The Natural History of Non-operatively Managed Legg-Calvé-Perthes' Disease.

Background: The purpose of this study was to examine the evolution of Legg-Calvé-Perthes' disease (LCPD) among children from British Columbia (BC), Canada who were treated non-operatively and to compare the results to a previously conducted study in India. Methods: This was a retrospective review of patients treated non-operatively for LCPD in BC between 1990 and 2006 compared with a cohort from India. Demographic and treatment information were collected from medical records. Radiographs were assigned modified Waldenstrom, Catterall, Salter-Thompson and Herring classifications and intra- and interobserver reliability were assessed. We evaluated epiphyseal extrusion (EE) and metaphyseal width (MW), and assessed radiographs using the Mose and modified Stulberg classifications. Results: 102 hips (90 patients) had radiographs available for evaluation. 95% of the BC cohort presented as Waldenstrom stages I and II, whereas, 90% of the Indian cohort presented as IIIa. Final EE was similar for both groups (BC 26.8%, India 27.3%) and final MW was 119% in both groups. Modified Waldenstrom and Herring classifications had substantial intra- and interobserver reliability, while Salter-Thompson and Catterall classifications had moderate agreement at best. Most hips were Catterall IV (80%) and Herring C (89%) for the BC cohort compared to only 44% and 43% of Indian hips, respectively. Most hips were irregular according to the Mose classification (BC 43%, India 52%) and aspherical according to the Stulberg classification (BC 78%). Conclusions: We found similar radiographic progression and final radiographic appearances of LCPD in India and BC though differences in the distribution of the classification systems warrant further study. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00543-x.

The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up.

INTRODUCTION: Custom 3D-printed acetabular implants are a new technology used in hip surgery with ever-increasing frequency. They offer patient-specific implants to optimise filling of bone defects and implant-bone contact, without the need for excessive bone resection. METHODS: This is a retrospective cohort study of 46 consecutive patients who underwent an Ossis unilateral custom 3D-printed acetabular implant. Clinical (Oxford Hip Score OHS-60), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS) and radiological (restoration of biomechanical hip centre, osteointegration, wear, heterotrophic ossification) results were assessed. RESULTS: Patient mean age was 68 years and follow-up was 38 months (minimum 24 months). 10 patients were excluded from the outcome analysis; 2 patients died, 1 required revision for deep infection and 7 were lost to follow-up. Of the 36 patients included, 21 had severe osteolysis. 7 were revised for infection, 3 for tumoural defects, 3 for metallosis, 1 for dysplasia and 1 for trauma (Paprosky 2a [n=6], 2b [n=2], 2c [n=5], 3a [n=6], 3b [n=11], pelvic dissociation [n=6]). OHS significantly improved postoperatively (16-8-48.4 p=0.027). Postoperative functional scores were good (WOMAC 98; HHS 79). The biomechanical hip centre was restored in all patients. 1 patient had early implant migration with subsequent stabilisation. 2 patients had radiographs concerning for failure of osteointegration. 1 patient had recurrent dislocations. CONCLUSIONS: The mid-term results of the Ossis custom 3D-printed tri-flanged acetabular implant for the management of severe acetabular defects are encouraging. The improvement in functional scores and radiographic outcomes are comparable to similar designs. In addition, no cases have required revision for aseptic loosening.

Does Orthopaedic Training Compromise the Outcome in Knee Joint Arthroplasty?

OBJECTIVE: This study investigates knee joint arthroplasty and compares the outcomes between attending (consultant) orthopedic surgeons and resident (trainee) surgeons. DESIGN: Retrospective review and comparison of knee joint arthroplasty outcomes between 4 surgeon groups (attending, supervised senior and junior residents, and unsupervised senior residents). Measured outcomes were implant survival (revision rate) and patient reported functional outcomes, measured by Oxford knee score (OKS). SETTING: New Zealand arthroplasty service. PARTICIPANTS: Seventeen years of knee joint arthroplasty data from the New Zealand Joint Registry (NZJR) was reviewed. RESULTS: The New Zealand Joint Registry (NZJR) data showed 79,671 total knee arthroplasties (TKA) and 8854 unicompartmental knee arthroplasties (UKA) performed between 1999 and 2016. Attending surgeons performed 90% and 97% of TKA and UKA, respectively. The number and proportion of resident performed knee joint arthroplasty has decreased. Faster operation times was observed in the attending surgeon group. Attending surgeon revision rate was 0.49 and 1.19/100 component years for TKA and UKA, respectively, this was not significantly increased in resident surgeon groups. Postoperative OKS was 37.7 and 39.7 for attending surgeon performed TKA and UKA, respectively. Mean OKS were less than 2 points worse in resident groups (resident range: 36.3-36.9) compared to attending colleagues for TKA, but for UKA scores were up to 11 points worse (resident range: 28.9-38.8). CONCLUSIONS: New Zealand has a high rate of attending surgeon performed TKA and UKA. Revision rates were not increased in resident surgeon groups. Postoperative function was not reduced by a clinically significant amount in TKA in any of the resident surgeon groups but was reduced in supervised junior resident and unsupervised senior resident surgeon groups for UKA.

Use and predictors of oral complementary and alternative medicine by patients with inflammatory bowel disease: a population-based, case-control study.

BACKGROUND: The use of complementary and alternative medicine (CAM) in the general population and in patients with chronic diseases has increased markedly in recent decades. We aimed to determine the prevalence, type, and predictors of oral CAM use among patients with inflammatory bowel disease (IBD) compared with the general population in a large, population-based, case-control study. METHODS: Overall, 1370 patients with IBD and 598 control subjects in Canterbury, New Zealand, were recruited. Environmental and phenotypic data were obtained through a questionnaire and case note review. Predictors of oral CAM use were identified using binary logistic regression. RESULTS: In the previous year, 44.1% of patients with IBD and 42.3% of control subjects used oral CAM (odds ratio [OR], 1.078; 95% confidence interval [CI], 0.885-1.312). The types of oral CAM used most frequently were vitamins (Crohn's disease [CD], 25.2%; ulcerative colitis, 23.7%; control subjects, 24.9%), followed by herbs (CD 15.1%, ulcerative colitis 15.2%, control subjects 12.8%), and dietary supplements (CD, 8.5%; ulcerative colitis 12.6%, control subjects 12.1%). Female gender (OR, 1.61; 95% CI, 1.25-2.08), younger age (P = 0.005), higher education (P = 0.002), higher income (P = 0.04), being a vegetarian (OR, 3.58; 95% CI, 1.97-6.48) and a middle social class at birth (P = 0.024) were independent predictors of oral CAM use in patients with IBD. Disease phenotype was not associated with oral CAM use. In control subjects, female gender (OR, 2.67; 95% CI, 1.85-3.86), higher education (P = 0.003) and a diagnosis of asthma (P = 0.017) predicted oral CAM use. CONCLUSIONS: Oral CAM use is common in, and does not differ between, patients with IBD and the general population in Canterbury, New Zealand. Socio-demographic factors, and not disease phenotype, predict oral CAM use in patients with IBD.