bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cruciate Retaining Versus Cruciate Stabilising Total Knee Arthroplasty – A Prospective Randomised Kinematic Study
Authors: Godwin T L , Bayan A 
Published: July 2016

Objective: While there is a large body of research in regards to cruciate retaining(CR) and cruciate sacrificing total condylar knee replacement, the literature is spars in regards to highly conforming polyetheylene such as the triatholon cruciate stabilising tibial insert (CS).The aim was to determine whether there is a difference in the range of motion, kinematics as well as the functional outcome for Triathlon CS and CR TKJR. Methods: A single hospital consecutive series of one surgeon between 2011 and 2013 were enrolled. Kinematic data recorded prospectively at the time of surgery utilizing imageless navigation included preoperative and post-replacement extension, gravity flexion, passive flexion and rotation. Intraoperative femoral and tibial cuts and definitive implants were also recorded. Statistically analysis performed to compare CS and CR TKJR range of motion, deformity correction, and rotation pre and post-operatively. Oxford functional scores were obtained at the final follow up. 124 patients were randomised to 71 CS and 53 CR TKJR. The demographics were comparable between the two groups. Results: No significant difference was found between the groups’ preoperative range of motion. The net gain in extension for the CS group was 5.65 degrees (4.14-7.17) and for CR 5.64 degrees (4.24-7.04, p=0.99) with no significant difference shown. Post-operative gravity flexion significantly increased in CS TKJR with 129.01 degrees (127.37130.66) compared with 126.35 degrees (124.39-128.30, p =0.04) for CR. A weak positive correlation was shown between the size of distal femoral cut and post-operative extension for both CS and CR TKJR. A weak positive correlation was also shown for the difference between the intraoperative cuts (tibial and femoral) and the size of the implants used, in relation to post-operative extension. Post-operative oxford scores at average of 3.4 year follow up comparable between groups. Conclusion: The kinematics of CS and CR TKJR are comparable. The post-operative gravity flexion achieved with CS TKJR was statistically greater than for CR TKJR. Patients perceptions at an average 3.4 year follow up were comparable.
Causes and incidence of 30 day hospital re-admissions after primary TKJR
Authors: Mortimer John , van Dalen John 
Published: July 2016

Objective: 30 day re-admission of patients following TKJR is estimated between 0.9-9.9%. It’s a cause of significant cost to the healthcare system and marks significant patient morbidity. Aim: The aim of this study is to describe the causes and incidence of patient re-admission to hospital within 30 days of a primary total knee joint replacement between 2009-2015 in a single centre. Methods: In a retrospective cohort study, computerized records were used to evaluated the causes and incidence of patient re-admission within 30 days of discharge following primary TKJR. Results: The total 30 day Re-admission rate was 5.0%. Medical causes for re-admission accounted for 29% of re-admissions. 34% were attributed to non-specific pain/swelling. Infection was attributed to 26%. 29% of patients presented with wound problems, either infective or non-infective. The total incidence of re-operation at 30 days was 0.77%. Conclusions: Our rate of re-admission is consistent with previous studies in the literature. Many patients were found to have no specific cause for re-admission. This suggests it may be possible to further reduce re-admission rates with improved patient education and management of common post-operative symptoms such as pain and swelling. Infection remains a common complication; fortunately the majority superficial infections are successfully treated with antibiotics and few requiring a washout operation. Medical complications account for almost a third showing the importance of good management of patient medical co-morbidities and risk factors.
Early Infection Following Arthroplasty – Are Patients Protected?
Authors: Young Simon W , Zhu Mark , Ravi Saiprasad , Luey Chris 
Published: July 2016

Objective: Prophylactic antibiotics significantly reduce prosthetic joint infection (PJI) rates after hip and knee arthroplasty. However, the rise of antibiotic resistance has raised concern over the adequacy of conventional prophylaxis. This study aimed to identify organisms causing early PJI in hip and knee arthroplasties and their sensitivity to current prophylactic antibiotics. Method: We performed a multicentre audit of 4009 primary hip and knee arthroplasties (1852 hips and 2157 knees) at three tertiary referral hospitals. PJIs were identified according to the Infectious Diseases Society of America (IDSA) definition and all patients were followed for two years. For patients with confirmed PJIs, causative bacteria and their antibiotic sensitivities were identified. Results: Thirty-five PJI cases in total were identified in the follow-up period of two years, consisting of 13 hips and 22 knees. The overall definite prosthetic joint infection rate was 0.87% (0.7% for hips, 1.0% for knees). 51.4% of PJIs occurred within the first 6 weeks, 62.9% within the first 3 months and 82.9% during the first year. Ninety-six percent (96%) of patients were given cefazolin as prophylaxis. Thirty-four percent (34%) of patients were infected with Coagulase-negative staphylococci, which were the most common infective organisms. 91.7% of these organisms were resistant to cefazolin. Twenty-five percent (25%) of patients were infected with Staphylococcus aureus, 9.1% of which were methicillin resistant. Overall, 58% of organisms were resistant to cefazolin. Sixty percent (60%) of patients who were treated with cefazolin and had available sensitivities for infective organism(s) were infected with cefazolin-resistant organisms. Conclusions: The majority of bacteria causing early PJI are resistant to the antibiotic prophylaxis given at the time of surgery. Whilst all the organisms cultured were sensitive to vancomycin, concerns regarding antibiotic stewardship remain and there is insufficient evidence to justify its routine use. However, the choice of empiric antibiotic when treating PJI in the early post-operative period should take into account resistance profiles.
Surgical Helmet Systems and Intraoperative Wound Contamination
Authors: Bayan A 
Published: July 2016

Objective: The original Charnley-type negative-pressure body-exhaust suit reduced infection rates in early trials of total joint arthroplasty. However, recent registry data on modern positive-pressure surgical helmet systems (SHS) have not shown this benefit, and have instead suggested a paradoxical increase in infection rates with SHS use. The gown-glove interface has been identified as a potential source of particle contamination. The aim of this study was to compare wound contamination in total knee arthroplasty (TKA) between conventional surgeon attire and SHS with and without protective tape at the gown/glove interface. Methods: 75 patients undergoing TKA were randomised into three groups: in group one the scrubbed theatre staff wore conventional surgical attire, in group two SHS without tape, and in group three SHS with tape sealing the gown-glove interface. All TKA operations were carried out in a standardised manner by a single surgeon. Bacterial contamination was assessed using both a culture-based tetrazolium stained membrane imprint technique (TSMI) technique (See Figure 1) and detection of bacterial ribosomal DNA using polymerase chain reaction (PCR). For PCR two tissue samples were taken at the beginning of the operation to act as controls and five at the end of the first hour. For culture a tetrazolium stained membrane imprint technique was used with membranes pressed onto the wound at the time of tissue sampling. Results: For TSMI culture, with a conventional attire 0/25 of the patients had a positive culture, with SHS and no tape 1/26, and with SHS and tape 4/24. Differences in measured contamination did not differ between groups (chi square test conventional gown (0/25) vs SHS (5/50) p= 0.16, SHS without tape (1/26) to SHS with tape (4/24) p = 0.18 (See Table 1). Conclusions: Overall contamination rates were low in all groups. No difference was seen in wound contamination between conventional attire and SHS. The use of tape at the gown glove interface with SHS did not appear to reduce contamination rates.
Success of Debridement and Implant Retention in Periprosthetic Joint Infection – Does the Surgeon Matter?
Authors: Young Simon W , Zhu Mark , Ravi Saiprasad , Luey Chris 
Published: July 2016

Objective: Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty (TJA). In acute haematogenous and early post-operative PJI, debridement and implant retention (DAIR) surgery is often the initial treatment and success rates vary. This study aimed to identify factors affecting success rates of DAIR and in particular whether involvement of a lower limb arthroplasty surgeon can affect outcome. Method: This retrospective review included one hundred and sixty-two patients undergoing DAIR for first-episode PJI following hip and knee arthroplasty at one of three tertiary hospitals. Treatment success was defined as no relapse within two years of DAIR. Data on patient, hospital, and surgical factors were identified including duration of symptoms, time from primary, previous revisions, age of prosthesis, bacterial subtype, whether modular component exchange was performed and whether an arthroplasty surgeon performed the procedure. Adjusted multivariate analysis was performed to identify factors associated with success of the DAIR procedure. Results: Overall success rate of DAIR in both hip and knee arthroplasty was 60%. A specialist arthroplasty surgeon was present in 42% of cases. Arthroplasty surgeons performed modular exchange in 51% of cases compared to 32.5% for other surgeons. Inclusion of modular exchange in the procedure was the only factor associated with DAIR success (OR 3.1, p<0.013). Time to theatre of less than 24 hours (OR 0.59), duration of symptoms less than one week (OR 1.28), age of prosthesis less than 3 months (OR 1.47) and having an arthroplasty surgeon perform DAIR (OR 1.6) did not lead to statistically significant improvements in success rate. Conclusions: Modular exchange was associated with a significantly higher success rate for both hip and knee PJI, suggesting thorough debridement is important in DAIR. Arthroplasty surgeons were more likely to perform modular exchange, but their presence in theatre alone did not reduce the risk of failure.
Two-Year Outcomes following Arthroscopic Treatment for Snapping Scapula Syndrome
Authors: Menge Travis , Horan Marilee P. , Mitchell Justin , Tahal Dimitri S. , Millett Peter J. 
Published: July 2016

Objectives: Snapping scapula syndrome is a rare cause of shoulder pain that can result in significant dysfunction. The purpose of this study was to report clinical outcomes following arthroscopic treatment for snapping scapula syndrome, as well as identify associated risk factors that affect outcomes. Methods: One-hundred patients underwent arthroscopic treatment for snapping scapula syndrome from October 2005 to October 2013. This was an IRB-approved retrospective outcomes study with prospectively collected data. Patients were excluded if they had prior scapula or rib surgeries, or concomitant sternoclavicular or glenohumeral reconstructive procedures. Patients included in this study failed non-operative modalities for mechanical symptoms of snapping scapula and reported symptomatic relief from a local anesthetic injection prior to surgery. Preoperative and postoperative pain and functioning levels were assessed with the American Shoulder and Elbow Surgeons (ASES), QuickDASH (Disabilities of the Arm, Shoulder and Hand), and general health SF-12 including both physical (PCS) and mental (MCS) components. Patient satisfaction was recorded on a 10-point visual analog scale (VAS). Results: There were 86 scapulae in 79 patients that met inclusion criteria. Mean age at time of surgery was 33 years old (range 12-65). A partial scapulectomy and bursectomy was performed in 79 scapulae, with 7 having bursectomy alone. Mean duration from onset of symptoms to surgery was 3.8 years (range 90 days-16.6 years). One patient died in the follow-up period from unrelated causes, and 6 patients refused to participate. Of the remaining 72 scapula, 8/72 (11%) failed and underwent a revision procedure at a mean of 309 days (SD+283 days). Of those that met inclusion criteria and did not require revision surgery, 86% (55/64) returned surveys with a mean follow-up of 3.4 years (range 2-7 years). There was a significant improvement following surgery in SF-12 PCS (p<0.001), SF-12 MCS (p=0.043), ASES (p<0.001), and QuickDASH (p=0.001) scores. Overall, median patient satisfaction was 7 out of 10 (range 1 to 10). Increasing age correlated with decreased postoperative SF-12 PCS (r= -.372;p=0.007), ASES (r= .279;p=0.043), and QuickDASH (r=.350;p=0.011) scores, while gender was not found to be associated with outcomes. A lower preoperative SF-12 MCS score was found to correlate with lower postoperative ASES scores (r=.395;p=0.011), while longer duration of symptoms prior to surgery also correlated with lower postoperative ASES (rho=-.296; p=0.027) and QuickDASH (rho=.315;p=0.019) scores. Conclusion: Arthroscopic surgery is an effective treatment for individuals that have failed conservative management for snapping scapula syndrome, demonstrating significant improvements in all postoperative outcome scores at a mean of 3.4 years. Lower preoperative mental status score, greater age, and longer duration of symptoms prior to surgery were associated with poorer outcomes.
Arthroscopic Treatment for Shoulder Instability with Glenoid Bone Loss Using Distal Tibia Allograft Augmentation - Short Term Results
Authors: Wong Ivan , Amar Eyal , Coady Catherine M. , Dilman Daryl B. , Smith Ben 
Published: July 2016

Objectives: Background: The results of arthroscopic anterior labral (Bankart) repair have been shown to have high failure rate in patients with significant glenoid bone loss. Several reconstruction procedures using bone graft have been described to overcome the bone loss, including autogenous coracoid transfer to the anterior glenoid (Latarjet procedure) as well as iliac crest autograft and tibial allografts. In recent years, trends toward minimally invasive shoulder surgery along with improvements in technology and technique have led surgeons to expand the application of arthroscopic treatment. Purpose: This study aims to perform a retrospective analysis of prospectively collected data to evaluate the clinical and radiological follow up of patient who underwent anatomic glenoid reconstruction using distal tibia allograft for the treatment of shoulder instability with glenoid bone loss at 1-year post operation time point. Methods: Between December 2011 and January 2015, 55 patients underwent arthroscopic stabilization of the shoulder by means of capsule-labral reattachment to glenoid ream and bony augmentation of glenoid bone loss with distal tibial allograft for recurrent instability of the shoulder. Preoperative and postoperative evaluation included general assessment by the western Ontario shoulder instability index (WOSI) questionnaire, preoperative and postoperative radiographs and CT scans. Results: Fifty-five patients have been evaluated with mean age of 29.73 years at time of the index operation. There were 40 males (mean age of 29.66) and 15 female (mean age of 29.93). Minimum follow up time was 12 months. The following adverse effects were recorded: none suffered from recurrent dislocation, 2 patients suffered from bone resorption but without overt instability, 1 patient had malunion due to screw fracture, none of the patients had nonunion. The mean pre-operative WOSI score was 36.54 and the mean postoperative WOSI score was 61.0. Conclusion: Arthroscopic stabilization of the shoulder with distal tibia allograft augmentation demonstrates promising result at 1year follow up.
Hemiarthroplasty versus Total Shoulder Arthroplasty For Shoulder Osteoarthritis
Authors: Sinatro Alec , Liu Joseph N. , Mahony Gregory Thomas , Wu Hao-Hua , Warren Russell F. , Dines David M. , Craig Edward V. , Gulotta Lawrence Vincent , Garcia Grant 
Published: July 2016

Objectives: Return to activity is a commonly used indication for shoulder hemiarthroplasty (HA) in comparison to total shoulder arthroplasty (TSA). Despite clinical studies demonstrating better functional outcomes after TSA, the literature has failed to show a difference in return to sport. The purpose of this study was to compare rates of return to sports in a matched cohort of TSA and HA patients with a preoperative diagnosis of glenohumeral osteoarthritis (OA). Methods: A prospectively collected registry was queried retrospectively for consecutive patients who underwent HA. Inclusion criteria were preoperative diagnosis of OA and > 2 years of follow up. After inclusion criteria, all HA were statistically matched to a TSA patient by preoperative diagnosis, age (+/- 5 yrs), sex, and follow up period (+/- 6 months). At final follow up both cohorts completed a questionnaire regarding physical fitness and sporting activities. Results: 40 HA and 40 TSA were available at final follow up. Average age at surgery was 65.7 years for HA and 66.2 year for TSA (p=0.06). Average follow up was 62.0 months for HA and 61.1 months for TSA (p=0.52). Average ASES scores improved for HA from 36.3 to 70.2 (p<0.001) and for TSA they improved from 34.0 to 78.5 (p<0.001). Final ASES scores were not significantly different between groups (p=0.21). Average VAS scores improved for HA from 6.3 to 2.2 (p<0.001), while TSA improved from 6.1 to 0.6 (p<0.001). HA patients had significantly worse final VAS scores compared to the TSA group (p=0.002). 70% (28) of HA patients compared to 15% (6) of TSA patients complained of postoperative problems with their shoulder (p<0.001). Significantly more TSA were satisfied with their surgery (p=0.01). 65.5% (19/29) of HA patients returned to at least one sport postoperatively compared to 97.3% (36/37) of TSA patients (p<0.001). Average timing for return to full sports was 5.5±4.2 months for HA and 5.4±3.1 months for TSA (p=0.92). Significantly more TSA patients returned to higher upper extremity use sports (p=0.01). Conclusion: In patients with OA, rate of return to sports was significantly better after TSA compared to HA. HA patients had significantly more pain, worse surgical satisfaction and decreased ability to return to high upper extremity use sports. For OA patients wishing to return to sporting activities, these result help manage expectations.
Risk of Fragments in Ulnar Collateral Ligament Injuries Of Baseball Players
Authors: Furushima Kozo , Itoh Yoshiyasu , Mitsui Yasuhiro , Kusano Hiroshi 
Published: July 2016

Objectives: Many baseball players with UCL injuries have avulsed persistent fragments by throwing disorder in the youth. The presence of fragments results in discontinuity of the medial elbow joint support structures; therefore, a ligament with fragments is considered more fragile than the normal ligament. This study compared three types (fragment, malunion, and normal) of throwing-related UCL injuries and prospectively examined the risk of surgical treatment. Methods: The total subjects were 439 baseball players (age 14-30 years; mean age, 17.5 years) diagnosed with UCL injuries at our hospital between November 2009 and June 2013. At the time of the initial examination, the medial epicondyle was assessed on plain frontal radiographs with the elbow flexed at 45°. Based on this assessment, subjects were divided into three groups: group with persistent fragments (fragment [F] group), group with complete union following avulsion fracture (malunion [M] group), and a group with no history of avulsion fracture (normal [N] group). Each patient’s ability to return to playing baseball was assessed after at least 3 months of systematic rehabilitation. Subjects who failed to comply with rehabilitation, played only recreationally, or with pain in sites other than the elbow were excluded. In this series, 220 cases were left for investigation. The Conway-Jobe scale was used as a standard to assess the return to playing after conservative therapy; subjects with excellent or good ratings were deemed able to return to playing baseball, whereas those with fair or poor ratings were deemed unable to return to playing baseball. The return rates were calculated for the F, M, and N groups respectively. The Magnetic resonance (MR) images consisted of three slices along the long axis of the anterior oblique ligament; these images were used to classify injuries as severe or mild, which were then compared with each other. SPSS 20.0 was used to perform the statistical analysis. Results: A total of 107 subjects were able to resume playing competitive baseball game, whereas 113 subjects were unable to resume playing and underwent surgical treatment (Table.1). The F group demonstrated a significantly lower return rate (p < 0.01) (Table.2). The F group demonstrated a significantly higher percentage of severe injuries (p < 0.01) (Table.2).Return rates in the mild and severe injury groups were 79.1% and 29.1%, respectively, demonstrating a significant difference (p < 0.01) (Table.3). Not surprisingly, the return rate among subjects with severe injuries in the F group was a mere 14.3% (7/49). Conclusion: The results of the present study demonstrated that the presence of fragments in UCL injuries tended to increase the severity of UCL injuries and significantly reduced patient the return rates of competitive game after conservative therapy. Therefore, this exacerbation of UCL injuries is considered a result of persistent medial epicondylar fragments in young baseball players.