Acta Orthopaedica Belgica
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Primary bone and soft tissue tumours: Epidemiological data from a non-referral teaching department in Belgium.
No full textPrimary bone and soft tissue tumours are rare in a non-referral teaching department. The incidence varies greatly among the different subtypes and every Orthopaedic surgeon will encounter one or more benign or malignant lesions during their careers. History, clinical examination and technical investigations are of great importance, but basic knowledge and basic principles are necessary for a correct clinical practice. It was the purpose of this study to raise awareness towards such pathology by exemplifying our cases from a two-year period in our community-based hospital and if necessary, to refer patients to specialised sarcoma centres
What are the determinants for return to work after primary total knee arthroplasty?
No full textTotal knee arthroplasty is increasingly performed on patients of working age, although little is known about return to work. This study aims to analyse the return to work percentage in a Belgian population and to identify underlying determinants. Data was gathered by analysing patients’ files and sending a questionnaire to patients aged ≤ 62 years who underwent a total knee arthroplasty between January 2013 and December 2017 in the University Hospitals of Leuven. A total of 99 patients were included in the study and 66 patients returned to work. Significant factors included preoperative sick leave, availability of job adaptations, employment type and postoperative Knee Society Score.The return to work percentage of 67% in this Belgian population is slightly lower in comparison with similar studies in other countries. This difference could be driven by Belgium’s specific insurance system or due to a lack of clear prescription guidelines for medical doctors.
Dutch translation and validation of the Norwich Patellar Instability score and Banff Patella Instability Instrument in patients after surgery for patellar instability
No full textPurposeRecently, two new English specific patient reported outcome measures (PROMs) to evaluate treatment of patients with patellofemoral complaints have been developed: the Banff Patella Instability Instrument (BPII) and the Norwich Patellar Instability (NPI) score. This study was designed to translate and validate the BPII and NPI in Dutch patients after surgical treatment for patellar instability.MethodsForward and backward translation of the outcome measures was performed. Patients who had been surgically treated for patellar instability filled out the NPI and BPII together with the Kujala Knee Score, numeric rating scales, Knee disability and Osteoarthritis Outcome Score (KOOS) and SF-36. We assessed internal consistency and construct validity. We evaluated the presence of ceiling and floor effects.ResultsNinety-seven patients completed the online questionnaires. The internal consistency of the NPI and BPII score was excellent for both outcome measures. The BPII and NPI had good correlations with other PROMs. For the BPII we found no floor nor ceiling effect. For the NPI we found a floor effect but no ceiling effect. ConclusionOur results indicate that the Dutch version of the BPII and the NPI can be used for patients with patellar instability. Both PROMs have specific (dis)advantages.
Three-Dimensional Correction of Fibular Hemimelia using Computer-Assisted Planning: Case Report and Literature Review
No full textThe purpose of this study is to investigate a stepwise approach to translate the principles of deformity correction from 2D plain radiographs to a 3D computer assisted pre-operative planning (CAP), when treating a complex case of fibular hemimelia. Computed tomography slices were used to perform a 3D reconstruction of the deformity. CAP determined the different axes and apex of deformity based on geometrical functions of the software. The obtuse angle was computed and used to determine the concomitant osteotomy angle. An additional review of the literature was performed, allowing comparison towards the current treatment approaches.The pre- and post-operative clinical and radiographic follow up is reported. The computer assisted planning was applicable in a complex fibular hemimelia deformity. The literature review demonstrated no previous use of a 3D computer assisted planning.This case report provides a feasible and effective method to convert the principles of deformity planning from a 2D to a 3D setting. The added value of this technique for clinical practice should be confirmed in further prospective studies
Radiographic assessment of calcifying tendinitis of the rotator cuff: an inter- and intraobserver study
No full textThe radiographic appearance of calcific tendinitis of the rotator cuff varies according to the stage of the disease. We compared currently used classification systems in a large group of observers to identify the most reliable classification system. Thirty-seven orthopaedic surgeons evaluated shoulder radiographs of 25 patients to classify the stage of the calcific tendinitis according to the classifications by (1) Gärtner and (2) Molé on a Web-based study platform. Inter and intraobserver agreement among observers was measured using the Siegel and Castellan multirater κ. Both classification systems had fair interobserver agreement: κ was 0.25 for the Molé classification and 0.34 for the Gärtner classification. The Gärtner classification was significantly more reliable than the Molé classification. Currently there is no radiographic classification that can serve the purpose of guiding the treatment in a reliable way. The Gärtner classification is the most reliable, although far from perfect, radiographic classification there is
The pathogenesis of heterotopic ossification after traumatic brain injury. A review of current literature.
No full textIntroduction: Neurogenic heterotopic ossification (NHO), mostly defined as a benign process of formation of bone outside the skeletal system, after traumatic brain injury (TBI) is a musculoskeletal disorder that causes pain and reduces the range of motion, often leading to marked impairment of quality of life. The pathogenic factors that link the brain and bone and cause the formation of heterotopic bone are largely unknown. This article will try to summarize the current literature on the pathogenesis of NHO and accelerated fracture healing after TBI.Pathogenesis: The heterotopic formation of bone after TBI seems to be inducted by a complex interplay between local and systemic factors. For all different forms of HO, the same three conditions are required for the formation of ectopic bone: The presence of osteoprogenitor cells, a permissive environment, and a stimulating factor. The osteoprogenitor cells are thought to be of mesenchymal origin, however recent research suggests a possible neural origin. The permissive environment is created mainly by reactions to hypoxia and both local and sensory nerve inflammation. Many possible inducing factors have been described; the endogenic route is thought to be the most dominant in the stimulation of HO formation after TBI
Orthopaedic support with 3D printing in children: marketing effect or solution of the future?
No full textINTRODUCTION. In pediatric orthopaedics, the immobilization of a limb is traditionally done by a cast. The emergence of 3D technologies allows us to produce restraints specific to the anatomical characteristics of the patient. This paper aims to determine the feasibility of the process of developing these restraints.MATERIAL AND METHOD. Descriptive study of the creation process involving 19 patients aged 2 to 14 years for whom a restraint was placed between April 2018 and November 2018. This was mainly post-traumatic pathology (12) and children having a clubfoot (7). RESULTS.This type of restraint has the following characteristics: use of recyclable material; lightness; ventilation; visibility of the underlying skin tissue and its hydro-compatibility. The major limitations remaining are production time and printing errors.DISCUSSION. The emergence of 3D printing, allows us to extend its application to the medical world. When the therapeutic effectiveness of a restraint is achieved, quality of life becomes the main selection criterion. Based on observations already made in the past, we were able to develop a model that combines the advantages of the different approaches.CONCLUSION.New 3D printing technologies allow the creation of restraint devices with many advantages and customized adaptation possibilities
The effect of anti-gravity training after meniscal or chondral injury in the knee. A Systematic Review.
No full textReduced impact loading or anti-gravity training has recently been introduced as a new tool in the rehabilitation of orthopaedic conditions that require restricted weight bearing. The purpose of this strategy is to speed up the functional rehabilitation while at the same time protect the healing structures from harmful effects associated with impact loading. Anti-gravity treadmills (AlterG ®) and harness suspension devices seem to be the two most promising techniques. It is however today unclear how effective these devices are.The purpose of our study was therefore to perform a systematic literature review on the actual technology available and its effect on impact load reduction, as well as its effectiveness in accelerating functional recovery after meniscal and chondral injury to the knee.The results from our work demonstrate that only a limited number of studies are available, usually of moderate quality. The data suggest a variable effect on cartilage regeneration, and a potential for accelerated functional recovery in gait and running dynamics both with anti-gravity treadmill as well as suspension harness systems
Outcome at 3 to 5 years of a treatment algorithm for rotator cuff tears in an elderly population.
No full text Background: The purpose of this study is to evaluate the results of a conservative approach of rotator cuff tears in an elderly population at 3 to 5 years of follow-up. Methods: Prospective comparative study. All patients started with a program of exercises of at least 1 to 3 months. When no satisfying results for pain relief and ADL were achieved, surgery for cuff tear repair was offered. Patients were contacted after 3 to 5 years for evaluation by questionnaire, an ultrasound and a strength measurement exam. Results: 97 patients (104 shoulders) with a mean age of 68,5 years were included.47.1% of shoulders were treated conservatively whereas 52.9% switched to surgical treatment.Evaluation after 3 to 5 years showed no significant difference between type of treatment and post treatment test scores (Constant score, SF12v2, OSS and WORC). Conclusion: Delaying surgery for till 3 months does not seem to influence outcome negatively
Pronator sparing plate osteosynthesis in distal radius fractures: early functional outcome
No full textPronator sparing plate osteosynthesis of the distal radius is a relatively new approach.A short overview of the technique is given with some tips and tricks. The objective of the study is to investigate whether pronator sparing approach to distal radius fractures gives better pronation force or grip force in the postoperative rehabilitation.The pronator force on 3 weeks and 6 weeks was significantly higher in the “pronator sparing” group, respectively 57% and 80% of the contralateral side compared with 43% and 67% in the “non sparing” group. Also swelling was significant less in the pronator sparing group. Pronator sparing plate osteosynthesis in distal radius fractures seems to give better pronation force and less swelling in early recovery after volar plate osteosynthesis.