Short-term results of a new self-locking cementless femoral stem: a prospective cohort study of the Lima MasterSL.

BACKGROUND: Total hip arthroplasty is a successful treatment for hip osteoarthritis. Primary and secondary implant fixation is dependent on implant design and plays an important role in the longevity of an implant. In this study, we assessed the self-locking cementless MasterSL femoral stem. MATERIALS AND METHODS: In this single-centre prospective study, 50 consecutive hips with the indication for total hip arthroplasty, who met the inclusion criteria, received the MasterSL stem from LIMA Corporate. Patients had pre- and post-operative clinical and radiological assessment and completed patient-reported outcome measures [Oxford Hip Score (OHS), Harris Hip Score (HHS) and Forgotten Joint Score (FJS)] at the 6-week and 6-, 12- and 24-month mark. Post-operative X-rays were assessed for osteointegration (Engh Score), alignment and subsidence. RESULTS: After 2 years, aseptic survival was 100%. One hip had to be explanted due to early deep infection and was excluded from the study. At 2 years, the patients reported a significant improved HHS and OHS of 95.3 ± 5.8 and 46.1 ± 3.6 (mean ± standard deviation), respectively, compared to preoperatively. The mean ± standard deviation for the FJS was 86.4 ± 18.7 with two-thirds of the patients reporting a score above 85. The mean Engh score is 15.1 ± 5.9 (mean ± standard deviation) with no patient scoring below 1 which suggests good osteointegration in all femoral stems. CONCLUSIONS: The MasterSL femoral stem performed well in this short-term follow-up study, with high patient satisfaction and good signs of osteointegration. Long-term follow-up will be necessary to evaluate longevity. LEVEL OF EVIDENCE: Level 3, Prospective cohort study. TRIAL REGISTRATION: The study was registered on the 30.03.2016 with Australia New Zealand Clinical Trials Registry (ACTRN12617000550303).

Defining the osteoarthritis patient: back to the future.

The history of osteoarthritis (OA) is important because it can help broaden our perspective on past and present controversies. The naming of OA, beginning with Heberden's nodes, is itself a fascinating story. According to Albert Hoffa, R. Llewellyn Jones and Archibald Edward Garrod, the name OA was introduced in the mid-nineteenth century by surgeon Richard von Volkmann who distinguished it from rheumatoid arthritis and gout. Others preferred the terms 'chronical rheumatism', 'senile arthritis', 'hypertrophic arthritis' or 'arthritis deformans'. A similar narrative applies to the concept of OA affecting the whole joint vs the 'wear-and-tear' hypothesis, inflammation and the role of the central nervous system (CNS). In the late nineteenth and early twentieth centuries, the Garrods (father and son) and Hermann Senator argued that OA was a whole joint disease, and that inflammation played a major role in its progression. Garrod Jnr and John Spender also linked OA to a neurogenic lesion 'outside the joint'. The remaining twentieth century was no less dynamic, with major advances in basic science, diagnostics, treatments, surgical interventions and technologies. Today, OA is characterized as a multi-disease with inflammation, immune and CNS dysfunction playing central roles in whole joint damage, injury progression, pain and disability. In the current 'omics' era (genomics, proteomics and metabolomics), we owe a great debt to past physicians and surgeons who dared to think 'outside-the-box' to explain and treat OA. Over 130 years later, despite these developments, we still don't fully understand the underlying complexities of OA, and we still don't have a cure.

Accuracy of MRI diagnosis of internal derangement of the knee in a non-specialized tertiary level referral teaching hospital.

This study was designed to assess the accuracy of knee MRI examinations carried out in a general tertiary referral hospital without a musculoskeletal fellowship trained radiologist. The study included all patients who had undergone a knee arthroscopy carried out within a 2-year period and who had had a prior MRI knee examination, where both were carried out at this institution. The accuracy of the MRI knee examination was determined by correlation to the arthroscopy report. The accuracy for diagnosis of meniscal and cartilage injuries, in this setting, was found to be similar to a published meta-analysis of previous studies correlating knee MRI and arthroscopy. The overall accuracy of this study was better than the previous similar study. However, the accuracy for diagnosing ACL injuries was lower than in the meta-analysis. The potential reasons for this and other sources of error are discussed.