Columbus® computer navigated total knee arthroplasty: Gap balancing versus measured resection.

BACKGROUND: The aim of this study was to compare the medium term functional outcome and patient satisfaction of gap balanced (GB) with measured resection (MR) total knee arthroplasty (TKA) using computer navigation. METHODS: A cohort of 144 consecutive computer navigated TKA were retrospectively identified from an arthroplasty database. Functional assessment using the Oxford Knee Score (OKS) and patient satisfaction were obtained from 113 patients at a mean follow-up of 5.4 (range four to seven) years. There were 44 patients in the GB group and 69 patients in the MR group. RESULTS: The mean OKS for the GB group was 36.9 (SD 9.2) and for the MR was 33.6 (SD 9.8), with a difference of 3.3 (95% CI 0.3 to 6.3) points, which was statistically significant (p=0.01). Linear regression analysis confirmed the independent effect of surgical technique when adjusting for confounding factors and surgeon, with the GB group achieving a greater post-operative OKS (R2=0.39, 3.0 points, 95% CI 1.2 to 4.8, p=0.001). There was a greater rate of patient satisfaction in the GB group (88.6%, n=39/44) compared to the MR group (81.1%, n=56/69), but this was not statistically significant (odds ratio 1.8, 95% CI 0.6 to 5.5, p=0.31). CONCLUSION: Computer navigated Columbus® TKA using a GB technique results in a statistically significantly greater functional outcome but no significant difference in patient satisfaction in the medium term compared to patients undergoing a MR technique.

Intra-articular hip viscosupplementation with synthetic hyaluronic acid for osteoarthritis: efficacy, safety and relation to pre-injection radiographs.

OBJECTIVE: The aim of this study was to determine the efficacy and safety of viscosupplementation with synthetic hyaluronic acid to the hip joint and to determine if there was any relation to pre-injection radiographic changes of osteoarthritis (OA). METHODS: Three Suplasyn injections were performed each to 15 hips with OA. Standing antero-posterior radiographs of the pelvis were performed prior to injection and scored according to Kelgren and Lawrence grades along with recordings of the minimum joint space width. Harris Hip Scores (HHS) which contain a component for pain, function, activities, absence of deformity and range of motion were recorded pre-injection and at 3 and 6 months. RESULTS: We established that at 3 months the HHS is significantly higher (P < 0.05). At 6 months, four hips had been excluded as they has went on to total hip arthroplasty (these hips showed a lower HHS at 3 months). For the remaining hips the HHS was highly significantly increased (P < 0.001). No side effects or complications were observed. Analysis of the pre-injection radiographs showed a trend towards a bigger increase in HHS with less radiographic OA changes. CONCLUSIONS: Viscosupplementation performed under fluoroscopic guidance is an effective and safe method of treating hip OA and appears to be more efficacious in those with less radiographic changes of OA.

[Pregnancy course and outcome in 2956 pregnancies after in-vitro fertilization in Netherlands]. / Beloop en uitkomst van 2956 zwangerschappen na in-vitrofertilisatie in Nederland.

OBJECTIVE: Description of the outcome of pregnancies after in vitro fertilisation (IVF) in Dutch IVF centers. DESIGN: Descriptive, retrospective. METHOD: Data were collected on IVF pregnancies in the period 1984-1992 from seven Dutch IVF centers. RESULTS: The study comprised 2956 pregnancies. Five centres provided data on 2133 ongoing and non-ongoing pregnancies. More than 25% ended in a spontaneous abortion (22.3%) or ectopic pregnancy (3.6%). From the seven centres there were data available on 2311 ongoing pregnancies. Of these, 30.8% were multiple; preterm delivery occurred in 29.2%. The birth weight of 40.6% of 3173 neonates was lower than 2500 g and that of 10.1% lower than 1500 g. A birth weight under the 10th percentile of the national reference curve was found in 16.7% and under the 2.3rd percentile in 4.3% of cases. Perinatal mortality was 31.3 pro mille. In 1588 singleton pregnancies preterm birth occurred in 15.6%; 41.3% of the singletons weighed less than 2500 g, of which 3.6% less than 1500 g while 12.3% had a birth weight below the 10th percentile. The results of our study are similar to those of other major studies in the literature and are unfavourable compared with to Dutch reference values. This is mainly due to the high proportion of multiple pregnancies. However, we found indications of a slight disturbance of pregnancy in IVF singleton and twin pregnancies.

Sperm analysis in a subfertile male with a Y;16 translocation, using four-color FISH.

Sperm analysis was performed in a male with oligoasthenoteratozoospermia (OAT) and a reciprocal t(Y;16) (q11. 21;q24), using four-color FISH. Intracytoplasmic sperm injection (ICSI) treatment in this patient had resulted in the birth of one chromosomally balanced and two chromosomally normal children. To assess the risk of having a chromosomally unbalanced conception after ICSI, morphologically normal spermatozoa were studied with a set of probes allowing detection of all segregation variants. There were 51% normal or balanced sperm cells. The fraction of sperm products resulting from alternate and adjacent I segregation was 87%, 12% were products of 3:1 disjunction, and the other 1% had other types of aneuploidy. If morphologically abnormal cells were also included in the FISH analysis, nearly 90% of all the spermatozoa were unbalanced. We conclude that although the majority of males with a Y/autosome translocation are infertile due to azoospermia, our patient produces sufficient morphologically and chromosomally normal spermatozoa to have chromosomally normal or balanced offspring after ICSI. Assuming that ICSI with an unbalanced spermatozoon from this patient would result in a nonviable embryo in many cases, the combination of in vitro and subsequent in vivo selection probably results in a risk of unbalanced offspring of much less than 50%. Hence, FISH studies on the sperm of translocation carriers are useful for estimating the risk of having unbalanced offspring after ICSI and in understanding the mechanisms underlying infertility in such carriers.

Subfertile men with constitutive chromosome abnormalities do not necessarily refrain from intracytoplasmic sperm injection treatment: a follow-up study on 75 Dutch patients.

A follow-up study was performed to investigate the impact of the detection of a chromosome abnormality in infertile men who are candidates for intracytoplasmic sperm injection (ICSI) treatment. In this collaborative study between clinical genetics centres and fertility clinics in the Netherlands, 75 ICSI couples of which the male partners had a chromosome abnormality were included. All couples were extensively counselled on the risk of having a chromosomally unbalanced child. Forty-two out of 75 couples chose to proceed with the ICSI treatment. So far, treatment has resulted in a pregnancy in 11 cases. Four of them opted to have invasive prenatal diagnosis. Despite the genetic risks related to a chromosome abnormality in infertile men, a small majority (56%) of the couples did not refrain from the ICSI treatment.

One normal child and a chromosomally balanced/normal twin after intracytoplasmic sperm injection in a male with a de-novo t(Y;16) translocation.

A balanced translocation t(Y;16)(q11.21;q24) is described in a male with severe oligoasthenoteratozoospermia (OAT). Before having a chromosome investigation, the patient and his partner had undergone intracytoplasmic sperm injection (ICSI) treatment resulting in the birth of a healthy 46,XX child. After detection of the t(Y;16) translocation, the couple opted for further ICSI treatment, although they were extensively counselled on the risk of having chromosomally unbalanced offspring. This treatment resulted in a twin pregnancy, one with a 46,XX karyotype and the other a 46,X,t(Y;16) (q11.21;q24) karyotype, the same as the father. After an uncomplicated pregnancy two healthy children were born. We conclude that patients with a Y/autosome translocation as a cause of OAT can have chromosomally normal children after ICSI treatment.

Direct intraperitoneal insemination compared to intrauterine insemination in superovulated cycles: a randomized cross-over study.

The aim of this randomized cross-over study was to determine whether direct intraperitoneal insemination (DIPI) is superior to intrauterine insemination (IUI) in hyperstimulated cycles. The treatment cycles were stimulated with either clomiphene citrate and human menopausal gonadotrophins, or buserelin and human menopausal gonadotrophins. 207 subfertile couples with a cervical factor, a male factor, a combined cervical and male factor, or an unexplained subfertility were randomly assigned to the first treatment cycle. IUI and DIPI were performed in alternate cycles to a maximum of 6 cycles per couple. Every treatment cycle was followed by a nontreatment cycle. The pregnancy rate per completed cycle was 24% for IUI and 16% for DIPI (p = 0.018), whereas the cumulative pregnancy rates for IUI and DIPI were 53 and 40%, respectively (p = 0.002). There were no significant differences between pregnancy rates for IUI and DIPI in the different categories of subfertility. We conclude that DIPI does not offer better pregnancy chances than IUI in superovulated cycles.