Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers.

BACKGROUND: Indigenous Australians experience significant socioeconomic disadvantage and healthcare disparity compared to non-Indigenous Australians. A retrospective cohort study to describe the association between rates of self-discharge in Indigenous orthopaedic patients and the introduction of routine Aboriginal Liaison Officers (ALO) within the Orthopaedic multi-disciplinary team (MDT) was performed. METHODS: ALO were introduced within our routine Orthopaedic MDT on the 22nd of February 2021. Two patient cohorts were analysed, Group 1; patients admitted in the 9-months prior to inclusion of ALO, and Group 2; patients admitted within 9-months thereafter. The primary outcome of interest was the rate of self-discharge among Indigenous patients. Secondary outcomes of interest were the stage of treatment when patients self-discharged, recurrent self-discharge, risk factors for self-discharge and association between self-discharge and length of hospital stay. RESULTS: Introduction of ALO within routine Orthopaedic MDT was associated with a significant 37% reduced risk of self-discharge among Indigenous patients (p = 0·009), and significantly fewer self-discharges before their definitive surgical and medical treatment (p = 0·0024), or before completion of postoperative intravenous antibiotic treatment (p = 0·030). There was no significant change in the risk of recurrent self-discharge (p = 0·557). Risk factors for self-discharge were younger age; pensioners or unemployed; residents of Alice Springs Town-Camps or of communities within 51 to 100 km of Alice Springs; and those diagnosed with lacerations of the upper limb, but without tendon injury, wound and soft tissue infections or osteomyelitis. In Group 2, the odds of self-discharge decreased with increased length of hospital stay (p = 0·040). CONCLUSIONS: Routine inclusion of ALO within the Orthopaedic MDT reduced the risk of self-discharge in Indigenous patients. Those who self-discharged did so only after critical aspects of their care were met.

Efficacy of hip resurfacing arthroplasty: 6 year results from an international multisurgeon prospective cohort study.

Metal-on-metal hip resurfacing is undertaken worldwide. This procedure helps preserve femoral bone stock and allows patients to return to high activity sports. Most outcome studies are individual surgeon case series from single centers where the results and outcomes are evaluated by the same surgeon. One method of increasing the external validity of a follow-up study is to have a multi-centre study design with independent assessment of the outcomes. We present an independent assessment of eleven year follow-up of hip resurfacing outcomes from an international hip resurfacing register. The purpose of this study was to assess: Implant survival at maximum follow-up for revision due to any reason, implant survival at maximum follow-up for revision due to major causes of failure, hip function following hip resurfacing and factors affecting hip function, effect of gender and age on hip function and implant survival, effect of femoral component size on hip function and implant survival. 4535 patients (5000 hips) entered into the registry during 1997-2002 were studied. In summary, at a maximum follow-up of 11 years hip resurfacing has a good implant survival of 96.2% and excellent post-operative function. This is excellent given the international and multisurgeon nature of this cohort where majority of the surgeons were in their learning curve.

Revision hip arthroscopic surgery: outcome at three years.

PURPOSE: This study describes the medium-term results of revision hip arthroscopy. METHODS: Patients with persistent hip pain and a positive impingement sign were considered for revision surgery after the exclusion of other causes of groin pain. Seventy-four consecutive patients were prospectively assessed using the modified Harris hip score for a period of 3 years after surgery. Of the 74 patients, 11 had inadequate follow-up data; thus, a total of 63 patients were qualified for the study. The mean age at index surgery was 37 years, comprising 27 males and 36 females. RESULTS: Revision surgery was performed at a mean of 3 years from index surgery. Chondral lesion associated with labral re-injury was the most common finding at revision arthroscopy. In contrast to other authors, however, only 31 % of our patients underwent revision for persistent femoroacetabular impingement. The mean pre-operative mHHS for all 63 patients was 54 (SD 14.5). The mean post-operative mHHS was 53 (SD 14.9) at 6 weeks, 62 (SD 17.5) at 6 months, 63 (SD 16.5) at 1 year, 64 (SD 16.5) at 2 years and 59 (SD 16.5) at 3 years (p = n.s., 0.02, 0.045, 0.039 and n.s., respectively). CONCLUSIONS: Revision arthroscopy results in improvement in outcome in the first 3 years after revision surgery with a success rate of 63.4 % at 1 year, falling to 55.6 % by 3 years.

A retrospective cohort study comparing outcomes following hip fractures in Australian indigenous patients with non-Australian indigenous patients.

BACKGROUND: Australian Indigenous (AI) populations face significant socioeconomic disadvantage and have poorer health outcomes when compared to their non-AI counterparts. There is a paucity of published literature on outcomes following hip fracture in the AI population. METHODS: We performed a retrospective cohort study comparing outcomes following hip fracture in AI and non- AI patients presenting to a single regional trauma centre. The primary outcome of interest was all-cause mortality. Secondary outcomes of interest were the odds of postoperative delirium and length of stay in hospital. All outcomes were adjusted against collected baseline covariates. RESULTS: One hundred and twenty-seven hip fractures were identified across 125 patients. There were 62 hip fractures in the AI group and 65 in the non-AI group. The adjusted hazard ratio (HR) for all-cause mortality was not statistically significant when comparing Indigenous versus non-Indigenous patients (HR = 2.37, P = 0.055). Adjusted odds of postoperative delirium was lower in Indigenous patients (OR = 0.12; P = 0.018). The AI cohort had a 4 day longer median length of stay, which was not statistically significant when adjusted for covariates. CONCLUSION: AI patients with hip fractures were younger, had a higher Charlson Comorbidity Index Score and American Society of Anaesthesiologists grade, as well as a higher incidence of diabetes and associated end-organ sequalae. There was no difference in all-cause mortality. Odds of postoperative delirium was lower in the AI group. We did not find any difference in the length of hospital stay.

Magnetic resonance arthrography for femoroacetabular impingement surgery: is it reliable?

BACKGROUND: Magnetic resonance arthrography (MRA) is commonly used to demonstrate injury to the labrum and hyaline cartilage in patients with femoroacetabular impingement (FAI). The purpose of this study was to assess the diagnostic correlation between MRA and findings at arthroscopic and open surgery. MATERIALS AND METHODS: MRA reports of 41 hips with symptomatic FAI were reviewed and compared with subsequent intraoperative findings (n = 21 surgical dislocations and n = 20 therapeutic hip arthroscopies). Each case was assessed for the presence of a cam deformity, a cartilage lesion of the femoral head, an os acetabuli, an injury to the labrum and injury to the acetabular cartilage. Results were collected prospectively in a cross-table and analysed retrospectively for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: The sensitivity, specificity, PPV and NPV in the presence of reported cam-type deformity or an os acetabuli were 100%. In the presence of cartilage lesions of the femoral head, the values were 46, 81, 55 and 73%, respectively. For labral tears, the values were 91, 86, 97 and 67%. In the presence of acetabular cartilage injuries, the values were 69, 88, 78 and 81%, respectively. CONCLUSIONS: MRA appears to be an efficacious imaging modality in the evaluation of labral tears, cam-type impingement lesions and os acetabuli of the hip. MRA is less efficacious in the diagnosis of cartilage abnormalities in the hip, both femoral and acetabular. Researchers should focus on further improvements in imaging techniques in order to give reliable preoperative information to the surgeon.

Timing in hip arthroscopy: does surgical timing change clinical results?

PURPOSE: To our knowledge, there is no report in the orthopaedic literature that correlates the duration of hip pain with the results of hip arthroscopic surgery. The aim of this study was to compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a two year period. METHODS: We present a prospective single-surgeon series of 525 consecutive patients undergoing hip arthroscopy for a labral tear, femoroacetabular impingement (FAI), or a chondral lesion. Modified HHS was recorded for all patients at the time of surgery and at six weeks, six months and one, two and three years after hip arthroscopy. At the time of surgery, patients were divided into three groups based on duration of preoperative symptoms: group A, under 6 months; group B, six months to three years; group C, over three years. RESULTS: Mean age was 39 years. There were significantly better outcomes for patients who underwent surgery within six months of symptom onset compared with those who waited longer. Patients who had symptoms for over 3 years by the time of surgery had a significantly poorer result than those with a shorter symptom duration and a higher chance of requiring revision surgery. CONCLUSIONS: We recommend that patients with a diagnosis of labral tear, FAI or a chondral lesion should undergo hip arthroscopic surgery within six months of symptom onset. Patients with persistent symptoms for over three years should be made aware of the poorer outcome after hip arthroscopy.

Corrigendum to: Safety of intraarticular corticosteroid injection preceding hip and knee arthroplasty: a systematic review and meta-analysis amid resolving COVID-19 arthroplasty restrictions.

[This corrects the article DOI: 10.1093/jhps/hnab064.].

Synovial fluid calprotectin performs better than synovial fluid polymerase chain reaction and interleukin-6 in the diagnosis of periprosthetic joint infection : a systematic review and meta-analysis.

AIMS: The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated the performance characteristics of polymerase chain reaction (PCR), interleukin-6 (IL6), and calprotectin of synovial fluid in the diagnosis of PJI. METHODS: We performed systematic search of PubMed, Embase, The Cochrane Library, Web of Science, and Science Direct from the date of inception of each database through to 31 May 2021. Studies which described the diagnostic accuracy of synovial fluid PCR, IL6, and calprotectin using the Musculoskeletal Infection Society criteria as the reference standard were identified. RESULTS: Overall, 31 studies were identified: 20 described PCR, six described IL6, and five calprotectin. The sensitivity and specificity were 0.78 (95% confidence interval (CI) 0.67 to 0.86) and 0.97 (95% CI 0.94 to 0.99), respectively, for synovial PCR;, 0.86 (95% CI 0.74 to 0.92), and 0.94 (95% CI 0.90 to 0.96), respectively, for synovial IL6; and 0.94 (95% CI 0.82 to 0.98) and 0.93 (95% CI 0.85 to 0.97), respectively, for synovial calprotectin. Likelihood ratio scattergram analyses recommended clinical utility of synovial fluid PCR and IL6 as a confirmatory test only. Synovial calprotectin had utility in the exclusion and confirmation of PJI. CONCLUSION: Synovial fluid PCR and IL6 had low sensitivity and high specificity in the diagnosis of PJI, and is recommended to be used as confirmatory test. In contrast, synovial fluid calprotectin had both high sensitivity and specificity with utility in both the exclusion and confirmation of PJI. We recommend use of synovial fluid calprotectin studies in the preoperative workup of PJI. Cite this article: Bone Joint J 2022;104-B(3):311-320.

Safety of intraarticular corticosteroid injection preceding hip and knee arthroplasty: a systematic review and meta-analysis amid resolving COVID-19 arthroplasty restrictions.

Intraarticular corticosteroid injection (ICSI) is a widely practiced management for hip and knee osteoarthritis. Imposed delays to arthroplasty during coronavirus disease 2019 pandemic have led us to postulate that many patients have opted for recent ICSI. We compared the odds of prosthetic joint infection (PJI) in patients who were or were not administered ICSI within 12 months prior to hip or knee arthroplasty. A systematic search of PubMed, Embase, The Cochrane Library and Web of Science was performed in February 2021, with studies assessing the effect of ICS on PJI rates identified. All studies, which included patients that received ICSI in the 12 months prior to primary hip and knee arthroplasty, were included. In total 12 studies were included: four studies with 209 353 hips and eight studies with 438 440 knees. ICSI administered in the 12 months prior to hip arthroplasty increased the odds of PJI [odds ratio (OR) = 1.17, P = 0.04]. This was not the case for knees. Subgroup analysis showed significantly higher odds of PJI in both hip [OR = 1.45, P = 0.002] and knee arthroplasty [OR = 2.04; P = 0.04] when ICSI was within the preceding 3 months of surgery. A significantly higher odds of PJI were seen in patients receiving ICSI within the 12 months prior to hip arthroplasty. Subgroup analysis showed increased odds of PJI in both hip and knee arthroplasty, in patients receiving ICSI within 3 months prior to their arthroplasty. We recommend delaying knee arthroplasty for at least 3 months after ICSI and possibly longer for hip arthroplasty. Level of Evidence: Level III - Systematic Review of Level II and III Studies.

Patients' Perception of Bone and Tissue Excision, and the Size and Weight of Prostheses at Total Knee Arthroplasty.

The aim of this study is to ascertain patients' perception of the amount of bone and tissue excision and size and weight of their implanted prostheses at total knee arthroplasty (TKA). To our knowledge, no prior study in the English orthopaedic literature has analyzed these parameters against patient perception of TKA. In a prospective study of eight consecutive TKA (six primary and two single-stage revision TKA procedures) by a single surgeon, patients estimated the weight of their implanted knee. We assessed actual weights of their implants and bone cement. Patients estimated the size of their prostheses by sketching the tibial and femoral bone cuts upon a printout of an anteroposterior and lateral radiographs of their preoperative knee. We utilized an articulated plastic model knee for patient reference. Our study shows almost half a kilogram of weight is added postoperatively to the surgical site as a result of tissue excision, explanted material, and implanted prosthesis and cement. All patients overestimated the weight of their implanted prostheses and extent of bone excision. Thus, even 'well-informed' patients overestimate their bone resection and weight of implanted prosthesis at TKA. We postulate such misconceptions among TKA patients are common, and may impact negatively upon patient perception of TKA, their postoperative recovery and outcome.

Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Transfer Results at a Follow-Up of 2 years.

There is limited data on the effectiveness of combined medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle transfer (TTT) in patients with patella instability. The aim of our study was to analyze the functional outcome in patients treated with MPFL reconstruction and TTT. Between July 2008 and April 2013, 18 patients (21 knees) underwent combined MPFL reconstruction and TTT; 15 patients (16 knees) with a mean age of 24 years (16-41) had a mean follow-up of 30 months (26-55). There was significant improvement in outcome scores in 12 out of 15 patients. KOOS score improved from 68.25 (44-93.9) to 77.05 (48.8-96.4) and KUJALA score improved from 63.3 (41-88) to 78.06 (45-99). Nine patients achieved at least a preinstability level of activity. Out of these nine patients, four had activity level better than the preinstability level. The remaining six patients had a lower activity level than preinstability level (2-lack of confidence and 4-lifestyle modification). Fourteen patients were satisfied and happy to recommend this procedure. There were three postoperative complications, with two cases of stiffness and one case of nonunion of the tibial tuberosity. Thus, the restoration of tibial tubercle to trochlear groove distance, patella height, and MPFL reconstruction yields good results in carefully selected patients.

Apparent Skin Discoloration about the Knee Joint: A Rare Sequela of Metallosis after Total Knee Replacement.

Introduction. Metallosis is a phenomenon most commonly associated with hip replacement. However it can occur in any metallic implant subject to wear. Wear creates metal debris, which is deposited in the surrounding soft tissue. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. Case Study. A 74-year-old lady represented to orthopaedic outpatient clinic. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. A plain radiograph revealed loosening of the patellar prosthesis. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. She remained symptom-free five years after revision. Discussion. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Surgical intervention with revision and debridement can have good functional results.

Hip Arthroscopy in the Presence of Acetabular Dysplasia.

PURPOSE: Hip arthroscopy is a well established therapeutic intervention for an increasing number of painful hip conditions. Developmental dysplasia of the hip (DDH) is commonly associated with intra-articular hip pathology. However, some surgeons perceive patients with hip dysplasia as poor candidates for hip arthroscopy. Our aim was to describe early outcomes of arthroscopic treatment for patients with DDH, who also had femoroacetabular impingement (FAI) treated when necessary, and to compare these outcomes against a control group of patients without DDH. METHODS: Prospective case-control study of 68 consecutive hip arthroscopy patients assessed with a modified Harris Hip Score (mHHS) preoperatively and at six weeks, six months, and one year after surgery. Presence of DDH was determined using a standard anteroposterior (AP) pelvic radiograph to measure the centre-edge angle (CEA) of Wiberg, with a CEA < 20º used as threshold for diagnosis of DDH. RESULTS: 12 patients (eight female and four male) with acetabular dysplasia and mean CEA of 15.4º (9º to 19º). The control, nondysplastic group comprised 54 patients (23 females and 31 males) with a mean CEA of 33.1º (22º to 45º). All patients in the dysplastic group had a labral tear and 11 (91.7%) had associated femoral cam impingement lesion addressed at arthroscopy. Our study demonstrates a significant (p=0.02) improvement in outcome in the dysplastic group at one year using the mHHS. CONCLUSION: Hip arthroscopy in the presence of DDH is effective in relieving pain for at least one year after surgery although does not address underlying acetabular abnormality.

Medial patellofemoral ligament reconstruction: a technique with a "v"-shaped patellar tunnel.

Patellofemoral dislocation is a common problem affecting the young and active population. The medial patellofemoral ligament (MPFL) is torn when the patella dislocates as it acts as a checkrein to lateral displacement. This leads to patellar instability, and MPFL reconstruction is required if the dislocation recurs after a trial of rehabilitation. We describe a "V"-shaped patellar tunnel technique to reconstruct the MPFL using an autologous gracilis graft. This modification of the patellar tunnel does not breach the lateral cortex of the patella, and it allows a broader attachment of the tendon graft to the patella, which mimics the normal anatomic attachment of the MPFL to the patella.

Fat pad entrapment at the hip: a new diagnosis.

PURPOSE: To establish if a positive impingement sign in femoroacetabular impingement (FAI) may result from entrapment of the fat pad located at the anterior head-neck junction of the upper femur. This fat pad is routinely removed before any cam lesion excision. METHODS: We report a prospective study of 142 consecutive hip arthroscopies for symptomatic FAI where the aim was to remove the arthroscopically identified area of impingement, not necessarily to create a spherical femoral head. Patients were divided into two groups. Group 1 (n = 92; 34 females, 58 males), where a cam-type bony FAI lesion was identified and excised in addition to the fat pad which overlay it, and Group 2 (n = 50; 29 females, 21 males) where the only identified point of impingement was a prominent fat pad. In this situation the fat pad was excised in isolation and the underlying bone preserved. Patients were assessed preoperatively, at six weeks, six months, one year and two years with a modified Harris hip score (mHHS). RESULTS: Both groups were comparable preoperatively for mean age, mean alpha angle and mean anterior offset ratio. Both groups improved significantly after surgery at all time points. However, Group 1 (fat pad and bone resection) demonstrated 16.0% improvement in mHHS by two years while for Group 2 (fat pad resection only) the improvement was 18.9% (p = 0.628). CONCLUSIONS: The fat pad found at the anterior head/neck junction of the hip joint can be a source of pain and we propose fat pad entrapment as a new, previously undescribed diagnosis. Our findings also suggest that a large number of cam lesions are being excised unnecessarily and that further efforts should be made to understand the role of the fat pad as a source of groin discomfort. LEVEL OF EVIDENCE: Level IV, case series.

Are crutches required after hip arthroscopy? A case-control study.

Hip arthroscopy provides a less invasive alternative to arthrotomy and has the potential for more rapid rehabilitation. Few guidelines exist for rehabilitation after hip arthroscopic surgery. However, these are not corroborated with evidence of objective outcome measures. In particular, the period for which crutches should be used is imprecisely explained, if explained at all. The purpose of this study was to determine whether or not crutch use is required after hip arthroscopic surgery, and if so, for how long.
 We compare a postoperative regimen of four weeks partial weight bearing on crutches (Group 1, n = 85) with a regimen that permitted patients to fully weight bear immediately after surgery if comfort allowed (Group 2, n = 80). We used the modified Harris hip score (mHHS) as an outcome measure at six weeks and six months after surgery. For Group 1, the mean duration of crutch use was 28.2 days and the mean postoperative mHHS at six weeks and six months showed significant improvement compared with preoperatively. For Group 2 the mean duration of crutch use was 13.4 days and the mean postoperative mHHS at six weeks and six months also showed significant improvement compared with preoperatively. The results demonstrated no significant difference in postoperative mHHS between the two groups at six weeks and six months after surgery.
 There thus appears to be no need to enforce a defined period of partial weight bearing on crutches after hip arthroscopic surgery, irrespective of the procedure undertaken.

The accuracy of magnetic resonance arthrography in hip arthroscopic labral revision surgery.

The interpretation of a magnetic resonance arthrogram (MRA) after a labral tear has been surgically treated can be challenging and there is no published evidence on its accuracy. The aim of this study was to evaluate the MRA accuracy in identifying labral pathology after hip arthroscopy. We reviewed 60 patients who had undergone a revision hip arthroscopy. Patients were divided into two groups. First, a study group (n = 40), which included patients who had undergone arthroscopic labral surgery at index operation. Secondly, there was a control group (n = 20), for patients who had not undergone labral surgery at index procedure. Findings regarding labral pathologies at MRA and at revision surgery were recorded. Sensitivity for MRA after hip arthroscopy was 53% and 71% in the study and control groups, respectively; specificity was 50% and 92%, positive predictive value was 81% and 83%, negative predictive value was 21% and 86% and accuracy was 53% and 85%. We conclude that the MRA is not reliable after hip arthroscopy where a labral tear has been addressed. When a labral tear has been repaired or partial labral excision has been performed, a postoperative MRA may inaccurately diagnose the presence of a persistent, recurrent, or unhealed tear.

Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy?

BACKGROUND: No published studies have explored the relationship between commonly reported clinical outcomes and patient satisfaction after hip arthroscopy. PURPOSE: To compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a 2-year period. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We reviewed our institutional database for prospectively collected mHHS and patient satisfaction data from 697 patients. Patients were evaluated preoperatively and at 1 and 2 years after surgery. RESULTS: The mHHS correlated with patient satisfaction at 1 year (P < .001, Pearson R = 0.451) and at 2 years (P < .001, Pearson R = .454). Considering scores from excellent to good as positive results and from fair to poor as negative results, sensitivity was 73% at 1 year and 77% at 2 years. Respectively, the specificity was 64% and 73%, positive predictive value 86% and 91%, negative predictive value 45% and 46%, and accuracy 71% and 76%. At 1- and 2-year follow-up, a respective 55% and 54% of patients with fair to poor mHHS were satisfied with the outcome of hip arthroscopy. In contrast, for those patients with an excellent to good mHHS at 1 and 2 years after surgery, 14% and 9%, respectively, were dissatisfied with their outcome. CONCLUSION: Our results show a correlation between patient satisfaction and the mHHS but also demonstrate a limitation of the mHHS as an outcome measure in the prediction of patient satisfaction. Further investigation is required to assess factors beyond current standard orthopaedic clinical outcome measures that may influence patient satisfaction after hip arthroscopy.

Long-term clinical outcomes following the use of synthetic hydroxyapatite and bone graft in impaction in revision hip arthroplasty.

Impaction grafting using morsellised allograft bone restores bone stock, but carries the potential for transmission of infection. Synthetic bone graft substitutes can eliminate this risk but may, however, influence outcome. In this study we tested the hypothesis that a 50/50 mix of hydroxyapatite and allograft does not affect long-term function, survival or radiological outcome. Sixty-five patients had revision hip arthroplasty using impaction grafting with either pure allograft (42 patients) or a 50/50 mixture of allograft and solid particulate hydroxyapatite. Harris hip scores were assessed pre-operatively and annual intervals thereafter. Function was analyzed using multilevel modeling, the Kaplan-Meier method used for survival analysis and graft incorporation was assessed radiologically. The hip score improved in both groups but showed a small annual decline (average 1.2/year, p<0.01). This decline was higher for females (average 3.4, p=0.025) and significantly related to pre-op scores (p<0.001). After adjusting for these, allograft patients had marginally higher scores (difference=3.1, p=0.3). The majority of revisions were for aseptic loosening. At 13 years survival in the allograft group was 84%, and 82% in the mixture group (p=0.96, log rank test). Radiologically the graft incorporation was similar in both groups (p=0.62). We conclude that long-term prosthesis survival and function following revision arthroplasty with a 50/50 mixture of allograft and hydroxyapatite are comparable to allograft alone.

Use of a simple suture to stabilize the chevron osteotomy: a prospective study.

A clinical and radiographic review was undertaken in 27 patients (30 feet) who underwent a chevron osteotomy stabilized with a double loop of polydioxanone suture. The mean patient age at the time of surgery was 40 years (range, 16 to 66 years). At 6 weeks postoperatively, all patients showed clinical and radiographic union at the osteotomy site. In 1 foot, the initial correction was lost with radiographic evidence of an angulated distal fragment with no medial translation. There were no cases of wound infection, sinus formation, or avascular necrosis of the metatarsal head. No patients required further surgery. This method of stabilizing a chevron osteotomy is technically straight forward, with a predictable outcome, and provides a valid low cost alternative to screw, bioabsorbable implant, or Kirschner wire.