Radiographic and clinical outcome of tibial plateau fractures treated with bone allograft.

BACKGROUND: To determine the clinical outcome of patients who had been treated with bone allografts during open reduction and internal fixation (ORIF) of tibial head fractures. METHODS: Patients who suffered a medial, lateral, or bicondylar fracture of the tibial plateau and underwent surgical treatment by open reduction and internal fixation (ORIF) using human femoral head bone allografts were included. Patients were invited to provide information for the following: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol Five Dimension score (EQ-5D), Lower Extremity Functional Scale (LEFS) and Parker Mobility Score. Bone mineral density (BMD) of the allograft area and the healthy human bone tissue were measured by quantitative computed tomography. RESULTS: A total of 22 patients with a mean follow-up time of 2.88 ± 2.46 years were included in our study. The most common fractures observed in this study were classified as Schatzker II (11 patients, 50.0%) or AO/OTA 41.B3 (12 patients, 54.5%) fractures. Postoperative WOMAC total was 13.0 (IQR = 16.3, range 0-33). Median quality of life (EQ-5D) score was 0.887 ± 0.121 (range 0.361-1.000). Median Lower Extremity Functional Scale (LEFS) score was 57.5 ± 19.0 (range 33-79). Mean Parker Mobility Score was 9 (range 6-9). Median bone mineral density (BMD) for the whole group was 300.04 ± 226.02 mg/cm3 (range - 88.68 to 555.06 mg/cm3) for region of interest (ROI 5) (central), 214.80 ± 167.45 mg/cm3 (range - 7.16 to 597.21 mg/cm3) for ROI 1-4 (marginal zones: medial, lateral, ventral, dorsal) and 168.14 ± 65.54 mg/cm3 (range 17.47-208.97 mg/cm3) for healthy bone tissue (femur and tibia). CONCLUSION: Based on WOMAC scores, LEFS, ambulatory status, and quality of life findings, it can be concluded that following tibial head ORIF with allograft bone patients has promising results.

Injuries to the anterolateral ligament are observed more frequently compared to lesions to the deep iliotibial tract (Kaplan fibers) in anterior cruciate ligamant deficient knees using magnetic resonance imaging.

PURPOSE: To determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees. METHODS: Ninety-one consecutive patients, out of those 25 children (age 14.3 ± 3.5 years), with diagnosed ACL tears were included. Two musculoskeletal radiologists retrospectively reviewed MRI data focusing on accuracy of detection and potential injuries to the ALL or dITT. Lesion were diagnosed in case of discontinued fibers in combination with intra- or peri-ligamentous edema and graded as intact, partial or complete tears. Cohen's Kappa and 95% confidence intervals (95% CI) were determined for inter- and intrarater reliability measures. RESULTS: The ALL and dITT were visible in 52 (78.8%) and 56 (84.8%) of adult-and 25 (100%) and 19 (76.0%) of pediatric patients, respectively. The ALL was injured in 45 (58.5%; partial: 36.4%, compleate: 22.1%) patients. Partial and comleate tears, where visualized in 21 (40.4%) and 16 (30.8%) adult- and seven (28.0%) and one (4%) peditric patients. A total of 16 (21.3%; partial: 13.3%, compleate: 8.0%) dITT injuries were identified. Partal and complete lesions were seen in seven (12.5%) and five (8.9%) adult- and three (15.8%) and one (5.3%) pediatric patients. Combined injuries were visualized in nine (12.7%) patients. Inter-observer (0.91-0.95) and intra-observer (0.93-0.95) reproducibility was high. CONCLUSION: In ACL injured knees, tears of the ALL are observed more frequently compared to lesions to the deep iliotibial tract. Combined injuries of both structures are rare. Clinically, the preoperative visualization of potentially injured structures of the anterolateral knee is crucial and is important for a more personalized preoperative planning and tailored anatomical reconstruction. The clinical implication of injuries to the anterolateral complex of the knee needs further investigation. LEVEL OF EVIDENCE: II.

A Prospective Assessment of Knee Arthroscopy Skills Between Medical Students and Residents-Simulator Exercises for Partial Meniscectomy and Analysis of Learning Curves.

BACKGROUND: The Covid-19 pandemic has created the largest disruption of education in history. In a response to this, we aimed to evaluate the knee arthroscopy learning curve among medical students and orthopaedic residents. METHODS: An arthroscopy simulator was used to compare the learning curves of two groups. Medical students with any prior knowledge of arthroscopy (n=24) were compared to a residents group (n=16). Analyzed parameters were "time to complete a task," assessment of the movement of tools and values scoring damage to the surrounding tissues. RESULTS: After several repetitions, both groups improved their skills in terms of time and movement. Residents were on average faster, had less camera movement, and touched the cartilage tissue less often than did students. Students showed a steeper improvement curve than residents for certain parameters, as they started from a different experience level. CONCLUSION: The participants were able to reduce the time to complete a task. There was also a decrease in possible damage to the virtual surrounding tissues. In general, the residents had better mean values, but the students had the steeper learning curve. Particularly less experienced surgeons can especially train their hand-eye coordination skills required for arthroscopy surgery. Training simulators are an important training tool that supplements cadaveric training and participation in arthroscopic operations and should be included in training.

Subsidence of a metaphyseal-anchored press-fit stem after 4-year follow-up: an EBRA-FCA analysis.

PURPOSE: Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analyse) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless metaphyseal-anchored press-fit stem after 4-year follow-up. METHODS: Applying a retrospective study design, we reviewed all consecutive patients who between 2012 and 2017 received a cementless Accolade II press-fit stem at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. EBRA-FCA measurements and statistical investigations were performed by two independent investigators. RESULTS: A total of 102 stems in 91 patients (female 60; male 31) fulfilled our inclusion criteria. Mean age at surgery was 66.2 (range 24.3-92.6) years. EBRA migration analysis showed a mean subsidence of 1.4 mm (range 0.0-12.0) at final follow-up. The angle between stem and femur axis was 0.5° (range 0.0°-2.8°) after 48 months. No correlations between gender or Dorr types and subsidence were found (p > 0.05). A body mass index > 30 kg/m2 showed a significant increase in stem subsidence within the first 6 (p = 0.0258) and 12 months (p = 0.0466) postoperative. CONCLUSIONS: Migration pattern of the metaphyseal-anchored stem and a low subsidence rate at final follow-up may predict a good long-term clinical result. TRIAL REGISTRATION: Number: 20181024-1875.

Migration characteristics of the Corail hydroxyapatite-coated femoral stem-a retrospective clinical evaluation and migration measurement with EBRA.

PURPOSE: Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analysis) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless press-fit stem after two years follow-up. Stem type and postoperative gap between collar and femur were evaluated as a risk factor. METHODS: Applying a retrospective study design, we reviewed all consecutive patients who between 2013 and 2017 received a cementless press-fit Corail stem (DePuy Orthopaedics Inc., Warsaw, IN, USA) at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. RESULTS: A total of 109 stems in 105 patients (female: 60; male: 45) fulfilled our inclusion criteria. Mean age at surgery was 67.8 (range, 21.6-90.5) years. EBRA migration analysis showed a mean subsidence of 1.8 mm (range, 0.0-12.1) at final follow-up. At 18 months mean subsidence of collared stems was significantly lower than in the collarless group [1.3 mm (range, 0.0-7.6) vs. 3.2 mm (range, 0.5-10.7), p = 0.0104]. Collared stems resting on the femoral cut presented a tendency to less subsidence than did collared stems showing a postoperative gap between collar and femur (1.3 vs. 2.0 mm) without finding statistical significance (p > 0.05). CONCLUSIONS: Low subsidence and the migration pattern of the cementless press-fit stem may predict a good long-term result. Collared stems investigated in our study provide good stability and are able to prevent significant subsidence. Trial registration number and date of registration: Number: 20181024-1875; Date: 2018-10-24.

Good mid-term results with the trident peripheral self-locking cup: a clinical evaluation and migration measurement with EBRA.

INTRODUCTION: The most common cause of failure in total hip arthroplasty (THA) is aseptic loosening. Uncemented cup migration analysis by means of Einzel-Bild-Roentgen-Analyse (EBRA) has shown to be a good predictive indicator for early implant failure if the cup migrates more than 2 mm within 4 years after surgery. In this study, we performed a migration analysis of an uncemented peripheral self-locking (PSL) press-fit cup after 4 years follow-up. MATERIALS AND METHODS: We retrospectively reviewed all patients who received a trident PSL press-fit cup at our department between 2004 and 2017. A total of 636 patients were identified. As inclusion criteria for radiological analysis, a minimum follow-up of 2 years was defined. We reviewed medical histories and performed radiological analysis using EBRA software. EBRA measurements and statistical investigations were performed by two independent investigators. RESULTS: A total of 149 cups in 146 patients (female 82; male 64) met our inclusion criteria. Mean age at surgery was 65 years (33-89). We found a significant improvement in the WOMAC score pre- to postoperative (p < 0.0001). EBRA migration analysis showed a mean total migration of 0.6 mm (0.0-8.2) over our follow-up period of 4 years. Of the investigated cups, 69.8% showed a migration rate smaller than 2 mm in the investigated follow-up. CONCLUSION: The acetabular cup used in our study provides low migration at final follow-up. Therefore, a good long-term outcome can be expected for the PSL cup. TRIAL REGISTRATION: Trial registration number is 20181024-1875 and date of registration is 2018-10-24.

The reversed dynamic patellar apprehension test mimics anatomical complexity in lateral patellar instability.

PURPOSE: To develop a dynamic physical examination test that functionally simulates actual patellar instability events and that mimics the range of patellar stabilizer insufficiency in an individual patient. METHODS: Seventy-eight consecutive patients (male/female 35/43; mean age 22 ± 7 years) with recurrent lateral patellar instability and 35 controls (male/female 16/19; mean age 31 ± 14 years) were prospectively evaluated using the reversed dynamic patellar apprehension test (ReDPAT). Anatomical predisposition was assessed according to Dejour's classification of trochlear dysplasia, tibial tuberosity-trochlear groove distance, tibial tuberosity-posterior cruciate ligament distance, patellar height, and varus/valgus malalignment. RESULTS: The study group had an average of 3.4 ± 1.0 (1-6) anatomical risk factors for lateral patellar dislocation. Severe trochlear dysplasia (84%) and patella alta (49%) were the most common. Test sensitivity and specificity was 93.7% (95% CI 0.8584-0.9791) and 88.2% (95% CI 0.7255-0.9670), respectively. The positive predictive value reached 94.9% (95% CI 0.8739-0.9859) and the negative predictive value was 85.7% (95% CI 0.6974-0.9519). The ReDPAT results became positive at a mean knee flexion angle of 58° ± 17° (20°-90°). Knee flexion angle correlated significantly with the severity of trochlear dysplasia (p = 0.018), valgus deformity (p = 0.011), and the total number of anatomical risk factors (p = 0.02). CONCLUSION: This study introduced the reversed dynamic patellar apprehension test as a reliable clinical examination tool in the assessment of lateral patellar instability. The results of this study indicate that the degree of knee joint flexion at which the provocative sense of apprehension becomes positive correlates with severity of trochlear dysplasia, valgus deformity and the total number of anatomical risk factors for patellar instability. This test indicates the patient-specific end of stable patellar tracking and the beginning of patellar stabilizer insufficiency. Therefore, this test might be helpful in deciding for or against a bony procedure in the treatment of patellar dislocation. LEVEL OF EVIDENCE: II.

Temporary postoperative treatment with compartment-unloading knee braces or wedge insoles does not improve clinical outcome after partial meniscectomy.

PURPOSE: To investigate whether temporary postoperative compartment-unloading therapy after arthroscopic partial meniscectomy (APM)-with either knee braces or wedge insoles-leads to superior clinical outcome as compared to controls. This difference in clinical outcome was tested in the form of two knee scores, physical activity and general health outcome over the first postoperative year. METHODS: Sixty-three patients who underwent arthroscopic partial meniscectomy (APM) were randomized to one of the following three groups: 12 weeks postoperative knee compartment-unloading therapy with either a knee brace (brace group) or wedge insoles (insole group) or no specific postoperative therapy (control group). Patient-reported outcome was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC Score), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the MARX score (physical activity) and the SF-12 (general health). RESULTS: Sixty-three patients were available for analysis. Except for the SF-12 mental score, all other scores showed significant improvement over time. With regard to the hypotheses proposed, no significant group * time interactions were observed for any of the outcome parameters. This means that the group (i.e. the type of postoperative treatment) was not related to the degree of improvement of any of the scores. CONCLUSIONS: It was concluded that 12 weeks of compartment-unloading therapy-with either a knee brace or wedge insoles-is ineffective with regard to clinical outcome after APM. This applies to the knee score outcome, physical activity and general health outcome over the first year following APM. LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

Maximum lifetime body mass index is the appropriate predictor of knee and hip osteoarthritis.

INTRODUCTION: In light of inconsistencies in the literature, this study aimed to investigate the relationship between obesity (current and historic) and osteoarthritis (OA) of the knee or hip. MATERIALS AND METHODS: We examined 99 people (knee OA, hip OA and controls), age > 50 years, in a case-control study. The current weight, height and waist circumference were measured on site, and detailed weight changes over their lifetime were based on questionnaires and standardized interviews. We used binomial logistic regression to determine the predictive value for an osteoarthritis group membership of each derived indicator. RESULTS: An increase in 'maximum-BMI' increased the odds ratio for both knee OA (OR 1.2; CI 1.1-1.4; p = 0.005; R 2 = 0.36) and hip OA (OR 1.2; CI 1.0-1.3; p = 0.027; R 2 = 0.16). Current BMI was significantly associated with knee OA but not with hip OA. A high "minimum-BMI" (over the age of 18 years) had the highest odds ratio of all calculated indicators for both osteoarthritis groups. CONCLUSIONS: Based on our findings, it is concluded that the maximum BMI over one's lifespan is a better predictor of OA of the hip or the knee than the current BMI. The knee joint seems to be more sensitive to obesity as current BMI was associated only with knee OA but not with hip OA.

Knee Extensor Strength and Gait Characteristics After Minimally Invasive Unicondylar Knee Arthroplasty vs Minimally Invasive Total Knee Arthroplasty: A Nonrandomized Controlled Trial.

BACKGROUND: In light of the existing lack of evidence, it was the aim of this study to compare gait characteristics and knee extensor strength after medial unicondylar knee arthroplasty (MUKA) with those after total knee arthroplasty (TKA), given the same standardized minimally invasive surgery (MIS) approach in both groups. METHODS: Patients scheduled for MIS-MUKA or MIS-TKA as part of clinical routine were invited to participate. A posterior cruciate ligament-retaining total knee design was used for all MIS-TKA. A 3-dimensional gait analysis was performed preoperatively with a VICON system and at 8 weeks postoperative to determine temporospatial parameters, ground reaction forces, joint angles, and joint moments. At the same 2 times, isokinetic tests were performed to obtain peak values of knee extensor torque. A multivariate analysis of variance was conducted and included the main effects time (before and after surgery) and surgical group and the group-by-time interaction effect. RESULTS: Fifteen MIS-MUKA patients and 17 MIS-TKA patients were eligible for the final analysis. The groups showed no differences regarding age, body mass index, sex, side treated, or stage of osteoarthritis. We determined neither intergroup differences nor time × group interactions for peak knee extensor torque or any gait parameters (temporospatial, ground reaction forces, joint angles, and joint moments). CONCLUSION: It is concluded that MUKA is not superior to TKA with regard to knee extensor strength or 3-dimensional gait characteristics at 8 weeks after operation. As gait characteristics and knee extensor strength are only 2 of the various potential outcome parameters (knee scores, activity scores…) and quadriceps strength might take a longer time to recover, our findings should be interpreted with caution.

Driving abstinence is necessary after lumbar spinal fusion: a prospective cohort study.

PURPOSE: Studies on driving safety after lumbar spinal procedures are rare. Previous studies solely reported on a) driving reaction time (DRT) after lumbar nerve root blocks, b) DRT after discectomy and c) preliminary DRT findings after lumbar fusion. METHODS: DRT was assessed with a driving simulator as described before. Measurements were done one day before surgery (preop DRT), one week after surgery (postop1 DRT), three months (postop2 DRT) and one year postoperatively (postop3 DRT). Back pain was determined with visual analogue scales (VAS) on all four occasions. Additionally, we monitored each patient's pre-operative driving frequency and intake of analgesics. For statistical analysis we used an ANOVA for repeated measurements. RESULTS: Thirt eight of 51 patients completed all measurements (17 monosegmental fusion, 14 polysegmental fusion, seven other lumbar fusion procedures). The longitudinal changes in DRT showed overall significance (p = 0.013). Post-hoc tests determined p = 0.035 for the DRT-increase from pre- to postoperative. We did not determine a significant statistical effect for the type of surgery (p = 0.581) or patient age (p = 0.134). A tendency towards statistical significance was ascertained for the influence of patients' driving frequency on DRT (p = 0.051). CONCLUSIONS: We found increased DRT at the time of discharge after lumbar spinal fusion and therefore recommend driving abstinence for the time thereafter. Based on our findings it appears safe to return to driving at 3 months postoperative.

Cartilage degeneration and not age influences the health-related quality of life outcome after partial meniscectomy.

PURPOSE: The purpose of this study is to investigate whether inconsistently reported factors influence the health-related quality of life (HRQOL) outcome of partial meniscectomy. METHOD: Short Form 36 (SF-36) data on 216 patients were retrospectively analysed for the influence of the factors age, gender and degree of cartilage degeneration. Mixed linear models were applied for univariate and multivariate analyses. RESULTS: All SF-36 scales, including the psychosocial scales, showed a significant improvement from pre- to post-operative (p < 0.001). The factor 'degree of cartilage degeneration' was found to significantly influence post-surgical improvement of the SF-36 'physical component summary' score. Patients with mild cartilage degeneration benefited significantly more from surgery than did patients with advanced cartilage degeneration (p = 0.011). Older patients had significantly lower scores on each subscale, but showed no significant age-time interaction, that is, no association was seen between age and the degree of improvement. No effect was determined for the variable gender. CONCLUSIONS: The findings of the current study can be interpreted to show that arthroscopic partial meniscectomy significantly improves HRQOL, even in mental or psychosocial dimensions of HRQOL. Not age but the degree of cartilage degeneration influences the HRQOL gain that can be expected. The factor gender has no effect on HRQOL. The findings of our study influence our daily routine, in that we take the degree of cartilage degeneration and not age as predictive value for the success to be anticipated from the procedure. Concerning the preoperative consenting, it is important to mention that advanced cartilage degeneration is a predictor of a less favourable outcome. LEVEL OF EVIDENCE: IV.

The incidence of implant fractures after total hip arthroplasty.

PURPOSE: Implant fractures after total hip arthroplasty (THA) are considered as rare in clinical practice. Nevertheless they are relevant complications for patients, physicians, and the public health system leading to high socioeconomic burdens. The aim of this study was to assess the incidence of fractures after THAs in a comparative analysis of clinical studies and worldwide arthroplasty register datasets. METHODS: We calculated the pooled incidence of revision operations after fractures of THAs in a comparison of clinical studies published in Medline-listed journals and annual reports of worldwide arthroplasty registers in a structured literature analysis based on a standardised methodology. RESULTS: Included clinical studies (sample-based datasets) were mono-centre trials comprising a cumulative number of approximately 70,000 primary implantations whereas worldwide national arthroplasty register datasets referred to 733,000 primary implantations, i.e. approximately ten times as many as sample-based datasets. In general, sample-based datasets presented higher revision rates than register datasets with a maximum deviation of a 14.5 ratio for ceramic heads, respectively. The incidence of implant fractures in total hip arthroplasty in pooled worldwide arthroplasty register datasets is 304 fractures per 100,000 implants. In other words, one out of 323 patients has to undergo revision surgery due to an implant fracture after THA in their lifetime. CONCLUSIONS: Implant fractures in total hip arthroplasty occur in a relevant number of patients. The authors believe that comprehensive arthroplasty register datasets allow more general evaluations and conclusions on that topic in contrast to clinical studies.

Does minimally invasive total knee arthroplasty improve isokinetic torque?

BACKGROUND: Less invasive dissection of the extensor apparatus, one of the aspects of minimally invasive surgical (MIS) TKA, might result in less reduction of postoperative quadriceps strength. However, it is unclear whether MIS is associated with less strength reduction. QUESTIONS/PURPOSES: We asked whether knee strength (extensor or flexor torque) would be greater in patients having a MIS TKA compared with patients having a standard TKA and whether knee scores, alignment, ROM, tourniquet and operating times, and hospital length of stay were improved. METHODS: We prospectively recruited 52 patients awaiting MIS or standard TKA, matched for age, weight, height, BMI, sex, and surgically treated side, but not randomized. Isokinetic tests were performed preoperatively and postoperatively to obtain peak values of extensor and flexor torque. Postoperative-to-preoperative ratios and the extensor-flexor torque ratio also were calculated. RESULTS: Mean baseline extensor torques were 57 Nm and 53 Nm for MIS and standard TKAs, respectively. At 8 weeks postoperatively, absolute values of the mean postoperative knee extensor torque also were similar: 47 and 45 Nm for patients with MIS and standard TKAs, respectively. The postoperative-to-preoperative ratios were 0.8 for extensor and flexor torque in both groups. The extensor-flexor torque ratios were similar between groups. CONCLUSIONS: Our data suggest a less invasive dissection of the extensor apparatus involved in MIS TKA does not enhance postoperative quadriceps strength. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The effect of gender on force, muscle activity, and frontal plane knee alignment during maximum eccentric leg-press exercise.

PURPOSE: To investigate for gender differences during eccentric leg-press exercise. Tears of the anterior cruciate ligament (ACL) are considered to be related to eccentric tasks, altered neuromuscular control (e.g., reduced co-contraction of hamstrings), and increased knee abduction (valgus alignment). Based on these observations and the fact that ACL tears are more common in women, it was hypothesized that men and women differ significantly with regard to key parameters of force, knee stabilization, and muscle activity when exposed to maximum eccentric leg extension. METHODS: Thirteen women and thirteen men were matched for age and physical activity. They performed maximum isokinetic eccentric leg-pressing against footplates of varied stability. The latter was done because earlier studies had shown that perturbational test conditions might be relevant in respect of ACL injuries. Key parameters of force, frontal plane knee stabilization, and muscle recruitment of significant muscles crossing the knee were recorded. RESULTS: The 'force stabilization deficit' (difference between maximum forces under normal and perturbed leg-pressing) did not differ significantly between genders. Likewise, parameters of muscle activity and frontal plane leg stabilization revealed no significant differences between men and women. CONCLUSION: This study is novel, in that gender differences in parameters of force, muscle activity, and leg kinematic were investigated during functional conditions of eccentric leg-pressing. No gender differences were observed in the measured parameters. However, the conclusion should be viewed with caution because the findings concurred with, but also contrasted, previous research in this field. LEVEL OF EVIDENCE: Diagnostic study, Level III.

Restoration and preservation of disc height and segmental lordosis with circumferential lumbar fusion: a retrospective analysis of cage versus bone graft.

STUDY DESIGN: Retrospective radiographic analysis. OBJECTIVE: To determine whether restoration and preservation of (a) disc height and (b) segmental lordosis differ between patients treated with circumferential lumbar fusion using a bone graft or a cage for anterior support. SUMMARY OF BACKGROUND DATA: Restoration of disc height and lordosis is considered to be of crucial importance in circumferential fusion (CF). To determine whether restoration and preservation of disc height and segmental lordosis are dependent on the type of anterior support used, we compared the use of a cage with that of a bone graft in CF. METHODS: We retrospectively analyzed disc height and segmental lordosis in patients treated with primary lumbar monosegmental CF. The minimum period of follow-up was 9 months. A cage was used for anterior support in 23 patients and a bone graft in a further 23 patients. Disc height was determined on radiographs using an earlier introduced and validated distortion-compensated roentgen analysis, which was developed to compensate for distortion in central projection, off-center position, variation of stature, axial rotation, and lateral tilt of the spine. RESULTS: Disc height was restored in both groups but differences between preoperative and postoperative disc heights were significantly greater in the cage group (P=0.006). The cage also proved to be superior with regard to disc height preservation after follow-up (P=0.001). In addition, there was significantly less postoperative loss of segmental lordosis in the cage group (P=0.026). CONCLUSIONS: The cage proved superior to the bone graft as anterior support in CF with respect to restoration/preservation of lordosis and disc height. However, no conclusions concerning clinical outcome or cost effectiveness can be drawn on the basis of this study.

Impact of the Covid-19 Pandemic on Orthopaedic and Trauma Surgery - A Systematic Review of the Current Literature.

BACKGROUND/AIM: The Coronavirus disease 2019 (COVID-19) has led to significant disruptions in various medical specialties. We herein aimed to provide a systematic review of the published literature on the impact by the Covid-19 pandemic on orthopaedic and traumatological care by focusing on the number of clinical visits, surgeries and reasons for consultation. MATERIALS AND METHODS: The published literature was reviewed using PubMed. Of 349 studies published between December 1, 2019 and October 1, 2020, 36 original articles met the inclusion criteria. Articles were selected on the basis of the PRISMA guidelines. October 1, 2020 was used as the concluding date of publication. RESULTS: The number of elective visits declined by 50.0% to 74.0%. The number of emergency and trauma visits showed a decrease of 37.7% to 74.2%. Trauma surgery decreased by 21.2% to 66.7% and elective surgeries by 33.3% to 100%. CONCLUSION: Orthopaedic and trauma surgery is clearly influenced by the pandemic. It will be important to maintain treatment and surgical care of patients in order to avoid negative effects on treatment progress.

Brake response time before and after total knee arthroplasty: a prospective cohort study.

BACKGROUND: Although the numbers of total knee arthroplasty (TKA) are increasing, there is only a small number of studies investigating driving safety after TKA. The parameter 'Brake Response Time (BRT)' is one of the most important criteria for driving safety and was therefore chosen for investigation.The present study was conducted to test the hypotheses that patients with right- or left-sided TKA show a significant increase in BRT from pre-operative (pre-op, 1 day before surgery) to post-operative (post-op, 2 weeks post surgery), and a significant decrease in BRT from post-op to the follow-up investigation (FU, 8 weeks post surgery). Additionally, it was hypothesized that the BRT of patients after TKA is significantly higher than that of healthy controls. METHODS: 31 of 70 consecutive patients (mean age 65.7 +/- 10.2 years) receiving TKA were tested for their BRT pre-op, post-op and at FU. BRT was assessed using a custom-made driving simulator. We used normative BRT data from 31 healthy controls for comparison. RESULTS: There were no significant increases between pre-op and post-op BRT values for patients who had undergone left- or right-sided TKA. Even the proportion of patients above a BRT threshold of 700 ms was not significantly increased postop. Controls had a BRT which was significantly better than the BRT of patients with right- or left-sided TKA at all three time points. CONCLUSION: The present study showed a small and insignificant postoperative increase in the BRT of patients who had undergone right- or left-sided TKA. Therefore, we believe it is not justified to impair the patient's quality of social and occupational life post-surgery by imposing restrictions on driving motor vehicles beyond an interval of two weeks after surgery.

Two-year gait analysis controls of the minimally invasive total hip arthroplasty by the direct anterior approach.

BACKGROUND: The purpose of the study was to determine the long-term functional outcome of two hip approaches by gait analysis. Patients were selected by prospective randomization, and operated on either by the anterolateral approach or by a minimally invasive direct anterior approach. METHODS: 33 patients (17 anterolateral approach; 16 direct anterior approach) were analyzed using a Vicon 870 system. Gait analysis was performed two years after total hip arthroplasty. Temporo-spatial and kinematic variables were obtained. FINDINGS: On chest and pelvic kinematics, no patient group demonstrated significant differences. The time-distance parameters showed significant differences with the anterior approach in cadence and stride time. INTERPRETATION: The study indicates that the direct anterior approach exerts positive effects compared with the anterolateral approach two years after surgery. The muscle-sparing concept of direct anterior approach results in significant differences in gait compared to the anterolateral approach 2 years after surgery.