To determine the benefit of dissolvable Balloon Arthroplasy in managing patients with massive irreparable rotator cuff tears (RCT). This is prospective pilot study carried out adhering to the local approval process. Patients having massive cuff tear with pain or functional limitation were seen by consultants and MRI confirmed the diagnosis. The patients were explained of ‘all available’ treatment options and information leaflet about the new procedure balloon arthroplasty, provided. Patients were seen after 4 weeks in a dedicated clinic to find out if they were willing to participate. Patients were seen by a physiotherapist pre and post-operatively at 6 weeks then at 3, 6 and 12months in addition to medical follow-ups, using VAS, Oxford Shoulder, Constant and SF36 scores. All procedures were carried out by consultant shoulder surgeons and where the cuff was reparable or contraindications identified were excluded.Aim
Methods
Metal-on-metal resurfacing of the hip (MoMHR)
has enjoyed a resurgence in the last decade, but is now again in question
as a routine option for osteoarthritis of the hip. Proponents of
hip resurfacing suggest that its survival is superior to that of
conventional hip replacement (THR), and that hip resurfacing is
less invasive, is easier to revise than THR, and provides superior
functional outcomes. Our argument serves to illustrate that none
of these proposed advantages have been realised and new and unanticipated
serious complications, such as pseudotumors, have been associated
with the procedure. As such, we feel that the routine use of MoMHR
is not justified. Cite this article:
We aimed to assess the long term results of patients who underwent Autologous Chondrocyte Implantation (ACI) for osteochondral lesions of the talus. Between 1998 and 2006, 28 patients underwent ACI for osteochondral lesions of the talus. All these patients were prospectively reviewed and assessed for long term results. Outcomes were assessed using satisfaction scores, Mazur ankle score and the AOFAS score, and Lysholm knee score for donor site morbidity. The 28 patients who underwent the procedure included 18 males and 10 females. Follow up ranged from 1–9 years. In all patients, there was an improvement in the Mazur and AOFAS ankle scores and the Lysholm scores showed minimal donor site morbidity. Improvement in ankle score was independent of age and gender. The better the pre-op score the less the difference in post-op ankle scores. Patients were unlikely to benefit with pre-op ankle scores over 75. The mid to long term results of ACIs in the treatment of localised, contained cartilage defects of the talus are encouraging and prove that it is a satisfactory treatment modality for symptomatic osteochondral lesions of the talus. Complications are limited. However, in view of limited number of patients, a multi-centre randomised controlled study is required for further assessment.
Overall there was a mean improvement in pain VAS scores of 1.9 (p=0.0875). SF36 scores showed minimal improvement in both physical and mental parameters and there was minimal improvement in subjective outcome in 55% of patients. However it was observed that a small subgroup of patients (30%) aged less than 40 with low volume positive discography and single level disease mean pain VAS scores improved by 3.78 from 7.52 to 3.74. 72% of these patients reported a subjective improvement in symptoms and SF36 scores improved significantly compared to the overall group. Further analysis also revealed that the use of pain diagrams when interpreted according to the principles of Mann et al was the predictive value.
The purpose of this study was to investigate the use of early post-operative bone scintigraphy to predict surgical outcome following vascularized fibular grafting (VFG) for osteonecrosis of the hip. Bone scans from one hundred and four hips (Steinberg stage I–IV) treated with VFG between 1994 and 2000 were retrospectively reviewed. Bone scan scores were significantly lower in the failed group (n=31) compared to the successful group (n=73), p=0.03. Logistic regression demonstrated that a higher bone scan score was associated with success, p=0.028, with an odds ratio of 3.08 (1.13–8.40). The purpose of this study was to investigate the use of bone scintigraphy to predict surgical outcome following vascularized fibular grafting (VFG) for osteonecrosis of the hip. Subjects with a higher bone scan score post-operatively had a three-fold higher chance of success than subjects with the lowest score. These results suggest that having a well perfused and viable graft in the early post-operative period improves the chances of a successful result. Single Photon Emission Computed Tomography images from one hundred and four hips (Steinberg I–IV) treated with VFG between 1994 and 2000 were retrospectively reviewed. Each scan was divided into three regions, the greater trochanter, neck, and head. The intensity at the graft in each region (axially and coronally) was compared to the intensity at the ipsilateral proximal femoral diaph-ysis and assigned a score: less than diaphysis (one), equal to (two), and greater than (three). Cumulative scores were obtained for each subject. Intraobserver variability was 0.93. Surgical failure was defined as conversion to or on the waiting list for total hip arthroplasty. Thirty percent of hips failed treatment (n=31, mean survival 34.9 months, range 5–98), while 70% were successful (n=73, mean follow-up 56.6 months, range 22–100). Bone scan scores were significantly lower in the failed group (mean 7.1, range 6–12) compared to the successful group (mean 8.5, range 6–18), p=0.03. Positive skewness (+1.7) was demonstrated as 64% of hips had a score of six while 36% had a score >
6 (range 8–18). Logistic regression demonstrated that a bone scan score >
6 was associated with success, p=0.028, with an odds ratio of 3.08 (1.13–8.40).
Malignant peripheral nerve sheath tumours (MPNSTs) constitute 10% of soft tissue sarcomas. A significant proportion arise in neurofibromatosis type 1 (NF1). Several publications have compared MPNST survival in sporadic and NF1 patients, without consensus on whether NF1 is an independent factor for poor prognosis. Clinical and histological data from 135 proven MPNSTs were analysed from 2 national centres for soft tissue tumour surgery diagnosed from 1979 to 2000. 129 patients had follow-up data from 6 months to 21 years. 35 were from patients with NF1. Local treatment involved surgery in surgery in 95%, radiotherapy in 44% and chemotherapy in 21%. NF1 patients were younger than those with sporadic tumours (median age 26 years vs 53 years, p<
0. 001). Overall MPNST survival was almost identical to that in soft tissue sarcomas as a whole, but was worse in NF1 than in sporadic tumours (33% vs 72% at 30 months [p<
0. 01], 17% vs 39% at 60 months, 6% vs 21% at 120 months). A trend towards shorter time to local recurrence was seen in NF1, but not time to metastasis. Superficial tumours gave improved prognosis. Tumour volume over 100ml was associated with worse survival (46% vs 91% at 30 months, p<
0. 02), as was histological grade (80% high grade vs 25% low grade at 60 months, p<
0. 01). In terms of location, a non-significant over-representation of NF1 MPNSTs in the sciatic and brachial plexii was identified. NF1 and sporadic MPNSTs exhibited no difference in depth or tumour volume profile, although NF1 tended towards higher grade. Analysis of survival in only high grade tumours, however, still resulted in a significant survival disadvantage in NF1 (33% vs 70% at 30 months, p<
0. 01). Removal of brachial and sciatic plexus tumours from analysis did not affect survivorship profiles in NF1 and sporadic MPNSTs. Grade, volume and tumour depth correlate with survival; only 7 of 45 patients with deep high grade tumours over 100ml volume were observed to survive beyond 2 years. MPNST survival is worse in NF1 than sporadic tumours. Grade, depth, site and volume differences could not explain this disadvantage.
