bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Functional and Radiological Outcomes after Computer-Assisted versus Conventional Total Knee Arthroplasty: A Matched-Control Retrospective Study
Authors: Ek ETH , Dowsey MM , Tse LF , Riazi A , Love BR , Stoney JD , Choong PFM 
Published: October 2016

Purpose. To compare the radiological and functional outcomes of patients who underwent either computer-assisted or conventional total knee arthroplasty (TKA). Methods. Two groups of 50 patients each underwent either computer-assisted or conventional TKA were retrospectively studied. Patients were matched according to body mass index (BMI), gender, and age. Three senior orthopaedic surgeons with comparable experience performed all surgeries, using 3 different prostheses. The surgical approach and peri- and postoperative regimens were the same. The mechanical axis and the tibial and femoral angles were measured using standardised long-leg weight-bearing radiographs. Overall function was assessed using the Short Form-12 (SF-12) and International Knee Society (IKS) scores. Results. No intra-operative technical difficulties were encountered in either group. The computer-assisted group resulted in more consistent and accurate alignments in both the coronal and sagittal planes and better SF-12 and IKS scores. In obese patients (BMI≥30 kg/m2), computer-assisted TKA provided better alignment than the conventional technique. Conclusion. Computer-assisted TKA improves implant positioning, limb alignment, and overall functional outcome. It may be particularly advantageous for obese patients.
Midterm Outcome of the Duracon Total Knee Arthroplasty
Authors: Yong CK , Choon DSK , Soon HC 
Published: October 2016

Purpose. To present midterm results of Duracon total knee arthroplasty (TKA) performed between 1991 and 2001. Methods. One man and 43 women (65 knees) aged 46 to 84 (mean, 63) years who underwent primary TKAs using the Duracon prosthesis performed by a single surgeon were followed up for a mean of 8.5 (range, 5–11) years. All TKAs were cruciate-retaining and cemented, with only 9 of the patellae resurfaced. The diagnosis was osteoarthritis in 42 patients (61 knees), and rheumatoid arthritis in 2 patients (4 knees). Patients were assessed using the Knee Society Clinical Rating System, the Oxford Knee Score, and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Results. The mean Knee Society knee score was 86 (range, 43–100) and the function score was 68 (0–100). 94% of patients reported no or only mild pain. The mean Oxford Knee Score was 19. There was no patellofemoral complication, deep vein thrombosis or pulmonary embolism. Complications included a superficial infection and an uncontrolled deep infection. One patient had the insert exchanged for wear at the 11-year follow-up, and another had the polyethylene insert and tibial tray revised after a motorcycle accident. Conclusion. The Duracon TKA had good midterm clinical results with absence of patellofemoral complications.
Radiological Features of Osteoarthritis of the Acromiclavicular Joint and its Association with Clinical Symptoms
Authors: Pennington RGC , Bottomley NJ , Neen D , Brownlow HC 
Published: October 2016

Purpose. To determine whether increasing age is associated with increased radiological features of osteoarthritis of the acromioclavicular joint (ACJ) in a general population, and whether clinical symptoms correlate with radiological features. Methods. Anteroposterior and axillary shoulder radiographs of 240 patients aged 20 to 80 years were randomly selected. The presence of stigmata of osteoarthritis of the ACJ including sclerosis, cysts, lysis, and osteophytes were recorded, and the width of the ACJ was measured. To determine the correlation between clinical symptoms and radiological features, the same radiological features were assessed for 100 further patients who had undergone either arthroscopic subacromial decompression (ASD) alone (n=50) or ASD plus ACJ excision (n=50, age-matched controls) based on clinical examination. Results. Radiological features of osteoarthritis of the ACJ increased significantly with increasing age but were not related to gender or the side affected. Of the 10 features, only medial acromial sclerosis and superior clavicular osteophytes were more prevalent in patients with ASD plus ACJ excision than in those with ASD alone (p=0.016). The sensitivity, specificity, positive and negative predictive values of these features were poor. Therefore, clinical symptoms were not associated with radiological features of osteoarthritis of the ACJ. Conclusion. Radiological features should only be used as an adjunct in the decision to excise the ACJ. A thorough clinical examination is crucial in the assessment of ACJ pathology.
Microbiology of Infected Arthroplasty: Implications for Empiric Peri-Operative Antibiotics
Authors: Sharma D , Douglas J , Coulter C , Weinrauch P , Crawford R 
Published: October 2016

Purpose. To classify the spectrum and antibiotic susceptibility of bacteria isolated from infected hip and knee arthroplasty specimens, and to recommend appropriate empiric peri-operative antibiotics. Methods. From January 1999 to August 2006, specimens from revision hip and knee arthroplasties (with or without suspected infection) were routinely collected for identifying possible organisms and their susceptibility patterns. During the period, 147 patients had positive specimens yielding 248 micro-organisms (from 195 tissue specimens, 43 fluid specimens, and 10 swabs). 140 isolates were from hips and 108 from knees. Results. Most isolates were Gram-positive; their distribution was similar in hip and knee specimens. Of the 248 micro-organisms isolated, Staphylococcus was the most common genus encountered (131, 53%), followed by Gram-negative isolates (24%). 88% of Gram-negative organisms were detected within 48 hours of inoculation and 94% of Gram-positive organisms within 96 hours. Overall, 46% of isolates were susceptible to cephalothin. Only 35% of coagulase-negative staphylococci were sensitive to cephalothin. No Gram-positive vancomycin resistance was encountered. Conclusion. Empiric prophylactic antibiotics for revision hip and knee arthroplasties should include vancomycin to cover Gram-positive organisms and gentamicin for most Gram-negative bacteria.
Diluted Povidone-Iodine versus Saline for Dressing Metal-Skin Interfaces in External Fixation
Authors: Chan CK , Saw A , Kwan MK , Karina R 
Published: October 2016

Purpose. To compare infection rates associated with 2 dressing solutions for metal-skin interfaces. Methods. 60 patients who underwent distraction osteogenesis with external fixators were equally randomised into 2 dressing solution groups (diluted povidone-iodine vs. saline). Fixations were attained using either rigid stainless steel 5-mm diameter half pins or smooth stainless steel 1.8-mm diameter wires. Half-pin fixation had one metal-skin interface, whereas wire fixation had 2 interfaces. Patients were followed up every 2 weeks for 6 months. Results. Of all 788 metal-skin interfaces, 143 (18%) were infected: 72 (19%) of 371 in the diluted povidone-iodine group and 71 (17%) of 417 in the saline group. Dressing solution and patient age did not significantly affect infection rates. Half-pin fixation was more likely to become infected than wire fixation (25% vs 15%). Conclusion. Saline is as effective as diluted povidone-iodine as a dressing solution for metal-skin interfaces of external fixators. Saline is recommended in view of its easy availability and lower costs.
Use of Suture Anchors for Coronoid Fractures in the Terrible Triad of the Elbow
Authors: Pai V , Pai V 
Published: October 2016

Purpose. To report outcomes in 6 patients with the terrible triad of the elbow treated with our modified protocol. Methods. 6 men aged 26 to 54 years underwent surgery for the terrible triad of the elbow by a single surgeon. All the patients had a displaced comminuted fracture of the radius, posterior dislocation of the elbow, and Morrey type-I fracture of the coronoid. They all underwent replacement of the radial head and repair of the lateral collateral ligament to the isometric part of the lateral condyle using suture anchors. Five had an additional capsular fixation to the anterior coronoid using suture anchors; in patient 6 the coronoid was not repaired because it was stable. Functional outcomes were evaluated using the Hospital for Special Surgery (HSS) elbow assessment score. Bone union, implant loosening, heterotopic ossification, and degenerative changes were assessed using anteroposterior and lateral radiographs. Results. After a mean follow-up of 2.2 (range, 1–3) years, the mean arc of flexion-extension was 116 degrees and the mean flexion contracture was 15 degrees. All patients maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation, with isometric fixation of the lateral collateral ligament. No patient had dislocation of the radial-head prosthesis. All had good-to-excellent HSS elbow scores, and none required re-operation. Patient 2 had neuropraxia of the radial nerve, which recovered within 3 months. Patient 4 had a range of movement of only 20 to 100 degrees, but was satisfied with the outcome. Conclusion. Repair of the articular capsule using suture anchors in addition to replacement of the radial head and repair of the lateral collateral ligament achieves favourable outcome in patients with the terible triad of the elbow.
Effects of Positioning and Notching of Resurfaced Femurs on Femoral Neck Strength: A Biomechanical Test
Authors: Nabavi A , Yeoh KM , Shidiac L , Appleyard R , Gillies RM , Turnbull A 
Published: October 2016

Purpose. To assess the effects of positioning and notching of resurfaced femurs on the mechanical strength of third-generation saw bone (TGSB) femurs using an in vitro analogue bone model. Methods. 30 TGSB femurs were equally divided into 6 resurfaced femur groups (intact, anatomic, varus, valgus, anatomically notched, and valgus notched) for testing the load to failure, stiffness, and total energy. Results. Compared to the intact femurs, the load to failure in all resurfaced femurs was significantly decreased by 29 to 57%. Among the resurfaced femurs, valgus and anatomic femurs had the highest load to failure, followed by valgus notched, varus, and anatomically notched femurs. Notching weakened the construct by a further 24 to 30%. Conclusion. To minimise the risk of femoral neck fracture, resurfaced femoral heads should be placed in an anatomic or valgus orientation, and the superior cortex of the femoral neck should remain intact.
Hereditary Multiple Exostoses of the Hip
Authors: El-Fiky Tarek AM , Chow Wang , Li Yun Hoi , To Michael 
Published: October 2016

Purpose. To assess the radiographic features of 36 hips with hereditary multiple exostoses (HME). Methods. Hip parameters of 12 males and 6 females (36 hips) aged 2 to 28 years with HME were assessed using anteroposterior radiographs. The recorded features included the sites of osteochondromas, the femoral head/neck ratio, the Reimer's migration percentage, Sharp's acetabular angle, the centre edge angle, the femoral neck-shaft angle, and degenerative changes. Results. 15 of the 18 patients were asymptomatic; 3 complained of pain (2 underwent excision or bone biopsy); no lesion was malignant. Osteochondromas were most commonly located in the femur followed by the ilium; only one was intra-articular. 32 hips had coxa valga; 26 had an abnormal Reimer's migration percentage; 17 had an abnormal Sharp's acetabular angle; 12 had an abnormal centre edge angle; 32 had an abnormal femoral neck-shaft angle; and 6 had degenerative changes. Acetabular and femoral dysplasia as well as subluxation are common in patients with HME. Conclusion. Borderline subluxated hips and those with marked coxa valga and/or acetabular dysplasia should be closely monitored to determine the need for surgery in the future. Subluxated hips should be operated on early, particularly in children and symptomatic adults.
Comparison of Total Knee Arthroplasty Using Computer-Assisted Navigation versus Conventional Guiding Systems: A Prospective Study
Authors: Pang CH , Chan WL , Yen CH , Cheng SC , Woo SB , Choi ST , Hui WK , Mak KH 
Published: October 2016

Purpose. To compare knee alignments in total knee arthroplasty (TKA) using computer-assisted navigation versus conventional guiding systems. Methods. Five men and 49 women aged 49 to 79 years underwent TKA for primary osteoarthritis of the knee with varus deformity. All valgus knees were associated with inflammatory arthritis and thus excluded. Computer-assisted navigation was used for the first 35 TKAs, whereas conventional extramedullary tibial and intramedullary femoral guiding systems were used for the next 35 TKAs. The mechanical axis, coronal tibial and femoral angles, sagittal tibial and femoral angles in the 2 groups were compared. Results. Sagittal tibial and femoral angles aligned more optimally in TKAs using computer-assisted navigation. In the respective computer-assisted navigation and conventional guiding systems, 33 (94%) and 26 (74%) of the TKAs attained a postoperative mechanical axis of <3° varus/valgus. Conclusion. Computer-assisted navigation gives a more consistent alignment correction and reduces outliers during implant positioning.
Fixed- versus Mobile-Bearing Total Knee Arthroplasty in Indian Patients
Authors: Vasdev Attique , Kumar Satish , Chadha Gaggan , Mandal Shyama Prasad 
Published: October 2016

Purpose. To compare the mid-term clinical outcomes in Indian patients after total knee arthroplasty (TKA) using a fixed- or mobile-bearing prosthesis. Methods. 120 consecutive patients (50 men and 70 women) aged 55 to 76 (mean, 63) years who had arthritis of the knee with similar deformity and range of motion were randomised to undergo TKA using a fixed- or mobile-bearing prosthesis. Patients with mediolateral instability and infective arthritis were excluded. Knee Society knee and functional scores, range of motion, and the presence of flexion contracture were assessed. Results. The mean follow-up duration was 3.5 (range, 1–4.6) years. The mid-term outcome of the 2 groups was comparable. One patient with a mobile-bearing prosthesis had recurrent dislocation at postoperative week 2, owing to iatrogenic medial collateral ligament injury. Conclusion. Long-term studies of both functional and radiological outcomes are needed to determine the indications for fixed- versus mobile-bearing prostheses.
Modified Incision for Brostrom Lateral Ligament Reconstruction of the Ankle
Authors: Mahajan Ravindra H , Dalal Rakesh B 
Published: October 2016

Purpose. To describe a modified incision for the Brostrom procedure to correct lateral ankle instability. Methods. 14 men and 12 women aged 23 to 38 (mean, 27) years with lateral ankle instability underwent the Brostrom procedure with a modified incision to repair both the anterior talofibular and calcaneofibular ligaments, without endangering the sural or superficial peroneal nerves. The incision ran longitudinally over the distal fibula extending 2.5 cm distal to the tip of the lateral malleolus. Results. There were no instances of wound healing problems, neurological damage, and repair failure. Surgical exposure of all patients was graded as excellent. Conclusion. The modified incision enables easy repair without endangering the sural and superficial peroneal nerves. Access to the peroneal tendons is allowed if necessary.
Quality of Life, Knee Function, and Physical Activity in Japanese Elderly Women with Early-Stage Knee Osteoarthritis
Authors: Watanabe Hiroyuki , Urabe Ken , Takahira Naonobu , Ikeda Noriaki , Fujita Mamoru , Obara Shinichi , Hendona Takashi , Aikawa Jun , Itoman Moritoshi 
Published: October 2016

Purpose. To compare quality of life, knee function, and physical activity in 33 elderly women with or without early-stage knee osteoarthritis (OA). Methods. 33 Japanese elderly women (mean age, 66 years) with (n=18) or without (n=15) early-stage knee OA symptoms (knee pain and decreased range of motion [ROM]) were recruited. The height, weight, and body mass index, disease severity, quality of life (according to the Japanese Knee Osteoarthritis Measure [JKOM]), knee function (knee extension strength, ROM, 10-m gait time), and the amount of physical activity (net energy expenditure and step count) of the 2 groups were compared. Results. The 2 patient groups did not differ significantly with respect to mean patient age, height, and body mass index, except for weight. Regarding knee function, mean knee extension strength, ROM (extension but not flexion), and 10-m gait speed (comfortable and maximum) were significantly inferior in patients with knee OA than in controls. Regarding the mean amount of physical activity undertaken, patients with knee OA did not differ significantly from controls with respect to net energy expenditure (179 vs. 212 Kcal/day) and step count (8016 vs. 9729 steps/day). Net energy expenditure ( r= −0.65, p=0.04) and step count ( r= −0.62, p=0.02) correlated negatively with JKOM scores in patients with knee OA but not in the controls. Conclusion. In Japanese elderly women with knee OA, quality of life (JKOM scores) correlated negatively with physical activity (net energy expenditure and step count). The 2 groups undertook similar amounts of physical activity, although those with knee OA exhibited less knee extension strength. Decreased knee extension strength coupled with high levels of physical activity may exacerbate the development of knee OA.
Short Proximal Femoral Nail Fixation for Trochanteric Fractures
Authors: Gadegone Wasudeo M , Salphale Yogesh S 
Published: October 2016

Purpose. To review outcomes of 100 patients who underwent short proximal femoral nailing for stable and unstable intertrochanteric fractures. Methods. Records of 62 men and 38 women aged 56 to 83 (mean, 67) years who underwent short proximal femoral nailing for stable peritrochanteric A1 (n=36), unstable peritrochanteric A2 (n=40), and unstable intertrochanteric A3 (n=24) fractures were reviewed. Results. 80 patients achieved anatomic reduction. At the one-year follow-up, 90% of the patients had good or excellent outcomes, and 50% had returned to their pre-injury functional level. One patient with avascular necrosis noted at 20 months and another patient with non-union/pseudarthrosis underwent a revision bipolar arthroplasty. Two patients had a Z effect and one a reverse Z effect. Six patients with osteoporosis had superior migration of the nail with varus collapse. Two patients had cutting out of the screw, but the fractures eventually healed. Ten patients had shortening of <2 cm. Seven patients had lateral thigh discomfort attributed to irritation of the protruding screws against the tensor fascia lata, and 5 of them underwent screw removal. None had fractures of the femoral shaft or trochanter or experienced nail breakage. Conclusion. The short proximal femoral nail is a superior implant for stable and unstable intertrochanteric fractures in terms of operating time, surgical exposure, blood loss, and complications, especially for patients with relatively small femora.
Effect of Cage Geometry on Sagittal Alignment after Posterior Lumbar Interbody Fusion for Degenerative Disc Disease
Authors: Takahashi Hiroshi , Suguro Toru , Yokoyama Yuichiro , Iida Yasuaki , Terashima Fumiaki , Wada Akihito 
Published: October 2016

Purpose. To compare the sagittal alignment of the lumbar spine after one-segment posterior lumbar interbody fusion (PLIF) using the horizontal cylinder (HC) or open box (OB) type cage. Methods. 66 patients underwent instrumented one-segment PLIF with bone grafting for lower lumbar degenerative disease. HC-type cages were used in 33 men and 13 women aged 20 to 73 (mean, 47) years between September 2001 and July 2004. OB-type cages with a 3° lordotic angle were used in 9 men and 11 women aged 25 to 70 (mean, 53) years between July 2004 and September 2006. Pre- and post-operative lumbar lordosis and intervertebral body angles in the fused and upper adjacent levels in the 2 groups were compared. Results. There was no significant difference between the 2 groups with regard to changes in the lumbar lordosis and intervertebral body angle in the fused and upper adjacent levels. In both groups, the upper adjacent intervertebral body angle increased significantly by about 2°. Conclusion. Lumbar alignment was similar after the use of the HC- or OB-type cages. This may be due to the surgical procedure and insufficient cage lordotic angle.
Occult Posterior Pelvic Ring Fractures in Elderly Patients with Osteoporotic Pubic Rami Fractures
Authors: Lau Tak-Wing , Leung Frankie 
Published: October 2016

Purpose. To evaluate postoperative walking status of elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. Methods. 33 women and 4 men aged 66 to 95 (mean, 85) years presented with osteoporotic pubic rami fractures after a fall. 22 (59%) of the patients had additional posterior pelvic ring fractures (9 had lateral compression type-II fractures involving the ilium and 13 had lateral compression type-I fractures involving the sacroalar region). Seven of the 9 patients with lateral compression type-II fractures underwent open reduction and internal fixation using plates and/or screws. The remaining 30 patients were treated conservatively. Results. Postoperative walking status was similar in elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. Conclusion. Posterior pelvic ring fractures are easily missed in elderly patients with pubic rami fractures. Routine computed tomography of the pelvis is useful in making the diagnosis.
Risk Factors for Early Dislocation after Total Hip Arthroplasty: A Matched Case-Control Study
Authors: Dudda Marcel , Gueleryuez A , Gautier E , Busato A , Roeder C 
Published: October 2016

Purpose. To evaluate risk factors for early dislocation after primary total hip arthroplasty (THA). Methods. Records of 175 cases with dislocation during hospitalisation after THA and 651 controls without dislocation were reviewed. Cases and controls were matched for age, gender, body mass index classification, primary diagnosis, cup design, hospital, and year of intervention. Version and inclination of the acetabular component and version of the femoral component were assessed intra- and post-operatively. Various risk factors were analysed, including surgical approach, cup positioning, combined cup and stem positioning, and femoral head size. Results. The posterior approach was 6 fold more prone to dislocation (odds ratio [OR]=6.3, p<0.018) than the anterolateral or straight lateral approach. With regard to combined cup and stem positioning, the acceptable position was at significantly higher risk of dislocation than the ideal position (OR=2.59, p=0.033). Larger femoral head sizes were associated with significantly lower risk of dislocation (OR=0.84, p=0.02). Conclusion. Surgical approach, combined cup and stem positioning, and femoral head size were significant risk factors for dislocation during hospitalisation.