SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Gap difference in navigated TKA: a measure of the imbalanced flexion-extension gap
No full textIntroduction: The success of Total Knee Arthroplasty (TKA) hinges on balanced flexion-extension gaps. This paper aims to evaluate the correlation between imbalanced gaps and clinical outcomes, and hence help quantify the imbalanced gap in navigation-assisted total knee arthroplasty.
Methods: We studied 195 knees with an average follow-up of two years. Flexion-extension gaps were obtained from computer calculation upon cementation of implants in both flexion (90°) and extension. The gap difference (GD) was defined as the measured difference between the gaps in flexion and extension.
Results: At 2 years after surgery, the mean ROM in the balanced group, with GD less than or equal to 2 mm, was 115.1° ± 16.6° and the mean ROM in the imbalanced group was 116.7° ± 12.1°. This was not statistically significant with p-value 0.589. Balanced flexion-extension gaps also did not show significant difference in terms of mechanical alignment, with 0.29 ± 0.89 in the balanced group at 2 years, and 0.65 ± 1.51 in the imbalanced group with p-value 0.123. Balanced gaps however, were associated with improved outcomes in terms of physical functioning, bodily pain, social functioning, Oxford and Knee scores at 6 months and improved social functioning scores at 2 years.
Conclusions: Computer navigation is a useful tool for assessing the gap balance in TKA. Balanced flexion-extension gaps, with gap differences of less than or equal to 2 mm, is associated with improved clinical outcomes at 6 months
Safety of a novel modular cage for transforaminal lumbar interbody fusion − clinical cohort study in 20 patients with degenerative disc disease
No full textIntroduction: Transforaminal lumbar interbody fusion (TLIF) is used to reconstruct disc height and reduce degenerative deformity in spinal fusion. Patients with osteoporosis are at high risk of TLIF cage subsidence; possibly due to the relatively small footprint compared to anterior interbody devices. Recently, modular TLIF cage with an integral rail and slot system was developed to reduce cage subsidence and allow early rehabilitation.
Objective: To study the safety of a modular TLIF device in patients with degenerative disc disorders (DDD) with regard to surgical complications, non-union, and subsidence.
Methods: Patients with DDD treated with a modular TLIF cage (Polyetheretherketone (PEEK), VTI interfuse S) were analysed retrospectively with one-year follow-up. Lumbar sagittal parameters were collected preoperatively, postoperatively and at one year follow-up. Cage subsidence, fusion rate, screw loosening and proportion of endplate coverage were assessed in computed tomography scan.
Results: 20 patients (age 66 ± 10 years, 65% female, BMI 28 ± 5 kg/m2) with a total of 37 fusion levels were included. 15 patients had degenerative spondylosis and 5 patients had degenerative scoliosis. The cages covered >60% of the vertebral body diameters. Lumbar lordosis angle and segmental disc angle increased from 45.2 ± 14.5 and 7.3 ± 3.6 to 52.7 ± 9.1 and 10.5 ± 3.5 (p = 0.029 and 0.0002) postoperatively for each parameter respectively without loss of correction at one year follow up. One case of deep postoperative infection occurred (5%). No cage subsidence occurred. No non-union or screw loosening occurred.
Conclusions: The modular TLIF cage was safe with regard to subsidence and union-rate. It restored and maintained lumbar lordosis angle, segmental disc angle and disc height, which can be attributed to the large footprint of this modular cage
Early clinical cxperience with the SIGN hip construct: a retrospective case series
No full textBackground: As the population ages, the developing world industrializes, and more urban centers emerge, the burden of orthopedic trauma will steadily increase. SIGN Fracture Care International has developed a unique intramedullary device for fixation of hip fractures in low-resource settings lacking fluoroscopy. The purpose of this study is to report the safety profile and complication rate for a consecutive series of hip fracture patients managed using this implant.
Methods: We conducted a retrospective analysis of the first 170 patients treated with the SIGN Hip Construct (SHC) from 2009 to 2014 using the SIGN Online Surgical Database (SOSD). Patients with follow-up greater than 12 weeks and adequate radiographs were included. Data recorded include patient demographics, time-to-surgery, union rate, AO/OTA classification, complications, neck-shaft angle, and clinical outcomes including painless weight bearing and knee flexion greater than 90°.
Results: Of 170 patients, 71 met inclusion criteria with mean follow-up of 39 weeks. Mean age was 49.5 and by WHO, regions were Africa (27), Eastern Mediterranean (21), Western Pacific (17), Americas (3), and Southeast Asia (3). Fractures included intertrochanteric (55), subtrochanteric (7), femoral neck (4), and combined (5). Reduction quality was good in 35 (49%), acceptable in 19 (27%), and poor in 17 (24%). Major complications consisted of varus collapse (6), non- or delayed union (3), intra-articular screw (5), and infection (3). Average postoperative neck-shaft angle was 126° and 119.3° at final follow-up.
Conclusions: This is the first comprehensive report of a novel implant for hip fractures specifically designed for low-resource settings. The early clinical data and outcomes suggest that the SHC can be safely inserted in the absence of fluoroscopy, and facilitates early mobilization while maintaining acceptable reduction until union
Complex primary hips for total hip replacement surgery at a tertiary institution in Nigeria
No full textIntroduction: Total hip replacement (THR) surgery is still evolving in Nigeria with increasing awareness as more cases are being done. This has attraction for individuals who hitherto had no solutions for their hip pathologies. These are mostly complex primary hips which present challenging technical difficulties with increased risk of complications, thus requiring detailed planning to ensure successful operation. This work aims to present the pattern of complex primary hips presenting for THR, the challenges and complications.
Methodology: Data collected over a seven year period, of patients who presented for THR, were analyzed for age, sex, diagnosis, type of hip, complications, duration of surgery, blood loss and transfusions, challenges and outcome.
Results: Fifty-nine (43.4%) of the 136 cases of THR done were complex primary hip replacement surgeries. Avascular necrosis of femoral head amongst sickle cell disease patients (23.7%) was the commonest cause of complex primary hips in our series. Most of them had absent/tight medullary canals. This is followed by old unreduced hip dislocation and non-united hip fractures with an incidence of 10.1% each. The major peri operative complication noted was calcar split in 10 patients (16.9%)
Discussion: Sickle cell disease patients presented more with complex primary hips and the commonest difficulty was recreating medullary canals. Increased operation time and blood loss alongside technical difficulties should be anticipated and measures put in place to avert complications
Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12
No full textIntroduction: When the postoperative outcome of primary total hip arthroplasty (THA) was compared with the direct anterior approach (DAA) and the posterior approach (PA), there was no significant difference of the clinical outcome at 6 months to 1 year after surgery in many studies. This study was performed to compare the medium-term outcome of THA via the DAA or PA and clarify which approach achieves better quality of life (QOL).
Methods: We investigated 61 hips receiving primary THA (30 via DAA and 31 via PA), using hip function scores such as the Harris Hip Score (HHS) and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS).
Results: The mean duration of postoperative follow-up was 36.8 months in the DAA group and 40.5 months in the PA group. There was no difference in preoperative or postoperative HHS between the two groups. Although there was no difference of postoperative WOMAC and JHEQ, the postoperative FJS-12 score was significantly higher in the DAA group than in the PA group (75.2 ± 15.9 versus 60.1 ± 24.4, p = 0.01).
Conclusion: When forgetting the artificial joint in daily life is the target, better QOL can be achieved by performing THA via the DAA
The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review
No full textIntroduction: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used.
Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE.
Hypothesis: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection.
Level of evidence: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence).
Design: Systematic Review (according to PRISMA guidelines).
Methods: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2.
Results: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. Clinical findings: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of patients with common extensor tendon tears noted in PRP group. (3) Fewer patients reported Probe-induced tenderness and oedema in the common extensor tendon in both corticosteroid and PRP groups (2 studies).
Conclusion: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma
Does the severity of pain correlate with severity of functional disability? Factors influencing ‘patient reported outcome measures’ in spinal patients
No full textAims: To assess correlation between the Visual Analogue Scale (VAS) pain score and the Oswestry Disability Index (ODI) and which patient factors can influence patient-reported outcome measures (PROMs). This study also aims to assess the response to the sexual function question of the ODI.
Methods: Retrospective analysis of 200 consecutive patients undergoing a range of different lumbar spinal procedures between July 2012 and September 2015 was performed. Subgroup analysis was also performed on the 122 patients who underwent microdiscectomy and/or decompression procedures only. Data from notes and clinical letters from the patient's first clinic appointment were collected. In addition to these outcome measures, data were also extracted regarding patients' gender, age, smoking status, alcohol use, employment and mental health status.
Results: Significant correlation was found between VAS pain score and ODI (p = 0.002) and between VAS pain score and question 1 of ODI (p = 0.0001). A lower ODI score was reported at time of surgery by those in employment compared to those who are unemployed (p = 0.008). In addition to this, a lower ODI score was reported in those who are self-employed compared to those in employment (p = 0.048) in both cohorts. A significantly higher mean ODI score was shown within the subgroup analysis for current smokers (p = 0.02). None of the other patient factors that were analysed were found to affect PROMs. 65% of patients answered the sexual function question of the ODI.
Conclusions: Significant correlation was demonstrated between VAS pain score and ODI. Those who are in employment are far more likely to report a lower ODI score than those who are unemployed at the time of surgery. Self-employed patients were found to have reported a significantly lower ODI score than those who are in employment. Smoking cessation should be encouraged as those who are current smokers may be more likely to report a higher ODI. As 65% of patients decided to answer the sexual function question of the ODI, this supports its further use
Novel anatomical-based surgical technique for positioning of the patellar component in total knee arthroplasty
No full textThe patella remains one of the main sources of post-operative complication following total knee arthroplasty surgery. Optimal positioning of the patellar component is still a controversy with no clear-cut guidelines. Instead of choosing an empirical position, we described a novel surgical technique to better locate the patellar button based on the individual patellar anatomy of each patient
Meniscal allograft transplantation: a meta-analysis
No full textPurpose: This meta-analysis evaluates the mid- to long-term survival outcome of MAT (meniscal allograft transplantation). Potential prognosticators, with particular focus on chondral status and age of the patient at the time of transplantation, were also analysed.
Study design: Meta-analysis.
Methods: An online database search was performed using following search string: “meniscal allograft transplantation” and “outcome”. A total of 65 articles were analysed for a total of 3157 performed MAT with a mean follow-up of 5.4 years. Subjective and clinical data was analysed.
Results: The subjective and objective results of 2977 patients (3157 allografts) were analysed; 70% were male, 30% were female. Thirty-eight percent received an isolated MAT. All other patients underwent at least one concomitant procedure. Lysholm, Knee injury and Osteoarthritis Outcome (KOOS), International Knee Documentation Committee (IKDC) and Visual Analogue Scale (VAS) scores were analysed. All scores showed a good patient satisfaction at long-term follow-up. The mean overall survival rate was 80.9%. Complication rates were comparable to standard meniscal repair surgery. There was a degenerative evolution in osteoarthritis with at least one grade in 1760 radiographically analysed patients. Concomitant procedures seem to have no effect on the outcome. Age at transplantation is a negative prognosticator. The body mass index (BMI) of the patient shows a slightly negative correlation with the outcome of MAT.
Conclusions: MAT is a viable solution for the younger patient with chronic pain in the meniscectomised knee joint. The complications are not severe and comparable to meniscal repair. The overall failure rate at final follow-up is acceptable and the allograft heals well in most cases, but MAT cannot be seen as a definitive solution for post-meniscectomy pain. The correct approach to the chronic painful total meniscectomised knee joint thus requires consideration of all pathologies including alignment, stability, meniscal abnormality and cartilage degeneration. It requires possibly combined but appropriate action in that order