Long-Term Survivorship of Modular Cementless Femoral Stem in Complex Primary Total Hip Arthroplasty: A Concise Minimum 15-Year Follow-Up Report.

BACKGROUND: S-ROM hip is a well-established and versatile prosthesis that offers extensive metaphyseal and diaphyseal geometries providing solutions for a variety of surgical scenarios. The aim of this study is to report on long-term survivorship and radiographic outcomes of complex primary total hip arthroplasty (THA) using a modular cementless stem (S-ROM). METHODS: Retrospective consecutive study was conducted of 167 patients (167 hips): 97 males and 70 females with average age at the time of surgery of 55 years (range 22-76). All patients underwent complex THA by the senior author from 1987 to 1999. Patients were identified using a prospective database. Demographic, clinical, and surgical data were collected from health records. All patients received a cementless acetabular component with a standard polyethylene liner. The primary outcome measure was survivorship beyond 15 years using stem revision for any cause as an end point. Secondary outcome measure was rate of radiographic loosening using Engh classification. RESULTS: Only 3 patients required stem revision for aseptic loosening and 1 for periprosthetic fracture. Isolated acetabular revision was undertaken in 23 of 167 patients (13.8%) due to polythene wear, osteolysis, and aseptic loosening. Proximal femoral stress shielding (zone 1, 7) was noted in 34 of 167 hips (20.4%). Stable bony ingrowth was noted in 144 hips (86.2%) and the remaining 23 hips had stable fibrous ingrowth (13.8%). Using stem "any-cause revision" as an endpoint, the mean stem survivorship was 31.5 years (95% confidence interval 31.007-31.985) with 30-year estimated survivorship of 97.6%. CONCLUSION: In a single designer surgeon series, S-ROM stem has stood the test of time with long-term, 30-year survivorship of 97.6% and continues to play an important role in modern hip surgery providing longevity and versatility. However, further comparative long-term studies from independent centers are needed for a definitive conclusion. LEVEL OF EVIDENCE: IV.

Early failure of coracoclavicular ligament reconstruction using TightRope system.

This prospective study reports the results of early failure of coracoclavicular (CC) ligament reconstruction using TightRope. Nine consecutive patients who had CC ligament reconstruction using TightRope or GraftRope were assessed for radiological and functional outcomes using DASH and Oxford Shoulder scores. With an average age of 38.4 (21-70) years, four patients had type III injuries, two type IV and two type V injuries. The mean follow-up was 22.8 (12-42) months. In 7 out of 9 patients, secondary progressive loss of reduction was observed at an average of 3.1 (1-7) months. Three patients underwent revision. The mean DASH score at latest follow-up was 27.45 (19.6-35) & Oxford shoulder score was 30.5 (20-43). Coraco-clavicular reconstruction with TightRope or GraftRope appears to result in failure with progressive AC joint subluxation perhaps due to 'windscreen wiper' micromotion. Surgeons should be wary of this potential problem whilst choosing this method of -reconstruction for CC ligament reconstructions.

Outcomes following non-operatively managed periprosthetic fractures surrounding uncemented femoral stems.

BACKGROUND: The primary aim of this study was to explore the outcomes of Vancouver B periprosthetic hip fractures that were managed non-operatively with a particular focus on 1-year mortality. Understanding this mortality data will allow surgeons to better understand the risk associated with non-operative management. The secondary aim was to evaluate our case series and current literature with regards to identifying suitable patients for non-operative treatment. METHODS: Our electronic fracture database was interrogated for all Vancouver B periprosthetic fractures treated at our institution between April 2009 to April 2019; 18 patients were identified. All available data was then collected from radiographic, electronic and paper notes. A comprehensive literature search of PUBMED and EMBASE databases was then conducted with all relevant literature reviewed. RESULTS: 1-year mortality of these patients was noted at 22.2%; highlighting the severity of these injuries. No patients required conversion to surgical management, sustained a dislocation or went into non-union. With regards to literature no case series focussing on non-operative management outcomes were reported. There was a marked paucity of literature relating to conservative management of these injuries. CONCLUSION: To our knowledge this is the first published case series focussing solely on nonoperatively managed Vancouver B periprosthetic hip fractures. This paper provides evidence from the first reported case series with which surgeons can counsel patients on the significant mortality risk associated with these fractures. Non-operative management of periprosthetic hip fractures is possible after careful analysis of the fracture configuration, implant and patient characteristics. Whilst we have outlined several findings from our first reported case series, further research is required from a larger prospective case series in order to make evidence based recommendations.

Acute pyomyositis of the adductor magnus muscle involving the posterior and lateral thigh compartments: a case report of diagnosis and management.

Bacterial infection of skeletal muscle can lead to the formation of abscesses. Primary pyomyositis is typically seen in tropical countries, and Staphylococcus aureus is the commonest causative organism. We present a case of acute adductor magnus muscle abscess (pyomyositis) with spread to adjacent thigh compartments via the perforators without iliopsoas muscle involvement. Due to the involvement of the entire thigh compartment, systemic antibiotic treatment alone was insufficient, whereas surgical drainage improved the clinical picture. The aetiological organism was S. aureus. Herein, we report the case of a patient who had primary pyomyositis, rather than a secondary type, that spread to the posterior and lateral aspect of the thigh through the second and third perforators, which pierce the adductor magnus muscle belly before entering the femur.

Mid-term outcomes of tantalum cup- a single centre study.

INTRODUCTION: The cementless acetabular implants are commonly used in primary and revision hip arthroplasty. Reconstruction of acetabulum in case of bone defects can be challenging. The aims of this single center study are to review the mid-term outcomes of porous tantalum cups (TM) and evaluate complications. METHODS: The midterm outcome of a trabecular metal tantalum modular uncemented cup was evaluated in 59 hips in 58 patients. In our group, we had 23 males and 35 females. The mean age was 70.11 years (range, 30 to 87 years). Four patients were lost to follow-up and 13 died during the period without having further surgeries attributed to the hip arthroplasty. The remaining 41 patients (42 revision hip arthroplasties) had complete data available. RESULTS: The mean follow-up was 87 months, ranging from 24 to 144 months. Standard pelvic anteroposterior (AP) radiographs were used to assess and preoperatively classify acetabular defects as per Paprosky classification. The serial radiographs showed excellent stability, bone opposition and graft incorporation. Four patients had further surgeries. Two of these were due to infection (one superficial and one deep infection). One of the patients had washout and then removal of metal work, the other patient only had a washout and symptoms settled. One patient had vascular compromise and went for surgery to stem the bleeding. One patient had re-revision due to stem loosening and hence required surgery but the revision cup remained stable. We noted a 96% survival at an average of 7.2 years follow-up. CONCLUSION: The mid-term results with the trabecular metal cementless cup appeared to be promising in both primary and revision hip arthroplasty, even in the presence of considerable bone loss which requires bone grafting and augments. LEVEL OF EVIDENCE: IV.

Experience of an isolated use of low-intensity pulsed ultrasound therapy on fracture healing in established non-unions: a prospective case series.

Fracture non-unions are responsible for approximately 5% of cases, with low expectation of spontaneous healing thereafter. The fractures that heal without complications can take months to heal completely. An ultrasound, typically at low intensities (0.5-50 mW/cm2), serves a diagnostic purpose, whereas at higher intensities (0.2-100 W/cm2), its role becomes more therapeutic by generating heat energy. Low-intensity pulsed ultrasound (LIPUS) is frequently used to stimulate or to accelerate fracture healing. We present a prospective review of fracture non-unions treated with low-intensity pulsed ultrasound (LIPUS). We enrolled 66 patients during August 2016 and December 2018, 38 males and 28 females; age range 19-85 years (average 49.2 years). All these patients were followed up to minimum 6 months. The average time of referral post-treatment for fractures was 8.2 months (range 6-18 months). Four patients were excluded due to various reasons. 39 out of 62 fractures showed successful healing with symptom improvement and callus formation with 67% success rate. In this case series, we noted LIPUS therapy failure in the post-ORIF scaphoid fracture and post-ankle joint fusion non-union. We did not observe any influence of a medical condition such as diabetes mellitus, osteoporosis or personal habits like smoking. The LIPUS therapy appears to have influence on bone healing, depending on the onset of therapy, fracture type and the approach to fracture care. In this case series, the compliant group showed 67% successful outcome.

Proximal ulna fractures in adults: A review of diagnosis and management.

Proximal ulna fractures are relatively common upper limb injuries, which may represent fragility fractures or result from high-energy trauma. These include fractures of the olecranon, coronoid and associated radial head dislocations. A wide variety of treatment options are available for the management of these injuries that makes the selection of most appropriate treatment difficult. We aim to provide a brief overview of the treatment options for such injuries.

Extensor mechanism reconstruction "Tubeplasty" in total knee arthroplasty with previous patellectomy: Surgical technique and clinical outcomes.

PURPOSE: to evaluate our consecutive series of tubeplasty and extensor mechanism reconstruction during knee arthroplasty in patients with previous patellectomy. METHODS: we describe our surgical technique and present a retrospective consecutive series of 4 patients with a minimum 6 months follow-up. Knee society score (KSS), clinical and radiographic outcomes were collected at final follow up. RESULTS: we included 4 patients (2 males/2 females) with average age 65.5 years (range 58-76). There were 2 primary and 2 revision knee arthroplasties. The follow up ranged from 0.5 to 13 years. All 4 patients regained function and satisfactory clinical outcomes with KSS score 84.7 (range 79-90). CONCLUSION: satisfactory clinical outcomes can be achieved with extensor mechanism reconstruction and tubeplasty in patients with previous patellectomy undergoing primary and revision knee arthroplasty. LEVEL OF EVIDENCE: IV.

Bone block procedures for glenohumeral joint instability.

Glenoid bone loss is a well established cause of instability and long term morbidity if not adequadely addressed. Anterior glenohumeral instability due an anterior glenoid defect is significantly more common, and for many years has been well treated with open anterior bone block augmentation procedures, most commonly the latarjet procedure. However, with refinement of this technique and some interest in reducing morbidity associated with iliac crest bone harvest, arthroscopic bone block procedures with allograft has become more popular. In this article we will review some of the key available evidence. We will also review management of the less common and more challenging posterior glenoid defects associated with posterior instability.

Current concepts in management of ACJ injuries.

Acromioclavicular joint injury is common in young individuals who suffer direct trauma to the shoulder. Treatment of acromioclavicular dislocation is controversial with regards to the indication of operative management, timing of surgery, whether to perform open or arthroscopic surgery, method of stabilisation (rigid or non-rigid) and type of graft used for repair or reconstruction. Current evidence supports conservative management for Rockwood types I and II, while types IV, V and VI benefit from surgery. The optimal management of type III injuries in high demand patients remains contentious. Surgical options include acromioclavicular fixation, coracoclavicular fixation and coracoclavicular ligament reconstruction. Few studies with a low level of evidence suggest arthroscopic techniques and anatomical ligament reconstruction have better outcomes when compared to older techniques of rigid coracoclavicular fixation. The aim of this article is to look at the current evidence and address these controversial issues.

Magnetic resonance imaging scans are not a reliable tool for predicting symptomatic acromioclavicular arthritis.

BACKGROUND: We investigated whether magnetic resonance imaging (MRI) scans can accurately diagnose arthritis of the acromioclavicular joint (ACJ) because it has recently been suggested that bone marrow oedema on MRI scans is a predictive sign of symptomatic ACJ arthritis. METHODS: The MRI scans of 43 patients (50 shoulders) who underwent ACJ excision for clinically symptomatic ACJ arthritis were compared to a control group of 43 age- and sex-matched patients (48 shoulders) who underwent an MRI scan for investigation of shoulder pain but did not have clinical symptoms or signs of ACJ arthritis. The scans were evaluated by an experienced musculoskeletal radiologist, who was blinded to the examination findings. RESULTS: Bone marrow oedema was present in only 15 (30%) shoulders in the ACJ excision group, although this was higher than the six shoulders in the asymptomatic group (p = 0.03). Forty-one (82%) shoulders in the symptomatic group had grade III/IV ACJ arthritis compared to 31 (65%) in the asymptomatic group (p = 0.05). However, 44 out of 48 (92%) shoulders in the asymptomatic group had signs of osteoarthritis on MRI scans. CONCLUSIONS: In contrast to recent reports, the present study shows that MRI is not helpful in making the diagnosis of ACJ arthritis. A focused history and clinical examination should remain the mainstay for surgical decision making. LEVEL OF EVIDENCE: Level 3.