An assessment of the clinical relevance of coracoid graft osteolysis following the Latarjet procedure: a clinical and radiological review.

Background: The Latarjet procedure was developed for the treatment of anterior shoulder instability in young, high-demand patients with attritional glenoid bone loss, whose risk of redislocation following primary dislocation may exceed 90%. Coracoid graft osteolysis and prominent screws are commonly observed in late computed tomography (CT) scans of patients who re-present following the procedure, but the clinical relevance of osteolysis in the overall Latarjet cohort is undetermined. We aimed to evaluate clinical and radiological outcomes in patients who underwent the Latarjet procedure, and to determine if severe coracoid graft osteolysis compromised clinical outcomes. Methods: This was a retrospective analysis of patients who underwent the open Latarjet procedure. Patients were invited via an e-questionnaire that contained a Western Ontario Shoulder Instability Index (WOSI), and queried about redislocation and reoperation since index surgery. Preoperative glenoid bone loss was calculated on CT using the best-fit circle method. Osteolysis was graded (0, screw head buried in graft; 1, screw head exposed; 2, threads exposed; 3, complete resorption/severe osteolysis) at the level of the proximal and distal screws respectively, on axial CT scans performed ≥ 12 months postoperatively. Results: Between 2011 and 2022, a single surgeon performed 442 Latarjet procedures. One hundred fifty eight patients responded to the questionnaire at median (interquartile range [IQR]) 44 (27-70) months postoperatively, among whom the median (IQR) WOSI score was 352 (142-666) points (0 = best, 2100 = worst). Recurrent anterior instability occurred in 3/158 (2%) patients. One patient required reoperation for this indication. Among patients who had CT scans ≥ 12 months postoperatively (median [IQR] 40 [29-69] months), 1 patient developed severe osteolysis around both screws (WOSI = 90), 17/62 (27%) patients developed severe osteolysis around 1 screw, all of which were proximal (median [IQR] WOSI = 235 [135-644]), and 44/62 (71%) patients did not develop severe osteolysis around either screw (median [IQR] WOSI = 487 [177-815]). There were no statistically significant differences in WOSI scores between groups based on the presence of severe osteolysis. Conclusion: The Latarjet is reliable procedure that has a low rate of redislocation and reoperation. Severe coracoid graft osteolysis occurs with time, and always affects the proximal graft first. The presence of severe osteolysis did not compromise clinical outcomes.

A short-term follow-up study of a surgeon-customised fully-coated hydroxyapatite femoral stem using a nation-wide joint registry.

OBJECTIVE: To compare revision rates between otherwise-identical fully-coated and proximally-coated hydroxyapatite (HA) femoral stems using a nation-wide registry. METHODS: 249 proximally-coated stems (50 µm HA) and 225 fully-coated stems (100 µm HA and 50 µm titanium) were followed over a mean of 34.9 and 23.2 months respectively. RESULTS: Four proximally-coated (rate: 1.61%) and five fully-coated stem revisions (rate: 2.20%) were reported, with no statistical difference between groups (p = 1.0, OR 0.90, 95% CI 0.20-3.97). Registry data showed no difference in performance between fully-coated and proximally-coated stems nationwide (rate: 2.22%, p = 0.82). CONCLUSION: There is no statistical difference in survival between fully-coated and proximally-coated HA prostheses in the short-term.

The influence of entry point and radius of curvature on femoral intramedullary nail position in the distal femur.

AIM: Perforation of the anterior cortex during femoral intramedullary nailing can be a major complication. We aim to determine the influence of entry point and radius of curvature on intramedullary nail position in the distal femur using a synthetic bone model. METHODS: Using synthetic femora, the greater trochanter was measured and entry points marked in two planes. A standard recommended technique was used to insert two different Stryker Gamma 3 intramedullary nails of different radius of curvature. The synthetic femora were sectioned and the centre of nail to anterior cortex distance (CAD) was measured. Statistical interpretation of the results was performed using linear regression analyses. RESULTS: We found that the more posterior entry points led to a more anterior placement in the distal femur in both nails of differing radius of curvature (11 mm and 13.5 mm CAD). The smaller radius of curvature led to a more central placement of the nail tip in the distal femur. CONCLUSION: Anterior penetration of the distal femur can be minimized by a more anterior entry point and with the use of a femoral intramedullary nail with a smaller radius of curvature.

Intra-articular injection of tranexamic acid to reduce blood loss after total knee arthroplasty.

PURPOSE: To evaluate the effect of intra-articular tranexamic acid (TXA) on blood loss after total knee arthroplasty (TKA). METHODS: Medical records of 73 men and 93 women (mean age, 68 years) who underwent primary TKA for osteoarthritis and received intra-articular TXA 1500 mg (n=56) or 3000 mg (n=56) or not at all (n=54) were reviewed. Reduction in haemoglobin levels on days 1 and 2 was measured, as were the rates of venous thromboembolism (VTE) and blood transfusion. RESULTS: Reduction in haemoglobin levels on day 2 was significantly greater in controls (35 ± 11 g/dl) than the 1500 mg TXA group (29 ± 9 g/dl, p=0.005) and the 3000 mg TXA group (23 ± 10 g/dl, p<0.001). The difference between the 2 TXA groups was also significant (p=0.002). There was a dose-dependent effect of TXA on blood loss. The rates of VTE and blood transfusion did not differ significantly between groups. CONCLUSION: Intra-articular administration of TXA is effective in reducing blood loss after TKA, without increasing the risk of VTE.

A comparison of alignment using patient specific guides, computer navigation and conventional instrumentation in total knee arthroplasty.

BACKGROUND: Patient specific guides (PSG) have been introduced as a tool in total knee arthroplasty (TKA) in an attempt to improve limb alignment and reduce operative time compared to other established surgical techniques. The purpose of this study was to compare the post-operative radiographic alignment and operative time in patients who underwent TKA surgery with PSG, conventional instrumentation or computer-assisted navigation surgery using fully cemented components. METHODS: A cohort of 260 patients who underwent TKA surgery using PSG (PSG group, n=115) was compared to patients who underwent TKA using either conventional instrumentation (CON group, n=92) or computer-assisted navigation (CAS group, n=53). Post-operative CT imaging using the Perth CT protocol was used to compare alignment between the three groups. RESULTS: In the PSG and CAS groups, the post-operative hip-knee angle (HKA) was within 3° of neutral alignment in 91.3% and 90.7% of patients, respectively. This compared to 80.4% of patients in the CON group (p=0.02). There were no significant differences with respect to alignment when comparing individual component positioning between the PSG and CAS groups apart from tibial slope (Table 3). Total operative time was found to be significantly reduced in the PSG group (80.2 min) compared to both the CON group (86 min, p=0.002) and the CAS group (110.2 min, p<0.0001). CONCLUSIONS: The use of PSG resulted in similar alignment accuracy to CAS and superior alignment to CON with significantly shorter operative times.

Verification of the Australian Orthopaedic Association National Joint Replacement Registry using a surgeon's database.

PURPOSE: To assess the completeness of registration and any discrepancies between the senior author's database and the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR). METHODS: From 2002 to 2005, the senior author performed 231 primary total hip arthroplasty (THA) on 217 patients using the Corail femoral stem and one of the 3 types of the acetabular component: Pinnacle, ASR, or Duraloc/Option. The name of each patient was forwarded to the AOA NJRR for matching and verification. RESULTS: The AOA NJRR recorded 230 of the 231 primary THAs; all but one was matched with the senior author's database. Nine (3.9%) of them were revised by the same (n=7) or another (n=2) surgeon. Three (43%) of the 7 revision surgeries were not recorded on the AOA NJRR. One patient revised for a ceramic liner fracture was incorrectly recorded as 'wear acetabulum' in the AOA NJRR. CONCLUSION: Although the AOA NJRR achieved high registration completeness for primary THA, accuracy for revision THA was much lower.

Laser etching causing fatigue fracture at the neck-shoulder junction of an uncemented femoral stem: A case report.

Fatigue fracture of a femoral component in total hip arthroplasty is a rare occurrence but well documented in the literature. It is understood that proximal loosing of a femoral stem with a well fixed stem distally will result in cantilever bending and eventual fatigue fracture of the stem. Other factors which may potentiate a fatigue fracture are material design, implant positioning, and patient characteristics. More recently, laser etching on the femoral neck of an implant has resulted in fatigue fracture. We report a case of a fatigue fracture at the neck-shoulder junction in a well fixed, uncemented, femoral component due to laser etching in the region of high tensile stress.