Total Hip and Knee Arthroplasties Are Highly Cost-Effective Procedures: The Importance of Duration of Follow-Up.

Background: Total hip and knee arthroplasties (THA/TKA) are clinically effective but high cost procedures. The aim of this study is to perform a cost-effectiveness analysis of THA and TKA in the New Zealand (NZ) healthcare system.

Methods: Data were collected from 713 patients undergoing THA and 520 patients undergoing TKA at our local public hospital.

The Relationship Between Preoperative Oxford Hip and Knee Score and Change in Health-Related Quality of Life After Total Hip and Total Knee Arthroplasty: Can It Help Inform Rationing Decisions?

Background: In countries with publicly funded health care, there is an increasing need for explicit rationing for total joint arthroplasty (TJA). The Oxford Hip and Knee Scores (OHS/OKS) have been used to set access thresholds for TJA despite not being developed for that purpose. The aim of this study was to determine whether preoperative OHS/OKS can aid rationing decisions by investigating the changes in general health-related quality of life after TJA.

Acetabular Liner Dissociation: A Comparative Study of Two Contemporary Uncemented Acetabular Components.

Background: There are a number of reports of polyethylene liner dissociation of third-generation modular acetabular components. This study compares our experience with 2 contemporary systems to determine whether this is an implant- or class-specific problem.

Methods: This is a single-center retrospective study of 961 primary total hip arthroplasties using 2 third-generation modular cementless acetabular shells: Pinnacle (535) and R3 (426) with a polyethylene liner.

National Referral Prioritization tool for first specialist assessment: results of a pilot study in orthopaedic surgery.

Background: Most public hospitals are receiving more referrals for first specialist assessment than they have capacity to see. Traditional priority categories are too broad for effective discrimination. In New Zealand (NZ) explicit prioritization is required by legislation and supported by the Medical Council of NZ.

The Functional Outcomes of Patients With Knee Osteoarthritis Managed Nonoperatively at the Joint Clinic at 5-Year Follow-Up: Does Surgical Avoidance Mean Success?

Background: Nonoperative management of patients with knee osteoarthritis (OA) through multidisciplinary programs may delay or reduce the need for total knee arthroplasty (TKA). However, avoidance of surgery may not represent success for the patient.

Methods: A cohort of 120 patients with knee OA managed with at least 6 months of supervised nonoperative treatment coordinated through the Joint Clinic were reviewed at 5 years.

Cemented or uncemented acetabular fixation in combination with the Exeter Universal cemented stem.

Aims: To compare long-term survival of all-cemented and hybrid total hip arthroplasty (THA) using the Exeter Universal stem.

Methods: Details of 1,086 THAs performed between 1999 and 2005 using the Exeter stem and either a cemented (632) or uncemented acetabular component (454) were collected from local records and the New Zealand Joint Registry. A competing risks regression survival analysis was performed with death as the competing risk with adjustments made for age, sex, approach, and bearing.

The Outcomes of Nonoperative Management of Patients With Hip and Knee Osteoarthritis Triaged to a Physiotherapy-Led Clinic at Minimum 5-Year Follow-Up and Factors Associated With Progression to Surgery.

Background: The purpose of this study is to determine outcomes of a nonoperative treatment service for hip and knee osteoarthritis (OA), the "Joint Clinic," at minimum 5-year follow-up, and investigate factors that may influence progression to joint replacement surgery.

Methods: This is an observational cohort study of 337 patients with hip (n = 151, 45%) or knee OA (n = 186, 55%) seen at the Joint Clinic, at 5-7 years of follow-up. Kaplan-Meier survival curves were used to determine survivorship of the affected joint and Cox regression used to determine factors associated with time to surgery.

infection of total hip arthroplasty after intravesicular Bacillus Calmette-Guérin.

Intravesicular application of Bacillus Calmette-Guérin (BCG), a live attenuated strain of , is effective in the treatment of bladder cancer. However, systemic dissemination and subsequent infection of implants have been reported. We present a case of infection of a total hip arthroplasty 5 years after BCG instillation for bladder cancer.

Hybrid Fixation for Total Hip Arthroplasty Showed Improved Survival Over Cemented and Uncemented Fixation: A Single-Center Survival Analysis of 2156 Hips at 12-18 Years.

Background: Despite increased use of uncemented and hybrid fixation, there is little evidence of their superiority over cemented implants. The aim of this study is to compare the long-term survivorship of cemented, hybrid and uncemented total hip arthroplasty (THA) at varying ages.

Methods: A total of 2156 hips (1315 cemented, 324 uncemented, and 517 hybrid) were performed in a single center between 1999 and 2005 with follow-up through to 2017.

Outcomes and Factors Influencing Response to an Individualized Multidisciplinary Chronic Disease Management Program for Hip and Knee Osteoarthritis.

Background: The objective of the study was to investigate the effectiveness of, and factors associated with, response to a chronic disease management program for patients with hip and knee osteoarthritis (OA).

Methods: Over a 2-year period (2012-2014), 218 patients (97 hip OA; 121 knee OA) were managed with an individualized program of interventions that could include education, physiotherapy, orthotics, occupational therapy, or dietitian referral. Changes in Oxford Hip Score or Oxford Knee Score and Short Form-12 (SF-12) Physical and Mental Component Summary Score (PCS, MCS) were analyzed by joint affected, both unadjusted, and gender and age adjusted.

The Joint Clinic: Managing Excess Demand for Hip and Knee Osteoarthritis Referrals Using a New Physiotherapy-Led Outpatient Service.

Background: There are increasing problems with access to both outpatient assessment and joint replacement surgery for patients with hip or knee osteoarthritis.

Methods: Data were collected on all patients seen at the Joint Clinic over a 2-year period with minimum 12-month follow-up. Patients were assessed by a nurse and a physiotherapist, baseline scores and demographic details collected, and an individualized personal care plan developed.

Functional Outcome of Acute Achilles Tendon Rupture With and Without Operative Treatment Using Identical Functional Bracing Protocol.

Background: The purpose of this study was to compare the functional results of operative and nonoperative treatment of acute Achilles tendon rupture using an identical rehabilitation program of functional bracing.

Methods: Over a 10-year period, 200 patients (99 operative, 101 nonoperative) aged between 18 and 65 years were treated at our institution's physiotherapy department after acute Achilles tendon rupture. There were 132 patients (62 operative, 70 nonoperative) available for a minimum 2-year follow-up (average 6.

Enhanced Recovery After Surgery for Hip and Knee Replacements.

Background: Enhanced recovery after surgery (ERAS) programs or hip and knee replacements have had a significant effect on streamlining patient care with shorter stays, no increase in complications, and improved outcomes including reduced mortality.

Purpose: To compare outcomes following the introduction of an ERAS program for hip and knee replacements developed at our institution with a historical cohort of patients.

Methods: ERAS protocols were developed at our institution for patients undergoing hip and knee joint replacements.

The Morscher Press-Fit Acetabular Component: An Independent Long-Term Review at 18-22 Years.

Background: There are relatively few 20-year results of uncemented acetabular components, and most of these are modular designs. This study reports the 20-year results of a monoblock press-fit acetabular component.

Methods: A total of 122 total hip arthroplasties (111 patients) using the Morscher cup were reviewed at a mean of 19.

Rationing for Total Hip and Knee Arthroplasty Using the New Zealand Orthopaedic Association Score: Effectiveness and Comparison With Patient-Reported Scores.

Background: There is increasing interest in scoring systems to prioritize patients for hip and knee arthroplasty. The purpose of this study was to determine the effectiveness of the New Zealand Orthopaedic Association (NZOA) score and compare it with patient-reported scores of patients listed for hip and knee arthroplasty.

Methods: Over a 1-year period, all patients listed for primary hip and knee arthroplasty were scored by a prioritization nurse.

Incidence of Carpal Tunnel Syndrome Requiring Surgical Decompression: A 10.5-Year Review of 2,309 Patients.

Purpose: To describe the demographics, neurophysiological grading, and incidence of patients undergoing carpal tunnel decompression (CTD) for carpal tunnel syndrome (CTS) in a single region.

Methods: A retrospective review of 2,313 patients aged greater than 16 years who underwent 3,073 CTDs between January 2000 and August 2010. Crude annual and age- and sex-specific incidences were calculated for the study period.

Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol.

Background: This study reports on the demographics of acute Achilles tendon rupture in our region and compares the results of a selective approach to operative and nonoperative treatment using an identical rehabilitation program with functional bracing.

Materials And Methods: A consecutive series of 363 patients, aged 15 to 60 years, treated over 8.5 years by either open operative repair (143) or nonoperatively (220) were compared with respect to demographics, re-rupture rate, and major wound complication.

Aberrant radial artery seen in the carpal tunnel at carpal tunnel decompression: case report.

We present a case in which the radial artery was found running within the carpal tunnel at the time of routine carpal tunnel decompression. It appears to be an anomalous superficial palmar branch of the radial artery that is substituting for the normal radial artery.

Failure strengths of concentric and eccentric implants for hamstring graft fixation.

The purpose of this study is to compare the initial failure strengths of various interference screw devices used for tibial fixation of hamstring grafts in anterior cruciate ligament reconstruction and the effect of concentric or eccentric screw position. Quadrupled tendon grafts were harvested from freshly killed sheep. The grafts were then prepared and fixed in the distal femur using various devices (Intrafix (DePuy Mitek Raynham, MA, USA), RCI screw (Smith and Nephew Acufex, Mansfield, MA, USA), Wedge screw (Stryker Endoscopy, San Jose, CA, USA) in concentric position and Wedge screw in eccentric position with an interlock pin).

Alendronate-induced synovitis.

We describe 7 cases of synovitis or arthritis occurring after commencement of alendronate for treatment of osteoporosis. These were cases from our practice or notified to the New Zealand Pharmacovigilance Centre, Dunedin, New Zealand. There was no evidence of rheumatoid arthritis, pyrophosphate arthropathy, or seronegative arthritis in any patient.

Iliotibial band Z-lengthening for refractory trochanteric bursitis (greater trochanteric pain syndrome).

Background: Trochanteric bursitis or greater trochanter pain syndrome (GTPS) is a frequent cause of lateral hip pain. This article reports our experience with a new method of Z-lengthening of the iliotibial band for refractory GTPS.

Methods: Fifteen patients (17 hips) were diagnosed with GTPS unresponsive to conservative treatment including steroid injection.

Ultrasound measurements in the management of unstable hips treated with the pavlik harness: reliability and correlation with outcome.

The purposes of this study were to determine the interobserver and intraobserver reliability of ultrasound measurements in unstable neonatal hips treated with the Pavlik harness and to determine whether ultrasound measurements correlate with radiological outcome at 6 months. Sixty-four babies treated from birth with the Pavlik harness for neonatal hip instability were scanned at 2 and 6 weeks. The alpha and beta angles of Graf, the combined (H) angle of Hosny, and the femoral head coverage (FHC) were measured by 3 observers and remeasured by each observer on a minimum of 50 scans.