Ankle arthrodesis in patients with haemophilia-associated ankle arthropathy - does the technique influence the outcome?

Management of symptomatic osteoarthritis (OA) of the ankle in patients with haemophilia can be challenging. Arthroscopic ankle arthrodesis has been shown in non-haemophiliac patients to provide similar or superior rates of fusion to open ankle fusion. However, the literature regarding ankle arthrodesis in patients with haemophilia is limited.

Tibial alignment technique and its influence on clinical and functional outcomes following total knee arthroplasty.

Background: Restoration of neutral mechanical axis is thought to influence implant survival and function in Total Knee Arthroplasty (TKA). There is no consensus whether Intramedullary (IM) or Extramedullary (EM) tibial alignment technique is superior to achieve this outcome. Study aims to evaluate functional and radiological outcome of TKA using the EM and IM technique.

Informed Consent in Patients Undergoing Primary Hip and Knee Arthroplasty: What Do Patients Want to Know?

Introduction The consenting process has been surgeon-focussed traditionally, but there is a recent trend towards making the process more patient and procedure-focussed. The primary aims were to identify the risks considered most important and requiring further discussion by the patients undergoing primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA), as well as to identify the sporting and recreational activities these patients would like to pursue after surgery according to the age group, taking into consideration their values and expectations. The secondary aim is to assess the compliance of the current consenting process with guidelines set out by a governing body in a tertiary referral arthroplasty unit.

Characteristics and management of the haemophilia-associated pseudotumours.

The management of haemophilia-associated pseudotumours presents an ongoing challenge to the haematologist, surgeon and interventional radiologist alike. There is a range of therapeutic approaches including factor replacement, embolization, radiotherapy and a variety of surgical interventions. However, there remains little evidence regarding the most appropriate treatment.

Fractures of the anterior process of the calcaneum; a review and proposed treatment algorithm.

Background: There remains a lack of recognition of these fractures, which leads to a delay in diagnosis and appropriate management.

Methods: A comprehensive literature search was performed. Following inclusion and exclusion criteria, 23 studies were available for analysis.

Three Cases of Femoral Stem Failure in Rotating Hinge Revision Total Knee Arthroplasty: Causes and Surgical Considerations.

Catastrophic failure of stemmed components in arthroplasty is an uncommon but a serious complication. Stem fractures and techniques for addressing these have been described following hip arthroplasty but much less so following total knee arthroplasty (TKA). We review three cases of catastrophic failure of the stem in rotating hinge revision TKA prostheses.

Biomechanical properties of bovine tendon xenografts treated with a modern processing method.

Xenograft tendons have been used in few human studies, with variable results. With the advent of novel tissue processing techniques, which may mitigate against an immune-mediated rejection response without adversely affecting mechanical properties, there may now be a clinical role for xenograft tendons, particularly in knee ligament reconstruction. We hypothesize that 'BioCleanse®' processed bovine extensor digitorum medialis (EDM) tendons exhibit favorable time-zero pre-implantation biomechanical characteristics when compared to both unprocessed bovine EDM tendons and BioCleanse® processed human cadaveric allograft tibialis anterior tendons.

Subchondral haematoma.

Unlabelled: Haemophilic arthropathy is a complex multifactorial disorder that poses significant challenges to both the treating haematologist and arthroplasty surgeon. Its pathogenesis is incompletely understood. Recent literature has concentrated on the toxic effects of iron and the characteristic inflammatory synovitis.

Subchondral haematoma. The missing link in understanding haemophilic arthropathy?

Unlabelled: Haemophilic arthropathy is a complex multifactorial disorder that poses significant challenges to both the treating haematologist and arthroplasty surgeon. Its pathogenesis is incompletely understood. Recent literature has concentrated on the toxic effects of iron and the characteristic inflammatory synovitis.

Diagnostic Efficacy of 3-T MRI for Knee Injuries Using Arthroscopy as a Reference Standard: A Meta-Analysis.

Objective: The objectives of our study were to assess the evidence for the diagnostic efficacy of 3-T MRI for meniscal and anterior cruciate ligament (ACL) injuries in the knee using arthroscopy as the reference standard and to compare these results with the results of a previous meta-analysis assessing 1.5-T MRI.

Materials And Methods: The online Cochrane Library, MEDLINE, and PubMed databases were searched using the following terms: MRI AND ((3 OR three) AND (Tesla OR T)) AND knee AND arthroscopy AND (menisc* OR ligament).

Learning Curves in Arthroplasty in Orthopedic Trainees.

The NHS is adapting to a changing environment, in which economical constraints have forced theatres to maximise efficiency. An environment in which working hours and surgical exposure has been reduced and outcomes are being published. Litigation is high, and patients are living longer with higher demands.

A case of femoral fracture in klippel trenaunay syndrome.

We present a case of Klippel Trenaunay syndrome (KTS) who presented with severe bilateral knee osteoarthritis (OA). Preoperative planning was commenced for a total knee replacement (TKR). Whilst on the waiting list the patient suffered a fall and sustained a complete femoral diaphysis fracture.

The use of the ligament augmentation and reconstruction system (LARS) for posterior cruciate reconstruction.

Purpose: To systematically review and assess the use of the Ligament Advanced Reinforcement System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) for posterior cruciate ligament (PCL) reconstruction.

Methods: A search of multiple databases was conducted using the following terms: (LARS[All Fields] AND posterior[All Fields]) OR (LARS[All Fields] AND PCL[All Fields]). The methodologic quality of each article was assessed by use of abridged Downs and Black criteria.

Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis.

Background: Knee osteoarthritis after anterior cruciate ligament (ACL) injury has previously been reported. However, there has been no meta-analysis reporting the development and progression of osteoarthritis.

Purpose: We present the first meta-analysis reporting on the development and progression of osteoarthritis after ACL injury at a minimum mean follow-up of 10 years, using a single and widely accepted radiologic classification, the Kellgren & Lawrence classification.

Publication trends in knee surgery: a review of the last 16 years.

The trends in the publication of articles regarding knee arthroplasty and soft tissue surgery were analysed with regard to geographical authorship, institutional funding and number of authors. Over 7500 articles from relevant journals with the highest impact factors according to the Thomson Reuters Journal Citation Report (2010) were evaluated from 1995 to 2010. The rate of publication increased by 16.

Red cell distribution width is an independent predictor of mortality in hip fracture.

Background: the red cell distribution width (RDW), an automated measure of variability in the red blood cell size on full blood count (FBC) is an independent predictor of mortality in several disease states and in healthy older people.

Objective: we wanted to determine the prognostic value of RDW in patients following a hip fracture-a condition associated with high mortality.

Design: we examined the relationship between admission RDW and mortality in 698 consecutive patients admitted with hip fracture.

Refractory metabolic acidosis in patients with sepsis following hemiarthroplasty for femoral neck fracture: a causative role for paracetamol and flucloxacillin?

The authors report two cases of pyroglutamic acidosis as a result of paracetamol and flucloxacillin therapy in patients with prosthesis infection following hemiarthroplasty for neck of femur fractures. Pyroglutamic acidosis is an important and often unrecognised cause of refractory metabolic acidosis that disproportionately affects older women, and can be caused by drugs such as paracetamol and flucloxacillin in the setting of sepsis, renal failure and malnutrition. Although relatively rare, the widespread use of these drugs in orthopaedic patients confirms the importance of this disorder.

Supracondylar femoral fracture after anterior cruciate ligament reconstruction with transfemoral fixation.

Femoral fractures following anterior cruciate ligament (ACL) reconstruction are rare. These injuries often are related to increased stresses at the femoral tunnel. Hamstring tendon autograft is often used for ACL reconstruction, and transfemoral fixation is one of many graft fixation techniques with few reported complications.

Incidence of heterotopic ossification after hip resurfacing.

Background: Heterotopic ossification has been noted around total hip arthoplasty in numerous studies. With hip resurfacing growing in popularity, we have prospectively evaluated the incidence in a cohort undergoing hip resurfacing.

Methods: Two hundred and twenty consecutive hip-resurfacing procedures were prospectively reviewed at a minimum of 2 years follow up to assess the incidence of heterotopic ossification and its effect on function and clinical outcome.

Hip resurfacing: indications, results, and conclusions.

Hip resurfacing using metal-on-metal bearings has increased in popularity as a viable treatment option for young, active patients with osteoarthritis. Theoretic advantages of this procedure include preservation of bone stock, reduction in osteolysis, and a reduced risk of dislocation when compared with conventional hip arthroplasty with smaller diameter metal-on-polyethylene bearings. Concerns associated with the use of metal-on-metal bearings during hip resurfacing include the production of metal ions with unknown carcinogenic and immunologic effects.

How do serum cobalt and chromium levels change after metal-on-metal hip resurfacing?

We prospectively monitored changes in serum cobalt and chromium levels after a new generation metal-on-metal hip resurfacing and the affect on renal function. Levels were measured using inductively coupled plasma mass spectrometry and atomic absorption spectrometry, preoperatively then sequentially at 3, 6, 9, 12, and 24 months. For serum cobalt, there was an initial increase to a peak level at 6 months, followed by a gradual decline during the next 15 months.

The nonoperative management of periprosthetic fractures associated with the Birmingham hip resurfacing procedure.

We reviewed the outcome of 7 patients sustaining undisplaced femoral neck periprosthetic fractures associated with the Birmingham hip resurfacing procedure. All fractures presented within 4 months of initial surgery. All fractures were treated conservatively with a period of nonweight bearing.

The octogenarian total knee arthroplasty.

Sixty-five patients aged > 80 years were compared to 65 patients aged between 60 and 70 years to assess total knee arthroplasty (TKA) outcome using the octogenarian postoperative Knee Society knee and function scores. Knee Society knee scores showed excellent outcomes with no statistically significant difference in the younger cohort (preoperative score, P = .7156; 5-year score, P = -.