Varus alignment of the tibial component up to seven degrees is not associated with poor long-term outcomes in a neutrally aligned total knee arthroplasty.

PURPOSE: The purpose of this retrospective study was to evaluate the effect of varus alignment of the tibial component on the outcomes with a minimum follow-up of 10 years. The hypothesis was that varus alignment of the tibial component might not affect the outcomes and survival of a neutrally aligned primary TKA. METHODS: A matched case-control study was designed between 66 patients with varus alignment of the tibial component and 66 with neutral alignment with a minimum follow-up of 10 years. Functional outcome was assessed with the knee surgery scores (KSS) and reduced Western Ontario and MacMaster Universities questionnaire (WOMAC). Patient satisfaction was evaluated by a 0-10 visual analog scale. Radiological evaluation was performed at early postoperative and at final follow-up. RESULTS: The mean follow-up was 11.9 (SD 2.6) years for both groups. The mean postoperative proximal tibial angle in the varus group was 85.0° (SD 0.9) and 88.8° (SD 0.9) in control group. At the final follow-up, there were no significant differences in KSS, WOMAC, range of motion or patient satisfaction. There were no differences in the coronal anatomical alignment of the TKA between groups. Revision of TKA was performed in four knees in the varus group, and one in control group, due to aseptic loosening of the tibial component in all cases. TKA survival at 10 years was not significantly different between groups. CONCLUSION: The alignment of the tibial component up to 7° varus did not negatively affect implant survival, patient satisfaction, and function of a well-aligned TKA, with a minimum postoperative follow-up of 10 years. LEVEL OF EVIDENCE: III.

A validated outcome categorization of the knee society score for total knee arthroplasty.

PURPOSE: To determine cutoff values for the Knee Society Scores (KSS) indicative of a categorical scale of medium-term outcomes. METHODS: One hundred and fifty-five patients who underwent primary cruciate-retaining TKA with a patellar button for osteoarthritis at a single-centre were assessed prospectively by the KSS and short-form Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) simultaneously at the 3-year follow-up. A validated categorization of the WOMAC score was used as a standard. The area under the curve (AUC) of receiver-operating characteristic (ROC) was used to assess the discriminative analysis accuracy of the, and the Youden index estimated the optimal cutoff point. RESULTS: For the KSS-knee score, the cutoff for an excellent outcome was 90.3 (AUC 0.75, 95% CI 0.71-0.78), 76.6 (AUC 76.6, 95% CI 0.70-076) for good, 64.8 (AUC 0.76, 95% CI 0.72-0.79) for fair, and < 64.8 (AUC 0.69, 95% CI 0.67-0.73) for poor. For the KSS-function score, the cutoff values were 85.2 (AUC 0.71, 95% CI 0.69-0.75), 73.1 (AUC 0.72, 95% CI, 0.70-0.76), 55.7 (AUC 0.70, 95% CI 0.71-0.74), and < 55.7 (AUC 0.68, 95% CI 0.66-0.72), respectively. CONCLUSION: A KSS-knee score ≥ of 90 was considered an excellent outcome, 77 good, 65 fair, and < 65 poor. For the KSS-function, those values are 85, 73, 56 and < 56, respectively. The treatment outcome's judgement may be clearer for the surgeon concerning a particular patient when using cutoff values for the scoring system employed, such as those determined in the present study. LEVEL OF EVIDENCE: II.

Better clinical outcomes and overall higher survival with hybrid versus cemented primary total knee arthroplasty: a minimum 15 years follow-up.

PURPOSE: To compare the clinical outcomes and survival at long-term between hybrid and cemented primary total knee arthroplasty (TKA). A better clinical outcome and survival following a follow-up as long as 15 years with the use of hybrid fixation as compared with cemented fixation was hypothesized. METHODS: Case-control study of 126 patients with a mean age of 62.4 years who underwent hybrid TKA matched with 126 patients underwent cemented TKA. Clinical outcome was assessed by the Knee Society scores (KSS) and reduced Western Ontario and MacMaster Universities questionnaire (WOMAC). Radiological assessment was made by the Knee Society method. RESULTS: The mean follow-up was 15.7 (range 15-17) years. At the final follow-up, clinical scores were significantly better in the hybrid group, although the differences were not clinically relevant. Revisions for all reasons were performed in five knees in the hybrid group and 15 knees in the cemented group (p = 0.033). In the hybrid group, there was one aseptic femoral loosening and no aseptic tibial loosening. In the cemented group, the main reasons for aseptic revisions were polyethylene wear (six knees) and tibial loosening (four knees). Cemented fixation was a significant risk factor for aseptic revision (hazard ratio 2.3; 95% CI 1.3-3.7%; p = 0.004). Survival at 15 years for aseptic reasons was 96.5% (95% CI 93.4-98.7%) in hybrid groups and 90.3% (95% CI 88.7-93.9%) in cemented group (p = 0.020). CONCLUSION: After a minimum follow-up of 15 years, hybrid fixation of primary TKA for osteoarthritis provide significantly higher clinical benefits compared with cemented fixation, but the differences were not clinically relevant. Hybrid fixation provides longer overall survival, although the femoral component survival was similar between groups. LEVEL OF EVIDENCE: III.

Successful mid- to long-term outcome after reconstruction of the extensor apparatus using proximal tibia-patellar tendon composite allograft.

PURPOSE: The purpose of the study was to assess the outcomes of extensor mechanism reconstruction with proximal tibia-patellar tendon composite allograft. METHODS: 24 consecutive patients treated with allograft-prosthetic composite for proximal tibia tumour resection and a conventional total knee arthroplasty were included. Extensor mechanism reconstruction was performed with a proximal tibia-patellar tendon composite allograft and the suture of the donor tendon to the remnant native patellar tendon. Function was evaluated by the Musculoskeletal Tumor Society score (MSTS) and range of motion. Western Ontario and MacMaster University (WOMAC) and visual analogue scale for pain also were used. RESULTS: After a mean follow-up of 11.7 (range 3-15) years, mean MSTS score was 22.4 (range 20-30), mean flexion was 94.0° (range 84°-110°), and mean extension lag was 7.2° (range 0°-18°). The mean VAS-pain was 4.3 (range 2-6), and WOMAC score was 72.4 (range 58-100). There was no failure of the reconstructed extensor mechanism. CONCLUSION: Patellar tendon reconstruction with allogeneic tissue from the proximal tibia allograft sutured to the recipient's remnant patellar tendon provides the mechanical support needed for healing of the reconstructed extensor mechanism with a substantial functional benefit to stabilize active knee extension and successful reconstruction survival at long-term. LEVEL OF EVIDENCE: III.

Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a prospective cohort study at a minimum five year follow-up.

PURPOSE: To evaluate prospectively the functional outcomes of tibiotalocalcaneal (TTC) arthrodesis with a contemporary retrograde intramedullary nail after a minimum follow-up of five years. METHODS: Sixty-one patients with a mean age of 51.3 (range, 18-79) years were included in the study. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society Ankle Hindfoot score (AOFAS), Short-Form 12-item Health Survey (SF12), and visual analog scales (VAS) for both pain and patient satisfaction. Radiographic evaluation was also assessed. RESULTS: The mean post-operative follow-up was 6.8 (range, 5-8) years. Mean AOFAS and SF12 scores significantly improved at the final follow-up (p < 0.001), and the mean VAS for pain significantly decreased (p < 0.001). At the final follow-up, only five (8.2%) patients gave an AOFAS score of less than 50, 52 (85.2%) were satisfied with their surgery, and 32 (52.4%) returned to their employment. There were two tibiotalar joint nonunions that required re-operations, and another patient required re-operation for screw removal. There was no deep infection. CONCLUSIONS: The retrograde intramedullary nail provided a stable TTC arthrodesis with a high union rate, acceptable functional outcomes, and a low severe complication rate. This procedure appears to offer a reliable salvage option for TTC arthrodesis in patients with severe ankle and hindfoot degeneration.

Outcomes of Total Hip Arthroplasty for Healed Intertrochanteric Hip Fractures. A Matched Retrospective Cohort Study.

BACKGROUND: Many studies have analyzed the outcomes of total hip arthroplasty (THA) after failed intertrochanteric fracture fixation, but not after healed fracture. The objective is to investigate the influence of a prior healed intertrochanteric fracture fixation on the outcomes of a subsequent THA for osteoarthritis. METHODS: This is a matched retrospective cohort study of THA between 43 patients who suffered a prior intertrochanteric fracture successfully managed with internal fixation and 43 patients without prior hip fracture. Mean age was 73.6 vs 74.2 years. A conventional cementless THA was used in both groups. Functional outcome was assessed by the Harris hip score (HHS) and reduced Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. Radiological assessment was also performed. RESULTS: Mean follow-up was 6.6 (range, 5-8) years. The mean operative time and blood transfusion rate were significantly higher in the fracture group (P = .001), but there was no significant difference in the length of stay. HHS significantly improved in both groups. At final follow-up, HHS was significantly higher in nonfracture group (P = .008), but the rate of patients with excellent and good outcomes was similar (P = .616). Western Ontario and McMaster Universities Osteoarthritis Index score at the final follow-up was not different between groups (P = .058). Complication rate was similar between groups. There were no revisions, dislocations, or loose implants in the study group. CONCLUSION: Cementless THA provided successful functional outcomes and implant durability at medium term in patients treated for osteoarthritis following healed intertrochanteric fracture fixation, comparable to those without prior fracture who underwent primary THA. Surgical complexity and complication rate were low.

First Metatarsophalangeal Arthrodesis After Failed Distal Chevron Osteotomy for Hallux Valgus.

BACKGROUND: The purpose of this study was to compare the clinical outcomes after first metatarsophalangeal (MTP) joint arthrodesis for hallux rigidus between patients who underwent primary arthrodesis and those who had had a prior surgery for hallux valgus. METHODS: Our design was a retrospective cohort study comparing 29 patients who underwent primary arthrodesis (primary group) and 34 patients with hallux rigidus after hallux valgus surgery (secondary group). The clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score and a visual analog scale (VAS) for pain. Radiological evaluation was also performed. Overall, the mean postoperative follow-up was 3.4 (range, 2-5) years. RESULTS: At final follow-up, AOFAS and VAS pain scores significantly improved in both groups (P = .001). However, the mean AOFAS (P = .001) and VAS pain (P = .008) scores were significantly better in the primary group than in the secondary group. Radiologically, there were no significant differences between the groups in any angle after arthrodesis. Revision surgeries were not required in the primary group. In the secondary group, there was 1 revision due to deep infection, and 3 other patients required dorsal plate removal. Excluding plate removal, the Kaplan-Meier survival at 3 years was not significantly different between groups (P = .775). CONCLUSION: Although arthrodesis of the first MTP joint was an effective procedure for hallux rigidus, the clinical outcomes in patients who had prior hallux valgus surgery were worse than those for patients who underwent primary surgery for hallux rigidus. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Footprint Curvature in Spanish Women: Implications for Footwear Fit.

The incorrect adjustment of footwear produces alterations in the foot that affect quality of life. The usual measurements for shoe design are lengths, widths and girths, but these measures are insufficient. The foot presents an angle between the forefoot and the rearfoot in the transverse plane, which is associated with foot pronation, hallux valgus and metatarsus adductus. Here, we aimed at identifying the groups formed by the angulations between the forefoot and rearfoot using a sample of footprints from 102 Spanish women. The angle between the forefoot and rearfoot was measured according to the method described by Bunch. A cluster analysis was performed using the K-means algorithm. Footprints were grouped into three types: curved, semi-curved and straight, according to the degrees of angulation between the forefoot and rearfoot. There is great variability in the morphology of the foot. Based on our findings, to achieve a better footwear fit, we propose the manufacture of three types of lasts with different curvatures.

Prospective comparison of functional outcomes of primary reverse shoulder arthroplasty for acute fractures versus rotator cuff deficiencies.

AIMS: The purpose of this study was to determine whether there were long-term differences in outcomes of reverse shoulder arthroplasty (RSA) undertaken for acute proximal humeral fracture versus rotator cuff deficiency with a minimum follow-up of five years. METHODS: This was a prospective cohort study comparing 67 patients with acute complex proximal humeral fracture and 64 patients with irreparable rotator cuff deficiency who underwent primary RSA. In the fracture group, there were 52 (77.6%) females and 15 (22.4%) males, with a mean age of 73.5 years (51 to 85), while in the arthropathy group, there were 43 (67.1%) females and 21 (32.9%) males, with a mean age of 70.6 years (50 to 84). Patients were assessed by the Constant score, University of California Los Angeles shoulder score (UCLA), short version of the Disability of the Arm Shoulder and Hand score (QuickDASH), and visual analogue scales (VAS) for pain and satisfaction. Radiological evaluation was also performed. RESULTS: Mean follow-up was 8.4 years (5 to 11). There were no significant differences in mean absolute (p = 0.125) or adjusted (p = 0.569) Constant, UCLA (p = 0.088), QuickDASH (p = 0.135), VAS-pain (p = 0.062), or range of movement at the final follow-up. However, patient satisfaction was significantly lower in the fracture group (p = 0.002). The complication rate was 1.5% (one patient) versus 9.3% (six patients), and the revision rate was 1.5% (one patient) versus 7.8% (five patients) in the fracture and arthropathy groups, respectively. The ten-year arthroplasty survival was not significantly different (p = 0.221). CONCLUSION: RSA may be used not only for patients with irreparable rotator cuff deficiencies, but also for those with acute complex proximal humeral fractures. We found that RSA provided similar functional outcomes and a low revision rate for both indications at long-term. However, satisfaction is lower in patients with an acute fracture. Cite this article: Bone Joint J 2020;102-B(11):1555-1559.

Calzado de seguridad y el papel del podólogo en la salud laboral / No disponible

Según datos del Ministerio de Trabajo y AsuntosSociales, en 2006 se produjeron en España 253.362accidentes con baja laboral, esto supone un elevadocoste económico y personal. Alguno de estos accidentespodría evitarse con la utilización de un calzadolaboral adecuado. El presente estudio se centra enel calzado de seguridad por ser uno de los más utilizados.Para realizar el estudio se ha realizado unarevisión de los estudios publicados sobre calzado deseguridad, utilizando como palabras clave: “safetyshoes” o “safety footwear”; se revisó en las bases dedatos: Pubmed, Medline, Embase y Scopus recogiendoun total de 79 referencias bibliográficas.Los objetivos del presente trabajo son: describir loscampos de estudio en el ámbito del calzado de seguridady señalar las funciones del podólogo dentrode un equipo de salud laboral.Resultados: se observó un evidente crecimiento en elinterés por el estudio del calzado dentro del ámbitolaboral, con un incremento en el número de artículospublicados. Se detectaron dos líneas básicas deestudio: la medición de coeficientes de rozamientoen la interfase suelo/piso para evitar caídas; y otravertiente dedicada a la valoración del confort delcalzado (reparto de presiones plantares, aislamientotérmico, etc.).Las lesiones podológicas asociadas a la utilizacióndel calzado laboral y los problemas de ajuste adicho calzado según las características personalesdel trabajador, ponen de manifiesto la importanciadel asesoramiento por parte de un podólogo en laselección del calzado laboral, la colaboración delpodólogo en el diseño del calzado y las revisionespodológicas como parte del chequeo médico de lostrabajadores...(AU)

According to data of the Ministry of Work and SocialSubjects, in 2006 253,362 accidents with labour losstook place in Spain, this supposes a high economicand personal cost. Some of these accidents could beavoided with the use of suitable labour footwear.The present study concentrates in the securityfootwear for being one of the most used. In order torealise the study a revision of the studies publishedon security footwear has been realised, using likekey words: “safety shoes” or “safety to footwear”; itwas reviewed in the data bases: Pubmed, Medline,Embase and Scopus gathering a total of 79 bibliographicalreferences.The objectives of the present work are: to describethe fields of study in the scope of the security footwearand to indicate the functions of the podiatristswithin an equipment of labour health. Results: anevident growth in the interest by the study of thefootwear within the labour scope was observed, withan increase in the number of published articles. Twobasic lines of study were detected: the measurementof coefficients of friction in the interphase ground/floor to avoid falls; and another slope dedicated tothe valuation of the comfort of the footwear (distributionof plantar pressures, heat insulation, etc.).The podiatry injuries associated to the use of the labourfootwear and the problems of adjustment to thisfootwear according to the personal characteristics ofthe worker, show the importance of the advising onthe part of a podiatrist in the selection of the labourfootwear, the collaboration of the podiatrist in thedesign of the footwear and revisions as it leaves fromthe medical control of the workers...(AU)

Calzado de seguridad y el papel del podólogo en la salud laboral / No disponible

Según datos del Ministerio de Trabajo y AsuntosSociales, en 2006 se produjeron en España 253.362accidentes con baja laboral, esto supone un elevadocoste económico y personal. Alguno de estosaccidentes podría evitarse con la utilización de uncalzado laboral adecuado. El presente estudio secentra en el calzado de seguridad por ser uno delos más utilizados. Para realizar el estudio se harealizado una revisión de los estudios publicadossobre calzado de seguridad, utilizando como palabrasclave: “safety shoes” o “safety footwear”;se revisó en las bases de datos: Pubmed, Medline,Embase y Scopus recogiendo un total de 79 referenciasbibliográficas.Los objetivos del presente trabajo son: describirlos campos de estudio en el ámbito del calzadode seguridad y señalar las funciones del podólogodentro de un equipo de salud laboral.Resultados: se observó un evidente crecimientoen el interés por el estudio del calzado dentro delámbito laboral, con un incremento en el númerode artículos publicados. Se detectaron dos líneasbásicas de estudio: la medición de coeficientes derozamiento en la interfase suelo/piso para evitarcaídas; y otra vertiente dedicada a la valoracióndel confort del calzado (reparto de presionesplantares, aislamiento térmico, etc.).Las lesiones podológicas asociadas a la utilizacióndel calzado laboral y los problemas de ajuste adicho calzado según las características personales del trabajador, ponen de manifiesto la importanciadel asesoramiento por parte de un podólogoen la selección del calzado laboral, la colaboracióndel podólogo en el diseño del calzado y las revisionespodológicas como parte del chequeo médicode los trabajadores...(AU)

According to data of the Ministry of Work andSocial Subjects, in 2006 253,362 accidents withlabour loss took place in Spain, this supposes ahigh economic and personal cost. Some of theseaccidents could be avoided with the use of suitablelabour footwear. The present study concentratesin the security footwear for being one of the mostused. In order to realise the study a revision of thestudies published on security footwear has beenrealised, using like key words: “safety shoes” or“safety to footwear”; it was reviewed in the databases: Pubmed, Medline, Embase and Scopus gatheringa total of 79 bibliographical references.The objectives of the present work are: to describethe fields of study in the scope of the securityfootwear and to indicate the functions of the podiatristswithin an equipment of labour health.Results: an evident growth in the interest by thestudy of the footwear within the labour scopewas observed, with an increase in the number ofpublished articles. Two basic lines of study weredetected: the measurement of coefficients of frictionin the interphase ground/floor to avoid falls;and another slope dedicated to the valuation of thecomfort of the footwear (distribution of plantarpressures, heat insulation, etc.).The podiatry injuries associated to the use of thelabour footwear and the problems of adjustmentto this footwear according to the personal characteristicsof the worker, show the importance of the advising on the part of a podiatrist in theselection of the labour footwear, the collaborationof the podiatrist in the design of the footwear andrevisions as it leaves from the medical control ofthe workers...(AU)