surg Br Source Type: journals

Potential risk of thermal damage to cervical nerve roots by a high-speed drill.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Using the transverse processes of fresh porcine lumbar spines as an experimental model we evaluated the heat generated by a rotating burr of a high-speed drill in cutting the bone. The temperature at the drilled site reached 174 degrees C with a diamond burr and 77 degrees C with a steel burr. With water irrigation at a flow rate of 540 ml/hr an effective reduction in the temperature was achieved whereas irrigation with water at 180 ml/hr was much less effective. There was a significant negative correlation between the thickness of the residual bone and the temperature measured at its undersurface adjacent to the drill...
Source: The Journal of Bone and Joint Surgery. British volume - November 1, 2009 Category: Orthopaedics Authors: Hosono N, Miwa T, Mukai Y, Takenaka S, Makino T, Fuji T Tags: J Bone Joint Surg Br Source Type: journals

Current trends in the relationship between orthopaedic surgeons and industry.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PMID: 19794157 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Rajaratnam A Tags: J Bone Joint Surg Br Source Type: journals

Total hip replacement in patients with neurological conditions.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Neurological conditions affecting the hip pose a considerable challenge in replacement surgery since poor and imbalanced muscle tone predisposes to dislocation and loosening. Consequently, total hip replacement (THR) is rarely performed in such patients. In a systematic review of the literature concerning THR in neurological conditions, we found only 13 studies which described the outcome. We have reviewed the evidence and discussed the technical challenges of this procedure in patients with cerebral palsy, Parkinson's disease, poliomyelitis and following a cerebrovascular accident, spinal injury or development of a Ch...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Queally JM, Abdulkarim A, Mulhall KJ Tags: J Bone Joint Surg Br Source Type: journals

Wrong-site surgery in orthopaedics.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Procedures performed at the incorrect anatomical site are commonly perceived as being relatively rare. However, they can be a devastating event for patients and doctors. Evidence from the United Kingdom and North America suggests that wrong-site, wrong-procedure and wrong-patient events occur more commonly than we think. Furthermore, their incidence may be increasing as NHS Trusts increase the volume and complexity of procedures undertaken in order to cope with increasing demands on the system. In previous studies from North America orthopaedic surgery has been found to be the worst-offending specialty. In this paper w...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Robinson PM, Muir LT Tags: J Bone Joint Surg Br Source Type: journals

Imageless computer navigation without pre-operative templating may lead to malpreparation of the femoral head in hip resurfacing.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The computed neck-shaft angle and the size of the femoral component were recorded in 100 consecutive hip resurfacings using imageless computer-navigation and compared with the angle measured before operation and with actual component implanted. The reliability of the registration was further analysed using ten cadaver femora. The mean absolute difference between the measured and navigated neck-shaft angle was 16.3 degrees (0 degree to 52 degrees). Navigation underestimated the measured neck-shaft angle in 38 patients and the correct implant size in 11. Registration of the cadaver femora tended to overestimate the corre...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Olsen M, Davis ET, Chiu M, Gamble P, Tumia N, Boyle RA, Schemitsch EH Tags: J Bone Joint Surg Br Source Type: journals

Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present the results in 90 patients with unilateral articular surface replacement (ASR) hip resurfacings (mean time to blood sampling 26 months) and 70 patients with unilateral Birmingham Hip Resurfacing (BHR) implants (mean time 47 months). The whole blood and serum chromium (Cr) and cobalt (Co) concentrations were inversely related to the size of the femoral component in both groups (p < 0.05). Cr and Co were more strongly influenced by the position of the acetabular component in the case of the ASR, with an increase in metal ions observed at inclinations > 45 degrees and anteversion angles of < 10 degrees and...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Langton DJ, Sprowson AP, Joyce TJ, Reed M, Carluke I, Partington P, Nargol AV Tags: J Bone Joint Surg Br Source Type: journals

The effect of obesity on the mid-term survival and clinical outcome of cementless total hip replacement.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The outcome of total hip replacement (THR) is potentially affected by the body mass index (BMI) of the patient. We studied the outcome of 2026 consecutive primary cementless THRs performed for osteoarthritis. The mean follow-up was 6.3 years (0 to 11.71) and no patient was lost to follow-up for survival analysis. The patients were divided into two groups according to their BMI as follows: non-obese (BMI < 30 kg/m(2)) and obese (BMI > or = 30 kg/m(2)). The obese patient undergoing surgery was found to be significantly younger (p < 0.001). The log-rank test for equality of survival showed no difference in the mi...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Jackson MP, Sexton SA, Yeung E, Walter WL, Walter WK, Zicat BA Tags: J Bone Joint Surg Br Source Type: journals

Total hip replacement in active advanced tuberculous arthritis.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We describe the results of cemented total hip replacement in 23 patients (23 hips) with active tuberculous arthritis of the hip with a mean follow-up of 4.7 years (4 to 7). In two patients the diagnosis was proved by pre-operative biopsy, whereas all others were diagnosed on a clinicoradiological basis with confirmation obtained by histopathological examination and polymerase chain reaction of tissue samples taken at the time of surgery. All patients received chemotherapy for at least three months before surgery and treatment was continued for a total of 18 months. Post-operative dislocation occurred in one patient and was...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Sidhu AS, Singh AP, Singh AP Tags: J Bone Joint Surg Br Source Type: journals

One-stage versus two-stage bilateral unicompartmental knee replacement: a comparison of immediate post-operative complications.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We retrospectively studied the major complications occurring after one- and two-stage bilateral unicompartmental knee replacements (UKR). Between 1999 and 2008, 911 patients underwent 1150 UKRs through a minimally invasive approach in our unit. Of these, 159 patients (318 UKRs) had one-stage and 80 patients (160 UKRs) had two-stage bilateral UKRs. The bilateral UKR groups were comparable in age and American Society of Anaesthesiology grade, but more women were in the two-stage group (p = 0.019). Mechanical thromboprophylaxis was used in all cases. Major complications were recorded as death, pulmonary embolus, proximal ...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Chan WC, Musonda P, Cooper AS, Glasgow MM, Donell ST, Walton NP Tags: J Bone Joint Surg Br Source Type: journals

Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A total of 218 patients with unilateral anterior cruciate ligament deficiency were randomly assigned to one of four groups. In group A an anatomical double bundle anterior cruciate ligament reconstruction was performed; group B were treated by a single bundle using an Endobutton for femoral fixation; in group C by a single bundle using RigidFix cross pins for femoral fixation; and in group D by a single bundle using a bioabsorbable TransFix II screw for femoral fixation. For tibial fixation a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gr...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Ibrahim SA, Hamido F, Al Misfer AK, Mahgoob A, Ghafar SA, Alhran H Tags: J Bone Joint Surg Br Source Type: journals

Patient-reported outcome at 62 to 67 years of age in 83 patients treated for congenital clubfoot.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The outcome in 83 patients with congenital clubfoot was evaluated at a mean age of 64 years using three validated questionnaires assessing both quality of life (short-form (SF)-36 and EQ-5D) and foot and ankle function (American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle questionnaire). In SF-36, male patients scored significantly better than male norms in seven of the eight domains, whereas female patients scored significantly worse than female norms in two of the eight. Male patients scored better than male norms in both the EQ-5D index (p = 0.027) and visual analogue scale (VAS) (p = 0.013), whereas femal...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Wallander H, Larsson S, Bjönness T, Hansson G Tags: J Bone Joint Surg Br Source Type: journals

The management of Charcot joint disease affecting the ankle and foot by arthrodesis controlled by an Ilizarov frame: early results.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report our experience of a series of 20 patients with Charcot osteoarthropathy of the foot and ankle treated with an Ilizarov external fixator. The mean age of the group was 30 years (21 to 50). Diabetes mellitus was the underlying cause in 18 patients. Five had chronic ulcers involving the foot and ankle. Each patient had an open lengthening of the tendo Achillis with excision of all necrotic and loose bone from the ankle, subtalar and midtarsal joints when needed. The resulting defect was packed with corticocancellous bone graft harvested from the iliac crest and an Ilizarov external fixator was applied. Arthrodesis w...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: El-Gafary KA, Mostafa KM, Al-Adly WY Tags: J Bone Joint Surg Br Source Type: journals

Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report a randomised controlled trial to examine the effectiveness and cost-effectiveness of arthroscopic acromioplasty in the treatment of stage II shoulder impingement syndrome. A total of 140 patients were randomly divided into two treatment groups: supervised exercise programme (n = 70, exercise group) and arthroscopic acromioplasty followed by a similar exercise programme (n = 70, combined treatment group). The main outcome measure was self-reported pain on a visual analogue scale of 0 to 10 at 24 months, measured on the 134 patients (66 in the exercise group and 68 in the combined treatment group) for whom endpoint...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Ketola S, Lehtinen J, Arnala I, Nissinen M, Westenius H, Sintonen H, Aronen P, Konttinen YT, Malmivaara A, Rousi T Tags: J Bone Joint Surg Br Source Type: journals

Early management of complex proximal humeral fractures using the Aequalis fracture prosthesis: a two- to five-year follow-up report.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We reviewed the outcome of 28 patients who had been treated using the Aequalis fracture prosthesis for an acute fracture of the proximal humerus at a mean follow-up of 39.3 months (24 to 63). The mean age of the patients at the time of the fracture was 66.3 years (38 to 80). The mean Constant score was 68.2 (37 to 84) for the operated shoulder, which represented 89.5% of the mean score for the uninjured side (p < 0.001). The quality of the reconstruction as shown on the immediate post-operative radiographs was categorised into three types, anatomical, acceptable, and unacceptable, depending on the position of the tu...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Kontakis GM, Tosounidis TI, Christoforakis Z, Hadjipavlou AG Tags: J Bone Joint Surg Br Source Type: journals

Osteotomy of the head of the radius for partial articular malunion.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Between 1995 and 2006, five intra-articular osteotomies of the head of the radius were performed in patients with symptomatic healed displaced articular fractures. Pre-operatively, all patients complained of persistent painful clicking on movement. Only patients with mild or no degenerative changes of the radial head and capitellum were considered for osteotomy. The operations were performed at a mean of 8.2 months (4 to 13) after injury and the patients were reviewed at a mean of 5.5 years (15 months to 12 years) after the osteotomy. The average Mayo Elbow Performance Index Score improved significantly from 74 before ...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Rosenblatt Y, Young C, MacDermid JC, King GJ Tags: J Bone Joint Surg Br Source Type: journals

A prospective, cohort study comparing translaminar screw fixation with transforaminal lumbar interbody fusion and pedicle screw fixation for fusion of the degenerative lumbar spine.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In a prospective observational study we compared the two-year outcome of lumbar fusion by a simple technique using translaminar screws (n = 57) with a more extensive method using transforaminal lumbar interbody fusion and pedicular screw fixation (n = 63) in consecutive patients with degenerative disease of the lumbar spine. Outcome was assessed using the validated multidimensional Core Outcome Measures Index. Blood loss and operating time were significantly lower in the translaminar screw group (p < 0.01). The complication rates were similar in each group (2% to 4%). In all, 91% of the patients returned their quest...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Grob D, Bartanusz V, Jeszenszky D, Kleinstück FS, Lattig F, O'Riordan D, Mannion AF Tags: J Bone Joint Surg Br Source Type: journals

Factors determining quality of life and level of sporting activity after internal fixation of an isolated acetabular fracture.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We investigated whether patients who underwent internal fixation for an isolated acetabular fracture were able to return to their previous sporting activities. We studied 52 consecutive patients with an isolated acetabular fracture who were operated on between January 2001 and December 2002. Their demographic details, fracture type, rehabilitation regime, outcome and complications were documented prospectively as was their level and frequency of participation in sport both before and after surgery. Quality of life was measured using the EuroQol-5D health outcome tool (EQ-5D). There was a significant reduction in level ...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Giannoudis PV, Nikolaou VS, Kheir E, Mehta S, Stengel D, Roberts CS Tags: J Bone Joint Surg Br Source Type: journals

Non-invasive extendible endoprostheses for limb reconstruction in skeletally-mature patients.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We describe the application of a non-invasive extendible endoprosthetic replacement in skeletally-mature patients undergoing revision for failed joint replacement with resultant limb-length inequality after malignant or non-malignant disease. This prosthesis was developed for tumour surgery in skeletally-immature patients but has now been adapted for use in revision procedures to reconstruct the joint or facilitate an arthrodesis, replace bony defects and allow limb length to be restored gradually in the post-operative period. We record the short-term results in nine patients who have had this procedure after multiple prev...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Sewell MD, Spiegelberg BG, Hanna SA, Aston WJ, Meswania JM, Blunn GW, Henry C, Cannon SR, Briggs TW Tags: J Bone Joint Surg Br Source Type: journals

Biological reconstruction after resection of bone tumours around the knee: long-term follow-up.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We reviewed 25 patients who had undergone resection of a primary bone sarcoma which extended to within 5 cm of the knee with reconstruction by a combination of a free vascularised fibular graft and a massive allograft bone shell. The distal femur was affected in four patients and the proximal tibia in 21. Their mean age at the time of operation was 19.7 years (5 to 52) and the mean follow-up period 140 months (28 to 213). Three vascularised transfers failed. The mean time to union of the fibula was 5.6 months (3 to 10) and of the allograft 19.6 months (10 to 34). Full weight-bearing was allowed at a mean of 21.4 months...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Abed YY, Beltrami G, Campanacci DA, Innocenti M, Scoccianti G, Capanna R Tags: J Bone Joint Surg Br Source Type: journals

The early results of joint-sparing proximal tibial replacement for primary bone tumours, using extracortical plate fixation.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This paper describes the preliminary results of a proximal tibial endoprosthesis which spares the knee joint and enables retention of the natural articulation by replacing part of the tibial metaphysis and diaphysis. In eight patients who had a primary malignant bone tumour of the proximal tibia, the distal stem, which had a hydroxyapatite-coated collar to improve fixation, was cemented into the medullary canal. The proximal end had hydroxyapatite-coated extracortical plates which were secured to the remaining proximal tibial metaphysis using cortical screws. The mean age of the patients at operation was 28.9 years (8 ...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Spiegelberg BG, Sewell MD, Aston WJ, Blunn GW, Pollock R, Cannon SR, Briggs TW Tags: J Bone Joint Surg Br Source Type: journals

Endoprosthetic reconstruction of the distal tibia and ankle joint after resection of primary bone tumours.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the outcome of six patients treated between 1981 and 2007. There were four males and two females, with a mean age of 43.5 years (15 to 75), and a mean follow-up of 9.6 years (1 to 27). No patient developed a local recurrence or metastasis. Two of the six went on to have a below-knee amputation for persistent infection after a mean 16 months (1 to 31). The four patients who retained their endoprosthesis had a mean musculoskeletal tumour society score of 70% and a mean Toronto extremity salvage score of 71%. All were pain free and able to perform most activities of daily living in comfort. A custom-made endoprosthe...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Shekkeris AS, Hanna SA, Sewell MD, Spiegelberg BG, Aston WJ, Blunn GW, Cannon SR, Briggs TW Tags: J Bone Joint Surg Br Source Type: journals

Shelf acetabuloplasty for children with Perthes' disease and reducible subluxation of the hip: prognostic factors related to hip remodelling.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We evaluated radiological hip remodelling after shelf acetabuloplasty and sought to identify prognostic factors in 25 patients with a mean age of 8.9 years (7.0 to 12.3) who had unilateral Perthes' disease with reducible subluxation of the hip in the fragmentation stage. At a mean follow-up of 6.7 years (3.2 to 9.0), satisfactory remodelling was observed in 18 hips (72%). The type of labrum in hip abduction, as determined by intra-operative dynamic arthrography, was found to be a statistically significant prognostic factor (p = 0.012). Shelf acetabuloplasty as containment surgery seems to be best indicated for hips in ...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Yoo WJ, Choi IH, Cho TJ, Chung CY, Shin YW, Shin SJ Tags: J Bone Joint Surg Br Source Type: journals

Femoral torsion in patients with Blount's disease: a previously unrecognised component.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In 1937 Blount described a series of 28 patients with 'Tibia vara'. Since then, a number of deformities in the tibia and the femur have been described in association with this condition. We analysed 14 children with Blount's disease who were entered into a cross-sectional study. Their mean age was 10 (2 to 18). They underwent a clinical assessment of the rotational profile of their legs and a CT assessment of the angle of anteversion of their hips (femoral version). We compared our results to previously published controls. A statistically significant increase in femoral anteversion was noted in the affected legs, with ...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Aird JJ, Hogg A, Rollinson P Tags: J Bone Joint Surg Br Source Type: journals

Limb lengthening with a submuscular locking plate.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ten patients, who were unsuitable for limb lengthening over an intramedullary nail, underwent lengthening with a submuscular locking plate. Their mean age at operation was 18.5 years (11 to 40). After fixing a locking plate submuscularly on the proximal segment, an external fixator was applied to lengthen the bone after corticotomy. Lengthening was at 1 mm/day and on reaching the target length, three or four screws were placed in the plate in the distal segment and the external fixator was removed. All patients achieved the pre-operative target length at a mean of 4.0 cm (3.2 to 5.5). The mean duration of external fixa...
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Oh CW, Song HR, Kim JW, Choi JW, Min WK, Park BC Tags: J Bone Joint Surg Br Source Type: journals

Bilateral idiopathic avascular necrosis of the scaphoid: a rare case of Preiser's disease.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We describe a rare case of bilateral Preiser's disease. Possible aetiological factors and a summary of the current concepts of management are discussed. PMID: 19794180 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)
Source: The Journal of Bone and Joint Surgery. British volume - September 30, 2009 Category: Orthopaedics Authors: Imam S, Aldridge C, Lyall H Tags: J Bone Joint Surg Br Source Type: journals

Further doubts over the performance of treatment centres in providing elective orthopaedic surgery.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Recent publication of reports showing high revision rates for hip and knee replacements carried out in Independent Sector Treatment Centres (ISTCs) has raised doubts regarding their ability to provide high quality healthcare. The high revision rates also create a financial burden to the NHS. The poor quality of data collected at ISTCs makes their performance difficult to evaluate. Funds may be better spent improving existing NHS facilities rather than establishing parallel ISTCs. PMID: 19721034 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)
Source: The Journal of Bone and Joint Surgery. British volume - August 31, 2009 Category: Orthopaedics Authors: Oussedik S, Haddad F Tags: J Bone Joint Surg Br Source Type: journals