Digastric olecranon osteotomy a new approach to the elbow: retrospective study of 24 Coonrad-Morrey® total elbow arthroplasty at 30-month follow-up.

BACKGROUND: Digastric olecranon osteotomy approach allows an excellent articular exposure and preserves principal vascular supply and the continuity of the extensor apparatus. The aim of this study was to assess the early clinical and radiological outcome after total elbow arthroplasty implanted from a digastric olecranon osteotomy approach. METHODS: We retrospectively enrolled 22 patients (two men and twenty women) treated with 24 Coonrad-Morrey® total elbow arthroplasty implanted from a digastric olecranon osteotomy approach in Island of France (Paris, Argenteuil and Saint-Denis). The mean age was 80 years (50-96). We treated 20 fractures; according to AO classification, seven patients suffered from a C1 fracture, seven from a C3 and C2, two from malunions, and four from rheumatoid arthritis. The mean time of follow-up was 30 months (6-132). Clinical outcomes were assessed with the Mayo elbow performance score. We evaluated triceps strength and radiographic healing. RESULTS: At the latest follow-up, the average flexion arc was 23° (5°-50°) to 112° (95°-130°). The Mayo elbow performance score averaged 92 points (75-100). The mean strength of the triceps in extension and flexion was, respectively, 1.9 and 4.7 kgs. All elbows were stable. A single immediate post-operative wound infection was reported and did not require any surgical revision. Radiological consolidation of the olecranon osteotomy was assessed in sixteen patients between 8 and 16 weeks. Heterotopic ossifications were noted in one elbow. One patient had an elbow dislocation by fracture of the axe's component. CONCLUSION: The early clinical and radiological outcomes are promising and support the use of digastric olecranon osteotomy for the implantation of total elbow arthroplasty. LEVEL OF EVIDENCE: Treatment study, level IV.

Can a Single-Use and Patient-Specific Instrumentation Be Reliably Used in Primary Total Knee Arthroplasty? A Multicenter Controlled Study.

BACKGROUND: The aim of this controlled multicenter study is to evaluate the clinical and radiologic outcomes of primary total knee arthroplasty (TKA) using single-use fully disposable and patient-specific cutting guides (SU) and compare the results to those obtained with traditional patient-specific cutting guides (PSI) vs conventional instrumentation (CI). METHODS: Seventy consecutive patients had their TKA performed using SU. They were compared to 140 historical patients requiring TKA that were randomized to have the procedure performed using PSI vs CI. The primary measure outcome was mechanical axis as measured on a standing long-leg radiograph using the hip-knee-ankle angle. Secondary outcome measures were Knee Society and Oxford knee scores, operative time, need for postoperative transfusion, and length of hospital stay. RESULTS: The mean hip-knee-ankle value was 179.8° (standard deviation [SD] 3.1°), 179.2° (SD 2.9°), and 178.3° (SD 2.5°) in the CI, PSI and SU groups, respectively (P = .0082). Outliers were identified in 16 of 65 (24.6%), 15 of 67 (22.4%), and 14 of 70 (20.0%) knees in the CI, PSI, and SU group, respectively (P = .81). There was no significant difference in the clinical results (P = .29 and .19, respectively). Operative time, number of unit transfusion, and length of hospital stay were not significantly different between the 3 groups (P = .45, .31, and 0.98, respectively). CONCLUSION: The use of an SU in TKA provided similar clinical and radiologic results to those obtained with traditional PSI and CI. The potential economic advantages of single-use instrumentation in primary TKA require further investigation.

Do oxidized zirconium femoral heads reduce polyethylene wear in cemented THAs? A blinded randomized clinical trial.

BACKGROUND: Charnley low-friction torque total hip arthroplasty (THA) remains the gold standard in THA. The main cause for failure is wear of the socket. Highly crosslinked polyethylene (HXLPE) has been associated with reduced wear rates. Also, oxidized zirconium has shown in vitro reduced wear rates. However, to our knowledge, there are no data comparing oxidized zirconium femoral heads with metal heads against HXLPE or ultrahigh-molecular-weight polyethylene (UHMWPE) when 22.25-mm bearings were used, which was the same size that performed so well in Charnley-type THAs. QUESTIONS/PURPOSES: We hypothesized that after a minimal 4-year followup (1) use of HXLPE would result in lower radiographic wear than UHMWPE when articulating with a stainless steel head or with an oxidized zirconium head; (2) use of oxidized zirconium would result in lower radiographic wear than stainless steel when articulating with UHMWPE and HXLPE; and (3) there would be no difference in terms of Merle d'Aubigné scores between the bearing couple combinations. METHODS: One hundred patients were randomized to receive cemented THA with either oxidized zirconium or a stainless steel femoral head. UHMWPE was used in the first 50 patients, whereas HXLPE was used in the next 50 patients. There were 25 patients in each of the four bearing couple combinations. All other parameters were identical in both groups. Complete followup was available in 86 of these patients. Femoral head penetration was measured using a validated computer-assisted method dedicated to all-polyethylene sockets. Clinical results were compared between the groups using the Merle d'Aubigné score. RESULTS: In the UHMWPE series, the median steady-state penetration rate from 1 year onward was 0.03 mm/year (range, 0.003-0.25 mm/year) in the oxidized zirconium group versus 0.11 mm/year (range, 0.03-0.29 mm/year) in the metal group (difference of medians 0.08, p < 0.001). In the HXLPE series, the median steady-state penetration rate from 1 year onward was 0.02 mm/year (range, -0.32 to 0.07 mm/year) in the oxidized zirconium group versus 0.05 mm/year (range, -0.39 to 0.11 mm/year) in the metal group (difference of medians 0.03, p < 0.001). The Merle d'Aubigné scores were no different between the groups with a median of 18 in each of the groups (range, 16-18). CONCLUSIONS: This study demonstrated femoral head penetration was reduced by oxidized zirconium when compared with metal on both UHMWPE and HXLPE. However, apart the metal-UHMWE group, all other groups had a steady-state penetration rate well below the osteolysis threshold with a low difference between groups that might not be clinically important at this point. Longer-term followup is needed to warrant whether wear reduction will generate less occurrence of osteolysis and aseptic loosening. LEVEL OF EVIDENCE: Level II, therapeutic study.

Randomized controlled trial of conventional versus modern surgical dressings following primary total hip and knee replacement.

PURPOSE: We prospectively compared two types of dressing (conventional gauze-based versus absorbing hydrofibre) after primary total hip (THA) or knee (TKA) arthroplasties. METHODS: Eighty candidates for THA (n = 40) or TKA (s = 40) were randomized: gauze-based versus hydrofibre absorbing (Aquacel®, ConvaTec). The two groups were comparable at baseline. RESULTS: There was a statistically significant decrease of dressing changes in the hydrofibre group (p = 0.0006). Two patients from the conventional group presented minor wound complications. Nurses' satisfaction was significantly higher in the hydrofibre group considering the adherence (p = 0.04) and flexibility (p = 0.03). Patients experienced a higher satisfaction with respect to ease of movement (p = 0.01) in the hydrofibre group. The cosmetic appearance of the scars six weeks after surgery was found to be similar between groups. CONCLUSIONS: Our findings support an overall improved comfort for the patients and the medical staff by using hydrofibre dressings after primary THA and TKA. The reduction of required dressing changes was observed also.

Does autologous leukocyte-platelet-rich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears?

PURPOSE: To evaluate the clinical and magnetic resonance imaging (MRI) outcome of arthroscopic rotator cuff repair with the use of leukocyte-platelet-rich plasma (L-PRP) in patients with large or massive rotator cuff tears. METHODS: A comparative cohort of patients with large or massive rotator cuff tears undergoing arthroscopic repair was studied. Two consecutive groups of patients were included: rotator cuff repairs with L-PRP injection (group 1, n = 35) and rotator cuff repairs without L-PRP injection (group 2, n = 35). A double-row cross-suture cuff repair was performed by a single surgeon with the same rehabilitation protocol. Patients were clinically evaluated with the Constant score; Simple Shoulder Test score; University of California, Los Angeles (UCLA) score; and strength measurements by use of a handheld dynamometer. Rotator cuff healing was evaluated by postoperative MRI using the Sugaya classification (type 1 to type 5). RESULTS: We prospectively evaluated the 2 groups at a minimum 2-year follow-up. The results did not show differences in cuff healing between the 2 groups (P = .16). The size of recurrent tears (type 4 v type 5), however, was significantly smaller in group 1 (P = .008). There was no statistically significant difference in the recurrent tear rate (types 4 and 5) between the 2 groups (P = .65). There was no significant difference between group 1 and group 2 in terms of University of California, Los Angeles score (29.1 and 30.3, respectively; P = .90); Simple Shoulder Test score (9.9 and 10.2, respectively; P = .94); Constant score (77.3 and 78.1, respectively; P = .82); and strength (7.5 and 7.0, respectively; P = .51). CONCLUSIONS: In our study the use of autologous L-PRP did not improve the quality of tendon healing in patients undergoing arthroscopic repair of large or massive rotator cuff tears based on postoperative MRI evaluation. The only significant advantage was that the L-PRP patients had smaller iterative tears. However, the functional outcome was similar in the 2 groups of patients. LEVEL OF EVIDENCE: Level III, case-control study.

Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty.

Alumina-on-alumina bearings in total hip arthroplasty have been developed in an attempt to minimise debris and the occurrence of osteolytic lesions. The outstanding tribological properties of this bearing system are explained by low surface roughness, high hardness for major scratch resistance, and high wettability. Since the 1970s, technological improvements in the manufacturing process of alumina components together with a better understanding of Morse taper technology have provided a surgical grade material with high density, high purity and small grains. Published studies on the outcome of total hip arthroplasty performed with this new generation of implants showed high survivorship especially in young and active patients, with survival rates free of revision of 90.8% to 97.4% at ten years. However, concern remains over ceramic liner fracture and squeaking, which has been noted recently with increasing prevalence. This review will discuss the current knowledge on the use of alumina-on-alumina bearings.

Biological reaction to polyethylene particles in a murine calvarial model is highly influenced by age.

Particle-induced osteolysis is driven by multiple factors including bone metabolism, inflammation, and age. The objective of this study was to determine the influence of age on polyethylene (PE) particle-induced osteolysis in a murine calvarial model comparing 2-month-old (young) versus 24-month-old (old) mice. After PE particle implantation, calvaria were assessed at days (D) 3, D7, D14, and D21 via chemoluminescent imaging for inflammation (L-012 probe). In addition micro-computed tomography (micro-CT) and histomorphometry end points addressed the bone reaction. Inflammation peaked at D7 in young mice and D14 in old mice. Using micro-CT, a nadir of mature bone was recorded at D7 for young mice, versus D21 for old mice. Besides, regenerating bone peaked at distinct timepoints: D7 for young mice versus D21 for old mice. In the young mice group, the histomorphometric findings correlated with micro-CT regenerating bone findings at D7, associated with ample osteoïd deposition. No osteoïd could be histologically quantified in the old mice group at D7. This study demonstrated that the biological reaction to polyethylene particles is highly influenced by age.

Validation of a computer-assisted method for measurement of radiographic wear in total hip arthroplasty using all polyethylene cemented acetabular components.

Although cemented all polyethylene (PE) cups have been routinely used in total hip arthroplasty for decades, no computer-assisted method for measurement of radiographic wear has ever been specifically validated for these implants. Using a validated hip phantom model, AP plain hip radiographs were obtained consecutively for eight simulated wear positions. A version of Martell's Hip Analysis Suite software dedicated to all polyethylene sockets was used by three different examiners of varied experience. Bias (mean, standard deviation and 95% confidence interval limit), repeatability (standard deviation and 95% limit) and reproducibility (standard deviation and 95% limit) for two-dimensional wear measurements were assessed, as recommended by the current ASTM guidelines. Using this protocol, the dedicated software showed an overall mean bias of 0.089 ± 0.060 mm (mean ± SD), and 0.118 mm for 95% CI limit. Repeatability (intra examiner) standard deviation and 95% limit were respectively 0.106 mm and 0.292 mm. Reproducibility (inter examiner) standard deviation and 95% limit were respectively 0.112 mm and 0.308 mm. Martell Hip Analysis for all PE cemented cups is a reliable and low-cost instrument in the assessment of wear, despite being less precise than its original version dedicated to cementless components.

Are multiple platelet-rich plasma injections useful for treatment of chronic patellar tendinopathy in athletes? a prospective study.

BACKGROUND: Chronic patellar tendinopathy (PT) is one of the most common overuse knee disorders. Platelet-rich plasma (PRP) appears to be a reliable nonoperative therapy for chronic PT. PURPOSE: To evaluate clinical and radiological outcomes of 3 consecutive ultrasound (US)-guided PRP injections for the treatment of chronic PT in athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 28 athletes (17 professional, 11 semiprofessional) with chronic PT refractory to nonoperative management were prospectively included for US-guided pure PRP injections into the site of the tendinopathy. The same treating physician at a single institution performed 3 consecutive injections 1 week apart, with the same PRP preparation used. All patients underwent clinical evaluation, including the Victorian Institute of Sport Assessment-Patella (VISA-P) score, visual analog scales (VAS) for pain, and Lysholm knee scale before surgery and after return to practice sports. Tendon healing was assessed with MRI at 1 and 3 months after the procedure. RESULTS: The VISA-P, VAS, and Lysholm scores all significantly improved at the 2-year follow-up. The average preprocedure VISA-P, VAS, and Lysholm scores improved from 39 to 94 (P < .001), 7 to 0.8 (P < .0001), and 60 to 96 (P < .001), respectively, at the 2-year follow-up. Twenty-one of the 28 athletes returned to their presymptom sporting level at 3 months (range, 2-6 months) after the procedure. Follow-up MRI assessment showed improved structural integrity of the tendon at 3 months after the procedure and complete return to normal structural integrity of the tendon in 16 patients (57%). Seven patients did not recover their presymptom sporting level (among them, 6 were considered treatment failures): 3 patients returned to sport at a lesser level, 1 patient changed his sport activity (for other reasons), and 3 needed surgical intervention. CONCLUSION: In this study, application of 3 consecutive US-guided PRP injections significantly improved symptoms and function in athletes with chronic PT and allowed fast recovery to their presymptom sporting level. The PRP treatment permitted a return to a normal architecture of the tendon as assessed by MRI.