Outcomes of acute versus delayed total hip arthroplasty following acetabular fracture.

PURPOSE: Post-traumatic arthritis is known complication following acetabular fracture. The aim was to compare mid- to long-term outcomes of acute THA (aTHA) for acetabular fracture and delayed THA (dTHA) following failure of ORIF or conservative management. METHODS: We retrospectively analysed 60 THA (21 aTHA; 39 dTHA) performed for acetabular fracture between 2004 and 2014 in 60 patients with a mean age of 59 years (20-94). Functional and Radiographic outcomes were assessed at a mean follow-up of 5 years (2-13) utilizing Oxford, Harris Hip (HHS), and Postel Merle d'Aubigné (PMA) scores and Brooker classification. RESULTS: The mean HHS (73), Oxford (32) and PMA (12) scores were significantly lower in the aTHA group. Acute THA was significantly associated with lower postoperative Oxford (ß = -4.2), HHS (ß = -7.8), and PMA (ß = -2.2) scores at mean 5 years (2-13). Eleven patients returned to the operating room. There were no significant differences between THA performed in acute or delayed fashion. The two primary reasons for revision were periprosthetic joint infection (n = 5) and aseptic loosening (n = 4). Survivorship free from reoperation at 10 years was 91% and 82% for aTHA and dTHA, respectively (p = 0.24). Increased PMA scores were associated with decreased overall survival of the THA free from reoperation (HR = 0.60). The degree of heterotopic ossification was significantly higher in the aTHA group (p < 0.001). CONCLUSION: Acute THA in the setting of acetabular fracture is a technically challenging procedure. However, in the present series, aTHA provided satisfactory immediate stability and good survivorship at 10 years in a medically vulnerable patient population. LEVEL OF EVIDENCE: Level 3; Therapeutic study.

Endoscopic resection of enthesopathy via a direct midline transtendinous approach with associated reattachment of the Achilles tendon (endo-REDMTART): a cadaveric feasibility study.

PURPOSE: The aim of our study was to determine the feasibility of an all-posterior endoscopic resection of enthesopathy via direct midline transtendinous approach with detachment and reattachment of the Achilles tendon (endo-REDMTART). MATERIALS & METHODS: Endo-REDMTART was performed in 10 ankles by two foot and ankle surgeons. Posterolateral and posteromedial portals were utilized. Three accessory, more distal portals were utilized (one posterolateral, one posteromedial, and one midline transtendinous). We measured the quality of the resection of the calcaneal spur and the length of tendon that was able to be reattached to the calcaneus. RESULTS: The procedure was successful in all 10 cases. The mean minimum thickness of resected calcaneal spur was 7 mm (5-9 mm) thick, and the mean anteroposterior distance was 23 mm (20-25 mm). In all 10 cases, the maximum distance between the distal Achilles tendon and calcaneus was 1 mm (0-1 mm), with good tendon-bone contact. CONCLUSIONS: The data here suggest that endo-REDMTART is feasible. This procedure provides all of the advantages of endoscopic technique without compromising the efficacy of Haglund deformity resection. TRIAL REGISTRATION: No Clinical Trials Registration or IRB is required. LEVEL OF EVIDENCE: Anatomy study; cadaveric dissection.

Influence of vitamin C on the incidence of CRPS-I after subacromial shoulder surgery.

PURPOSE: The primary aim of this study was to determine whether postoperative administration of vitamin C (VC) is associated with reduced risk of complex regional pain syndrome type I (CRPS-I) after subacromial shoulder surgery (SaSS). The secondary objective of the study was to identify risk factor for the development of CRPS-I after SaSS. MATERIALS AND METHODS: A retrospective cohort study was performed to evaluate 542 patients undergoing SaSS from January 2015 to December 2016. The cohort was divided into two groups based on VC administration [Group I (no VC) and Group II (500 mg/day oral VC for 50 days postoperatively)]. The relationship between VC administration and development of CRPS-I was assessed. Demographics, preoperative clinical parameters, and operative variables were evaluated to determine their effect on the incidence of CRPS-I. RESULTS: A total of 267 patients (Group II) undergoing SaSS received VC, and 266 patients (Group I) did not. The incidence of CRPS-I was significantly different between two groups (36(13%) vs 18(7%), p = 0.009). Multivariable regression, however, demonstrated that VC reduced the risk of CRPS-I after SaSS by > 50% (aOR = 0.49; 95% CI 0.27-0.91). Patients undergoing open surgery (aOR = 2.19; 95% CI 1.2-4.0) were more likely to develop CRPS-I postoperatively. Higher preoperative Constant score (aOR = 0.94; 95% CI 0.91-0.98) was associated with lower risk for CRPS-I development. CONCLUSIONS: The present study found that VC administered prophylactically for 50 days postoperatively is effective in preventing CRPS-I development after SaSS. CRPS-I is a common complication following SaSS, especially in the setting of an open approach. The authors recommend preventive management with VC and arthroscopic approaches when possible for SaSS. LEVEL OF EVIDENCE III: Retrospective comparative study.

Community-based livestock breeding programmes: essentials and examples.

Breeding programmes described as community-based (CBBP) typically relate to low-input systems with farmers having a common interest to improve and share their genetic resources. CBBPs are more frequent with keepers of small ruminants, in particular smallholders of local breeds, than with cattle, pigs or chickens with which farmers may have easier access to alternative programmes. Constraints that limit the adoption of conventional breeding technologies in low-input systems cover a range of organizational and technical aspects. The analysis of 8 CBBPs located in countries of Latin-America, Africa and Asia highlights the importance of bottom-up approaches and involvement of local institutions in the planning and implementation stages. The analysis also reveals a high dependence of these programmes on organizational, technical and financial support. Completely self-sustained CBBPs seem to be difficult to realize. There is a need to implement and document formal socio-economic evaluations of CBBPs to provide governments and other development agencies with the information necessary for creating sustainable CBBPs at larger scales.

Community-based alternative breeding plans for indigenous sheep breeds in four agro-ecological zones of Ethiopia.

Based on the results of participatory approaches to define traits in the breeding objectives, four scenarios of ram selection and ram use were compared via deterministic modelling of breeding plans for community-based sheep breeding programmes in four diverse agro-ecological regions of Ethiopia. The regions (and production systems) were Afar (pastoral/agro-pastoral), Bonga and Horro (both mixed crop-livestock) and Menz (sheep-barley). The schemes or scenarios differed in terms of selection intensity and duration of ram use. The predicted genetic gains per year in yearling weight (kilograms) were comparable across the schemes but differed among the breeds and ranged from 0.399 to 0.440 in Afar, 0.813 to 0.894 in Bonga, 0.850 to 0.940 in Horro, and 0.616 to 0.699 in Menz. The genetic gains per year in number of lambs born per ewe bred ranged from 0.009 to 0.010 in both Bonga and Horro. The predicted genetic gain in the proportion of lambs weaned per ewe joined was nearly comparable in all breeds ranging from 0.008 to 0.011. The genetic gain per year in milk yield of Afar breed was in the order of 0.018 to 0.020 kg, while the genetic gain per generation for greasy fleece weight (kg) ranged from 0.016 to 0.024 in Menz. Generally, strong selection and shorter duration of ram use for breeding were the preferred options. The expected genetic gains are satisfactory but largely rely on accurate and continuous pedigree and performance recording.

Pulmonary adenomatosis and maedi-visna in Ethiopian central highland sheep: a microscopic study.

Microscopic examination of pneumonic lungs of the Ethiopian highland sheep (n = 35) was made and compared with the pneumonic lungs from ten sheep and 66 goats from the lowlands. Lesions compatible with sheep pulmonary adenomatosis (SPA; 8/35, 22.8%), and maedi-visna (MV; 9/35, 25.7%) were recorded only in sheep from the central highlands. Interstitial pneumonia (43.2%), bronchopneumonia (35.1%), and verminous pneumonia (6.3%) were recorded in both sheep and goats from the high- and the lowlands. SPA was documented for the first time in sheep from Ethiopia in this report. We believe that MV and SPA were introduced into Ethiopia through importation of exotic sheep. These infections should be considered in dealing with the diagnosis of respiratory diseases in all the sheep breeds in the central highlands and in the exotic and the crossbred sheep in the other parts of the country.

Variation in mitochondrial DNA and maternal genetic ancestry of Ethiopian cattle populations.

This study describes complete control region sequences of mitochondrial DNA (mtDNA) from 117 Ethiopian cattle from 10 representative populations, in conjunction with the available cattle sequences in GenBank. In total, 79 polymorphic sites were detected, and these defined 81 different haplotypes. The haplotype and nucleotide diversity of Ethiopian cattle did not vary among the populations studied. All mtDNA sequences from Ethiopian cattle converged into one main maternal lineage (T1) that corresponds to African Bos taurus cattle. According to the results of this study, no zebu mtDNA haplotypes have been found in Ethiopia, where the most extensive hybridization took place on the African continent.

Microsatellite analysis reveals high genetic diversity but low genetic structure in Ethiopian indigenous cattle populations.

Ethiopian cattle are under threat from uncontrolled mating practices and are at high risk of becoming genetically homogeneous. Therefore, to evaluate genetic diversity, population structure and degree of admixture, 30 microsatellite markers were genotyped using 351 DNA samples from 10 Ethiopian cattle populations and the Holstein breed. The mean number of alleles per cattle population ranged from 6.93 +/- 2.12 in Sheko to 7.50 +/- 2.35 in Adwa. The mean observed and expected heterozygosities were 0.674 +/- 0.015 and 0.726 +/- 0.019 respectively. Ethiopian cattle populations have maintained a high level of within-population genetic differentiation (98.7%), the remainder being accounted for by differentiation among populations (1.3%). A highly significant deficiency in heterozygotes was detected within populations (F(IS) = 0.071; P < 0.001) and total inbreeding (F(IT) = 0.083; P < 0.001). The study populations were highly admixed but distinct from pure Bos taurus and Bos indicus breeds. The various levels of admixture and high genetic diversity make Ethiopian cattle populations suitable for future genetic improvement and utilization under a wide range of agro-ecologies in Ethiopia.

A field trial of production and financial consequences of helminthosis control in sheep production in Ethiopia.

We used a partial-budget analysis to evaluate profitability of different management strategies of three genotypes of sheep in a 2 x 2 x 3 factorial experiment conducted at Debre Berhan research station in the central highlands of Ethiopia. This involved two anthelmintic-treatment levels (treated vs. non-treated), two supplementary nutrition levels (protein-energy supplementation yes/no) and three genotypes: indigenous Menz (n=40), 50% Awassi x 50% Menz crosses (n=38) and 75% Awassi x 25% Menz crosses (n=31). All sheep were exposed to natural sub-clinical helminthosis challenge. Supplemented sheep were offered a concentrate mix daily on an individual basis. Anthelmintic-treated sheep were drenched with fenbendazole against nematodes and with triclabendazole against trematodes. Data were collected during the experimental period (for 10 months from approximately 1 year of age) on feed intake, live weight, eggs per gram (EPG) of faeces, packed-cell volume (PCV), wool weight, and adult-worm burden. Actual market input and output prices were recorded. Supplemented sheep had significantly higher marginal profit (MP) per sheep than non-supplemented sheep (ETB 33 vs. 4). Likewise, anthelmintic treated sheep performed significantly better than their non-treated contemporaries (MP=ETB 28 vs. 8). The 75% Awassi crosses were least profitable.

Degenerative subtalar joints complicated by medial plantar intraneural cysts : cutting the cystic articular branch prevents recurrence.

AIMS: The pathogenesis of intraneural ganglion cysts is controversial. Recent reports in the literature described medial plantar intraneural ganglion cysts (mIGC) with articular branches to subtalar joints. The aim of the current study was to provide further support for the principles underlying the articular theory, and to explain the successes and failures of treatment of mICGs. PATIENTS AND METHODS: Between 2006 and 2017, five patients with five mICGs were retrospectively reviewed. There were five men with a mean age of 50.2 years (33 to 68) and a mean follow-up of 3.8 years (0.8 to 6). Case history, physical examination, imaging, and intraoperative findings were reviewed. The outcomes of interest were ultrasound and/or MRI features of mICG, as well as the clinical outcomes. RESULTS: The five intraneural cysts followed the principles of the unifying articular theory. Connection to the posterior subtalar joint (pSTJ) was identified or suspected in four patients. Re-evaluation of preoperative MRI demonstrated a degenerative pSTJ and denervation changes in the abductor hallucis in all patients. Cyst excision with resection of the articular branch (four), cyst incision and drainage (one), and percutaneous aspiration/steroid injection (two) were performed. Removing the connection to the pSTJ prevented recurrence of mIGC, whereas medial plantar nerves remained cystic and symptomatic when resection of the communicating articular branch was not performed. CONCLUSION: Our findings support a standardized treatment algorithm for mIGC in the presence of degenerative disease at the pSTJ. By understanding the pathoanatomic mechanism for every cyst, we can improve treatment that must address the articular branch to avoid the recurrence of intraneural ganglion cysts, as well as the degenerative pSTJ to avoid extraneural cyst formation or recurrence. Cite this article: Bone Joint J 2018;100-B:183-9.

A randomized controlled trial of fixed- versus mobile-bearing total knee arthroplasty: a follow-up at a mean of ten years.

Aims: It has been suggested that mobile-bearing total knee arthroplasty (TKA) might lead to better outcomes by accommodating some femorotibial rotational mismatch, thereby reducing contact stresses and polyethylene wear. The aim of this study was to determine whether there is a difference between fixed- and mobile-bearing versions of a contemporary TKA with respect to durability, range of movement (ROM) and function, ten years postoperatively. Patients and Methods: A total of 240 patients who were enrolled in this randomized controlled trial (RCT) underwent a primary cemented TKA with one of three tibial components (all-polyethylene fixed-bearing, modular metal-backed fixed-bearing and mobile-bearing). Patients were reviewed at a median follow-up of ten years (IQR 9.2 to 10.4). Results: There was no difference in durability, as measured by survivorship free of revision for any reason, nor in mean maximal ROM at ten years (p = 0.8). There was also no difference in function, as measured by Knee Society (KS) function scores (p = 0.63) or the prevalence of patellar tilt (p = 0.12). Conclusion: In this clinical RCT, the mobile-bearing design of TKA was found to be reliable and durable, but did not provide better maximum knee flexion, function or durability ten years postoperatively compared with a posterior-stabilized, fixed-bearing design incorporating either an all-polyethylene or a modular-metal-backed tibial component. Cite this article: Bone Joint J 2018;100-B:925-9.

The minimum follow-up required for radial head arthroplasty: a meta-analysis.

AIMS: The primary aim of this study was to define the standard minimum follow-up required to produce a reliable estimate of the rate of re-operation after radial head arthroplasty (RHA). The secondary objective was to define the leading reasons for re-operation. MATERIALS AND METHODS: Four electronic databases, between January 2000 and March 2017 were searched. Articles reporting reasons for re-operation (Group I) and results (Group II) after RHA were included. In Group I, a meta-analysis was performed to obtain the standard minimum follow-up, the mean time to re-operation and the reason for failure. In Group II, the minimum follow-up for each study was compared with the standard minimum follow-up. RESULTS: A total of 40 studies were analysed: three were Group I and included 80 implants and 37 were Group II and included 1192 implants. In Group I, the mean time to re-operation was 1.37 years (0 to 11.25), the standard minimum follow-up was 3.25 years; painful loosening was the main indication for re-operation. In Group II, 33 Group II articles (89.2%) reported a minimum follow-up of < 3.25 years. CONCLUSION: The literature does not provide a reliable estimate of the rate of re-operation after RHA. The reproducibility of results would be improved by using a minimum follow-up of three years combined with a consensus of the definition of the reasons for failure after RHA. Cite this article: Bone Joint J 2017;99-B:1561-70.

Mid-term outcomes of 77 modular radial head prostheses.

AIMS: Radial head arthroplasty (RHA) may be used in the treatment of non-reconstructable radial head fractures. The aim of this study was to evaluate the mid-term clinical and radiographic results of RHA. PATIENTS AND METHODS: Between 2002 and 2014, 77 RHAs were implanted in 54 men and 23 women with either acute injuries (54) or with traumatic sequelae (23) of a fracture of the radial head. Four designs of RHA were used, including the Guepar (Small Bone Innovations (SBi)/Stryker; 36), Evolutive (Aston Medical; 24), rHead RECON (SBi/Stryker; ten) or rHead STANDARD (SBi/Stryker; 7) prostheses. The mean follow-up was 74.0 months (standard deviation (sd) 38.6; 24 to 141). The indication for further surgery, range of movement, mean Mayo Elbow Performance (MEP) score, quick Disabilities of the Arm, Shoulder and Hand (quickDASH) score, osteolysis and positioning of the implant were also assessed according to the design, and acute or delayed use. RESULTS: The mean MEP and quickDASH scores were 90.2 (sd 14; 45 to 100), and 14.0 points (sd 12; 1.2 to 52.5), respectively. There were no significant differences between RHA performed in acute or delayed fashion. There were 30 re-operations (19 with, and 11 without removal of the implant) during the first three post-operative years. Painful loosening was the primary indication for removal in 14 patients. Short-stemmed prostheses (16 mm to 22 mm in length) were also associated with an increased risk of painful loosening (odds ratio 3.54 (1.02 to 12.2), p = 0.045). Radiocapitellar instability was the primary indication for re-operation with retention of the implant (5). The overall survival of the RHA, free from re-operation, was 60.8% (sd 5.7%) at ten years. CONCLUSION: Bipolar and press-fit RHA gives unsatisfactory mid-term outcomes in the treatment of acute fractures of the radial head or their sequelae. The outcome may vary according to the design of the implant. The rate of re-operation during the first three years is predictive of the long-term survival in tight-fitting RHAs. Cite this article: Bone Joint J 2017;99-B1197-1203.

Risk factors for mortality associated with respiratory disease among Menz and Horro sheep in Ethiopia.

A retrospective case-control study was conducted on 6718 sheep of two breeds (2772 Horro and 3946 Menz) on risk factors for mortality associated with respiratory disease (MARD) in Ethiopia, based on data collected between October 1993 and December 1997. Potential risk factors examined were breed, gender, age, month, and air temperatures.Fifty-four per cent of total deaths in the flock could be attributed to respiratory disease and the annual MARD rate ranged between 6.3 and 19.0%. There was significant breed (P<0.0001) and gender (P<0.0001) difference in MARD. The Horro breed had a higher (P<0.0001) annual MARD than the Menz breed (16.5+/-0.18 vs. 12.4+/-0.15%). A higher (P<0.0001) proportion of males suffered than females (15.1+/-0.23% vs. 13.8+/-0.13%). Age was also an important risk factor for MARD: there was a strong polynomial relationship (R(2)=0.91, P<0.0001) between MARD and age; the risk of being young if a sheep was a MARD case was high. MARD was high between October and March but relatively low between the months of April and September. There was a significant (P<0.05) negative cubic relationship (R(2)=0.49) between monthly MARD and monthly average minimum air temperatures. There was also a significant (P<0.01) positive exponential relationship (R(2)=0.61) between monthly MARD and average monthly daily deviation between maximum and minimum air temperatures. Timely health and management interventions focusing on these factors are necessary to alleviate losses from MARD. Understanding variations in MARD risk within a population can enhance early response to potential outbreaks, reducing losses.

Between and within breed variation in lamb survival and the risk factors associated with major causes of mortality in indigenous Horro and Menz sheep in Ethiopia.

Data collected on 3256 lambs born to Horro and Menz breed ewes single-sire mated to 71 rams at the International Livestock Research Institute (ILRI) Debre Berhan station between September 1992 and June 1996 were analysed for rates of survival and growth from birth to weaning. A significantly lower proportion of Menz lambs died before 1 year of age (28%) than the Horro lambs (59%). Least squares means for pre- and post-weaning mortality were 8.8 and 19.3%, respectively in Menz, and 25.3 and 34.2% for Horro sheep. Major causes of death were similar in Horro versus Menz lambs and were pneumonia (53 vs. 54%, respectively), digestive problems (14 vs. 12%), endoparasite infections (9 vs. 13%), starvation-mismothering-exposure (SME) complex (10 vs. 7%) and septicemia (3 vs. 2%). Relationships among causes of mortality with breed, birth weight (BWT), season of birth, parity, litter size and lamb health category (number of times a lamb was sick between birth and 1 year of age) were determined. The impact of these factors on mortality varied with lamb age. Lambs that were born with <2kg BWT had a greater risk of dying from any cause except pneumonia. But, even though Horro lambs were heavier than Menz at birth (2.4 vs. 2.1kg, respectively), twice as many died before 1 year of age. The cause of mortality was further influenced by season of birth, lamb sex and health category. In addition, sires were a significant source of variation for progeny survival at 6, 9 and 12 months of age, but not at the younger ages. The best and worst Horro ram sired progeny groups that had mortality rates up to 1 year of age of 22 vs. 80%, respectively. The same estimates in Menz rams were 11 and 48%, respectively. Reduced mortality rate would significantly increase lamb output. However, isolated efforts to solve this problem are likely to have limited impact. Instead, an integrated approach to minimise the impact of underlying factors is advocated. Farm (animal) management routines that could be introduced in the short or longer term are discussed.

Ovine progressive pneumonia (Maedi-Visna): an emerging respiratory disease of sheep in Ethiopia.

A serological study was done to assess the role of Maedi-Visna (MV) infection in sheep from flocks with high respiratory tract disease morbidity in Ethiopia. Of 105 sheep examined from central Ethiopia 78 (74%) were positive for MV-infection. However, antibodies to the virus were not detected in 48 sheep and 70 goats from elsewhere in Ethiopia. The infection was detected in all breeds of sheep examined (Awassi, Hampshire, Corriedale, indigenous Menz breeds and their crosses) but with a significant breed difference (chi 2 = 20, p < 0.001) varying from 48% in imported Awassi sheep to 92% in the indigenous Menz sheep. This suggests that Menz sheep are more susceptible to infection, which may support the observation of a higher incidence of clinical disease in these sheep compared to exotic breeds and their crosses. It also supports recent studies indicating that MV is becoming one of the most important respiratory tract diseases in sheep in central Ethiopia. Our findings indicate that MV was introduced into Ethiopia via sheep imported into the central highlands and that it now constitutes an important emerging disease is discussed. Measures to control the disease are suggested.

Prevalence of bluetongue virus antibodies in sheep in central Ethiopia.

Competitive ELISA was applied to detect antibodies against bluetongue virus in sheep sera collected from different agro-climatic areas in Ethiopia. A total of 90 serum samples were tested and 42 (46.67%) were positive for bluetongue virus antibodies. A prevalence rate ranging from 9.67% for sheep sampled in the highland to 92.85% for sheep sampled in the lowland was recorded. The prevalence correlated with the probable distribution of the Culicoides vector. This is the first report indicating the presence of bluetongue virus infection in animals from Ethiopia.

Assessment of biosecurity practices of small-scale broiler producers in central Egypt.

In the current situation of endemicity of highly pathogenic avian influenza (HPAI) in Egypt, improving the biosecurity of poultry production has become essential to the progressive reduction the incidence of the disease. A significant proportion of the Egyptian commercial poultry system consists of small-scale poultry producers operating with low to minimal biosecurity measures. An investigation was conducted into the level of adoption of standard biosecurity measures of the small-scale commercial chicken growers, including both farm- and home-based commercial production, input suppliers and other actors along the meat chicken value chain in Fayoum, Egypt. The study which used direct observations and group discussions of nearly 160 participants and structured interviews with 463 respondents, assessed biosecurity implementation to improve management practices and ultimately to control and prevent highly pathogenic avian influenza (HPAI). The survey found that overall, biosecurity measures are rarely implemented in small-scale commercial poultry production units. Compliance with recommended biosecurity practices did not greatly vary from home-based to farm-based commercial production. Furthermore, serious risk practices were identified, such as unsafe disposal of poultry carcasses and potential disease spread posed by poor biosecurity measures implemented during vaccination. HPAI control measures have been ineffective due to limited cooperation between public and private sector, aggravated by the unpopular measures taken in the event of outbreaks and no compensation paid for incurred losses. Outreach and biosecurity awareness raising initiatives should be specifically developed for small-scale producers with the objective of improving general poultry management and thus preventing HPAI and other poultry diseases.