Patellofemoral Joint Arthroplasty: Early Results and Functional Outcome of the Zimmer Gender Solutions Patello-Femoral Joint System.

BACKGROUND: Improved knee prosthesis designs have led to an increase in the use of patellofemoral arthroplasty as a primary treatment option in recent times. We report the early results and outcomes of the Zimmer Gender Solutions Patello-Femoral Joint (PFJ) system used to treat isolated patellofemoral osteoarthritis (PFA). METHODS: We retrospectively reviewed and analysed data of patients who underwent PFJ replacement (PFJR) at our institution with a minimum follow-up of 2 years. RESULTS: Median Oxford Knee score (OKS) was 38 (interquartile range, 28 to 42) at the latest follow-up with a significant improvement from preoperative scores (p < 0.0005). Median OKS was 40 for unilateral PFJRs and 39 for nonobese patients (body mass index [BMI] < 30 kg/m2). There was no significant difference in OKS between unilateral and bilateral procedures (p = 0.462). Likewise, there was no significant difference in OKS between obese and nonobese patients (p = 0.272). Two knees (4%) were revised for progression of osteoarthritis. No complications were reported related to infectious or thromboembolic causes. CONCLUSIONS: Our study showed good early results of the PFJ system, at least equal to those of other leading brands in the National Joint Registry for England, Wales and Northern Ireland (NJR). There have been no complications related to either the implantation technique or prosthetic design for this new implant. Progression of tibiofemoral arthritis remains a major concern. Our study also suggests that PFJR in obese patients and bilateral procedures can have good results.

Stabilisation for the disrupted acromioclavicular joint using a braided polyester prosthetic ligament.

PURPOSE: To report outcomes of 21 men who underwent stabilisation for the disrupted acromioclavicular joint (ACJ) using a braided polyester prosthetic ligament. METHODS: 21 men aged 23 to 76 (mean, 43) years underwent stabilisation for the disrupted ACJ of Rockwood type 3 (n=12), type 4 (n=1), and type 5 (n=8) using a braided polyester prosthetic ligament. RESULTS: The mean time from injury to surgery was 6.8 (range, 0-19) months. The mean follow-up duration was 30 (range, 7-67) months. The mean Constant Score was 86.8 (range, 62-100), and the mean individualised Constant Score was 88.5 (range, 68-100). The mean Oxford Shoulder Score was 43.1 (range, 28-48). The mean abduction power of the operated side was 82% (range, 31%-97%) that of the normal side. 20 patients were satisfied with the procedure. One patient was dissatisfied who developed scapulothoracic bursitis. One patient required arthroscopic subacromial decompression for impingement. One patient sustained a redislocation following a fall at 6 weeks and declined further surgery. CONCLUSION: The braided polyester prosthetic ligament achieved good outcome for patients undergoing stabilisation for the disrupted ACJ.

The Targon FN system for the management of intracapsular neck of femur fractures: minimum 2-year experience and outcome in an independent hospital.

BACKGROUND: The Targon FN implant was developed in 2007 to treat intracapsular neck of femur fractures. Early results from the design centre have shown good results in terms of fracture complications. We wished to see if these results can be reproduced in an independent institution. METHODS: The records of consecutive patients, treated with this implant between 2008 and 2011 at Queen Elizabeth Hospital, were identified and collected for this study. Operations were performed by all grades of surgeons under supervision as appropriate. These patients went on to have both clinical and radiological assessment for fracture healing and function. RESULTS: Fifty-one patients were identified with 43 patients available for final follow-up. The average age was 66 years with a minimum follow-up of 24 months. A non-union rate of 0% in the undisplaced fracture group and 1 in 12 (8%) in the displaced fracture group was observed. An avascular necrosis rate of 6% and 8% was observed for undisplaced and displaced fracture types, respectively. No significant change in premorbid to postoperative ambulation was observed and there was no wound complication. CONCLUSIONS: Our study shows similar results with those of the design centre and which are superior to those currently found in the literature for the more traditional fixation methods. It also shows that the promising results with this new implant as seen from the design institutions can be reproduced by all cadres of surgeons in non-specialist practice.

Conservative treatment for acute Achilles tendon rupture: survey of current practice.

PURPOSE: To survey the practice of orthopaedic consultants in the Greater London area for treating Achilles tendon ruptures. METHODS: 221 orthopaedic consultants working in 28 hospitals within the Greater London area were identified. A questionnaire regarding conservative treatment for acute Achilles tendon ruptures was sent. The choice of immobilisation, the period of immobilisation, the time to weight bearing, the use of heel raises, and the use of diagnostic ultrasonography were enquired about. RESULTS: 62 of 86 respondents treated Achilles tendon ruptures conservatively by below-knee casts (n=51), above-knee casts (n=5), or functional braces (n=6). The most common immobilisation regimen (n=7) was to keep the foot in a sequence of an equinus position, a semi-equinus position, and a neutral position (3 weeks in each position). After cast removal, 45 of respondents preferred to use a heel raise for a median duration of 4 (range, 2-36) weeks. Respectively for foot and ankle specialists (n=24) and other orthopaedic specialists (n=38), the median immobilisation period prescribed was 8 (range, 3-13) and 9 (range, 6-36) weeks, respectively (p=0.625), whereas the median time to weight bearing prescribed was 6 (range, 0-9) and 6 (range, 0-12) weeks, respectively (p=0.402). CONCLUSION: Functional bracing was not as widely used as below-knee cast immobilisation. There was no consensus on the optimal immobilisation regimen.

What follow-up is required for children with a family history of developmental dysplasia of the hip?

To determine what follow-up is needed for children with a family history of developmental dysplasia of the hip (DDH) but who have had a normal clinical and ultrasound examination at 6 weeks of age. A retrospective review of medical and imaging records of all children with a family history of DDH referred to the hip-screening clinic over a 5-year period. An absolute acetabular index value of greater than 30 degrees or gross asymmetry in acetabular index values was used as an indication of occult acetabular dysplasia. One hundred and eighty-one children were identified as having had a normal ultrasound scan with a positive family history of DDH. Two (1.1%) children had acetabular dysplasia on their radiograph performed at 9-12 months of age. The dysplasia, however, resolved in both cases with simple observation and both children have now been discharged from further follow-up. We do not feel that it is necessary for children with a positive family history of DDH to have a radiograph of their pelvis at 1 year of age if they have had a normal clinical and ultrasound examination at 6 weeks of age and such children can safely be discharged from further follow-up at that time.

Carotid artery imaging in the United kingdom: a postal questionnaire of current practice.

There has been a steady rise in the use of carotid duplex imaging in the selection of patients for carotid endarterectomy (CEA). Some would suggest that CEA could be safely performed without preoperative contrast angiography. The purpose of this study was to focus on the role of duplex imaging among vascular surgeons in the United Kingdom and to highlight current practices in imaging prior to CEA. A postal questionnaire was sent to all consultant members of the Vascular Surgical Society of Great Britain and Ireland about the choice of imaging prior to selection of patients for CEA, preoperative imaging, and choice of imaging (if any) in the confirmation of carotid occlusion indicated by duplex scanning. Of 396 questionnaires sent, 323 (82%) were returned. Of these, 259 (80%) consultants performed carotid surgery, 118 (45%) in university hospitals (UHs) and 141 (53%) in district general hospitals (DGHs). One hundred eighteen (100%) and 137 (97%) respondents, respectively, chose duplex scanning as their first-line investigation. Sixty (51%) respondents in UHs and 49 (35%) respondents in DGHs repeated duplex scanning immediately preoperatively, with 57 (95%) and 46 (94%), respectively, using duplex scanning. Forty-seven (40%) respondents in UHs and 78 (55%) respondents in DGHs would reconfirm an occlusion, with 30 (64%) and 48 (62%), respectively, using computed tomography and magnetic resonance imaging as their preferred tool. Our study shows that duplex scanning is the first-line imaging technique for patient selection for CEA by vascular surgeons in the United Kingdom. Magnetic resonance imaging and computed tomography are replacing conventional angiography where duplex scanning is equivocal.

Arteritis in the appendix: an unusual cause of right iliac fossa pain.

Many conditions can cause or mimic appendicitis, of which necrotising arteritis remains an unusual cause. Its significance stems from its association with the vasculitides in general. We describe here a 15-year-old-girl with an incidental finding of a focal arteritis in the vasculature of the appendix and with right iliac fossa pain. There was no evidence of suppurative inflammation of the appendix, and she made a good recovery following laparoscopic appendicectomy.