Patellectomy for osteoarthritis: a new tension preserving surgical technique to reconstruct the extensor mechanism with retrospective review of long-term follow-up.

Background: The management of severe patellofemoral arthritis in young patients remains a significant problem. For many, patellofemoral replacement is not a desirable option. Current surgical techniques for patellectomy disrupt the extensor lever arm causing weakness.

Patients' preferred mode of travel to the orthopaedic theatre.

Aim: To determine the preferred mode of travel to the operating theatre for elective orthopaedic patients.

Methods: Data was collected prospectively over a 2-wk period at an elective Orthopaedic Treatment Centre. Patients were asked to complete a patient satisfaction questionnaire following their surgery on their experience and subsequent preferred mode of transport to theatre.

Anterior cruciate ligament reconstruction best practice: A review of graft choice.

There is much literature about differing grafts used in anterior cruciate ligament (ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts.

Trunnionosis: A pain in the neck.

Metal-on-metal (MoM) hip replacements have proven to be a modern day orthopaedic failure. The early enthusiasm and promise of a hard, durable bearing was quickly quashed following the unanticipated wear rates. The release of metal ions into the blood stream has been shown to lead to surrounding soft tissue complications and early failure.

Anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system: a systematic review.

Purpose: The Ligament Augmentation and Reconstruction System (LARS) is a third generation of synthetic ligament, designed to overcome the issues of graft failure and synovitis which led previous generations of synthetic ligaments to fall out of favour. The theoretical benefits of LARS are appealing but this has not led to widespread uptake of the system in preference to autograft. The aim of this systematic review is to assess whether the evidence exists to support the use of LARS with respect to outcomes and complications.

A cheap and readily available assistant in hand surgery.

Controlling the digits during hand surgery can be challenging. During elective and emergency surgery, a "lead hand" can be used; however, during fracture surgery where an image intensifier is required, the lead hand prevents imaging. Sterile surgical gloves provide a cheap and readily available radiolucent alternative.

Sciatic palsy after total hip arthroplasty associated with vascular graft occlusion.

Sciatic nerve palsy is a well-recognised complication of total hip arthroplasty, and causes include direct injury during surgery (crushing or electrocautery), compression or stretching of the nerve, thermal damage caused by leaked bone cement, trauma during dislocation or reduction of the hip, haematoma, traction caused by leg lengthening or inadvertent intraneural injection from nerve blocks. We describe what we believe to be a case of sciatic nerve ischemia due to intra-operative arterial occlusion, and we discuss the vascular anatomy which may have contributed.

The long-term benefit of computer-assisted surgical navigation in unicompartmental knee arthroplasty.

We reviewed the outcomes of 30 consecutive primary unicompartmental knee arthroplasties (UKA) performed by a single surgeon for medial compartmental osteoarthritis. Fifteen Allegretto knees were implanted without computer navigation and 15 EIUS knees were implanted with navigation. We compared the survivorship, radiological and clinical outcomes of the two groups at an average of 8.

Bilateral hip arthroplasty: is 1-week staging the optimum strategy?

Seventy-nine patients underwent bilateral hip arthroplasty staged either at 1 week (Group 1) or after greater intervals (as suggested by the patients, mean 44 weeks, range 16-88 weeks) (Group 2), over a five year period at one Institution. Sixty-eight patients (29 bilateral hip resurfacings and 39 total hip replacements) completed questionnaires regarding their post-operative recovery, complications and overall satisfaction with the staging of their surgery.There was no significant age or ASA grade difference between the patient groups.

Differences in hip morphology between the sexes in patients undergoing hip resurfacing.

There is limited morphological data on the sex differences between the commonly used pelvic parameters. This study analysed the CT scans of 100 consecutive Caucasian patients, 61 males and 39 females, undergoing hip resurfacing arthroplasty surgery for hip osteoarthritis in one institution.There were no sex differences in femoral torsion/anteversion, femoral neck angle and acetabular inclination.

Biomechanical testing of implant free wedge shaped bone block fixation for bone patellar tendon bone anterior cruciate ligament reconstruction in a bovine model.

Background: The use of an interference fit wedged bone plug to provide fixation in the tibial tunnel when using bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction offers many theoretic advantages including the potential to offer a more economical and biological alternative to screw fixation. This technique has not been subjected to biomechanical testing. We hypothesised that a wedged bone plug fixation technique provides equivalent tensile load to failure as titanium interference screw fixation.

Bilateral ganglion cysts of the cruciate ligaments: a case report.

Symptomatic ganglion cysts of the cruciate ligaments are rare, and bilateral cases are extremely rare, with only one reported case in the literature. We report a case of bilateral cruciate ligament ganglion cysts successfully treated with arthroscopic resection, and review the literature regarding aetiology, diagnosis and management.

Bone mineral density in the femoral neck increases after hip resurfacing: a cohort with five-year follow-up.

Hip resurfacing is an effective treatment modality for arthritis of the hip in carefully selected patients; however, its use remains controversial due to its higher revision rates compared with conventional total hip replacement surgery. The most frequent reason for revision is femoral neck fracture, and preoperative bone mineral density is an important factor when considering the option of hip resurfacing. Whilst reduction in bone mineral density following total hip replacement is well documented, little is known about the long-term changes in femoral neck bone mineral density after hip resurfacing.

Rare case of bilateral posterior fracture dislocation of the shoulders secondary to a syncopal episode.

Bilateral posterior fracture-dislocations of the shoulders are a rare injury that usually occurs secondary to a tonic-clonic seizure, electrocution or a high energy trauma. In this unique case, we present the first case of this injury resulting from a simple syncope in a 49 year old man with no history of epilepsy. He was fully investigated and no cause was found for his syncope.

Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy.

The viability of unicondylar knee arthroplasty (UKA) as a stand-alone or temporising option for the management of gonarthrosis is a topic of considerable contention. Despite recent advances in prosthesis design and surgical technique, as well as mounting evidence of long-term survivorship, UKA remains infrequently used, accounting for just 8-15% of all knee arthroplasties. Instead this group is more typically managed using total knee arthroplasty (TKA).

A deceptive MRI appearance of the medial meniscus in a 14 year old boy: a case report.

Background: A 14 year old boy with a history and clinical examination suggestive of a medial meniscal tear is presented.

Case Presentation: The MRI findings suggested a horizontal cleavage tear so arthroscopy was carried out. No intra articular pathology was found at the time of surgery.

Bilateral femoral neck fractures due to transient osteoporosis of pregnancy: a case report.

We describe a case of bilateral femoral neck fractures secondary to transient osteoporosis of pregnancy, which were diagnosed after delivery due to the desire to avoid ionising radiation. These fractures were presumed to be secondary to transient osteoporosis of pregnancy and were treated successfully with internal fixation despite delayed presentation. We discuss the role of MRI in the evaluation of hip pain in pregnancy.

Atopic dermatitis: insights from linkage overlap and disease co-morbidity.

Atopic dermatitis (AD) is a strongly heritable, chronic relapsing dermatosis that frequently co-occurs with other atopic phenotypes including asthma and allergic rhinitis (the so-called atopic triad disorders). However, despite high levels of co-morbidity, relatively low levels of genomic co-incidence have been observed between atopic triad disorders. Conversely, current mapping data have revealed a striking pattern of co-localisation between AD disease loci and those mapped using another chronic dermatological disease - psoriasis.